Motor-cognitive dual-task deficits in individuals with early-mid stage Huntington disease

Fritz, Nora; Hamana, Katy; Kelson, Mark; Rosser, Anne Elizabeth; Busse, Monica; Quinn, Lori

doi:10.1016/j.gaitpost.2016.07.014

Cited by 29 publications

(52 citation statements)

References 30 publications

(39 reference statements)

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“…Our findings are related to prior gait studies in HD where performing a cognitive‐motor DT resulted in decreased stride length, cadence, and gait speed, with increased gait speed DTC . Our findings are also consistent with the elevated DTC for combined cognitive and balance tasks in individuals with other neurodegenerative diseases, including MS and PD …”

Section: Discussionsupporting

confidence: 89%

“…Previously, difficulties in DT gait performance were associated with increased falls in PD and HD . We hypothesize that DT balance assessments and knowledge of how cognition impacts balance will provide important information about fall risk in HD.…”

Section: Introductionmentioning

confidence: 94%

“…Furthermore, current understanding of postural control suggests it is an active process, requiring attentional resources . Previous studies found HD participants demonstrate decreased gait speed, cadence, and stride length while dual‐tasking . However, the extent to which dual‐tasking and cognitive deficits exacerbate balance dysfunction in HD is unknown.…”

Section: Introductionmentioning

confidence: 99%

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The Effects of Dual‐Task Cognitive Interference and Environmental Challenges on Balance in Huntington's Disease

Purcell

Goldman

Ouyang

et al. 2019

Movement Disord Clin Pract

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Background Huntington's disease (HD) is characterized by chorea, balance and gait impairments, and cognitive deficits, which increase fall risk. Dual task (DT) and environmentally challenging paradigms reflect balance related to everyday life. Furthermore, the impact of cognitive deficits on balance dysfunction and falls in HD is unknown. Objective To determine the impact of DT interference, sensory feedback, and cognitive performance on balance and falls in HD. Methods Seventeen participants with HD (55 ± 9.7 years) and 17 age‐matched controls (56.5 ± 9.3 years) underwent quantitative balance testing with APDM inertial sensors. Postural sway was assessed during conditions of manipulated stance, vision, proprioception, and cognitive demand. The DT was a concurrent verbal fluency task. Neuropsychological assessments testing multiple cognitive domains were also administered. Results HD participants exhibited significantly greater total sway area, jerk, and variability under single‐task (ST) and DT conditions compared to controls (P = 0.0002 – < 0.0001). They also demonstrated greater DT interference with vision removed for total sway area (P = 0.01) and variability (P = 0.02). Significantly worse postural control was observed in HD with vision removed and reduced proprioception (P = 0.001 – 0.01). Decreased visuospatial performance correlated with greater total sway and jerk (P = 0.01; 0.009). No balance parameters correlated with retrospective falls in HD. Conclusions HD participants have worse postural control under DT, limited proprioception/vision, and greater DT interference with a narrowed base and no visual input. These findings may have implications for designing motor and cognitive strategies to improve balance in HD.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

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The Effects of Dual‐Task Cognitive Interference and Environmental Challenges on Balance in Huntington's Disease

Purcell

Goldman

Ouyang

et al. 2019

Movement Disord Clin Pract

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“…Cognitive deficits are also prevalent, notably in the domains of executive function, visuospatial processing, processing speed, and short-term memory, which can further exacerbate motor impairments [9,10]. Cognitivemotor dual-task paradigms are a means to assess an individual's ability to divide their attention during concurrent tasks and have been shown to reveal motor deficits not seen under singletask in Parkinson's disease (PD) [11], HD [8,12], and multiple sclerosis (MS) [13]. Under DT, individuals with HD have exhibited a decrease in gait speed, cadence, and stride length [8,12] compared to healthy controls, characteristics which contribute to an increased fall risk in other movement disorders [11].…”

mentioning

confidence: 99%

“…Cognitivemotor dual-task paradigms are a means to assess an individual's ability to divide their attention during concurrent tasks and have been shown to reveal motor deficits not seen under singletask in Parkinson's disease (PD) [11], HD [8,12], and multiple sclerosis (MS) [13]. Under DT, individuals with HD have exhibited a decrease in gait speed, cadence, and stride length [8,12] compared to healthy controls, characteristics which contribute to an increased fall risk in other movement disorders [11]. Previously, we found that individuals with HD exhibited significant DT cognitive motor interference for postural stability when vision was removed, and base of support was narrowed [14].…”

mentioning

confidence: 99%

The effects of dual-task cognitive interference on gait and turning in Huntington’s disease

