# Vestibulopathy, imbalance and gait disturbances in Parkinson disease

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2021 · —

## Abstract

The management of dopamine resistant postural instability and gait difficulty (PIGD) features, such as freezing
of gait (FoG), represents perhaps the most important unmet clinical need in Parkinson's disease (PD).
Research into the role of the vestibular system in the etiology of FoG has largely been neglected. Age-
associated vestibular impairment (presbyvestibulopathy, PVP) is present in about half of older community-
dwelling older persons and is a significant contributor to imbalance and falls. PVP is also common in PD, an
age-related neurodegenerative disorder. We have novel preliminary data showing that PVP may be an
important factor contributing to FoG. Confirmation of a mechanistic link between vestibular dysfunction and
FoG has high clinical translational impact and may augur novel vestibular rehabilitation interventions, such as
in-home portable thermoneuromodulation (TNM) to treat PD Veterans with otherwise treatment-refractory FoG.
Plan: Our main aim will be a cross-sectional study in 64 Veterans with PD to investigate the relationship
between PVP and FoG. Our exploratory aim will be a mechanistic feasibility trial of portable TNM in PD
Veterans with FoG and PVP.
Methods: We will perform detailed clinical, including dedicated motor and vestibular testing. PE2I dopamine
transporter (DAT) PET will be used to assess the integrity of dopaminergic nigrostriatal innervation.
Hypothesis 1: The prevalence of FoG is higher in Veterans with PD who also have evidence of PVP
compared to those without PVP independent of nigrostriatal dopaminergic losses.
Exploratory hypothesis: Active TNM stimulation will result in improved FoG severity ratings compared to
sham stimulation in PD Veterans with FoG and PVP.

## Key facts

- **NIH application ID:** 10179754
- **Project number:** 1I01RX003397-01A2
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Nicolaas Ida Bohnen
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2021-07-01 → 2025-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10179754

## Citation

> US National Institutes of Health, RePORTER application 10179754, Vestibulopathy, imbalance and gait disturbances in Parkinson disease (1I01RX003397-01A2). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10179754. Licensed CC0.

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