Clinical and dual‐tasking aspects in frequent and infrequent fallers with progressive supranuclear palsy

Abstract

Progressive supranuclear palsy (PSP) is a rare neurodegenerative disease with no sufficient therapeutic options to date. Falls are the most devastating feature. The causes of these falls are not well understood. To test the impact of PSP-associated motor and cognitive features on falls, 26 PSP patients were prospectively recruited and divided into frequent fallers (> one fall/month, 18 patients) and infrequent fallers (<or= one fall/month, 8 patients). Further parameters were assessed by clinical investigation and biomechanical gait and balance analysis with and without dual-task paradigms. Physical activity was measured through an ambulatory device. Frequent fallers scored higher on the total PSP rating scale and the subscales "history," "mental," "bulbar," "supranuclear ocular motor," and "gait/midline exam" but not on disease duration, the subscale "limb exam," the UPDRS motor score and the sway analysis. Frequent fallers also showed an increased probability of an altered walking pattern with shortened step lengths and increased cadence under a dual-task situation. It is concluded that the occurrence of falls in PSP seems strongly associated with the deterioration of bulbar function, but not relevantly with typical parkinsonian features like rigidity and bradykinesia. The decreased ability to deal with distraction of attention under a dual-task situation points to a relevant impact of cortical and subcortical dysfunction on the frequency of falls.

Dual-task interference and brain structural connectivity in people with Parkinson's disease who freeze

“…Moreover, individuals with PSP (and particularly those who experience a high rate of falls), exhibited marked SL dysfunction during DT walking. 35 Together, these reports underscore the importance of the PPN as one of several regions contributing to FoG and attention regardless of disease pathophysiology.…”

Direction specific preserved limits of stability in early progressive supranuclear palsy: A dynamic posturographic study

“…In addition, Probst et al [22] reported presence of neurofibrillary fibers, neuropil threads throughout the basal ganglia and brainstem in PSP. In addition impairment of balance in PSP has been attributed to central vestibular dysfunction [9], deficits in motor programming [23], abnormal otolith-mediated reflexes [24], synergistic deterioration of brainstem and higher cortical functions [25] and involvement of cerebellum [26].…”

Evidence for a Selectively Regulated Prioritization Shift Depending on Walking Situations in Older Adults

“…As a next step, dual-task costs (DTC) were determined, reflecting the relative performance in the dual-task setting as compared to the single task setting. They were calculated using the following formula according to Bock (2008) and Lindemann et al (2010): DTC [%] = (single task-dual task) / (single task) * 100. This formula gives information about the percentage change relative to the single-task value.…”