Department of Neurology, Oregon Health & Science University, Portland, OR, USA.
J Parkinsons Dis. 2021;11(2):653-664. doi: 10.3233/JPD-202289.
There is a lack of recommendations for selecting the most appropriate gait measures of Parkinson's disease (PD)-specific dual-task costs to use in clinical practice and research.
We aimed to identify measures of dual-task costs of gait and turning that best discriminate performance in people with PD from healthy individuals. We also investigated the relationship between the most discriminative measures of dual-task costs of gait and turning with disease severity and disease duration.
People with mild-to-moderate PD (n = 144) and age-matched healthy individuals (n = 79) wore 8 inertial sensors while walking under single and dual-task (reciting every other letter of the alphabet) conditions. Outcome measures included 26 objective measures within four gait domains (upper/lower body, turning and variability). The area under the curve (AUC) from the receiver-operator characteristic plot was calculated to compare discriminative ability of dual-task costs on gait across outcome measures.
PD-specific, dual-task interference was identified for arm range of motion, foot strike angle, turn velocity and turn duration. Arm range of motion (AUC = 0.73) and foot strike angle (AUC = 0.68) had the largest AUCs across dual-task costs measures and they were associated with disease severity and/or disease duration. In contrast, the most commonly used dual-task gait measure, gait speed, showed an AUC of only 0.54.
Findings suggest that people with PD rely more than healthy individuals on executive-attentional resources to control arm swing, foot strike, and turning, but not gait speed. The dual-task costs of arm range of motion best discriminated people with PD from healthy individuals.
目前缺乏关于选择最适合帕金森病（PD）特定双重任务步态成本的建议，以便在临床实践和研究中使用。
我们旨在确定区分 PD 患者和健康个体步态和转弯双重任务成本表现的最佳指标。我们还研究了最具区分性的步态和转弯双重任务成本指标与疾病严重程度和疾病持续时间之间的关系。
轻度至中度 PD 患者（n=144）和年龄匹配的健康个体（n=79）在单任务和双重任务（每隔一个字母背诵字母表）条件下佩戴 8 个惯性传感器进行行走。结果测量包括四个步态域（上下体、转弯和变异性）中的 26 个客观测量值。使用接收器操作特性图计算曲线下面积（AUC），以比较不同步态双重任务成本指标的区分能力。
发现了特定于 PD 的、双重任务干扰的手臂运动范围、脚着地角度、转弯速度和转弯持续时间。手臂运动范围（AUC=0.73）和脚着地角度（AUC=0.68）在双重任务成本指标中具有最大的 AUC，它们与疾病严重程度和/或疾病持续时间相关。相比之下，最常用的双重任务步态指标——步行速度，其 AUC 仅为 0.54。
研究结果表明，与健康个体相比，PD 患者在执行注意力资源方面更依赖于控制手臂摆动、脚着地和转弯，而不是步行速度。手臂运动范围的双重任务成本最能区分 PD 患者和健康个体。
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