Movement Disorders Unit, Department of Neurology, Laboratory for Gait and Neurodynamcis, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., Tel-Aviv 64239, Israel.
Exp Brain Res. 2011 Jan;208(2):169-79. doi: 10.1007/s00221-010-2469-y. Epub 2010 Nov 10.
Recent studies have demonstrated that cognitive loading aggravates the gait impairments that are typically seen in Parkinson's disease (PD). To better understand the relationship between cognition and gait in PD, we evaluated 30 subjects with PD who suffer from motor response fluctuations. The subjects were clinically and cognitively assessed using standard clinical (e.g., Unified Parkinson's Disease Rating Scale) and cognitive tests while in the "ON" period of the medication cycle. In addition, the subjects wore force-sensitive insoles to quantify the timing of the gait cycles during 80-m walks at a self-selected, comfortable pace during three randomly presented gait conditions: (1) usual-walking, (2) dual tasking (DT), performing serial 3 subtractions (DT_S3), and (3) DT_S7. Stride length, gait speed, gait variability and bilateral coordination of gait were affected by DT, compared to the usual-walking (P < 0.001) as was gait asymmetry (P = 0.024). Stepwise regression analyses showed that a subset of the cognitive performance scores accounted for the changes seen in the gait parameters during DT, e.g., set shifting capabilities as expressed by the Trial Making Test Scores (P < 0.001). Affect (e.g., anxiety) was not associated with DT-related gait changes. For most gait features, DT had a large impact on the DT_S3 condition with only minimal additional effect in the DT_S7 condition. These results demonstrate that the complex cognitive-motor interplay in the control of gait in patients with PD who suffer from motor response fluctuations has a profound and marked effect during DT conditions on gait variability, asymmetry and bilateral coordination, even in the "ON" state when patients are likely to be most active, mobile and vulnerable to the negative effects of dual tasking.
最近的研究表明，认知负荷会加重帕金森病（PD）患者通常出现的步态障碍。为了更好地理解 PD 患者认知与步态之间的关系，我们评估了 30 名患有运动反应波动的 PD 患者。这些患者在药物周期的“ON”期接受了标准临床（例如，统一帕金森病评定量表）和认知测试的临床和认知评估。此外，患者穿着力敏鞋垫，在三个随机呈现的步态条件下（1）通常行走、（2）双重任务（DT）、进行连续 3 次减法（DT_S3）和（3）DT_S7，以自选择的舒适速度进行 80 米行走，以量化步态周期的时间。与通常行走相比，DT 会影响步幅长度、步态速度、步态变异性和步态双侧协调性（P < 0.001），步态不对称性（P = 0.024）也是如此。逐步回归分析表明，认知表现得分的一部分解释了 DT 期间步态参数的变化，例如，由连线测试得分（TMT）表示的转换能力（P < 0.001）。情绪（例如焦虑）与 DT 相关的步态变化无关。对于大多数步态特征，DT 在 DT_S3 条件下的影响较大，而在 DT_S7 条件下的影响较小。这些结果表明，患有运动反应波动的 PD 患者在控制步态时的复杂认知运动相互作用在 DT 条件下对步态变异性、不对称性和双侧协调性有深远而显著的影响，即使在患者可能最活跃、最灵活且最容易受到双重任务负面影响的“ON”状态下也是如此。
