ReviewRelationships between gait and emotion in Parkinson’s disease: A narrative review
Introduction
Parkinson’s disease (PD) is a progressive neurodegenerative condition characterized by movement disorders such as bradykinesia, rigidity, resting tremor, and postural instability. [1]. Disturbance of gait is a key feature of PD and can have a negative impact on quality of life [2]. Gait disorders are associated with immobility and falling, as well as loss of independence [3,4]. Gait disorders in PD also vary widely across individuals and across the time course of the disease [2]. The pathophysiology is complex [5], with variable contributions of motor, cognitive and affective disturbances [6]. Deficits in cognition and sensorimotor processing can impair the ability of people with PD to walk safely, particularly in challenging conditions that require adaptation to environmental changes and obstacles. Gait disorders in PD can also be influenced by a person’s emotions.
This scoping review aims to analyse the relationship between walking ability and emotional disturbance in individuals with PD. In particular, we investigate: (i) the associations between cognition, emotion and gait in healthy individuals and in those with continuous and episodic walking disturbances, (ii) the contribution of emotional symptoms to gait disorders and falls in people with PD and (iii) the potential effects of pharmacological, surgical and physical therapy interventions for emotional disturbance on gait in PD.
Section snippets
Interplay between cognition, emotion and gait
Although human gait was historically viewed as an automatic task [7], it is now clear that emotion and cognition contribute to the motor control of gait in health and disease [[8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21]]. The contribution of these non-motor functions to locomotion is particularly evident in complex walking situations [8,9]. For example, considerable research indicates that, compared to normal conditions, ‘dual tasking’ alters gait [[10], [11]
Gait disorders and emotion in Parkinson’s disease
Gait abnormalities associated with PD can be categorized as “continuous” and “episodic” disturbances [38].
Emotion and Parkinson’s disease
Emotional symptoms are a major source of disability in people living with PD [70]. Amongst the affective disturbances, depression is the most common in PD, with an estimated prevalence of around 35%, and a mixture of affective phenotypes [71]. It can sometimes manifest prior to the onset of motor symptoms [72].
Anxiety can be also a problem in PD, with a prevalence of about 31%, approximately double that of the general population (15%) [73]. Anxiety can exacerbate motor symptoms and may
Influence of emotion on gait and falls in Parkinson’s disease
Recent studies indicate that affective disturbance and affective processing contribute to gait disorders in PD (references are summarized in Table 1).
Treatment: current status and future possibilities
Although it is clear that gait performance in people with PD can be influenced by mood (especially depressive symptoms and high anxiety), the extent to which pharmacological and physical therapies for these non-motor symptoms improves walking remains unclear. Emotional disorders are under-researched in PD [117]. Moreover, the effects of antidepressants and anxiolytic therapies on gait disturbances in PD remains open to question. Recent PD trials showed that although walking ability was impaired
Concluding remarks
The study of the influence of emotional processing and emotional disturbance on gait characteristics in PD helps to elucidate the motor control of locomotion in this debilitating condition. Further neurophysiological and clinical studies are needed to better understand the interplay between emotion and gait in PD, to further inform therapies and self-management strategies.
Funding statement
The authors have no support or funding to report.
Financial disclosures/conflicts of interest
The Authors have no conflict of interest to disclose in respect to this manuscript.
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2022, Journal of Clinical NeuroscienceCitation Excerpt :Although the relationship between motor and non-motor symptoms of PD is complex [37], previous studies have suggested that the most important NMSs of PD (i.e., depression and anxiety)[38] are mainly caused by the main pathology of PD (i.e., dopaminergic system degeneration), so that the NMSs can be a clue for PD onset and severity [39]. In addition, NMSs can aggravate the motor symptoms and affect response to the medications [40,41]. Furthermore, even before the COVID-19 pandemic emergence, NMSs have been causing a greater impact on the quality of life in PD patients than motor symptoms [42].