Takla Taylor N, Chargo Alexis N, Daugherty Ana M, Fritz Nora E
Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI, USA.
Translational Neuroscience Program, Wayne State University, Detroit, MI, USA.
Mult Scler Int. 2023 Aug 11;2023:5582242. doi: 10.1155/2023/5582242. eCollection 2023.
Individuals with multiple sclerosis (MS) are at an increased fall risk due to motor and cognitive dysfunction. Our past studies suggest that backward walking (BW) velocity predicts fall risk; however, specific cognitive domains associated with BW velocity remain understudied. The goal of this study was to determine the specific contributions of cognitive functioning to BW velocity in persons with MS. We hypothesized that better visuospatial memory, verbal immediate recall, and faster information processing speed would contribute to faster BW velocity, and deficits in these domains would partially account for disease severity-related impairment in BW velocity.
Participants completed demographic questionnaires, walking tests, and cognitive assessments. Applied structural equation modeling was used to test our hypothesized model of competing cognitive mediators. Within the model, disease severity was a predictor of BW via three intercorrelated cognitive mediators.
Participants included 39 individuals with relapsing-remitting MS. Results indicated that 35.3% of the significant total effect of disease severity on BW was accounted for by specific cognitive deficits. Verbal immediate recall had the largest contribution, followed by visuospatial memory and information processing speed.
When examining the unique effects of cognitive domains on disease severity-related deficits in BW, a meaningful source of impairment related to visuospatial memory and verbal immediate recall was demonstrated. Considering the utility of BW velocity as a predictor of falls, these results highlight the importance of assessing cognition when evaluating fall risk in MS. Cognitive-based intervention studies investigating fall prevention may find BW as a more specific and sensitive predictor of fall risk than forward walking.
由于运动和认知功能障碍，多发性硬化症（MS）患者跌倒风险增加。我们过去的研究表明，倒走（BW）速度可预测跌倒风险；然而，与BW速度相关的特定认知领域仍未得到充分研究。本研究的目的是确定认知功能对MS患者BW速度的具体影响。我们假设，更好的视觉空间记忆、言语即时回忆和更快的信息处理速度将有助于提高BW速度，而这些领域的缺陷将部分解释与疾病严重程度相关的BW速度受损情况。
参与者完成了人口统计学调查问卷、步行测试和认知评估。应用结构方程模型来检验我们假设的竞争性认知中介模型。在该模型中，疾病严重程度通过三个相互关联的认知中介因素预测BW速度。
参与者包括39例复发缓解型MS患者。结果表明，疾病严重程度对BW速度的显著总效应中，35.3%可由特定的认知缺陷来解释。言语即时回忆的贡献最大，其次是视觉空间记忆和信息处理速度。
在研究认知领域对与疾病严重程度相关的BW速度缺陷的独特影响时，发现了与视觉空间记忆和言语即时回忆相关的有意义的损伤来源。考虑到BW速度作为跌倒预测指标的效用，这些结果突出了在评估MS患者跌倒风险时评估认知的重要性。基于认知的预防跌倒干预研究可能会发现，BW速度比向前行走是更具体、更敏感的跌倒风险预测指标。
