Dual-Task Effects During a Motor-Cognitive Task in Parkinson's Disease: Patterns of Prioritization and the Influence of Cognitive Status.
Hanna Johansson, Urban Ekman, Linda Rennie and 3 others
PMID 33719728WHAT IT FOUND
Walking while responding to tones slowed gait in mild to moderate Parkinson's disease, especially in those with mild cognitive impairment.
Those with mild cognitive impairment prioritized the tone task over walking; those without prioritized walking speed.
Key findings
01Walking while performing the auditory Stroop task caused dual-task costs in the pace and variability domains of gait, and it lengthened reaction time and increased reaction-time variability; accuracy did not change.
02People classified as having PD-MCI had larger dual-task costs on gait speed and step time variability than people classified as PD non-MCI, but their overall cognitive dual-task cost was not significantly different.
03During the dual task, PD non-MCI prioritized gait speed over the cognitive task, while PD MCI prioritized the cognitive task over gait speed and over step time variability.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study was cross-sectional and used baseline data from a trial, so it cannot show that any treatment caused the dual-task costs or that prioritization can be changed by training. No power calculation was done for these aims, and the sample was limited to people with mild to moderate Parkinson's disease who could walk indoors without a mobility aid and scored at least 21 on the MoCA. Testing was done in the ON medication state and in a quiet laboratory walkway, so results may not apply to people when medication is OFF or to walking outdoors with traffic and pedestrians. The cognitive-status analyses excluded 24 intermediate participants and 4 participants without neuropsychological testing, so they describe clear PD MCI and PD non-MCI groups, not the whole Parkinson's population. Reliability was imperfect: the dual-task effect on gait speed had moderate test-retest reliability, step time variability dual-task effect had no reported reliability, and the combined cognitive dual-task effect needed further validation.
Declared interests
The authors declared no potential conflicts of interest. The study was supported by grants from the Doctoral School in Health Care Sciences at Karolinska Institutet, the Norrbacka-Eugenia Foundation, the Swedish Research Council, and the Center for Innovative Medicine at Karolinska Institutet and Region Stockholm.
The easy way to misread this
Do not read the posture-second pattern as proof that dual-task training will improve gait or reduce falls in people with Parkinson's disease with mild cognitive impairment. This was a cross-sectional baseline study, and it did not test an intervention or follow participants over time.