Objective: To evaluate supervised and real-world mobility in people with Parkinson’s disease (PwPD) with and without nocturnal hypokinesia (NH).

Background: Mobility impairment and NH are two common occurrences in PwPD significantly impacting quality of life [1-4]. However, although there is a rationale for an association between the two [5], no studies specifically investigated the relationship between mobility and NH.

Method: One hundred PwPD [females: 31 (31%); age: 67.4±8.6; disease duration: 6.0±4.2; LEDD: 537±297 mg; mHY: 2 (2-2.5; 1-3)] performed two supervised mobility tests at self-selected speed: a 20-meter forward walking (FW) task and a Timed-Up-and-Go (TUG) test. A lower-back-mounted inertial sensor (BTS G-WALK) was used to compute spatiotemporal gait parameters as well as mean (MAV) and peak angular velocity (PAV) of 180° turning during the execution of the TUG. PwPD also performed a 3-meter backward walking test (3MBWT). Participants further wore a Garmin Vivosmart 4 smartwatch for 5 consecutive days on the wrist least affected by the disease allowing the computation of average daily steps (avDS) [6,7]. Data regarding levodopa equivalent daily dose (LEDD), disease duration, modified Hoehn and Yahr stage (mHY) were collected. The MDS Unified Parkinson’s disease Rating Scale (MDS-UPDRS) parts I-III were used to clinically evaluate participants. Freezing of gait (FOG) presence was assessed as a score ≥ 1 at item 2.13 of MDS-UPDRS-II. PwPD were dichotomized based on the presence (NH+) or absence (NH-) of NH (item 2.9 of MDS-UPDRS-II≥1).

Results: Twenty-eight (28%) PwPD reported NH. Compared to NH- group, NH+ group exhibited a longer total TUG duration and lower MAV and PAV, reduced walking speed and stride length during FW, reduced 3MBWT speed, as well as lower avDS. Clinically, NH+ group demonstrated higher LEDD and mHY stage, as well as higher MDS-UPDRS part I-III scores. Finally, NH+ group showed a higher prevalence of FOG.

Conclusion: NH was associated with worse supervised and real-world mobility as well as a higher prevalence of FOG and worse motor and non-motor symptoms. This could be linked to the higher prevalence of NH along disease progression and/or could suggest a detrimental effect on global PwPD conditions. Our results highlight the need to investigate NH and develop therapeutical strategies for this symptom in PwPD.

References: 1. Mirelman A, Bonato P, Camicioli R, et al. Gait impairments in Parkinson’s disease. Lancet Neurol. 2019;18(7):697-708. doi:10.1016/S1474-4422(19)30044-4

2. Louter M, Munneke M, Bloem BR, Overeem S. Nocturnal hypokinesia and sleep quality in Parkinson’s disease. J Am Geriatr Soc. 2012;60(6):1104-1108. doi:10.1111/j.1532-5415.2012.03966.x

3. Bhidayasiri R, Trenkwalder C. Getting a good night sleep? The importance of recognizing and treating nocturnal hypokinesia in Parkinson’s disease. Parkinsonism Relat Disord. 2018;50:10-18. doi:10.1016/j.parkreldis.2018.01.008

4. Mirelman A, Hillel I, Rochester L, et al. Tossing and Turning in Bed: Nocturnal Movements in Parkinson’s Disease. Mov Disord. 2020;35(6):959-968. doi:10.1002/mds.28006

5. Taniguchi S, D’cruz N, Nakagoshi M, Osaki T, Nieuwboer A. Determinants of impaired bed mobility in Parkinson’s disease: Impact of hip muscle strength and motor symptoms. NeuroRehabilitation. 2022;50(4):445-452. doi:10.3233/NRE-210301

6. Bianchini E, Galli S, Alborghetti M, et al. Four Days Are Enough to Provide a Reliable Daily Step Count in Mild to Moderate Parkinson’s Disease through a Commercial Smartwatch. Sensors (Basel). 2023;23(21):8971. doi:10.3390/s23218971

7. Bianchini E, Caliò B, Alborghetti M, et al. Step-Counting Accuracy of a Commercial Smartwatch in Mild-to-Moderate PD Patients and Effect of Spatiotemporal Gait Parameters, Laterality of Symptoms, Pharmacological State, and Clinical Variables. Sensors (Basel). 2022;23(1):214. doi:10.3390/s23010214

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MDS Abstracts - https://www.mdsabstracts.org/abstract/exploring-supervised-and-real-world-mobility-in-people-with-parkinsons-disease-with-and-without-nocturnal-hypokinesia/