New insight into Parkinson's disease-related impairment of the automatic control of upright stance

Parkinson's disease (PD) affects the automatic control of body movements. In our study, we tested PD-related impairments in automatic postural control in quiet upright stance. Twenty PD patients (mean age: 60 +/- 8 years; Hoehn and Yahr: 2.00 +/- 0.32, on-drug) and twenty age-matched controls (61 +/- 7 years) were recruited. We studied interrelations between center-of-pressure movements, body movements (head, neck, and lower back), eye movements and variability of pupil size. Participants performed two fixation tasks while standing, during which they looked at: (a) a cross surrounded by a white background; and (b) a cross surrounded by a structured visual background (images used: rooms in houses). PD patients exhibited stronger and weaker correlations between eye and center-of-pressure/body movement variables than age-matched controls in the white and structured fixation tasks, respectively. Partial correlations, controlling for variability of pupil size showed that PD patients used lower and greater attentional resources than age-matched controls to control their eye and center-of-pressure/body movements simultaneously in the white fixation and structured fixation tasks, respectively. In the white fixation task, PD patients used attentional resources to optimize visuomotor coupling between eye and body movements to control their posture. In the structured fixation task, the salient visual stimuli distracted PD patients' attention and that possibly affected postural control by deteriorating the automatic visuomotor coupling. In contrast, age-matched controls were able to use surrounding visual background to improve the automatic coupling between eye and center-of-pressure movements to control their posture. These results suggest that cluttered environments may distract PD patients and deteriorate their postural control.