Which cognitive dual-task walking causes most interference on the Timed Up and Go test in Parkinson’s disease: a controlled study
- 264 Downloads
There is evidence that cognitive load has a negative effect on the gait of patients with Parkinson’s disease (PD). However, it is not clear which type of cognitive activities are more likely to affect dual-task abilities in this patient group.
To compare the cognitive dual-task abilities in patients with PD and control subjects and to analyze the effect of different cognitive activities on the walking ability of patients with PD.
The Hoehn and Yahr scale, the Freezing of Gait Questionnaire (FOGQ), Montreal Cognitive Assessment (MoCA), and the Functional Reach Test were used to include and exclude the patients. The Timed Up and Go (TUG) test was applied under single and dual-task conditions.
The completion time of TUG was found to be increased in the PD group compared with the healthy controls under single- and dual-task conditions (p < 0.05). The completion time of TUG was significantly increased in dual-task conditions with complex attention activity (serial subtractions test) compared with other dual-task conditions in patients with PD (p < 0.001).
The gait performance of both healthy subjects and patients with PD was impaired with cognitive activity during walking, and patients with PD showed more impairment under different cognitive dual tasks. Among the other cognitive tasks, the ‘serial sevens’ test, a measure of complex attention, significantly increased the completion time of TUG.
While assessing the dual-task ability of patients with early-stage PD, tasks that increase the demand for complex attention seem to be more sensitive to showing impaired dual-task ability.
KeywordsParkinson’s disease Dual-task Gait Error Balance
This work was supported by Scientific Research Projects Coordination Unit of Istanbul University. Project Number: TYL-2016-20130.
Compliance with ethical standards
The study was approved by the Istanbul Medipol University Non-Invasive Clinical Research Ethics Committee, (Protocol Number: 646). All participants were informed about the procedure and gave informed consent. The research also followed the STROBE statement.
Conflict of interest
The authors declare that they have no conflict of interest.
Human and animal rights
All procedures performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
- 3.Belghali M, Chastan N, Cignetti F, Davenne D, Decker LM (2017) 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. GeroScience 39(3):305–329. https://doi.org/10.1007/s11357-017-9977-7 CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Plummer P, Eskes G (2015) Measuring treatment effects on dual-task performance: a framework for research and clinical practice. Front Hum Neurosci 9Google Scholar
- 8.Nieuwhof F, Bloem BR, Reelick MF, Aarts E, Maidan I, Mirelman A, Hausdorff JM, Toni I, Helmich RC (2017) Impaired dual tasking in Parkinson's disease is associated with reduced focusing of cortico-striatal activity. Brain 140(5):1384–1398. https://doi.org/10.1093/brain/awx042 CrossRefPubMedGoogle Scholar
- 12.de Bruin N, Doan JB, Turnbull G, Suchowersky O, Bonfield S, Hu B, Brown LA (2010) Walking with music is a safe and viable tool for gait training in Parkinson's disease: the effect of a 13-week feasibility study on single and dual task walking. Parkinsons Dis 2010:483530. https://doi.org/10.4061/2010/483530
- 23.Martinez-Martin P, Rodriguez-Blazquez C, Mario A, Arakaki T, Arillo VC, Chana P, Fernandez W, Garretto N, Martinez-Castrillo JC, Rodriguez-Violante M, Serrano-Duenas M, Ballesteros D, Rojo-Abuin JM, Chaudhuri KR, Merello M (2015) Parkinson's disease severity levels and MDS-unified Parkinson's disease rating scale. Parkinsonism Relat Disord 21(1):50–54. https://doi.org/10.1016/j.parkreldis.2014.10.026 CrossRefPubMedGoogle Scholar
- 28.Carmela L, Feys P, Moumdjian L, D’Amico E, Zappia M, Francesco P (2017) Cognitive-motor dual-task interference: a systematic review of neural correlates. Neurosci Biobehav Rev 75:348–360. https://doi.org/10.1016/j.neubiorev.2017.01.010
- 29.Montero-Odasso M, Muir SW, Speechley M (2012) Dual-task complexity affects gait in people with mild cognitive impairment: the interplay between gait variability, dual tasking, and risk of falls. Arch Phys Med Rehabil 93(2):293–299. https://doi.org/10.1016/j.apmr.2011.08.026 CrossRefPubMedGoogle Scholar
- 30.Campbell CM, Rowse JL, Ciol MA, Shumway-Cook A (2003) The effect of cognitive demand on timed up and go performance in older adults with and without Parkinson disease. J Neurol Phys Ther 27(1):2–7Google Scholar
- 31.Wild LB, de Lima DB, Balardin JB, Rizzi L, Giacobbo BL, Oliveira HB, de Lima A II, Peyre-Tartaruga LA, Rieder CR, Bromberg E (2013) Characterization of cognitive and motor performance during dual-tasking in healthy older adults and patients with Parkinson's disease. J Neurol 260(2):580–589. https://doi.org/10.1007/s00415-012-6683-3 CrossRefPubMedGoogle Scholar
- 32.Kleiner AFR, Pagnussat AS, di Prisco G, Vagnini A, Stocchi F, De Pandis MF, Galli M (2017) Analyzing gait variability and dual-task interference in patients with Parkinson’s disease and freezing by means of the word-color Stroop test. Aging Clin Exp Res 30(9):1137–1142. https://doi.org/10.1007/s40520-017-0862-0
- 33.Maclean LM, Brown LJ, Khadra H, Astell AJ (2017) Observing prioritization effects on cognition and gait: the effect of increased cognitive load on cognitively healthy older adults' dual-task performance. Gait Posture 53:139–144. https://doi.org/10.1016/j.gaitpost.2017.01.018 CrossRefPubMedGoogle Scholar
- 35.Strouwen C, Molenaar EA, Keus SH, Munks L, Heremans E, Vandenberghe W, Bloem BR, Nieuwboer A (2016) Are factors related to dual-task performance in people with Parkinson's disease dependent on the type of dual task? Parkinsonism Relat Disord 23:23–30. https://doi.org/10.1016/j.parkreldis.2015.11.020 CrossRefPubMedGoogle Scholar
- 37.Hobert MA, Meyer SI, Hasmann SE, Metzger FG, Suenkel U, Eschweiler GW, Berg D, Maetzler W (2017) Gait is associated with cognitive flexibility: a dual-tasking study in healthy older people. Front Aging Neurosci 9:154. https://doi.org/10.3389/fnagi.2017.00154 CrossRefPubMedPubMedCentralGoogle Scholar