Kremer Lea, Schreff Lucas, Hamacher Daniel, Oschmann Patrick, Rothhammer Veit, Keune Philipp M, Müller Roy
Departments of Neurology and Orthopedic Surgery, Klinikum Bayreuth GmbH, Bayreuth, Germany.
Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
Front Neurol. 2025 Mar 17;16:1546183. doi: 10.3389/fneur.2025.1546183. eCollection 2025.
Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system, leading to motor and cognitive impairment. These impairments become especially evident during dual-tasks, such as walking while performing a cognitive activity. Previous research has highlighted changes in gait-specific parameters during dual-tasks, but the cognitive component remains underexamined in MS. This study aims to expand on prior findings by using wearable inertial sensors and the Paced Auditory Serial Addition Test (PASAT) to evaluate the effects of dual-tasks on gait and cognitive performance in persons with MS (PwMS) compared to healthy controls.
Eighty-six adults (54 PwMS and 32 healthy controls) participated. PwMS were further divided into groups with lower (MS_LCP) and higher (MS_HCP) cognitive performance based on performance on the Symbol-Digit-Modalities Test (SDMT). Gait parameters were assessed using wearable inertial sensors during single- and dual-task 3-min-walking. Statistical analyses compared gait and cognitive performance across conditions and groups.
Under dual-task conditions, PwMS showed significant changes in all gait parameters, including reduced walking speed, stride length, percentage of swing phase and toe clearance, and increased stride time and percentage of stance phase compared to single-task condition. However, under dual-task condition in PwMS only walking speed, stride length and stride time differed from healthy controls. MS_LCP exhibited greater changes in both gait and PASAT performance than MS_HCP and healthy controls. While MS_HCP showed gait parameters comparable to healthy controls during single-tasks, deficits became apparent during dual-tasks. Correlations revealed strong associations between SDMT and PASAT scores but weak links between cognitive and self-reported measures.
The findings confirm that dual-task conditions exacerbate gait impairments in PwMS, particularly in those with lower cognitive performance. The use of PASAT as a dual-task cognitive challenge was feasible and had a considerable influence on gait. Results support the capacity sharing theory, suggesting that limited cognitive resources are redistributed between tasks under dual-task conditions.
多发性硬化症（MS）是一种影响中枢神经系统的慢性自身免疫性疾病，会导致运动和认知障碍。这些障碍在执行双重任务时，比如在进行认知活动的同时行走时，会变得尤为明显。先前的研究强调了双重任务期间特定步态参数的变化，但MS中的认知成分仍未得到充分研究。本研究旨在通过使用可穿戴惯性传感器和听觉节律连续加法测试（PASAT）来扩展先前的研究结果，以评估双重任务对MS患者（PwMS）与健康对照者步态和认知表现的影响。
86名成年人（54名PwMS和32名健康对照者）参与了研究。根据符号数字模式测试（SDMT）的表现，PwMS被进一步分为认知表现较低（MS_LCP）和较高（MS_HCP）的组。在单任务和双重任务3分钟行走过程中，使用可穿戴惯性传感器评估步态参数。统计分析比较了不同条件和组之间的步态和认知表现。
在双重任务条件下，与单任务条件相比，PwMS的所有步态参数都出现了显著变化，包括步行速度降低、步幅长度减小、摆动相百分比和足尖离地距离减小，以及步幅时间增加和站立相百分比增加。然而，在PwMS的双重任务条件下，只有步行速度、步幅长度和步幅时间与健康对照者不同。MS_LCP在步态和PASAT表现方面的变化比MS_HCP和健康对照者更大。虽然MS_HCP在单任务期间的步态参数与健康对照者相当，但在双重任务期间缺陷变得明显。相关性分析显示SDMT和PASAT分数之间存在强关联，但认知和自我报告测量之间的联系较弱。
研究结果证实，双重任务条件会加剧PwMS的步态障碍，尤其是在认知表现较低的患者中。使用PASAT作为双重任务认知挑战是可行的，并且对步态有相当大的影响。结果支持能力共享理论，表明在双重任务条件下，有限的认知资源会在任务之间重新分配。
