Dopamine-mediated improvements in dynamic balance control in Parkinson’s disease

Background Impaired dynamic balance control increases fall risk and contributes to immobility in individuals with Parkinson’s disease (PD). It is unclear whether higher-level neural processes of the central nervous system contribute to impaired balance control. Research Question Are dopamine-mediated neural processes of the higher-level central nervous system important for dynamic balance control in PD? Methods 21 individuals with idiopathic PD performed step-threshold assessments before and after self-administered dopaminergic medication. Individuals withstood progressively larger postural perturbations, during which they were explicitly instructed to avoid stepping to recover balance. The perturbation magnitude which elicited stepping responses on four consecutive trials is referred to as the step-threshold. Dynamic balance control was quantified as the minimum margin of stability captured during the largest sub-threshold trial (i.e., the maximum amount of compensated postural instability during the task). We compared dynamic balance between off and on medication states and between individuals who exhibited motor adaptive behavior and those who did not. Results Dopaminergic medications significantly improved step-thresholds and allowed individuals to withstand greater amounts of instability without stepping, indicating dopamine-mediated improvement in dynamic balance control. Individuals who displayed behavioral evidence for higher-level neural processes (motor adaptation across repeated perturbations) displayed superior dynamic balance control versus those who did not. Anteroposterior ground reaction forces captured during perturbations suggest that individuals alter force profiles to avoid stepping at ∼200 ms after perturbation onset–a latency consistent with a transcortical process. Significance Combined, our results indicate that higher-level, dopamine-mediated neural processes are responsible for dynamic balance control in PD. We hypothesize that this process incorporates sensorimotor integration, motor response initiation/inhibition, and goal- and reward-driven behaviors. Interventions targeting these processes may improve dynamic postural control in individuals with PD.