Objective: To describe commonly observed gait phenotypes in a cohort of advanced Parkinson’s Disease (PD) patients.

Background: Gait disorders in PD are varied and complex.  Even the most experienced movement disorders neurologists have difficulty characterizing PD-related gait phenotypes because current rating scales lack the necessary qualitative details. Here we propose categorizing Parkinsonian gait in relation to specific gait characteristics such as stride length, base width and regularity of the movements and whether movement is affected by dyskinesia and/or dystonia.

Methods: We studied 18 advanced PD patients who were evaluated at our Parkinson’s disease and Movement Disorder Center and subsequently underwent deep brain stimulation between January and October 2016.  Patient performance on standardized assessments of gait and motor function was captured including the freezing of gait questionnaire (FOGQ) and UPDRS motor score and gait item 3.10.

Results: Our cohort included 13 men and 5 women (mean age 62.2 +/- 8.1; mean disease duration in years 8.1 +/-4.0), 14 of whom had gait disturbance.  We identified four distinct gait phenotypes in these patients during their most representative on-state: 1) Small, symmetric, shuffling steps (5 patients); 2) Asymmetric hypokinetic stride (2 patients); 3) Asymmetric dyskinetic/dystonic stride (6 patients); 4) Lurching with postural instability (1 patient).  The median off-medication UPDRS motor scores for each group were as follows: 51.0 +/- 11.1; 30.0 +/- 1.4; 50.5 +/- 17.4; 40 (single value), respectively.  The median FOGQ score for each group were as follows: 5.0+/-3.8; 8.5 +/- 3.5; 5.0 +/- 5.0; 17, respectively. The mean UPDRS gait scores were similar among the four groups (1.0 +/- 0.9; 1.5 +/- 0.7; 2.0 +/- 0.5; 3, respectively).

Conclusions: Our exploratory study of gait disorders in a cohort of advanced Parkinson’s disease patients reveals 4 gait impairment categories that are not easily discerned with current gait questionnaires or metrics.  Our study highlights the need for further study of Parkinsonian gait phenotypes in PD and their differential responses to deep brain stimulation.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/beyond-shuffling-gait-phenotypes-in-parkinsons-disease/