DISORDERED AXIAL MOVEMENT IN PARKINSONS-DISEASE

Axial motor impairments are a common cause of disability in patients w ith Parkinson's disease, become more prominent with longer disease dur ation, and have been said to be less responsive to levodopa replacemen t therapy. The ability to turn in bed while lying supine before and af ter dopaminergic stimulation was studied in a group of 36 patients wit h Parkinson's disease; 23 were in Hoehn and Yahr stages 3-5 when ''off '', and 13 were in stages 1-2. Turning was also compared with postural stability and gait before (''off'') and after (''on'') dopaminergic s timulation. Failure to turn in bed was noted in 19 of the 36 patients in the ''off'' state, with significant associations between disturbanc es of gait, postural stability, rising from a chair, whole body bradyk inesia, and axial rigidity. Gait, postural stability, rising from a ch air, whole body bradykinesia, and axial rigidity were significantly co rrelated in the ''off'' state. Disorder of axial movement, gait, and p ostural stability were not dependent on age at onset of Parkinson's di sease, but did relate to duration of disease. After a levodopa challen ge, turning in bed returned to normal in all but one patient, and gait , postural stability, rising from a chair, whole body bradykinesia, an d axial rigidity also improved in nearly all. It is concluded that in the later stages of Parkinson's disease at least some aspects of axial motor control can remain dopamine responsive.