Avanzino Laura, Lagravinese Giovanna, Abbruzzese Giovanni, Pelosin Elisa
Department of Experimental Medicine, Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino, IRCCS, Genoa, Italy.
Department of Experimental Medicine, Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, University of Genoa, Genoa, Italy.
Gait Posture. 2018 Sep;65:57-64. doi: 10.1016/j.gaitpost.2018.06.171. Epub 2018 Jun 28.
Disturbance of gait is a key feature of Parkinson's disease (PD) and has a negative impact on quality of life. Deficits in cognition and sensorimotor processing impair the ability of people with PD to walk quickly, efficiently and safely. Recent evidence suggests that emotional disturbances may also affect gait in PD.
We explored if there were relationships between walking ability, emotion and cognitive impairment in people with PD.
The literature was firstly reviewed for unimpaired individuals. The recent experimental evidence for the influence of emotion on gait in people with PD was then explored. The contribution of affective disorders to continuous gait disorders was investigated, particularly for bradykinetic and hypokinetic gait. In addition, we investigated the influence of emotional processing on episodic gait disturbances, such as freezing of gait. Potential effects of pharmacological, surgical and physical therapy interventions were also considered.
Emerging evidence showed that emotional disturbances arising from affective disorders such as anxiety and depression, in addition to cognitive impairment, could contribute to gait disorders in some people with PD. An analysis of the literature indicated mixed evidence that improvements in affective disorders induced by physical therapy, pharmacological management or surgery improve locomotion in PD.
When assessing and treating gait disorders in people with PD, it is important to take into the account non-motor symptoms such as anxiety, depression and cognitive impairment, in addition to the motor sequalae of this progressive neurological condition.
步态障碍是帕金森病（PD）的关键特征，对生活质量有负面影响。认知和感觉运动处理方面的缺陷会损害帕金森病患者快速、高效和安全行走的能力。最近的证据表明，情绪障碍也可能影响帕金森病患者的步态。
我们探讨了帕金森病患者的行走能力、情绪与认知障碍之间是否存在关联。
首先对未受损个体的文献进行综述。然后探讨情绪对帕金森病患者步态影响的最新实验证据。研究情感障碍对持续性步态障碍的影响，特别是对运动徐缓和运动减退性步态的影响。此外，我们研究了情绪处理对发作性步态障碍（如冻结步态）的影响。还考虑了药物、手术和物理治疗干预的潜在效果。
新出现的证据表明，除认知障碍外，焦虑和抑郁等情感障碍引起的情绪障碍可能导致一些帕金森病患者出现步态障碍。文献分析表明，关于物理治疗、药物治疗或手术引起的情感障碍改善是否能改善帕金森病患者的运动能力，证据不一。
在评估和治疗帕金森病患者的步态障碍时，除了这种进行性神经疾病的运动后遗症外，考虑焦虑、抑郁和认知障碍等非运动症状也很重要。
