Effect of Acetylcholinesterase Inhibitors on the Gait of the Patients With Parkinson Disease
Effect of Acetylcholinesterase Inhibitors on the Gait of the Patients With Parkinson Disease
Cholinergic deficiency in the brain can be related to gait and balance problems in Parkinson
 disease (PD). Recent clinical trials suggested a beneficial role of acetylcholinesterase
 inhibitors (AchEI) on gait in PD. In this study, the investigators are planning to study the
 influence of AchEI on a brain network for gait and balance in PD. As gait problem is
 prominent in postural instability and gait disturbance (PIGD) subtype, this study will focus
 on the patients with PIGD phenotype.
PD patients with PIGD subtype will be included.

 1. Assessment:

 -  Overall features of PD are assessed by Unified Parkinson Disease Rating Scale
 (UPDRS). Non-motor features including cognition will be assessed by standard
 scales. Gait and balance will be assessed by gait analysis system, which measures
 physiological parameters of gait such as velocity, variability and center of
 pressure. Positron emission tomography using 18F-fluorodeoxyglucose (FDG PET) will
 be done to brain activities related to gait and balance.

 -  Clinical evaluation will be done at the baseline, 4th, 8th and 12th week

 -  Gait analysis and FDG PET will be done at the baseline and 12th week

 2. Drug dosage

 -  For the first 4 weeks, 5 mg/day

 -  Then, 10 mg/day for 8 weeks
Inclusion Criteria:

 -  Parkinson disease diagnosed by United Kingdom Parkinson's disease Society Brain Bank
 Criteria

 -  Postural instability and gait disturbance phenotype

 -  Hoehn and Yahr stage ≤ 3

 -  Mini-Mental status examination ≥ 24

 Exclusion Criteria:

 -  Significant motor complication affecting daily activities

 -  Drugs related to acetylcholine metabolism