Exploring the relationship between orthostatic hypotension and gait in people with Parkinson's disease

Orthostatic hypotension (OH) is a non-motor feature in people with Parkinson's disease that can lead to falls from syncope. Current knowledge is lacking on the effects of OH on gait function.

Participants enrolled in a prospectively monitored longitudinal cohort who had OH on vitals at one of two consecutive visits approximately 6 months apart were analyzed. Gait measures were compared at the orthostatic versus non-orthostatic visit using the Wilcoxon signed-rank test and a linear mixed model. Motor and non-motor assessments were also compared.

Thirty-nine people with Parkinson's disease and seven age-matched controls in the longitudinal study met the inclusion criteria. Mean stride length and foot-strike length were shorter, and stride velocity was slower at the orthostatic visit compared to the non-orthostatic visit in people with Parkinson's disease. Levodopa dose, duration from last dose, motor and total Unified Parkinson's Disease Rating Scale scores, and cognitive and non-motor assessment scores did not differ between visits. The number of people reporting falls was higher at the orthostatic visit, and the fall frequency in fallers also trended higher. Gait measures did not differ between those with and without symptomatic OH.

In our cohort of people with Parkinson's disease with repeated measures, gait was more parkinsonian (slower velocity, shorter stride, and decreased foot strike to the ground) when they had OH on vitals at the visit than when they did not. Based on our results, future studies exploring the impact of adequate treatment of OH on gait function are warranted.