Gait Disorders in Parkinson's disease: pharmacological and non-pharmacological approaches

Gait deficits are common and debilitating features of Parkinson s disease (PD). Many pharmacological and non-pharmacological therapies have been proposed to improve gait in PD patients. Adequate and timely recognition of balance and gait disorders is important to identify patients at risk of falling. The timed up and go test (TUG) is a widely used clinical test for the evaluation of balance and mobility. An instrumented version of TUG (iTUG) has been proposed to provide quantitative information on TUG performances. Our results suggest different involvement of dopaminergic mechanisms on gait as assessed by iTUG. This is important for those aspects which are not improved by pharmacological therapy. An alternative strategy to treat gait disorders could consist in cognitive rehabilitation, which demonstrated to improve neural plasticity and attentional functions in treated PD patients. Despite the demonstrated interplay between cognition and gait, no studies have investigated the effect of cognitive rehabilitation protocols on gait in PD. Our pilot study suggests that a computer-assisted rehabilitation protocol based on executive functions training could improve walking in PD patients with freezing of gait.