Objective: We investigated gait characteristics of progressive supranuclear palsy (PSP) and multiple system atrophy (MSA), with the aim to elucidate relatively specific disease differences in gait pattern. Gait alterations are generally observable phenomena in movement disorders patients. Gait is not automated motor activity – executive functioning is critical in complex gait situations, such as dual tasks performance while walking.

Background: PSP and MSA are a neurodegenerative disorders with several differing clinical presentations. PSP and MSA are types of diseases showing progressive atypical parkinsonism that are frequently misdiagnosed as Parkinson’s disease (PD). In clinical practice, it is of crucial importance to distinguish and diagnose atypical parkinsonian disorders from PD at disease onset, due to the different treatment and prognosis they require. Despite the progress in the field of PSP and MSA research in the past years, the diagnosis in clinical practice still relies largely on clinical symptoms and signs.

Methods: Patients performed demanding dual mental and motor tasks while walking on GAITRite electronic walkway carpet. Patients and healthy subjects performed a self-paced basic walking task, a dual-motor task, a dual-mental task, and a combined motor and mental task while walking. Analyzed parameters were cycle time, stride length, swing time, double support time and variability of those parameters. Gait parameters were analyzed in 34 PSP patients (23 PSP-c and 11 PSP-p), 18 MSA patients and 24 healthy control subjects.

Results: Base walk shows that PSP-c patients have higher variability of gait parameters then PSP-p, MSA and control subjects. During motor task, the significant changes were found only for stride length in PSP-c patients. The effect of mental task was present for all parameters and all groups except for swing time, more pronounced in PSP. The combined task (performing motor and mental tasks together) compared to mental task only, showing no further significant differences in both groups of patients. Further, MSA gait is different only in gait cycle time comparison.

Conclusions: Study shows differences in gait patterns characteristics between PSP-p and PSP-c subtypes, but also compared to MSA gait pattern. Gait pattern differences could separate PSP and MSA disease variants based on different level of postural instability during gait in complex walking situations.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/gait-characteristics-in-atypical-parkinsonism/