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Article

The Executive-Function-Related Cognitive–Motor Dual Task Walking Performance and Task Prioritizing Effect on People with Parkinson’s Disease

by
Yen-Po Lin
1,2,
I-I Lin
3,
Wei-Da Chiou
3,4,
Hsiu-Chen Chang
3,5,
Rou-Shayn Chen
6,7,8,
Chin-Song Lu
5 and
Ya-Ju Chang
3,8,9,*
1
Department of Medical Education, National Cheng Kung University Hospital, Tainan 704, Taiwan
2
Department of Medical Education, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
3
School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
4
Department of Physical Rehabilitation, Kaohsiung Armed Forces General Hospital, Kaohsiung 802, Taiwan
5
Professor Lu Neurological Clinic, Taoyuan 333, Taiwan
6
Department of Neurology, Chang Gung Memorial Hospital Linkou, Taoyuan 333, Taiwan
7
School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
8
Neuroscience Research Center, Chang Gung Memorial Hospital Linkou, Taoyuan 333, Taiwan
9
Health Aging Research Center, Chang Gung University, Taoyuan 333, Taiwan
*
Author to whom correspondence should be addressed.
Healthcare 2023, 11(4), 567; https://doi.org/10.3390/healthcare11040567
Submission received: 28 December 2022 / Revised: 31 January 2023 / Accepted: 4 February 2023 / Published: 14 February 2023
(This article belongs to the Special Issue Health Promotion in Older Adults—Physical Activity/Exercise/Wearable Device)
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Abstract

:
To safely walk in a community environment requires dual cognitive–walking ambulation ability for people with Parkinson’s disease (PD). A past study showed inconsistent results on cognitive–walking performance for PD patients, possibly due to the various cognitive tasks used and task priority assignment. This study designed cognitive–walking tests that used executive-related cognitive tasks to evaluate patients with early-stage Parkinson’s disease who did not have obvious cognitive deficits. The effect of assigning task prioritization was also evaluated. Sixteen individuals with PD (PD group) and 16 individuals without PD (control group) underwent single cognitive tests, single walking tests, dual walking tests, and prioritizing task tests. Three types of cognitive, spatial memory, Stroops, and calculation tasks were employed. The cognitive performance was evaluated by response time, accuracy, and speed–accuracy trade off composite score. The walking performance was evaluated by the temporal spatial gait characteristics and variation in gait. The results showed that the walking performance of the PD group was significantly worse than the control group in both single and dual walking conditions. The group difference in cognitive performance was shown in composite score under the dual calculation walking task but not under the single task. While assigning priority to walking, no group difference in walking was observed but the response accuracy rate of PD groups declined. This study concluded that the dual task walking test could sharpen the cognitive deficits for early-stage PD patients. The task priority assignment might not be recommended while testing gait deficits since it decreased the ability to discriminate group differences.

