Levodopa influence on turning dynamics in people with Parkinson’s disease

Abstract Turning behaviors are affected in people with Parkinson’s disease (PwPD) leading to falls and Freezing of Gait (FOG). Levodopa therapy is commonly recommended for PwPD to help alleviate motor symptoms. Knowledge of turning dynamics with levodopa therapy is limited and could improve clinical care. We enrolled 44 PwPD already on levodopa therapy and analyzed their turns on an instrumented gait mat. Participants made 180-degree turns in their OFF-state (> 8 hours off levodopa) then ON-state (1 hour after levodopa). Thirteen turn measures were assessed for changes between the OFF to ON-state. Turns in the ON-state had faster stride-velocity, fewer steps, and trending towards lengthier turns, better foot ground contact, and decreased variability in stance-time. Regression modeling suggested greater improvement in turn stride-velocity, better foot contact, and lengthier turns with longer levodopa duration, and fewer steps and lower variability in stance-time with higher FOG severity. Our data suggests worse OFF-state function and retained levodopa responsiveness leading to larger improvement in turn measures in those on levodopa longer (or longer disease duration) and in those with levodopa unresponsive FOG. Our results provide important evidence for continued aggressive levodopa management to improve mobility during turns even in advanced Parkinson’s disease.