Functional correlates of mild parkinsonian signs in the community-dwelling elderly: Poor balance and inability to ambulate independently

Mild tremor, rigidity, and bradykinesia (mild parkinsonian signs, MPS) are commonly detected during the clinical examination of elderly people without known neurological disease. The functional correlates of these incidental findings are not well understood. Balance and ability to ambulate independently are important functions in the elderly. The objective of this study is to examine whether MPS were associated with impaired balance. Balance was assessed using a subjective measure (complaint of poor balance) and a functional measure (the need to use a walker, cane, or wheelchair). Our methods included the neurological evaluation of nondemented older people in Washington Heights-Inwood, NY. Of 2,251 participants, 527 (23.4%) complained of poor balance; 538 (23.9%) required a cane, walker, or wheelchair; and 363 (16.1%) had MPS. In adjusted logistic regression analyses, MPS were associated with a complaint of poor balance (OR = 1.5, 95% CI = 1.1-2.0) and the need to use a cane, walker, or wheelchair (OR = 1.9, 95% CI = 1.4-2.6). The need to use a cane, walker, or wheelchair was associated with changes in axial function (OR = 5.5, 95% CI = 2.6-11.6) as well as rigidity (OR = 1.5, 95% CI = 1.07-2.2). Although they are incidental and subtle, signs of bradykinesia, rigidity, and tremor are associated with impaired function. The elderly in whom these signs have been detected are 50% more likely to complain of poor balance and 90% more likely to require a cane, walker, or wheelchair than are their counterparts without these signs.