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Original Article Association Between Gait and Dysautonomia in Patients With De Novo Parkinson’s Disease: Forward Gait Versus Backward Gait
Seon-Min Lee1orcid , Mina Lee2orcid , Eun Ji Lee2orcid , Rae On Kim2orcid , Yongduk Kim1orcid , Kyum-Yil Kwon2orcid

DOI: https://doi.org/10.14802/jmd.22045 [Epub ahead of print]
Published online: September 7, 2022
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1Department of Neurology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
2Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Korea
Corresponding author:  Kyum-Yil Kwon, Tel: +82-2-709-9026, Fax: +82-2-709-9226, 
Email: denovo78@naver.com
Received: 25 March 2022   • Revised: 7 June 2022   • Accepted: 27 June 2022

Studies on gait and autonomic dysfunction have been insufficient so far, particularly de novo Parkinson’s disease (PD). The aim of this study was to identify the association between gait dynamics and autonomic dysfunction in patients with de novo PD.
A total 38 patients with de novo PD were retrospectively included in this study. Details of patients’ dysautonomia were assessed using the Scales for Outcomes in Parkinson’s Disease-Autonomic Dysfunction (SCOPA-AUT). For assessment of gait, a computerized gait analysis was performed using the GAITRite system for forward gait and backward gait. High SCOPA-AUT score (PD-HSAS) group and low SCOPA-AUT score (PD-LSAS) group were identified according to their SCOPA-AUT scores.
Nineteen (50%) patients with high SCOPA-AUT scores above median value (12.5) were assigned into the PD-HSAS group and others were assigned to the PD-LSAS group. Compared with the PD-LSAS group, the PD-HSAS group exhibited slower gait, shorter stride, decreased cadence, increased double support phase, decreased swing phase, and increased variability in swing time. Total SCOPA-AUT score showed significantly positive correlations with gait variability and instability but a negative correlation with gait hypokinesia. In subdomain analysis, urinary dysautonomia was highly associated with impairment of gait dynamics. All significant results were found to be more remarkable in backward gait than in forward gait.
Our findings suggest that alteration in gait dynamics, especially backward gait, is highly associated with autonomic dysfunction in patients with de novo PD.

JMD : Journal of Movement Disorders