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Balance and gait disorders in de novo Parkinson’s disease : support for early rehabilitation

Lindholm, Beata LU ; Hagell, Peter LU ; Odin, Per LU orcid ; Hansson, Oskar LU orcid ; Siennicki-Lantz, Arkadiusz LU orcid ; Elmståhl, Sölve LU ; Dahlin, Lars LU orcid and Franzén, Erika (2025) In Journal of Neurology 272.
Abstract
Background

Postural instability is considered a late complication of Parkinson’s disease (PD). However, growing evidence shows that balance and gait problems may occur early in the disease.
Objective

To describe balance, gait, and falls/near falls in persons with newly diagnosed, untreated PD (“de novo”), and to compare this with persons with mild-moderate PD (Later PD). In addition, we evaluated differences relative to PD subtypes in de novo PD.
Methods

De novo (n = 54) and Later (n = 58) PD were assessed regarding motor symptoms, balance, gait, and falls/near falls.
Results

At least 25% of de novo PD had impaired reactive balance and/or comfortable gait speed ≤ 1.0 m/s. At least 50% had... (More)
Background

Postural instability is considered a late complication of Parkinson’s disease (PD). However, growing evidence shows that balance and gait problems may occur early in the disease.
Objective

To describe balance, gait, and falls/near falls in persons with newly diagnosed, untreated PD (“de novo”), and to compare this with persons with mild-moderate PD (Later PD). In addition, we evaluated differences relative to PD subtypes in de novo PD.
Methods

De novo (n = 54) and Later (n = 58) PD were assessed regarding motor symptoms, balance, gait, and falls/near falls.
Results

At least 25% of de novo PD had impaired reactive balance and/or comfortable gait speed ≤ 1.0 m/s. At least 50% had abnormal dynamic balance. A third reported balance problems during dual-tasking. Five persons (9%) reported falls/near falls. The median (q1–q3) motor symptom score was 21 (14–28) in de novo PD and 13.5 (9–20) in Later PD (p < 0.001). Later PD performed worse on more balance-demanding tests and a higher percentage of individuals reported falls/near falls (p ≤ 0.048). De novo PIGD PD (n = 10) exhibited worse motor symptoms, reactive and dynamic balance, gait speed, mobility, and freezing of gait as compared to the non-PIGD de novo PD (n = 37) (p ≤ 0.049).
Conclusion

