Peripheral neuropathy in Parkinson's disease: prevalence and functional impact on gait and balance

Peripheral neuropathy is common in Parkinson’s disease (PD), with a reported prevalence of 4.8–55% compared with 9% in the general population. Its impact on motor performance, gait, and balance in PD remains unclear. This study aimed to determine the prevalence and type of peripheral neuropathy in PD and to evaluate its functional impact on gait and balance.

Consecutive PD patients diagnosed according to UK Brain Bank criteria underwent comprehensive clinical, neurophysiological (nerve conduction studies and quantitative sensory testing), and neuropathological (skin biopsy for intraepidermal nerve fibre density) assessments in a cross-sectional design. Gait and balance were assessed using wearable health technology in OFF and ON medication states, with parameters extracted using validated algorithms.

Ninety-nine PD participants (mean age 67.2 ± 10 years; disease duration 6.5 ± 5 years) were included. Peripheral neuropathy was identified in 40.4% of patients, predominantly small fibre neuropathy (70%). In the OFF state, peripheral neuropathy was associated with shorter stride length (P = 0.029), slower gait speed (P = 0.005), and smaller toe-off angles (P = 0.002) during straight walking, as well as slower speed (P = 0.019) and reduced toe-off angles (P = 0.007) during circular walking. These effects persisted in the ON state, though attenuated. Balance impairments were observed in patients with peripheral neuropathy during stance with eyes closed on foam in the OFF state, but not in the ON state.

Peripheral neuropathy is frequent in PD and significantly affects gait and balance as measured by mobile health technology. These findings support the importance of identifying and treating peripheral neuropathy to improve gait and reduce balance-related disability, contributing to individualized care in PD.

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