Sandri Angela, Bonetto Chiara, Fiorio Mirta, Salaorni Francesca, Bonardi Giulia, Geroin Christian, Smania Nicola, Tinazzi Michele, Gandolfi Marialuisa
Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P. le L.A. Scuro, 10, Verona, 37134, Italy.
Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy.
J Neural Transm (Vienna). 2025 Jan;132(1):95-104. doi: 10.1007/s00702-024-02829-4. Epub 2024 Sep 6.
Functional gait disorders (FGDs) are a disabling subset of Functional Neurological Disorders in which presenting symptoms arise from altered high-level motor control. The dual-task paradigm can be used to investigate mechanisms of high-level gait control. The study aimed to determine the objective measures of gait that best discriminate between individuals with FGDs and healthy controls and the relationship with disease severity and duration. High-level spatiotemporal gait outcomes were analyzed in 87 patients with FGDs (79.3% women, average age 41.9±14.7 years) and 48 healthy controls (60.4% women, average age 41.9±15.7 years) on single and motor, cognitive, and visual-fixation dual tasks. The area under the curve (AUC) from the receiver operator characteristic plot and the dual-task effect (DTE) were calculated for each measure. Dual-task interference on the top single-task gait characteristics was determined by two-way repeated measures ANOVA. Stride time variability and its standard deviation (SD) failed to discriminate between the two groups in single and dual-task conditions (AUC<0.80 for all). Significant group x task interactions were observed for swing time SD and stride time on the cognitive dual tasks (p<0.035 for all). Longer disease duration was associated with poor gait performance and unsteadiness in motor and cognitive DTE (p<0.003) but improvement in stride length and swing time on the visual dual tasks (p<0.041). Our preliminary findings shed light on measures of gait automaticity as a diagnostic and prognostic gait biomarker and underline the importance of early diagnosis and management in individuals with FGDs.
功能性步态障碍（FGDs）是功能性神经障碍中的一个致残子集，其表现出的症状源于高级运动控制的改变。双任务范式可用于研究高级步态控制的机制。本研究旨在确定能够最佳区分FGDs患者与健康对照者的步态客观测量指标，以及这些指标与疾病严重程度和病程的关系。对87例FGDs患者（女性占79.3%，平均年龄41.9±14.7岁）和48名健康对照者（女性占60.4%，平均年龄41.9±15.7岁）在单任务以及运动、认知和视觉注视双任务下的高级时空步态结果进行了分析。针对每项测量指标，计算了受试者工作特征曲线的曲线下面积（AUC）和双任务效应（DTE）。通过双向重复测量方差分析确定双任务对顶级单任务步态特征的干扰。在单任务和双任务条件下，步幅时间变异性及其标准差（SD）均无法区分两组（所有AUC均<0.80）。在认知双任务中，观察到摆动时间SD和步幅时间存在显著的组×任务交互作用（所有p<0.035）。病程较长与运动和认知DTE中的步态表现不佳和不稳定相关（p<0.003），但在视觉双任务中步幅长度和摆动时间有所改善（p<0.041）。我们的初步研究结果揭示了步态自动性测量指标作为诊断和预后步态生物标志物的作用，并强调了FGDs患者早期诊断和管理的重要性。
