The Effect of Levodopa on Dual-Tasking in Parkinson’s Disease Freezing of Gait

Ece Bayram¹, Jason Longhurst¹, Sarah J. Banks¹, Zoltan Mari¹, Brent Bluett¹

¹Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA.

Background and Objective: Starting to walk, turning, narrow spaces, and dual-tasking increase the frequency and severity of freezing of gait (FOG) in Parkinson’s disease (PD). Although levodopa may improve FOG in up to 60% of PD patients, its effects on FOG while dual-tasking have not been investigated.

Methods: 21 PD patients (12 without FOG, 9 with FOG) were evaluated using FOG assessment score during levodopa off and on. This score consists of ratings with three dual-tasking levels (walk; walk & carry tray; walk, carry tray & perform mental calculations). Higher scores indicate worse performance. Individual scores during the dual-tasking levels, time to complete each level, and total score were compared between groups and levodopa states within each group.

Results: Between group comparisons revealed the FOG group had higher scores and were slower during all levels of the FOG assessment. Levodopa improved the total score for both groups. PD without FOG group were faster during levodopa on compared to off, and had lower scores while walking, carrying tray & performing mental calculations during levodopa on. Levodopa did not affect walking speed in FOG group, and only improved the score while walking, carrying tray & performing mental calculations.

Discussion and Conclusions: Levodopa improved the FOG assessment score for both groups of PD patients, and improved walking performance during dual-tasking. However, while levodopa improved movement speed for PD without FOG, this was not observed in the FOG group. Other treatment modalities in addition to levodopa are needed to fully alleviate FOG in PD.

Acknowledgement: Research reported in this publication was supported by an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under grant number 5P20GM109025.