et al. 2020

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Huntington's disease (HD) is characterized by motor, cognitive, and psychiatric dysfunction. HD progression causes loss of automaticity, such that previously automatic tasks require greater attentional resources. Dual-task (DT) paradigms and fast-paced gait may stress the locomotor system, revealing deficits not seen under single-task (ST). However, the impact of gait "stress tests" on HD individuals needs further investigation. Therefore, the aims of this study were to investigate whether: 1) fast-paced and dual-task walking uncover deficits in gait and turning not seen under single-task, 2) cognitive and gait outcomes relate to fall incidence, and 3) gait deficits measured with wearable inertial sensors correlate with motor symptom severity in HD as measured by the Unified Huntington's disease Rating Scaletotal motor score (UHDRS-TMS). Seventeen HD (55 ± 9.7 years) and 17 age-matched controls (56.5 ± 9.3 years) underwent quantitative gait testing via a 25m, two-minute walk test with APDM TM inertial sensors. Gait was assessed under a 1) ST, self-selected pace, 2) fastas-possible (FAP) pace, and 3) verbal fluency DT. The UHDRS-TMS and a cognitive test battery were administered, and a retrospective fall history was obtained. During ST, DT, and FAP conditions, HD participants demonstrated slower gait, shorter stride length, and greater lateral step and stride length variability compared to controls (p<0.00001 to 0.034). Significant dual-task costs (DTC) were observed for turns; HD participants took more time (p = 0.013) and steps (p = 0.028) to complete a turn under DT compared to controls. Higher UHDRS-TMS correlated with greater stride length variability, less double-support, and more swing-phase time under all conditions. Decreased processing speed was associated with increased gait variability under ST and FAP conditions. Unexpectedly, participant's selfreported falls did not correlate with any gait or turn parameters. HD participants demonstrated significantly greater DTC for turning, which is less automatic than straight walking, requiring coordination of body segments, anticipatory control, and cortical regulation. Turn complexity likely makes it more susceptible to cognitive interference in HD. (2020) The effects of dualtask cognitive interference on gait and turning in Huntington's disease. PLoS ONE 15(1): e0226827.Huntington's disease (HD) is an autosomal dominant, neurodegenerative disease caused by an expanded CAG repeat (�40 repeats, full-penetrance) in the gene for the huntingtin protein (HTT), though symptoms may also occur in some with CAG repeat lengths � 36 (reduced penetrance range) [1]. The expansion results in aggregation of insoluble mutant HTT (mHTT) in neurons, the most vulnerable being striatal medium spiny neurons (MSNs) of the basal ganglia [2]. Ultimately, the proteinaceous aggregates disrupt neuronal function, causing cell death and subsequent motor dysfunction [3]. The progression of HD results in gait and balance impairment which can lead to an increased fall risk [4]. In addition to...

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Dual tasking impairments are associated with striatal pathology in Huntington’s disease

Reyes

Pulverenti

et al. 2020

Ann Clin Transl Neurol

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Background Recent findings suggest that individuals with Huntington’s disease (HD) have an impaired capacity to execute cognitive and motor tasks simultaneously, or dual task, which gradually worsens as the disease advances. The onset and neuropathological changes mediating impairments in dual tasking in individuals with HD are unclear. The reliability of dual tasking assessments for individuals with HD is also unclear. Objectives To evaluate differences in dual tasking performance between individuals with HD (presymptomatic and prodromal) and matched controls, to investigate associations between striatal volume and dual tasking performance, and to determine the reliability of dual tasking assessments. Methods Twenty individuals with HD (10 presymptomatic and 10 prodromal) and 20 healthy controls were recruited for the study. Individuals undertook four single and dual task assessments, comprising motor (postural stability or force steadiness) and cognitive (simple or complex mental arithmetic) components, with single and dual tasks performed three times each. Participants also undertook a magnetic resonance imaging assessment. Results Compared to healthy controls, individuals with presymptomatic and prodromal HD displayed significant deficits in dual tasking, particularly cognitive task performance when concurrently undertaking motor tasks (P < 0.05). The observed deficits in dual tasking were associated with reduced volume in caudate and putamen structures (P < 0.05),however, not with clinical measures of disease burden. An analysis of the reliability of dual tasking assessments revealed moderate to high test–retest reliability [ICC: 0.61‐0.99] for individuals with presymptomatic and prodromal HD and healthy controls. Conclusions Individuals with presymptomatic and prodromal HD have significant deficits in dual tasking that are associated with striatal degeneration. Findings also indicate that dual tasking assessments are reliable in individuals presymptomatic and prodromal HD and healthy controls.

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Motor-cognitive dual-task deficits in individuals with early-mid stage Huntington disease

Abstract: Background. Huntington's disease (HD) results in a range of cognitive and motor impairments

Cited by 29 publications

References 30 publications

The Effects of Dual‐Task Cognitive Interference and Environmental Challenges on Balance in Huntington's Disease

The Effects of Dual‐Task Cognitive Interference and Environmental Challenges on Balance in Huntington's Disease

The effects of dual-task cognitive interference on gait and turning in Huntington’s disease

Dual tasking impairments are associated with striatal pathology in Huntington’s disease

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