Objective: To assess the prevalence of tandem gait abnormality in patients with Parkinson’s disease (PD), comparing Hoehn and Yahr (HY) stages 2 and 3.

Background: Classically, as Parkinson’s disease (PD) progresses, patients develop antero-posterior instability detected by the pull test. Detecting this abnormality defines the transition from Hoehn and Yahr stages 2 and 3. Historically, detecting a mediolateral balance impairment, via tandem gait (TG) testing, in a patient with PD is considered a “red flag” pointing towards an underlying atypical parkinsonism (1,2).

Methods: Our study protocol assessed subjective balance impairment, fall history, antero-posterior postural instability, and quantified TG abnormality in PD patients. To test TG, patients were asked to walk heel-to-toe for 10 consecutive steps with their arms at their sides and eyes open. Patients were allowed two trials, and the best performance was scored—as defined by the relevant sections of the UHDRS and SARA scales. Postural instability was defined by the pull test (MDS-UPDRS 3.12). We recorded the age, sex, current medications, HY stage, Schwab and England Scale and MOCA score for each patient. Patients with clinically apparent peripheral sensory neuropathy, gross orthopedic abnormality or concern for atypical PD were excluded.

Results: 83 patients with PD were assessed, 34 women and 49 men, from ages 36 to 85 years. 50 patients were HY 2; 10 patients HY 2.5; and 8 patients HY 3. 64.0% of HY 2 patients had a TG abnormality. 100% of HY stages 2.5 and 3 patients had a TG abnormality.

Conclusions: TG abnormality is common in PD patients and it preceded the development of anteroposterior balance instability in our cohort. Detecting TG abnormality in a patient with PD may predict fall risk. A follow up longitudinal study will help determine if TG is a predictor of impending progression from HY 2 to HY 3.

References: 1. Aerts M, Esselink R, Abdo W. Ancillary investigations to diagnose parkinsonism: a prospective clinical study. Journal of Neurology. 2016; 262: 346-356. 2. Abdo WF, Borm GF, Munneke M, Verbeek MM, Esselink RA, & Bloem BR (2006) Ten steps to identify atypical parkinsonism. J Neurol Neurosurg Psychiatry, 77, 1367-1369.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-prevalence-of-tandem-gait-abnormality-in-parkinsons-disease/