Dual-Task Effects During a Motor-Cognitive Task in Parkinson’s Disease: Patterns of Prioritization and the Influence of Cognitive Status

Abstract

People with Parkinson’s disease (PD) experience greater difficulties during dual task (DT) walking compared to healthy controls, but factors explaining the variance in DT costs remain largely unknown. Additionally, as cognitive impairments are common in PD it is important to understand whether cognitive status influences the strategies used during DT paradigms. The study aimed to (1) explore DT costs on gait and cognition during DT walking, (2) investigate factors associated with DT costs, and (3) to investigate to what extent patterns of DT costs and prioritization differed according to cognitive status. A total of 93 people with Parkinson’s disease were examined when walking in single and DT conditions. Information regarding demographics, PD severity, mobility, and cognitive and affective symptoms was collected, and an extensive neuropsychological test battery was used to classify whether participants had mild cognitive impairment (PD MCI) or not (PD non-MCI). Dual task costs were observed across all gait domains except asymmetry. Cognitive status was associated with DT costs on both gait and cognition. Nonmotor experiences of daily living were further associated with DT cost on cognition, and TUG-cog associated with DT cost on gait. People with PD MCI had larger DT costs on gait than PD non-MCI. Strategies differed according to cognitive status, whereby PD MCI used a posture-second strategy, and PD non-MCI used a posture-first strategy. Once verified in future studies, these results can inform clinicians and researchers when tailoring DT training paradigms to the specific characteristics of people with PD.

Effects of Cycling Dual-Task on Cognitive and Physical Function in Parkinson’s Disease: A Randomized Double-Blind Pilot Study

“…Al-Yahya's et al meta-analysis [37] showed that in healthy individuals there is a strong association between age and decreased gait speed during dual tasks and between cognitive level and decreased gait speed during dual tasks. In the study by Johansson et al [38], it was observed that the performance of the dual task generated a deterioration in a significant percentage of the variables associated with gait, while without observing variations in symmetry, as we also observed in our study. These authors also observed a longer reaction time during the dual task and also with significant individual variability, which reached a deterioration of almost 40% in some individuals [38].…”

“…In the study by Johansson et al [38], it was observed that the performance of the dual task generated a deterioration in a significant percentage of the variables associated with gait, while without observing variations in symmetry, as we also observed in our study. These authors also observed a longer reaction time during the dual task and also with significant individual variability, which reached a deterioration of almost 40% in some individuals [38]. De Oliveira Silva et al [39] suggest that poor DT and spatial navigation abilities are present in partial functional de-pendence in instrumental activities of daily living, and these tasks should be considered as a functionality screening tool in patients with dementia.…”

Characterization of Mild and Moderate Dysarthria in Parkinson’s Disease: Behavioral Measures and Neural Correlates

“…Within the EXPANd trial, participants were assessed with a large neuropsychological test battery comprising the domains executive function, attention/working memory, episodic memory, and visuospatial functions ( Franzén et al, 2019 ). This test battery enabled the classification of mild cognitive impairment, previously described by Johansson and colleagues ( Johansson et al, 2021 ). In this study we focused on the following scales to assess cognition and executive function: the Delis-Kaplan Executive Function System (D-KEFS) ( Fine and Delis, 2011 ), the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) ( Wechsler, 1955 ), and MoCA ( Borland et al, 2017 ).…”

Dual task gait deteriorates gait performance in cervical dystonia patients: a pilot study

“…Spatiotemporal data were computed from all the steps recorded during the entire task. As previously reported (Johansson et al 2021;Vitorio et al 2021), to characterize the performance of usual and DT walking, the DT cost ([dual task − single task)/single task] × 100) was The order of the task was randomly assigned calculated for two key measurements (Morris et al 1998) of walking (i.e. gait speed and stride length).…”