Cognitive-Motor Interference in Neurodegenerative Disease: A Narrative Review and Implications for Clinical Management

Abstract

This paper provides a narrative review of cognitive motor interference in neurodegeneration, including brain imaging findings specific to interference effects in neurodegenerative disease, and dual task assessment and intervention in Parkinson's disease (PD), multiple sclerosis (MS), and Huntington's disease (HD). In a healthy central nervous system the ability to process information is limited. Limitations in capacity to select and attend to inputs influence the ability to prepare and perform multiple tasks. As a result, the system balances demands, switching attention to the most task-relevant information as it becomes available. Limitations may become more apparent in persons with neurodegenerative diseases (ND) with system-specific impairments in PD, MS, and HD. These ND affect both cognitive and motor function and are thus particularly susceptible to dual task interference. Issues related to performer and task characteristics and implications of these findings for both the standard assessment of dual task abilities as well as development and evaluation of interventions aimed at improving dual task ability are discussed. In addition, we address the need for optimizing individualized assessment, intervention and evaluation of dual task function by choosing cognitive and motor tasks and measures that are sensitive to and appropriate for the individual's level of function. Finally, we use current evidence to outline a 5-step process of clinical decision making that uses the dual task taxonomy as a framework for assessment and intervention.

Keywords: Huntington’s disease; Parkinson’s disease; attention; multiple sclerosis; multitasking.

FIGURE 1

Legend – Framework for assessment and intervention with dual task. The diagram begins in the center with (1) patient goals and values and projects to the clinician’s role to (2) determine needs. At point (3) the clinician can match the needs from an assessment to the level of complexity and novelty along the dual task taxonomy to create targets for (4) intervention. (5) Re-assessment should address where needs have been met as well as new needs that may arise or be revealed as the intervention progresses.