Objective: To Assess the impact of fatigue on gait in Parkinson Disease patients in different evaluation conditions.

Background: Fatigue is a common and disabling symptom in Parkinson’s disease (PD). How fatigue is associated with gait is not well understood, especially in the home environment under unsupervised conditions(UC) (Warmerdam et al. 2020).

Method: The prospective study included cognitively unimpaired PD patients under dopaminergic treatment without motor and non-motor fluctuations and age-matched controls. Each participant underwent an extensive motor and cognitive assessment and a gait analysis using inertial measurement units (IMUs) in supervised conditions (SC), namely 20-meter straight walking under normal, fast and dual-task conditions. Moreover, participants wore a similar IMUs for 4 consecutive days in the home environment (UC). Fatigue was assessed using the PD Fatigue Scale (Brown et al, 2005). Differences in gait parameters under SC and UC between patients with (F-PD) and without (NF-PD) fatigue were calculated with ANCOVA adjusting for age, sex and motor severity.

Results: Forty-four controls (65+7 ys) and 37 PD patients (68+8 ys, disease duration 5+3 years) entered the study. Compared to controls, PD patients showed longer step time, higher asymmetry and higher step time variability in both SC and US. F (n=18) and NF (n=19) PD patients were comparable concerning motor, cognitive and demographic variables. Under SC conditions, no relevant gait differences could be observed. Under UC, however, F-PD patients showed significantly longer step time, higher step time variability and higher asymmetry, compared to NF-PD patients, particularly during walking bouts >20 steps.

Conclusion: Fatigue has an impact on gait parameters under UC, but not SC, in PD patients. Our findings support the importance of remote assessment to evaluate fatigue in PD. The findings need to be verified in larger ongoing multicentre studies (e.g., IDEA-FAST, https://idea-fast.eu) focusing on MHT assessment under UC.

References: 1. Warmerdam E, Hausdorff JM, Atrsaei A, Zhou Y, Mirelman A, Aminian K, Espay AJ, Hansen C, Evers LJW, Keller A, Lamoth C, Pilotto A, Rochester L, Schmidt G, Bloem BR, Maetzler W. Long-term unsupervised mobility assessment in movement disorders.
Lancet Neurol. 2020 May;19(5):462-470. doi: 10.1016/S1474-4422(19)30397-7.
2. Brown, R. G., Dittner, A., et al. (2005). “The Parkinson fatigue scale”. Parkinsonism Relat Disord 11(1): 49-55.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/gait-under-unsupervised-but-not-supervised-conditions-differentiates-between-parkinson-disease-with-and-without-fatigue/