Balance and gait were impaired in de novo PD and most pronounced in PIGD subtype. In addition, balance difficulties during dual-tasking and falls/near falls were evident during this early stage. The lower scores of motor symptoms in Later PD did not result in better mobility, balance, or less falls/near falls indicating that medications have less effect on these symptoms. (Less)
Abstract (Swedish)
BACKGROUND: Postural instability is considered a late complication of Parkinson’s
disease (PD). However, growing evidence shows that balance and gait problems may
occur early in the disease.
OBJECTIVE: To describe balance, gait, and falls/near falls in persons with newly
diagnosed, untreated PD (“de novo”), and to compare this with persons with mildmoderate
PD (Later PD). In addition, we evaluated differences relative to PD subtypes
in de novo PD.
METHODS: De novo (n=54) and Later (n=58) PD were assessed regarding motor
symptoms, balance, gait, and falls/near falls.
RESULTS: At least 25% of de novo PD had impaired reactive balance and/or
comfortable gait speed ≤1.0m/s. At least 50% had abnormal... (More)
BACKGROUND: Postural instability is considered a late complication of Parkinson’s
disease (PD). However, growing evidence shows that balance and gait problems may
occur early in the disease.
OBJECTIVE: To describe balance, gait, and falls/near falls in persons with newly
diagnosed, untreated PD (“de novo”), and to compare this with persons with mildmoderate
PD (Later PD). In addition, we evaluated differences relative to PD subtypes
in de novo PD.
METHODS: De novo (n=54) and Later (n=58) PD were assessed regarding motor
symptoms, balance, gait, and falls/near falls.
RESULTS: At least 25% of de novo PD had impaired reactive balance and/or
comfortable gait speed ≤1.0m/s. At least 50% had abnormal dynamic balance. A third
reported balance problems during dual-tasking. Five persons (9%) reported falls/near
falls. The median (q1-q3) motor symptom score was 21 (14-28) in de novo PD and
13.5 (9-20) in Later PD (p<0.001). Later PD performed worse on more balancedemanding
tests and a higher percentage of individuals reported falls/near falls
(p≤0.048). De novo PIGD PD (n=10) exhibited worse motor symptoms, reactive and
dynamic balance, gait speed, mobility, and freezing of gait as compared to the non-
PIGD de novo PD (n=37) (p≤0.049).
CONCLUSIONS: Balance and gait were impaired in de novo PD and most pronounced
in PIGD subtype. In addition, balance difficulties during dual-tasking and falls/near falls
were evident during this early stage. The lower scores of motor symptoms in Later PD
did not result in better mobility, balance, or less falls/near falls indicating that
medications have less effect on these symptoms. (Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Balance and gait, De novo, Falls, Near falls, Neurorehabilitation, Parkinson's disease
in
Journal of Neurology
volume
272
article number
11
pages
9 pages
publisher
Springer
external identifiers
  • pmid:39666175
  • scopus:85211915282
ISSN
0340-5354
DOI
10.1007/s00415-024-12804-4
language
English
LU publication?
yes
id
9dc598b9-3b46-4431-ae77-fc84b45fe612
date added to LUP
2025-01-08 09:48:11
date last changed
2025-04-04 15:17:11
@article{9dc598b9-3b46-4431-ae77-fc84b45fe612,
  abstract     = {{Background<br/><br/>Postural instability is considered a late complication of Parkinson’s disease (PD). However, growing evidence shows that balance and gait problems may occur early in the disease.<br/>Objective<br/><br/>To describe balance, gait, and falls/near falls in persons with newly diagnosed, untreated PD (“de novo”), and to compare this with persons with mild-moderate PD (Later PD). In addition, we evaluated differences relative to PD subtypes in de novo PD.<br/>Methods<br/><br/>De novo (n = 54) and Later (n = 58) PD were assessed regarding motor symptoms, balance, gait, and falls/near falls.<br/>Results<br/><br/>At least 25% of de novo PD had impaired reactive balance and/or comfortable gait speed ≤ 1.0 m/s. At least 50% had abnormal dynamic balance. A third reported balance problems during dual-tasking. Five persons (9%) reported falls/near falls. The median (q1–q3) motor symptom score was 21 (14–28) in de novo PD and 13.5 (9–20) in Later PD (p &lt; 0.001). Later PD performed worse on more balance-demanding tests and a higher percentage of individuals reported falls/near falls (p ≤ 0.048). De novo PIGD PD (n = 10) exhibited worse motor symptoms, reactive and dynamic balance, gait speed, mobility, and freezing of gait as compared to the non-PIGD de novo PD (n = 37) (p ≤ 0.049).<br/>Conclusion<br/><br/>Balance and gait were impaired in de novo PD and most pronounced in PIGD subtype. In addition, balance difficulties during dual-tasking and falls/near falls were evident during this early stage. The lower scores of motor symptoms in Later PD did not result in better mobility, balance, or less falls/near falls indicating that medications have less effect on these symptoms.}},
  author       = {{Lindholm, Beata and Hagell, Peter and Odin, Per and Hansson, Oskar and Siennicki-Lantz, Arkadiusz and Elmståhl, Sölve and Dahlin, Lars and Franzén, Erika}},
  issn         = {{0340-5354}},
  keywords     = {{Balance and gait; De novo; Falls; Near falls; Neurorehabilitation; Parkinson's disease}},
  language     = {{eng}},
  publisher    = {{Springer}},
  series       = {{Journal of Neurology}},
  title        = {{Balance and gait disorders in de novo Parkinson’s disease : support for early rehabilitation}},
  url          = {{http://dx.doi.org/10.1007/s00415-024-12804-4}},
  doi          = {{10.1007/s00415-024-12804-4}},
  volume       = {{272}},
  year         = {{2025}},
}