1. Introduction

Parkinson’s disease (PD) is the second-most-common neurodegenerative disease, and the proportion of the population suffering from Parkinson’s disease increases with age [1]. The prevalence of PD is around 0.3% of the entire population and about 1% in people over 60 years of age, but the numbers vary according to different geographical area and methodology of investigation [2,3]. Generally, the average age of onset is between 50 and 60 years old [3]. Insufficient dopamine secretion can also affect the frontostriatal circuits, which causes cognitive problems [4,5]. Clinical diagnosis relies on cardinal motor features, but non-motor symptoms, such as cognitive deficits, could increase the overall disability [6]. Declined walking ability is an important deficit that causes falls and prevents patients from outdoor functional activities and, thus, affects patients’ quality of life [7]. Precise evaluation of the patients’ walking ability, especially the walking ability that could reflect their community walking ability, is important for clinical decision making in terms of adjusting medication and rehabilitation plans [8]. It is not easy to evaluate community ambulation ability clinically. People often perform walking under cognitive load (dual walking tasks) in their daily lives, such as memorizing shopping lists while walking, calculations while walking, and so on. Walking under cognitive load requires simultaneous control of walking and cognitive functions [9]. It has been demonstrated that even young healthy adults walk slower when they are required to walk while performing another task [10]. This paradigm is also known as the dual task walking paradigm. Under the execution of one task, the performance of another task in progress may be poor. In this paradigm, a deficit could be shown in gait, such as a reduction in walking speed. Reductions in step length and increases in the coefficient of variation (CV) of walking speed and step length, or cognitive performance, such as a decrease in the correct response rate and an increase in response time, are also known as deficits in the dual walking task paradigm [11,12,13,14].
Compared with healthy people of the same age, studies have shown that patients with Parkinson’s disease are more susceptible to walking deficits under cognitive load [12], which was related to a decrease in gait automaticity. The dual task walking test has been popular clinically due to this paradigm, which is suggested to make the gait automaticity deficit more obvious to detect under cognitive loads. In a previous study, Zirek et al., compared 48 PD and 48 control subjects to analyze the effect of cognitive activities on the walking ability of patients [15]. The result showed that the completion time of a quick test for the assessment of mobility, balance, and risk of falls in the PD group was longer than the healthy controls under cognitive loading conditions.
Similar results were also found in the dual task during a motor cognitive task experiment by Johansson et al., a total of 93 patients with PD showed significantly worse postural control and pace when walking with cognitive load versus no cognitive load [16]. The hypothesized mechanism is that the PD patients use more cortical attention resources than healthy people to control gait [12,17]. Therefore, as the patient is performing a dual walking task, the two tasks compete for the limited attention resources of the cerebral cortex, resulting in a lack of ability to execute dual walking tasks [18,19]. The dual task test paradigm could be explained by capacity theory and/or bottleneck theory [12,20]. Capacity theory holds that attention capacity is limited, but the brain can flexibly allocate attention to specific tasks autonomously. If both tasks require attention, because the attention capacity is limited or the attention cannot be divided appropriately, as in patients with Parkinson’s disease, the dual walking task deficit will be shown [21]. The bottleneck theory believes that when two tasks pass through the same processing path, the center will process one task first and delay the processing or reduce the performance of the other task [21,22,23].
