Lee Seon-Min, Lee Mina, Lee Eun Ji, Kim Rae On, Kim Yongduk, Kwon Kyum-Yil
Department of Neurology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea.
Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Korea.
J Mov Disord. 2023 Jan;16(1):59-67. doi: 10.14802/jmd.22045. Epub 2022 Sep 7.
Studies on gait and autonomic dysfunction have been insufficient so far, particularly de novo Parkinson's disease (PD). The aim of this study was to identify the association between gait dynamics and autonomic dysfunction in patients with de novo PD.
A total 38 patients with de novo PD were retrospectively included in this study. Details of patients' dysautonomia were assessed using the Scales for Outcomes in Parkinson's Disease-Autonomic Dysfunction (SCOPA-AUT). For assessment of gait, a computerized gait analysis was performed using the GAITRite system for forward gait and backward gait. High SCOPA-AUT score (PD-HSAS) group and low SCOPA-AUT score (PD-LSAS) group were identified according to their SCOPA-AUT scores.
Nineteen (50%) patients with high SCOPA-AUT scores above median value (12.5) were assigned into the PD-HSAS group and others were assigned to the PD-LSAS group. Compared with the PD-LSAS group, the PD-HSAS group exhibited slower gait, shorter stride, decreased cadence, increased double support phase, decreased swing phase, and increased variability in swing time. Total SCOPA-AUT score showed significantly positive correlations with gait variability and instability but a negative correlation with gait hypokinesia. In subdomain analysis, urinary dysautonomia was highly associated with impairment of gait dynamics. All significant results were found to be more remarkable in backward gait than in forward gait.
Our findings suggest that alteration in gait dynamics, especially backward gait, is highly associated with autonomic dysfunction in patients with de novo PD.
迄今为止，关于步态与自主神经功能障碍的研究尚不充分，尤其是新发帕金森病（PD）。本研究的目的是确定新发PD患者步态动力学与自主神经功能障碍之间的关联。
本研究回顾性纳入了38例新发PD患者。使用帕金森病自主神经功能障碍结局量表（SCOPA-AUT）评估患者自主神经功能障碍的详细情况。为评估步态，使用GAITRite系统对向前步态和向后步态进行计算机化步态分析。根据SCOPA-AUT评分确定高SCOPA-AUT评分（PD-HSAS）组和低SCOPA-AUT评分（PD-LSAS）组。
19例（50%）SCOPA-AUT评分高于中位数（12.5）的患者被分配到PD-HSAS组，其他患者被分配到PD-LSAS组。与PD-LSAS组相比，PD-HSAS组步态更慢、步幅更短、步频降低、双支撑期增加、摆动期减少以及摆动时间变异性增加。SCOPA-AUT总分与步态变异性和不稳定性呈显著正相关，但与步态运动迟缓呈负相关。在亚领域分析中，泌尿自主神经功能障碍与步态动力学损害高度相关。所有显著结果在向后步态中比向前步态中更明显。
我们的研究结果表明，步态动力学改变，尤其是向后步态，与新发PD患者的自主神经功能障碍高度相关。
