Dual tasking in Parkinson’s disease: Cognitive consequences while walking.

Abstract

Objective Cognitive deficits are common in Parkinson’s disease (PD) and exacerbate the functional limitations imposed by PD’s hallmark motor symptoms, including impairments in walking. Though much research has addressed the effect of dual cognitive-locomotor tasks on walking, less is known about their effect on cognition. The purpose of this study was to investigate the relation between gait and executive function, with the hypothesis that dual tasking would exacerbate cognitive vulnerabilities in PD as well as being associated with gait disturbances. Method Nineteen individuals with mild-moderate PD without dementia and 13 age- and education-matched normal control adults (NC) participated. Executive function (set-shifting) and walking were assessed singly and during dual tasking. Results Dual tasking had a significant effect on cognition (reduced set-shifting) and on walking (speed, stride length) for both PD and NC, and also on stride frequency for PD only. The impact of dual tasking on walking speed and stride frequency was significantly greater for PD than NC. Though the group by condition interaction was not significant, PD had fewer set-shifts than NC on dual task. Further, relative to NC, PD showed significantly greater variability in cognitive performance under dual tasking, whereas variability in motor performance remained unaffected by dual tasking. Conclusions Dual tasking had a significantly greater effect in PD than in NC on cognition as well as on walking. The results suggest that assessment and treatment of PD should consider the cognitive as well as the gait components of PD-related deficits under dual-task conditions.

Combining a Cognitive Concurrent Task with a Motor or Motor-Cognitive Task: Which Is Better to Differentiate Levels of Affectation in Parkinson’s Disease?

“…As expected [11], the combination of the fluency task with pedaling, a pure motor task largely preserved in PD patients [29,30], seems to be responsible for the similarity in fluency performance regardless of the experimental condition. In addition, all performance differences by condition for fluency when combined with tracking, pedaling when combined with fluency, and tracking when combined with fluency were neutralized when the cognitive status measure was included in the model as a covariate, supporting the suggestion that dual costs in PD could be largely related to cognitive status even for those associated to the almost pure motor task, namely, the pedaling task [7][8][9]. Parkinson's Disease…”

“…us, voluntary movements in everyday life rarely are wholly automatic and therefore impose cognitive demands that could impair cognitive performance [6]. Conversely, because of loss of movement automaticity in PD, higher demands in attentional resources seem to be expected to maintain movement amplitude, rhythm, or posture [7,8]. As some attentional resources must be allocated to the voluntary movement, performing a concurrent cognitive task may well interfere in the motor performance of PD patients [9].…”

Differentiation in Theta and Beta Electrocortical Activity between Visual and Physical Perturbations to Walking and Standing Balance

“…Despite our study being limited to healthy, young adults, there seems to be enough evidence to suggest that similar time–frequency, perturbation-evoked EEG activity should be studied in patient populations. While Parkinson’s disease has been primarily associated with basal ganglia dysfunction ( Blandini et al, 2000 ), dual-task studies have indicated that cortical activity is also affected ( Yogev et al, 2005 ; Salazar et al, 2017 ), making EEG a potentially relevant recording site. It is also interesting to note similarities between our perturbation time–frequency pattern and the gait-related time–frequency pattern seen in other studies during foot–ground contact and initial stance ( Gwin et al, 2011 ; Seeber et al, 2014 ).…”

The relationship between cognitive decline and motor dysfunction in Parkinson’s disease: A focused mini‐review on cognitive‐locomotor dual‐task interference

“…38 In studies using the dual-task paradigm, patients with PD showed greater dual-task interference in both cognitive and gait tasks compared with that of age-matched healthy controls. 39 Under dual-task conditions, gait kinematics including cadence, stride length, gait velocity, and arm swing were also reduced compared with those under singletask conditions. 40 Moreover, it is also suggested that high cognitive and postural dual-task cost is associated with the presence of gait freezing.…”