Impaired scaling of long latency postural reflexes in patients with Parkinson's disease.

Young normal subjects adapt the size of posturally stabilizing reflexes in the lower extremity to predictable and unpredictable perturbations through shifts in cognitive set. It is unknown whether limitations in this ability to shift cognitive set may contribute to impaired scaling of postural reflexes in patients with Parkinson's disease. In this study, we have addressed this issue in 12 posturally unstable Parkinson patients and 13 age- and sex-matched controls. Postural stability was disturbed by sudden toe-up rotations of a supporting platform upon which subjects were standing. Subjects' cognitive set was altered by varying the perturbation amplitude either predictably (serial 4 degrees versus serial 10 degrees) or unpredictably (random mixture of 4 degrees and 10 degrees). Posturally stabilizing long latency (LL) reflexes were recorded from the shortened tibialis anterior muscle of both legs. We found that Parkinson patients, unlike some control subjects, were unable to scale the size of their LL reflex in response to variations in perturbation amplitude during predictable conditions. In addition, we observed that Parkinson patients could not modify the amplitude of the LL reflex through alterations in cognitive set during random conditions. We conclude that Parkinson patients have a fundamental difficulty in modifying the size of posturally stabilizing LL reflexes, as reflected by both problems with amplitude scaling and difficulties with changes in cognitive set. It is possible that this inability to modify LL reflexes may be a factor contributing to postural instability in Parkinson's disease.