Although the cognitive–walking paradigm has been suggested for evaluating gait automaticity, past results of the dual task walking test on PD patients are inconsistent. In a study designed by Salazar et al., the variability in motor performance remained unaffected under the dual task that consisted of walking while performing the oral trail making test [24]. However, for 30 PD patients in another study when walking under the dual task condition, the subjects’ speed was greatly reduced and stride time variability became very large [25]. The inconsistent results could be due to different dual task designs and evaluation parameters used in different study designs. For example, different cognitive loads may apply to different brain regions and result in different assessments. In addition, factors, such as disease severity, bradykinesia, rigidity, postural instability, and other factors, can lead to reduced walking control. Slow movement results in reduced step length and slower walking speed [26]. Impaired executive function, attention, processing speed, memory, and visual space can also cause a loss of dual walking task ability [27,28]. The executive function of patients with Parkinson’s disease is significantly impaired [9,29], especially in the aspect of response inhibition and spatial memory [30,31]. Previous studies on the evaluation of dual task walking ability in PD patients did not employ a cognitive function that focused on executive function. It is possible that that a dual task paradigm requiring walking under executive-function-related cognitive load might enhance the motor deficit and make the test more sensitive for early-stage PD patients. However, there is no previous study design on the cognitive–walking dual task walking paradigm for PD patients, especially for early-stage patients.
Another potential factor to influence the application of the dual task walking test is the task prioritization assignment. Researchers [32] reported that healthy people prioritize gait stability over cognitive tasks when no specific prioritization instruction or allocation of attention is given to prevent a loss of balance. Studies also showed that patients with PD prioritized the cognitive task when they did not receive explicit instructions to prioritize gait, which inadvertently increased their risk for falling [33]. However, other studies quantified both primary and secondary tasks and found that the dual task did not always cause interference. A dual task facilitation phenomenon was also reported, but not systematically, in previous studies [34]. This condition cannot be explained by the conventional capacity or bottleneck models. The prediction of traditional models is worse in conditions when the prioritization was assigned. Another limitation of the dual task walking test for PD patients might come from the influence of the prioritization of task. O’Shea et al., compared 15 patients with PD and 15 healthy adults and reported that focus on walking improved the walking speed but cognitive task performance reduced in PD [21]. This is a phenomenon that can be predicted by the dual task theories. However, Yogev-Seligmann’s study, which used a verbal fluency walking paradigm to test young and old people [35], found that gait speed was reduced when priority was given to the cognitive task, but the effect was less dramatic in older adults. This suggested that when priorities are assigned, older people do not use allocation strategies as young people do. In addition, dual task costs related to prioritization were not associated with the baseline executive or cognitive function in older adults. In a recent study by Longhurst et al. [34], in which they evaluated the dual task effect separately on cognitive and motor tasks, they found the prioritization category was not reliable.
The primary aim of this study is to evaluate whether the executive-function-related cognitive–walking test paradigms could reveal deficits, which could not be shown in the single task paradigm in early-stage PD patients. We hypothesize that this paradigm will show significant differences in gait (speed, step length, and cadence) and/or cognitive functions (response time and accuracy) between the early-stage PD patients and control group, which could not be shown in the single walking or cognitive tests. The secondary aim is to evaluate the effect of assigning prioritization on the executive-function-related cognitive–walking test paradigms.

