Objective: The aim of this study is to analyse the responsiveness of arm swing during walking to dopaminergic medication in patients with Parkinson’s disease.

Background: The evidence of the responsiveness of dopaminergic medication on gait in patients with Parkinson’s disease is contradicting. Only gait speed, stride length and stride velocity have consistently shown an improvement with medication [1], [2]. The effect of medication on other gait parameters is unclear. This could be due to the differences in complexity of the context the walking was performed in. Two studies have found an effect of task complexity on gait speed [3] and stride time variability [4]. This study will analyse the responsiveness of arm swing to dopaminergic medication during walking tasks with different complexity.

Method: Forty-five patients with Parkinson’s disease, who did not suffer from dyskinesia, were measured while walking at preferred speed, at fast speed and with a cognitive dual-task (subtracting sevens) on a 20 m walkway. All patients performed these walking assessments both OFF and ON dopaminergic medication. The patients wore a wearable sensor on each wrist. A validated publicly available algorithm was used to obtain multiple arm swing parameters [5]. The arm swing parameters were corrected for gait speed, since gait speed is known to influence arm swing.

Results: At preferred speed, and even more at fast speed, arm swing parameters improved with medication. However, the responsiveness of arm swing to dopaminergic medication during dual-tasking was less clear, the responsiveness was rather small and sometimes even negative (Figure 1). The changes in arm swing due to medication were not relevantly associated with changes in the MDS-UPDRS III total and sub-score(s).

Conclusion: The responsiveness of arm swing to dopaminergic medication depends on task complexity. Assuming that dual-task walking most closely reflects real-life situations, the results suggest that the effect of dopaminergic medication on mobility-relevant movements, such as arm swing, might be small in everyday conditions. This could have highly relevant implications for Parkinson disease treatment and counselling.

References: [1] M. S. Bryant, D. H. Rintala, J. G. Hou, E. C. Lai, and E. J. Protas, “Effects of levodopa on forward and backward gait patterns in persons with Parkinson’s disease,” NeuroRehabilitation, vol. 29, no. 3, pp. 247–252, 2011. [2] L. Rochester, K. Baker, A. Nieuwboer, and D. Burn, “Targeting dopa-sensitive and dopa-resistant gait dysfunction in Parkinson’s disease: Selective responses to internal and external cues,” Mov. Disord., vol. 26, no. 3, pp. 430–435, 2011. [3] M. Elshehabi et al., “Limited effect of dopaminergic medication on straight walking and turning in early-to-moderate parkinson’s disease during single and dual tasking,” Front. Aging Neurosci., vol. 8, no. 4, 2016. [4] M. Dagan et al., “Dopaminergic therapy and prefrontal activation during walking in individuals with Parkinson’s disease: does the levodopa overdose hypothesis extend to gait?,” J. Neurol., vol. 268, no. 2, pp. 658–668, 2021. [5] E. Warmerdam, R. Romijnders, J. Welzel, C. Hansen, G. Schmidt, and W. Maetzler, “Quantification of arm swing during walking in healthy adults and Parkinson’s disease: Wearable sensor-based algorithm development and validation,” Sensors, vol. 20, no. 20, 2020.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-responsiveness-of-arm-swing-to-dopaminergic-medication-in-parkinsons-disease-depends-on-task-complexity/