TY - JOUR
T1 - Overview of the cholinergic contribution to gait, balance and falls in Parkinson's disease
AU - Morris, Rosie
AU - Martini, Douglas N.
AU - Madhyastha, Tara
AU - Kelly, Valerie E.
AU - Grabowski, Thomas J.
AU - Nutt, John
AU - Horak, Fay
N1 - Funding Information:
This research was supported by the Pacific Udall Center ( P50 NS062684-07 ) and the Department of Veterans Affairs Northwest Parkinson's Disease Research, Education and Clinical Care Center .
Publisher Copyright:
© 2019
PY - 2019/6
Y1 - 2019/6
N2 - Mobility deficits, including gait disturbance, balance impairments and falls, are common features of Parkinson's disease (PD) that negatively impact quality of life. Mobility deficits respond poorly to dopaminergic medications, indicating a role for additional neurotransmitters. Due to the critical role of cortical input to gait and balance, acetylcholine—an essential neurotransmitter system for attention—has become an area of interest for mobility. This review aimed to identify the role of cholinergic function on gait, balance, and falls in PD using three techniques; pharmacological, imaging, and electrophysiological. Studies supported the role of the cholinergic system for mobility in PD, with the most promising evidence indicating a role in falls. Imaging studies demonstrated involvement of anterior cholinergic (basal forebrain) systems in gait, and posterior (brainstem) systems in balance. However, this review identified a small number of studies which used varying protocols, making comparisons difficult. Further studies are warranted, measuring comprehensive gait and balance characteristics as well as gold standard falls detection to further quantify the relationship between ACh and mobility in PD.
AB - Mobility deficits, including gait disturbance, balance impairments and falls, are common features of Parkinson's disease (PD) that negatively impact quality of life. Mobility deficits respond poorly to dopaminergic medications, indicating a role for additional neurotransmitters. Due to the critical role of cortical input to gait and balance, acetylcholine—an essential neurotransmitter system for attention—has become an area of interest for mobility. This review aimed to identify the role of cholinergic function on gait, balance, and falls in PD using three techniques; pharmacological, imaging, and electrophysiological. Studies supported the role of the cholinergic system for mobility in PD, with the most promising evidence indicating a role in falls. Imaging studies demonstrated involvement of anterior cholinergic (basal forebrain) systems in gait, and posterior (brainstem) systems in balance. However, this review identified a small number of studies which used varying protocols, making comparisons difficult. Further studies are warranted, measuring comprehensive gait and balance characteristics as well as gold standard falls detection to further quantify the relationship between ACh and mobility in PD.
KW - Acetylcholine
KW - Balance
KW - Falls
KW - Gait
KW - Parkinson's disease
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U2 - 10.1016/j.parkreldis.2019.02.017
DO - 10.1016/j.parkreldis.2019.02.017
M3 - Review article
C2 - 30796007
AN - SCOPUS:85061668814
SN - 1353-8020
VL - 63
SP - 20
EP - 30
JO - Parkinsonism and Related Disorders
JF - Parkinsonism and Related Disorders
ER -