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The nature of dual-task interference during gait in incident Parkinson's disease

Lookup NU author(s): Professor Lynn Rochester, Dr Brook Galna, Dr Susan Lord, Professor David Burn

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Abstract

Dual-task interference during gait is a common phenomenon in older adults and people with Parkinson's disease (PD). Dual-task performance is driven by cognitive processes involving executive function, attention and working memory which underpin resource capacity and allocation. The underlying processes that contribute to dual-task interference are poorly understood, and confounded by methodological differences. The aim of this study was to explore the nature of dual-task interference in PD with respect to age-matched controls. We examined 121 people with early PD and 189 controls and controlled for baseline task demand on both tasks allowing between-group differences to be attributed to dual-task interference rather than differences in baseline performance. We also compared a wide range of gait characteristics to evaluate the pattern of interference. Participants walked for two minutes at a preferred pace under single- and dual-task (test of working memory capacity - digit span recall) conditions. In a subgroup task demand was increased (digit span + 1) (n = 55 control, n = 44 PD) to assess the influence of resource capacity. Finally the association between dual-task interference with motor and cognitive characteristics was examined to evaluate resource capacity and allocation. PD and controls responded similarly to the dual-task for all gait characteristics except for step width and step width variability and this was the same when task demand increased (dual + 1). Control participants took wider steps (p = 0.006) and step width variability increased significantly for controls (p = 0.001) but not PD. Interference was specific to the gait characteristic rather than a global pattern of impairment. Digit span error rates were not significantly different between/groups during dual-task performance. There were no significant correlations with dual-task interference and global cognition, motor deficit, and executive function for either group. Effects of dual-tasks on gait performance are twofold and specific to the gait characteristic. They reflect an age-related reduction in gait performance (especially forward progression) in PD and controls possibly due to reduced resource capacity; and secondly, show postural stability during walking in early PD is disproportionately affected highlighting a PD-specific dual-task co-ordination deficit. Further work is required to identify the cognitive, executive and motor correlates of dual-task interference from which inferences about underlying cognitive processes can be made. These findings inform an understanding of dual-task impairment in early PD and suggest that management should target postural control under dual-task conditions from the early stages. (C) 2014 IBRO. Published by Elsevier Ltd. All rights reserved.


Publication metadata

Author(s): Rochester L, Galna B, Lord S, Burn D

Publication type: Article

Publication status: Published

Journal: Neuroscience

Year: 2014

Volume: 265

Pages: 83-94

Print publication date: 18/04/2014

Online publication date: 04/02/2014

Acceptance date: 21/01/2014

ISSN (print): 0306-4522

ISSN (electronic): 1873-7544

Publisher: Pergamon Press

URL: http://dx.doi.org/10.1016/j.neuroscience.2014.01.041

DOI: 10.1016/j.neuroscience.2014.01.041


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