Motor dual-tasking deficits predict falls in Parkinson's disease: A prospective study

Heinzel, Sebastian; Maechtel, Mirjam; Hasmann, Sandra E.; Hobert, Markus A.; Heger, Tanja; Berg, Daniela; Maetzler, Walter

doi:10.1016/j.parkreldis.2016.03.007

Cited by 93 publications

(89 citation statements)

References 10 publications

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“…The unexpected novel finding of our study is that kinematic features of index finger abductions in PD patients, unlike healthy subjects, changed according to the time lapse between paired electrical stimuli and movement onset, with slower values being observed when 200 ms elapsed between movement onset and paired stimuli for STDT than when paired stimuli were delivered concomitantly with movement onset. Since the performance of PD patients worsens during dual task procedures (32–34), one explanation for the decrease in the mean velocity of index finger abductions during STDT testing in PD patients might be the dual task design of our experimental protocol. However, we can exclude this hypothesis since changes in the mean velocity of index finger abductions were significant only at 200 ms all the intervals tested implied a dual task effect.…”

Section: Discussionmentioning

confidence: 99%

Abnormal Temporal Coupling of Tactile Perception and Motor Action in Parkinson’s Disease

et al. 2017

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Evidence shows altered somatosensory temporal discrimination threshold (STDT) in Parkinson’s disease in comparison to normal subjects. In healthy subjects, movement execution modulates STDT values through mechanisms of sensory gating. We investigated whether STDT modulation during movement execution in patients with Parkinson’s disease differs from that in healthy subjects. In 24 patients with Parkinson’s disease and 20 healthy subjects, we tested STDT at baseline and during index finger abductions (at movement onset “0”, 100, and 200 ms thereafter). We also recorded kinematic features of index finger abductions. Fifteen out of the 24 patients were also tested ON medication. In healthy subjects, STDT increased significantly at 0, 100, and 200 ms after movement onset, whereas in patients with Parkinson’s disease in OFF therapy, it increased significantly at 0 and 100 ms but returned to baseline values at 200 ms. When patients were tested ON therapy, STDT during index finger abductions increased significantly, with a time course similar to that of healthy subjects. Differently from healthy subjects, in patients with Parkinson’s disease, the mean velocity of the finger abductions decreased according to the time lapse between movement onset and the delivery of the paired electrical stimuli for testing somatosensory temporal discrimination. In conclusion, patients with Parkinson’s disease show abnormalities in the temporal coupling between tactile information and motor outflow. Our study provides first evidence that altered temporal processing of sensory information play a role in the pathophysiology of motor symptoms in Parkinson’s disease.

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Section: Discussionmentioning

confidence: 99%

Abnormal Temporal Coupling of Tactile Perception and Motor Action in Parkinson’s Disease

et al. 2017

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“…In daily life, falls are the result of an interaction of environmental and personal circumstances with risk factors (Bloem et al, 2006; Rubenstein, 2006; WHO, 2007; Yogev-Seligmann et al, 2008). More recently, also the role of cognitive dysfunction as a risk factor for falling was recognized (Woollacott and Shumway-Cook, 2002; Bloem et al, 2006; Holtzer et al, 2006; Yogev-Seligmann et al, 2008; Heinzel et al, 2016). This observation is supported by the overwhelming evidence that there are cognitive demands of gait rather than viewing gait as a series of automated motor actions (Woollacott and Shumway-Cook, 2002; Yogev-Seligmann et al, 2008; Maetzler et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

“…Specifically, impaired executive function seems to be a relevant determinant of walking impairment and fall risk in older adults (Binder et al, 1999; Ble et al, 2005; Coppin et al, 2006; Buracchio et al, 2011; Muir-Hunter et al, 2014). This is especially true for patient populations such as patients with Parkinson's disease (PD) (Yogev et al, 2005, 2007; Bloem et al, 2006; Heinzel et al, 2016) and elderly fallers (Springer et al, 2006; Yogev et al, 2007). …”

Section: Introductionmentioning

confidence: 99%

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

Salkovic

Hobert

Bellut

et al. 2017

Front. Aging Neurosci.

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Background: Older adults have increased risks of balance issues and falls when walking and performing turns in daily situations. Changes of prioritization during different walking situations associated with dual tasking may contribute to these deficits. The objective of this study was therefore to investigate whether older adults demonstrate changes of prioritization during different walking paths.Methods: In total, 1,054 subjects with an age range from 50 to 83 years were selected from the first follow-up visit of the TREND (Tuebinger evaluation of Risk factors for Early detection of Neurodegenerative Disorders) study. They were classified according to their performance on the Trail Making Test (TMT) into good and poor TMT performers (based on recent results showing that cognitive flexibility affects prioritization strategies during straight walking). Absolute dual-task performance and relative dual-task costs (DTC, relative performance under dual-task conditions compared with single-task conditions) were assessed in two paradigms: walking while subtracting serial 7 s and walking while checking boxes on a clipboard. Both tasks were performed on straight and curved paths.Results: Overall, the poor TMT performers group performed worse in all single and dual tasks. Interestingly, the relative change in performance measured by dual-task costs differed in the groups between the two walking paths. On straight paths, poor TMT performers had a similar DTC of walking to that of good performers (p = 0.10) but had a significantly lower DTC of subtracting (p = 0.02). On curved paths, poor performers had a similar DTC of subtracting (p = 0.10), but their DTC of walking was significantly higher (p < 0.0001).Conclusion: Given that walking on curved paths is considered more difficult than that on straight paths and that the serial subtracting dual task is more difficult than the box checking dual task, this study in older adults provides evidence for the existence of a (walking) situation-dependent change of prioritization. If confirmed in other studies, situation-dependent change of prioritization should be included as a potential factor contributing to gait and balance impairments, and increased fall risk in older adults.

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“…Dual‐task (DT) performance relies on the capacity to perform motor tasks automatically as well as on the cognitive (executive) ability to integrate different task demands. Several studies demonstrated compromised DT gait in mid to moderate stages of PD, correlating with an increased risk of falling, more freezing of gait (FOG), and reduced functional mobility …”

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confidence: 99%

Training dual tasks together or apart in Parkinson's disease: Results from the DUALITY trial

et al. 2017

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Motor dual-tasking deficits predict falls in Parkinson's disease: A prospective study

Cited by 93 publications

References 10 publications

Abnormal Temporal Coupling of Tactile Perception and Motor Action in Parkinson’s Disease

Abnormal Temporal Coupling of Tactile Perception and Motor Action in Parkinson’s Disease

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

Training dual tasks together or apart in Parkinson's disease: Results from the DUALITY trial

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