Objective: To evaluate the association between gait impairment and striatal dopamine terminals and assess the hypothesis that gait impairment correlates with disease progression in de novo PD patients.

Background: Gait impairment is a common symptom in Parkinson’s disease (PD) patients, however, the mechanisms underlying its development remain unclear. This study used [123I]FP-CIT SPECT to evaluate the association between gait impairment and disease pathology (striatal dopamine uptake) and clinical progression (motor and cognitive symptoms).

Method: We included 390 de novo PD patients from the Parkinson´s Progression Markers Initiative (PPMI) database. Using the motor examination reported in the MDS-UPDRS at baseline, the patients were classified as presence (slight, mild, moderate, severe) or absence (normal) of gait impairment. Patients underwent an [123I]FP-CIT SPECT and MRI scan at baseline and clinical assessments at baseline and follow-up visits at 60 months. We investigated association between gait impairment with clinical and neuroimaging data and its correlation with disease progression.

Results: Gait impairment was prevalent in 54.4% of PD patients. PD patient with gait impairment had worse motor and cognitive scores at baseline and lower dopamine transporter binding ratio in putamen (p<0.05), nucleus accumbens (p<0.05) and ventral striatum (P<0.05). Cox regression analysis revealed that the severity of gait impairment was associated with motor progression, slight gait impairment (HR=0.113; P=0.003; 95%CI=0.027-0.478), mild gait impairment (HR=0.141; P=0.007; 95%CI=0.034-0.589).

Conclusion: PD patients with gait impairment at baseline had significantly lower striatal dopamine transporter binding ratio compared to patients with normal gait. Furthermore, the severity of gait impairment was associated with worse progression of motor symptoms. This abstract was also submitted for presentation at the 2019 European Academy of Neurology conference.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/gait-impairment-in-parkinsons-disease-an-123ifp-cit-spect-study/