The objective of this review is to evaluate the effectiveness of therapeutic (structured asana- and pranayama-based) yoga versus physiotherapy-based balance and proprioceptive neuromuscular facilitation (PNF) training in improving postural stability and fall-related outcomes in older adults with early-stage Parkinsonism.

Freezing of gait (FOG) is a disabling motor symptom in Parkinson's disease (PD) with substantial impact on mobility and quality of life. Anxiety is frequently implicated in triggering or worsening FOG, yet the lived experience of this interaction remains poorly understood. This study explored how individuals with PD reflect on the interaction between anxiety and FOG following an anxiety-focused intervention, aiming to better understand how and why this interaction develops and impacts daily life. A thematic analysis was conducted using semistructured interviews with 12 individuals with PD who reported daily FOG episodes influenced by anxiety or stress. Interviews were conducted during the final session of a behavioral intervention targeting anxiety related to FOG. Interviews were transcribed verbatim and analyzed iteratively to identify patterns of meaning. Five overarching themes emerged. First, participants described how anxiety was linked to a gradual loss of confidence in their walking abilities, driven by perceived loss of control, unpredictability of FOG, and feelings of vulnerability. Second, regaining control over walking was mentioned to reduce anxiety, either through having a compensatory strategy available in case of a freezing episode, or through contextual factors (e.g., being in the dopaminergic ON state). Third, anxiety typically developed gradually alongside the progression of FOG and the concomitant decline in confidence during walking, but could also intensify following negative events, such as falls. Fourth, anxiety was reported to divert attentional resources toward potential threats and make it more difficult to focus on strategies for managing FOG. Finally, many participants engaged in avoidance behaviors, causing negative downstream effects such as limiting social participation and physical activity. These findings highlight the importance of early recognition, as well as the potential for interventions that enhance confidence to help reduce anxiety surrounding FOG.

A randomized crossover study of five patients with Parkinson's disease (PD) demonstrates that gait-synchronized adaptive deep brain stimulation is feasible and safe, and reduces falls compared with continuous stimulation. Gait dysfunction in PD is a major source of disability and is often insufficiently treated by continuous deep brain stimulation (cDBS). Although adaptive DBS (aDBS) has shown efficacy for other motor symptoms using β-based, state-driven neural signals, gait is a dynamic, cyclical behavior that may require temporally precise modulation. Here we evaluated a behavior-contingent aDBS approach that synchronizes stimulation to gait phase. We reported a single-center, blinded, randomized, crossover study evaluating the feasibility of identifying patient-specific biomarkers to drive aDBS. The primary outcome was feasibility of successful identification of gait-phase biomarkers to implement aDBS. Five participants with PD undergoing pallidal DBS and subdural electrode paddle implantation were enrolled. We successfully identified personalized gait-phase biomarkers from cortical or pallidal field potentials in all five patients and embedded them into a bidirectional neurostimulator. During acute in-clinic testing, aDBS improved step variability and step symmetry versus cDBS. Three participants subsequently completed a double-blinded, multi-day crossover phase. In this setting, aDBS maintained general motor symptom control, reduced falls and yielded patient-specific gait improvements. No adverse events occurred and aDBS was well tolerated. These findings establish the feasibility of biomarker-driven, movement-synchronized neuromodulation and support the development of a larger randomized trial to determine clinical efficacy. ClinicalTrial.gov registration: NCT04675398 .

Freezing of gait (FOG) is common in Parkinson's disease (PD), yet uncertainty remains regarding the optimal criterion for identifying freezers. Self-reported FOG and performance-based FOG assessments are widely used, but their relative value is unclear. This study compared four different tools for identifying freezing and how these classifications relate to simple functional tests feasible in home or clinical environments. The participants with PD completed four FOG-related assessments (two movement disorder society-unified Parkinson's disease rating scale [MDS-UPDRS] items and two observations during Parkinson's disease functional movement battery [PD-FUNC] items). Based on the outcomes, individuals were classified as freezers (positive on at least two tools), occasional freezers (nonzero score on one indicator), or nonfreezers (zero on all tools). Disease severity was recorded using Hoehn and Yahr (H&Y) staging. Groups were compared using the PD-FUNC test battery, which includes rotation, dexterity, balance, and locomotion tasks. Analyses were adjusted for disease severity. Additionally, a 5-year longitudinal case study illustrated fluctuations in FOG-related and functional performance over time. As expected, freezing was the most prevalent in advanced disease (H&Y Stage 3). However, up to 40% of those classified as freezers were in earlier stages (H&Y Stages 1 and 2). After adjustment for disease severity, only a small subset of PD-FUNC items differentiated groups. Post hoc analysis of these items showed that significant differences were limited to comparisons between freezers and nonfreezers. Freezers required more time to complete a 360° rotation. Unexpectedly, typing speed, a dexterity measure, also differed significantly between freezers and nonfreezers. Occasional freezers showed higher MDS-UPDRS Part III scores compared with nonfreezers, whereas Part II scores displayed a graded increase across groups. The longitudinal case study demonstrated recurrent periods of reported freezing and severe falls that coincided with prolonged rotation times, followed by recovery periods linked with return to physical activity. Combining multiple indicators improves the identification of FOG and reveals that freezing is present even in earlier PD stages. Simple PD-FUNC items, particularly rotation time and typing speed, distinguish freezers from nonfreezers after adjusting for disease severity. The case study highlights that reported freezing may occur in discrete periods, often associated with falls, but recovery is possible and appears related to resumption of physical activity. These findings support the clinical utility of PD-FUNC for monitoring FOG-related functional changes over time.

Chronic dizziness is defined as dizziness or vertigo symptoms that are continuously present for more than 3 months. Typical complaints include persistent to-and-fro vertigo accompanied by postural imbalance and gait unsteadiness with an increased risk of falling. Patients often experience inadequate or inappropriate medical care despite being significantly impaired in their daily lives. Common vestibular causes include persistent peripheral vestibular disorders (such as bilateral vestibulopathy or incompletely compensated unilateral vestibulopathy), central vestibular syndromes (e. g., downbeat nystagmus with or without evidence of ataxia, dementia syndromes with cognitive-motor disorders), as well as non-organic functional disorders. A systematic medical history and a thorough clinical neurological examination - paying particular attention to the vestibular, oculomotor, cerebellar, sensory, and extrapyramidal systems, as well as cognitive function - are key to establishing the correct differential diagnosis. Even long-standing syndromes can often still be positively influenced by targeted physiotherapy, psychotherapy, or medication, leading to an improved quality of life for patients. This article provides a hands-on overview of the clinical characteristics of the most important organic and non-organic vestibular disorders underlying chronic dizziness as a primary symptom, as well as their specific effective treatment approaches.

An 83-year-old male presented with a months-long ataxic gait and recent frequent falls. Initial evaluation revealed ventriculomegaly and acute ischemic infarction to the right cerebellar and occipital regions in addition to severe cervical stenosis. Syphilis serology with reflex returned positive, and neurosyphilis was confirmed on cerebrospinal fluid with a reactive Venereal Disease Research Laboratory test, lymphocytic pleocytosis, and elevated protein. The patient was put on a two-week course of intravenous penicillin G while completing inpatient physical rehabilitation and demonstrated significant improvement. This case highlights the importance of considering neurosyphilis as a differential in the elderly with new-onset gait disturbance and first-time stroke without a contributory past medical history. This report underscores the emergence of neurosyphilis in elderly populations and the challenge in correctly identifying cases in this demographic, considering its reputation as a "great imitator" of other neurocognitive disorders.