A Review of Dual-Task Walking Deficits in People with Parkinson's Disease: Motor and Cognitive Contributions, Mechanisms, and Clinical Implications

Abstract

Gait impairments in Parkinson's disease (PD) are exacerbated under dual-task conditions requiring the simultaneous performance of cognitive or motor tasks. Dual-task walking deficits impact functional mobility, which often requires walking while performing concurrent tasks such as talking or carrying an object. The consequences of gait impairments in PD are significant and include increased disability, increased fall risk, and reduced quality of life. However, effective therapeutic interventions for dual-task walking deficits are limited. The goals of this narrative review are to describe dual-task walking deficits in people with PD, to discuss motor and cognitive factors that may contribute to these deficits, to review potential mechanisms underlying dual-task deficits, and to discuss the effect of therapeutic interventions on dual-task walking deficits in persons with PD.

Loss of gait control assessed by cognitive-motor dual-tasks: pros and cons in detecting people at risk of developing Alzheimer’s and Parkinson’s diseases

“…As for AD, dual-taskrelated gait changes in the clinical phase of PD is clinically relevant to detect patients at risk of falls. Also, some studies have shown that dual-task walking performance was associated with gait quality (Kelly et al 2012), freezing (Spildooren et al 2010), disease severity, and disability (Fuller et al 2013). Hollman et al 2011 andLord et al 2013 (pace, rhythm, phases, asymmetry, variability, andpostural control), and arm swing parameters inspired from Mirelman et al 2016 (amplitude, variability, and Dual-task-related gait changes: comparison between AD and PD at the clinical stage Even though the neuropathological origin of dual-task-related gait changes is different between the two diseases, the corresponding gait patterns display some similarities, particularly in the pace, rhythm, postural control, and variability domains of gait.…”

Effects of dual-task interventions on gait performance of patients with Parkinson’s Disease: A systematic review

“…5 Some studies have demonstrated that PD patients have impaired equilibrium and gait in DT conditions when compared to age-matched controls. 7,8 The interference of DT on PD is frequently associated with reduced gait speed as well as step asymmetry, variability and length. 8 Increased step variability during DT is associated to reduced executive functioning.…”

“…7,8 The interference of DT on PD is frequently associated with reduced gait speed as well as step asymmetry, variability and length. 8 Increased step variability during DT is associated to reduced executive functioning. 9 In PD patients, the automaticity promoted by basal ganglia is compromised and it becomes necessary to consciously control gait.…”

“…While gait anomalies are not pronounced in early stages of the disease, their prevalence and severity increases as the disease progresses. 13 Patients with PD also display several movement deficits during DTs, including postural control, 8,12,14 upper limb movements 8,15,16 and speech, 9,17 while gait impairments are accentuated. 8 There are several alternatives to explain this interference and the bottleneck theory is well-known.…”

“…13 Patients with PD also display several movement deficits during DTs, including postural control, 8,12,14 upper limb movements 8,15,16 and speech, 9,17 while gait impairments are accentuated. 8 There are several alternatives to explain this interference and the bottleneck theory is well-known. When two tasks are performed simultaneously and engage the same neural processes/networks this creates a functional "bottleneck", causing a delay in one of the tasks until those neural processes/networks can be recruited again.…”