Elsevier

Gait & Posture

Volume 65, September 2018, Pages 57-64
Gait & Posture

Review
Relationships between gait and emotion in Parkinson’s disease: A narrative review

https://doi.org/10.1016/j.gaitpost.2018.06.171Get rights and content

Highlights

  • Gait abnormalities in PD can be “continuous” and “episodic”.

  • Emotional disturbances may affect gait in individuals with PD.

  • Emotional disorders are undertreated and understudied in PD subjects.

  • New rehabilitation strategies might impact gait and emotion in PD.

Abstract

Background

Disturbance of gait is a key feature of Parkinson’s disease (PD) and has a negative impact on quality of life. Deficits in cognition and sensorimotor processing impair the ability of people with PD to walk quickly, efficiently and safely. Recent evidence suggests that emotional disturbances may also affect gait in PD.

Research question

We explored if there were relationships between walking ability, emotion and cognitive impairment in people with PD.

Methods

The literature was firstly reviewed for unimpaired individuals. The recent experimental evidence for the influence of emotion on gait in people with PD was then explored. The contribution of affective disorders to continuous gait disorders was investigated, particularly for bradykinetic and hypokinetic gait. In addition, we investigated the influence of emotional processing on episodic gait disturbances, such as freezing of gait. Potential effects of pharmacological, surgical and physical therapy interventions were also considered.

Results

Emerging evidence showed that emotional disturbances arising from affective disorders such as anxiety and depression, in addition to cognitive impairment, could contribute to gait disorders in some people with PD. An analysis of the literature indicated mixed evidence that improvements in affective disorders induced by physical therapy, pharmacological management or surgery improve locomotion in PD.

Significance

When assessing and treating gait disorders in people with PD, it is important to take into the account non-motor symptoms such as anxiety, depression and cognitive impairment, in addition to the motor sequalae of this progressive neurological condition.

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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