2. Materials and Methods

2.1. Research Design and Subjects

This study is a case-control study. Participants were 16 patients with PD (PD group) and 16 healthy subjects (control group). One subject in the control group withdrew due to personal reasons. Patients with Parkinson’s were recruited from the Department of Neurology division at a medical center. Age-matched control subjects with an average age of 60.93 ± 2.87 were recruited from the community. Parkinson’s patients must meet the following admission and inclusion criteria: idiopathic Parkinson’s disease with Hoehn and Yahr stage (H&Y) 1–3 (mild to moderate unilateral or bilateral disease; some postural instability; physically independent) levels diagnosed according to the United Kingdom Brain Bank Criteria. All PD participants had the postural instability gait difficulty (PIGD) motor subtype, without freezing of gait and with stable medication usage. Stable medication usage refers to no medication dosage changes three months before enrolling in the study and during the test period. Patients had physical/mental adaptations with effective maintenance by medication without symptom progress. Eligibility for inclusion was assessed by a neurologist. Subjects in both groups must be able to walk at least six meters indoors without using assistive devices and score at least 26 in Montreal Cognitive Assessment (MoCA) to avoid the influence of mild cognitive impairment [36,37]. The excluded conditions for both groups are: diagnosis of central nervous system diseases other than Parkinson’s disease, cardiopulmonary vascular disease, orthopedic disease, audiovisual sensory disease, symptoms of dementia, dyskinesia, or receiving deep brain stimulation. Subjects in the PD group were tested clinically “on” medication state. The single and dual task evaluations were performed by trained research team members who are licensed physical/occupational therapists. Patients and assessors were blind to the purpose of the study. Only the patients’ name and age were known prior to the subject’s evaluation; details were unknown. This study was approved by the Institutional Review Board and informed consent was obtained.
After inclusion, subjects were assessed by the MoCA, which is a scale for quick screening of mild cognitive impairment. This assessment was suggested to be sensitive in screening patients with early cognitive impairment [38]. By definition, a score of ≥26 points is considered normal.
Subjects then received a single cognitive test, single walking test, and dual walking test. The total duration of evaluation, including rest time, was less than 1.5 h to avoid fatigue. To avoid order effects, the experimental procedure was to perform single and dual tasks twice each. The three cognitive tasks were randomly assigned. The contents of cognitive questions for the same paradigm (spatial memory, Stroops, or calculation) were different between the two tests. Between tasks, there were at least two minutes for subjects to rest. The average of the two measurements was used for analysis. The single cognitive test was tested in a sitting position. Wireless headset microphone (Aibo, Mini A8, LY-MIC-BTA8, New Taipei City, Taiwan) was used to record the oral response to the cognitive tasks. The audio signal was sent to a computer through Bluetooth wireless transmission (v4.0) so the response time could be accurately analyzed corresponding to the test question. There are three cognitive tasks used in this study: spatial memory task, visual Stroop task, and calculation task. Each task is performed twice. The spatial memory task is to memorize the position and order of three yellow squares in a blank nine-square grid. Each position is given 1 s of memory time. Then, the yellow squares disappear and the numbers are shown on the nine-square grid. Subjects had to say the three corresponding numbers in the nine-square grid. For the visual Stroop task, there are colorful words shown on screen with one word each time. Subjects had to name the color of the word. For example, for a word “purple” shown in red, the answer should be red instead of purple. The colors and the words were all incongruent to increase the test difficulty. When performing this task, automated responses must be suppressed, which is used to assess response inhibition [39]. The calculation task required serial subtraction of “three” beginning with a number randomly selected between 60 and 100, which is a test commonly used in dual task tests in patients with Parkinson’s disease [40]. Before the three cognitive tasks officially started, there were 10 sample questions each for subjects to practice to ensure they understood the test.
The single walking task requires subjects to walk on a pressure mat (GAITRite, CIR systems Inc, Franklin, NJ, USA) (Figure 1) at a self-chosen comfortable speed and at the fastest speed. Each task is performed twice. When the subject walks across the trail, the temporal spatial parameters of gait, step time, step length, speed, and coefficient of variation (CV) were recorded.
For the dual walking task, subjects walked at a self-chosen comfortable speed and performed cognitive tasks simultaneously. Three combinations of dual tasks were employed in this study: walking combined with spatial memory tasks, walking combined with visual Stroop tasks, and walking combined with calculation tasks. In this dual walking test, no task prioritization was assigned.
Following dual walking test, subjects received dual calculation walking tests with priority assigned. While priority was assigned to the cognitive task, subjects were instructed to focus their attention on calculation rather than walking. In contrast, while priority was assigned to the walking task, subjects were instructed to focus their attention on walking rather than calculation. The research flowchart and experimental environment settings are as shown in Figure 1 and Figure 2, respectively.

2.2. Data Processing and Analysis

Performance parameters include walking speed (cm/s), step length (cm), CV of step length and step time (%), the response accuracy rate (%), reaction time (milliseconds), and composite score (%) of cognitive tasks.
The CV of response accuracy and reaction time was calculated by the following formulas:
CV = (Standard Deviation/Mean) × 100%
Response accuracy = number of correct responses total number of stimuli × 100%
Composite score = response accuracy/reaction time × 100%

2.3. Statistical Analysis

SAS (version 9.4; SAS Institute, Cary, NC, USA) was used for statistical analysis. Because some of the parameters show a non-normal distribution (response accuracy), the non-parametric test is used. The Chi-square test compares the ratio of males to females in the PD and healthy groups. The Mann–Whitney U test was used for between-group comparison and the Wilcoxon signed-rank test was used for within group comparison. The significance level was set at p < 0.05.

3. Results

3.1. Patient Characteristics

In total, 31 subjects were analyzed, 16 in the Parkinson’s disease group (5 female, 11 male, age: 63.13 ± 5.75 years) and 15 in the control group (4 female, 11 male, age: 60.93 ± 2.87 years). There was no statistically significant difference between the Parkinson’s and control group in the basic data (Table 1). Clinical characteristics of the participants, such as leg length, education level, MoCA, modified H&Y, disease duration (yrs), and levodopa equivalent dosage (mg/day), are shown in Table 2. The average levodopa dosage was 553.75 mg/day.

