Delval Arnaud, Krystkowiak Pierre, Delliaux Marie, Dujardin Kathy, Blatt Jean-Louis, Destée Alain, Derambure Philippe, Defebvre Luc
Department of Neurology and Movement Disorders, Salengro Hospital, Lille Regional University Hospital, Lille Cedex, France.
Mov Disord. 2008 Apr 15;23(5):684-9. doi: 10.1002/mds.21896.
Patients with Huntington's disease (HD) suffer from cognitive deficits with impaired executive functions, including limited attentional resources. We sought to use a dual-task paradigm to evaluate attentional demands and the ability of patients with HD to concentrate on two tasks simultaneously. We analyzed the interference effects of cognitive and motor tasks on walking in HD and the contribution of clinical symptoms to gait disturbances. Patients and controls were asked to perform either a motor task (carrying a tray with four glasses), a cognitive task (counting backwards), or no task at all while walking at their preferred speed. Kinematic spatial parameters, temporal parameters, and angular parameters related to gait were recorded in 15 patients and 15 controls by means of a videomotion analysis system. Gait instability was assessed using the stride-to-stride variability of the various gait parameters. For patients with HD, performing a concurrent cognitive task resulted in a lower gait speed (compared with free walking), with decreased cadence and stride length. However, this effect was not observed in controls. Performing a motor task did not change any kinematic gait parameters in either HD or control subjects. We found correlations between gait speed in the dual cognitive/walking task on one hand and the motor UHDRS score, cognitive status and executive function on the other. Patients with HD had greater difficulty walking while performing a concurrent cognitive task; the drain on attentional resources deteriorated walking performance.
患有亨廷顿舞蹈症（HD）的患者存在认知缺陷，执行功能受损，包括注意力资源有限。我们试图使用双任务范式来评估注意力需求以及HD患者同时专注于两项任务的能力。我们分析了认知和运动任务对HD患者行走的干扰效应以及临床症状对步态障碍的影响。要求患者和对照组在以自己喜欢的速度行走时，要么执行一项运动任务（端着一个装有四杯水的托盘），要么执行一项认知任务（倒着数数），要么什么任务都不执行。通过视频运动分析系统记录了15名患者和15名对照组与步态相关的运动学空间参数、时间参数和角度参数。使用各种步态参数的步幅间变异性来评估步态不稳。对于HD患者，执行一项并发认知任务会导致步态速度降低（与自由行走相比），步频和步长减小。然而，在对照组中未观察到这种效应。执行一项运动任务在HD患者和对照组中均未改变任何运动学步态参数。我们发现一方面在认知/行走双任务中的步态速度与另一方面的运动UHDRS评分、认知状态和执行功能之间存在相关性。HD患者在执行并发认知任务时行走困难更大；注意力资源的消耗使行走表现变差。
