Gait and Cognition in Parkinson's Disease: Cognitive Impairment Is Inadequately Reflected by Gait Performance during Dual Task

Abstract

Introduction: Cognitive and gait deficits are common symptoms in Parkinson's disease (PD). Motor-cognitive dual tasks (DTs) are used to explore the interplay between gait and cognition. However, it is unclear if DT gait performance is indicative for cognitive impairment. Therefore, the aim of this study was to investigate if cognitive deficits are reflected by DT costs of spatiotemporal gait parameters.

Methods: Cognitive function, single task (ST) and DT gait performance were investigated in 67 PD patients. Cognition was assessed by the Montreal Cognitive Assessment (MoCA) followed by a standardized, sensor-based gait test and the identical gait test while subtracting serial 3's. Cognitive impairment was defined by a MoCA score <26. DT costs in gait parameters [(DT - ST)/ST × 100] were calculated as a measure of DT effect on gait. Correlation analysis was used to evaluate the association between MoCA performance and gait parameters. In a linear regression model, DT gait costs and clinical confounders (age, gender, disease duration, motor impairment, medication, and depression) were correlated to cognitive performance. In a subgroup analysis, we compared matched groups of cognitively impaired and unimpaired PD patients regarding differences in ST, DT, and DT gait costs.

Results: Correlation analysis revealed weak correlations between MoCA score and DT costs of gait parameters (r/r_Sp ≤ 0.3). DT costs of stride length, swing time variability, and maximum toe clearance (|r/r_Sp| > 0.2) were included in a regression analysis. The parameters only explain 8% of the cognitive variance. In combination with clinical confounders, regression analysis showed that these gait parameters explained 30% of MoCA performance. Group comparison revealed strong DT effects within both groups (large effect sizes), but significant between-group effects in DT gait costs were not observed.

Conclusion: These findings suggest that DT gait performance is not indicative for cognitive impairment in PD. DT effects on gait parameters were substantial in cognitively impaired and unimpaired patients, thereby potentially overlaying the effect of cognitive impairment on DT gait costs. Limits of the MoCA in detecting motor-function specific cognitive performance or variable individual response to the DT as influencing factors cannot be excluded. Therefore, DT gait parameters as marker for cognitive performance should be carefully interpreted in the clinical context.

Keywords: Montreal Cognitive Assessment; Parkinson’s disease; cognition; dual task; gait; gait analysis.

Figure 1

Flowchart.

Figure 2

Correlation analysis between cognitive performance [Montreal Cognitive Assessment (MoCA)] and dual task (DT) costs of spatiotemporal gait parameters. r, Pearson’s correlation coefficient; r_Sp, Spearman’s rank correlation coefficient.

Figure 3

Selected spatiotemporal gait parameters in single and dual task ◼ condition (cognitively impaired, n = 21, and unimpaired Parkinson’s disease patients, n = 21). *Adapted significance level (α_C) by Benjamini–Hochberg multiple testing correction (see Table 3).