3.2. Gait Performance of Healthy Group and Parkinson’s Disease Group under Single Walking Task and Dual Task

In Figure 3, the Mann–Whitney U test showed that the walking speed of the Parkinson’s disease group was significantly lower than the control group in the single walking task (p = 0.005), dual spatial memory task (p = 0.002), dual Stroop Task (p = 0.044), and dual calculation task (p = 0.009).
In terms of the step length performance, the Parkinson’s disease group showed significantly shorter step length in the single walking task (p = 0.003), dual walking with spatial memory task (p = 0.003), dual walking with Stroop task (p = 0.027), and dual walking with calculation task (p = 0.003) than the healthy group.
In the CV of step length, the PD group showed greater CV than the control group in only the dual walking with spatial memory task (p = 0.024) and Stroop task (p = 0.010), showing no difference in the single walking task (p = 0.155).
In terms of step time, no significant difference was found between the groups in the single walking task or any dual task conditions (p > 0.05)
The CV of step time in the PD group was greater than the control group in the single walking task (p = 0.022). No difference in CV was observed in the dual spatial memory task (p = 0.843), dual Stroop task (p = 0.553), and dual calculation task (p = 0.782) in these two groups.

3.3. Cognitive Performance of Healthy Group and PD Group under Single Cognitive Task and Dual Task

For response accuracy and reaction time, no group differences were found between PD and control groups in the single or any of the dual cognitive tasks (Figure 4). These suggested that the subjects in this study did not have obvious impairments in cognitive function.
In terms of the composite score, there was no significant difference between the groups in space memory task or Stroop task under the single and dual task conditions (p > 0.05). However, in the dual calculation task, the composite score in the PD group was significantly lower than that in the control group (p = 0.018) (Figure 4). This suggests that the PD patients had disadvantaged cognitive function under the dual calculation task.

3.4. The Performance of Dual Calculation Tasks in the Control Group and the Parkinson’s Disease Group under Designated Task Priority (Comparing the Difference between Gait Priority and Calculation Priority)

When priority was assigned to the walking task, no group difference was found. The PD group showed lower response accuracy than the control group (control: 95.33 ± 13.56%, PD: 72.50 ± 32.51% p = 0.037) but not the reaction time (p = 0.651) or composite score (p = 0.156). This suggested an improvement in gait performance with a detriment in cognitive performance. When priority was assigned to cognitive tasks, no group difference was observed in either walking performance or cognitive performance (Table 3).

