Association of cognitive domains with postural instability/gait disturbance in Parkinson's disease

Abstract

Introduction Research suggests an association between global cognition and postural instability/gait disturbance (PIGD) in Parkinson’s disease (PD), but the relationship between specific cognitive domains and PIGD symptoms is not clear. This study examined the association of cognition (global and specific cognitive domains) with PIGD symptoms in a large, well-characterized sample of individuals with PD. Methods Cognitive function was measured with a detailed neuropsychological assessment, including global cognition, executive function, memory, visuospatial function, and language. PIGD symptoms were measured using the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part III, Motor Examination subscale. Multiple linear regression analyses were performed to assess the relationship between cognition and PIGD symptoms with models adjusting for age, sex, education, enrollment site, disease duration, and motor symptom severity. Results The analysis included 783 participants, with mean (standard deviation) age of 67.3 (9.7) years and median (interquartile range) MDS-UPDRS Motor Subscale score of 26 (17, 35). Deficits in global cognition, executive function, memory, and phonemic fluency were associated with more severe PIGD symptoms. Deficits in executive function were associated with impairments in gait, freezing, and postural stability, while visuospatial impairments were associated only with more severe freezing, and poorer memory function was associated only with greater postural instability. Discussion While impairments in global cognition and aspects of executive functioning were associated with more severe PIGD symptoms, specific cognitive domains were differentially related to distinct PIGD components, suggesting the presence of multiple neural pathways contributing to associations between cognition and PIGD symptoms in persons with PD.

Dual task interference on postural sway, postural transitions and gait in people with Parkinson’s disease and freezing of gait

“…This is in keeping with recent findings showing impaired postural control in FoG+ compared to FoG− [16]. We hypothesized that sway dispersion or smoothness would be affected by dual task since executive and memory functions have been found to be related to postural instability assessed by the PIGD subscore [24]. However, although we found differences between groups in PIGD and in the MiniBESTest, we did not see a dual-task interference during postural sway in FoG+ compared to FoG−, which may be explained by the fact that both groups were cognitively intact, as the MoCA scores were similar.…”

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“…Our findings are in line with these concepts. Indeed, our observation of significant improvements in motor and cognitive performances after four weeks of treadmill training in the Intervention group provides further confirmation of the close relationship between impaired cognitive performance and motor dysfunction in patients with PD (Varalta et al, 2015;Kelly et al, 2015). These findings have relevance to rehabilitation, considering that PDassociated cognitive deficits are important features of the disease, contributing to reduced quality of life and an increased risk of disability and mortality (Kelly et al, 2015).…”

Association ofGBAMutations and the E326K Polymorphism With Motor and Cognitive Progression in Parkinson Disease

“…This finding is consistent with findings from a recent study of patients with PD that showed that after adjusting for non-PIGD items on the MDS-UPDRS III, a higher PIGD score was associated with more severe deficits in global cognition, executive function, memory, and phonemic fluency. 22 …”