Vestibular Sensory Conflict During Postural Control, Freezing of Gait, and Falls in Parkinson's Disease

Background The vestibular system has been implicated in the pathophysiology of episodic motor impairments in Parkinson's disease (PD), but specific evidence remains lacking. Objective We investigated the relationship between the presence of freezing of gait and falls and postural failure during the performance on Romberg test condition 4 in patients with PD. Methods Modified Romberg sensory conflict test, fall, and freezing-of-gait assessments were performed in 92 patients with PD (70 males/22 females; mean age, 67.6 +/- 7.4 years; Hoehn and Yahr stage, 2.4 +/- 0.6; mean Montreal Cognitive Assessment, 26.4 +/- 2.8). Results Failure during Romberg condition 4 was present in 33 patients (35.9%). Patients who failed the Romberg condition 4 were older and had more severe motor and cognitive impairments than those without. About 84.6% of all patients with freezing of gait had failure during Romberg condition 4, whereas 13.4% of patients with freezing of gait had normal performance (chi(2) = 15.6; P < 0.0001). Multiple logistic regression analysis showed that the regressor effect of Romberg condition 4 test failure for the presence of freezing of gait (Wald chi(2) = 5.0; P = 0.026) remained significant after accounting for the degree of severity of parkinsonian motor ratings (Wald chi(2) = 6.2; P = 0.013), age (Wald chi(2) = 0.3; P = 0.59), and cognition (Wald chi(2) = 0.3; P = 0.75; total model: Wald chi(2) = 16.1; P < 0.0001). Patients with PD who failed the Romberg condition 4 (45.5%) did not have a statistically significant difference in frequency of patients with falls compared with patients with PD without abnormal performance (30.5%; chi(2) = 2.1; P = 0.15). Conclusions The presence of deficient vestibular processing may have specific pathophysiological relevance for freezing of gait, but not falls, in PD. (c) 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society