Balance and gait disorders in de novo Parkinson's disease: support for early rehabilitation

Background: Postural instability is considered a late complication of Parkinson’s disease (PD). However, growing evidence shows that balance and gait problems may occur early in the disease. 

Objective: To describe balance, gait, and falls/near falls in persons with newly diagnosed, untreated PD (“de novo”), and to compare this with persons with mild-moderate PD (Later PD). In addition, we evaluated differences relative to PD subtypes in de novo PD. 

Methods: De novo (n = 54) and Later (n = 58) PD were assessed regarding motor symptoms, balance, gait, and falls/near falls. 

Results: At least 25% of de novo PD had impaired reactive balance and/or comfortable gait speed ≤ 1.0 m/s. At least 50% had abnormal dynamic balance. A third reported balance problems during dual-tasking. Five persons (9%) reported falls/near falls. The median (q1–q3) motor symptom score was 21 (14–28) in de novo PD and 13.5 (9–20) in Later PD (p < 0.001). Later PD performed worse on more balance-demanding tests and a higher percentage of individuals reported falls/near falls (p ≤ 0.048). De novo PIGD PD (n = 10) exhibited worse motor symptoms, reactive and dynamic balance, gait speed, mobility, and freezing of gait as compared to the non-PIGD de novo PD (n = 37) (p ≤ 0.049). 

Conclusion: Balance and gait were impaired in de novo PD and most pronounced in PIGD subtype. In addition, balance difficulties during dual-tasking and falls/near falls were evident during this early stage. The lower scores of motor symptoms in Later PD did not result in better mobility, balance, or less falls/near falls indicating that medications have less effect on these symptoms.