Dopamine Replacement Medication Does Not Influence Implicit Learning of a Stepping Task in People With Parkinson’s Disease

Abstract

Introduction. Treatment of Parkinson’s disease (PD) with exogenous dopamine (ie, levodopa) may positively affect motor symptoms, but may negatively affect other functions such as the learning of motor skills necessary for rehabilitation. This study aimed to determine whether levodopa medication affects general and sequence-specific learning of a stepping task and the transfer of movement skill to untrained balance tasks in people with PD. Methods. Participants with PD were randomized to practice “on” (n = 14) or “off” (n = 13) levodopa medication. Participants practiced 6 blocks of 6 trials of 24 steps of a stepping task over an acquisition period of 3 consecutive days, followed by single retention blocks of 6 trials 2 and 9 days later. Participants were also assessed on untrained balance (ie, transfer) tasks “on” levodopa before practice and following late retention. Results. There were no between-group differences in general learning, sequence-specific learning, or transfer of skill to untrained balance tasks ( P > .05). Both groups demonstrated general and sequence-specific learning ( P < .001) and trends for improvement in untrained tasks ( P < .001 to P = .26) following practice. Detailed analysis of early acquisition revealed no difference between medication groups. Conclusion. People with PD improved performance on the stepping task with practice. The between-group effect sizes were small, suggesting that levodopa medication status (“on” versus “off”) during practice did not significantly affect general or sequence-specific learning of the task or components of early acquisition. The practice dose required to optimally result in functional improvements in untrained balance tasks, including reductions in falls, remains to be determined.