ForeFront Research Team, Brain and Mind Centre, University of Sydney, Sydney, Australia.
Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, Australia.
Mov Disord. 2019 Sep;34(9):1374-1380. doi: 10.1002/mds.27780. Epub 2019 Jun 26.
Although motor abnormalities have been flagged as potentially the most sensitive and specific clinical features for predicting the future progression to Parkinson's disease, little work has been done to characterize gait and balance impairments in idiopathic rapid eye movement sleep behavior disorder (iRBD).
The objective of this study was to quantitatively determine any static balance as well as gait impairments across the 5 independent domains of gait in polysomnography-confirmed iRBD patients using normal, fast-paced, and dual-task walking conditions.
A total of 38 participants (24 iRBD, 14 healthy controls) completed the following 5 different walking trials across a pressure sensor carpet: (1) normal pace, (2) fast pace, (3) while counting backward from 100 by 1s, (4) while naming as many animals as possible, (5) while subtracting 7s from 100.
Although no gait differences were found between the groups during normal walking, there were significant differences between groups under the fast-paced and dual-task gait conditions. Specifically, in response to the dual tasking, healthy controls widened their step width without changing step width variability, whereas iRBD patients did not widen their step width but, rather, significantly increased their step width variability. Similarly, changes between the groups were observed during fast-paced walking wherein the iRBD patients demonstrated greater step length asymmetry when compared with controls.
This study demonstrates that iRBD patients have subtle gait impairments, which likely reflect early progressive degeneration in brainstem regions that regulate both REM sleep and gait coordination. Such gait assessments may be useful as a diagnostic preclinical screening tool for future fulminant gait abnormalities for trials of disease-preventive agents. © 2019 International Parkinson and Movement Disorder Society.
虽然运动异常已被标记为预测帕金森病未来进展的最敏感和最特异的临床特征，但在特发性快速眼动睡眠行为障碍（iRBD）中，很少有研究对步态和平衡障碍进行特征描述。
本研究的目的是使用正常、快速和双重任务行走条件，在多导睡眠图确诊的 iRBD 患者中定量确定 5 个独立步态域中的任何静态平衡和步态障碍。
共有 38 名参与者（24 名 iRBD，14 名健康对照）完成了以下 5 种不同的行走试验，行走过程中使用压力传感器地毯：（1）正常速度，（2）快速速度，（3）从 100 倒数 1 秒，（4）尽可能多地说出动物的名字，（5）从 100 中减去 7。
尽管在正常行走时两组之间没有发现步态差异，但在快速和双重任务行走条件下，两组之间存在显著差异。具体来说，在双重任务下，健康对照组在不改变步宽变异性的情况下扩大了步宽，而 iRBD 患者则没有扩大步宽，而是显著增加了步宽变异性。同样，在快速行走时也观察到了组间的变化，iRBD 患者的步长不对称性大于对照组。
本研究表明，iRBD 患者存在细微的步态障碍，这可能反映了调节 REM 睡眠和步态协调的脑干区域的早期进行性退化。这种步态评估可能作为未来针对步态异常的预防性药物试验的一种诊断性临床前筛查工具。