4. Discussion

In this study, the walking performance in the early Parkinson’s disease group (speed, step length) was significantly worse than the healthy group, regardless of the single task or dual task walking. The step length CV was not different between groups in the single walking task but was different in dual walking. In other words, the dual walking with spatial memory and Stroop task sharpened the deficits of step length CV. The step time CV showed group differences in single task walking but the difference was gone (no difference/reduced to insignificant level) in the dual task walking due to the increase in step time CV in the healthy group. The cognitive performance (accuracy rate, reaction time) showed no between-group difference if tested in the single task condition. The group difference was shown in composite score under the dual calculation walking task. These results suggested that the dual task paradigm sharpened the cognitive test and step length CV and saturated the step time CV for early-stage PD patients. Furthermore, the results suggested that, in the PD group, when the focus was prioritized on walking, group differences in walking parameters were gone (no difference/reduced to insignificant level) with a lower response accuracy rate. In contrast, when the focus was prioritized on the cognitive task, the between-group difference on walking was gone, with no detriment on cognitive tasks.
The walking speed for a single task was less in the PD group compared to the control group, regardless of single or dual task conditions. Past studies showed that the speed of a single walking task was affected by disease, age, test environment, and related gait parameters [41]. The slower walking speed in the PD group was shown by a shorter step length but not the step time [42]. This finding was consistent with previous studies, which reported that slow movement in PD patients was related to reductions in speed and step length [12,41,43]. The patients in our study were relatively early-stage patients whose disease duration was around 5.25 years. Our results showed that, even in the early stage of PD, walking speed significantly declined, mainly due to the decline in step length. This was in accordance with previous studies. Short step length could be related to the reduced balance ability, in that people with impaired balance usually had short step length, according to the reports [44]. Our study showed that the single limb support ability that was reduced in the PD group provided evidence that the decline in walking speed in the PD group was related to balance function rather than dual-task-related detriments.
Some previous studies suggested that the variability in walking was a significant feature in PD patients [45]. Our study showed that the PD group had more CV in step time but not step length in single walking if tested in the single task condition. The increased step time CV in the PD group was attributed to the declined automaticity [46]. However, the group difference of step time CV was gone in the dual walking condition. A closer look into the data showed that this was caused by an increase in step time CV in the control group in the dual task condition and, possibly, resulted in the celling effect. Dual task walking has been suggested to trigger the automaticity of gait [47]. However, it might still require some subconscious resources, such as cerebellar-related gait coordination control, to regulate the step time [48]. The dual task walking might occupy these resources and increased step time CV in the control group, whereas these resources had already been occupied during single walking in the PD group.
The performance of dual task walking has been suggested to show the ability of walking automation [49]. In our study, we employed three types of cognitive task, spatial memory, visual Stroop, and calculation tasks, as the dual task paradigms. Both groups showed significant decreases in walking speed and step length under all three types of dual task walking conditions, and the step time was insensitive to different conditions. In general, visual Stroop tests are included in executive function tasks and correlate with the functioning of frontal regions [50]. Compared to the visual Stroop task, spatial memory engages different visual selection, both of which are required in normal attention processing [51]. In the study of Ambrosini et al., they found that participants with stronger resting-state-related activity in the left prefrontal region were better able to solve spatial tasks than the visual Stroop task [52]. However, evoked potentials in the left temporal region reduced during arithmetic tasks [53]. According to previous studies, the spatial memory task requires short-term memory, memory encoding, and retrieval processes [54], and the calculation task requires working memory and performing mental manipulation [55]. These different tasks were considered to affect the extent of cognitive performance, and different levels of difficulties will also cause different levels of interference [56]. Further studies are required for the detailed mechanism. In our study, a possible reason that all three types of dual walking paradigms had similar effects on walking parameters might be that the cognitive tasks employed were related to the executive function. No previous research has compared the walking performance of the Parkinson’s disease group and the healthy group on dual spatial memory or dual visual Stroop tasks. Wild et al. [57] compared walking with an executive-function-related calculation task, and non-related phoneme monitoring and story content comprehension. They showed that PD patients’ walking speed significantly slowed down only in the calculation conditions, suggesting that the executive function task was more sensitive than the non-executive function task in detecting walking deficits in PD patients.
In terms of cognitive variables, the results of our study showed no group difference in the accuracy or reaction time in single spatial memory, Stroop task, calculation task, and dual task if no prioritization was assigned. In the single task condition, both the control and the PD group had at least 90% accuracy. There was also no significant group difference in education level or Montreal Cognitive Assessment. Our results supported that the patients in the PD group had no obvious cognitive functional decline. Researchers suggested that cognitive dysfunction is independent of motor disability [58]. Wild et al., reported non-significant results in the correct number of single and dual consecutive minus seven calculation tasks in a healthy and PD group [57]. Our study showed that if a composite score was employed in a dual task paradigm, the group difference could be shown in a dual calculation task. This suggested that the dual task paradigm using a composite score sharpened the cognitive test for early-stage PD patients. Fitts et al., proposed a speed–accuracy phenomenon [59]; that is, measurement of the single parameters might cause variability and decrease the sensitivity of the test. The composite score of speed and accuracy could overcome the speed–accuracy phenomenon and could be a sensitive cognitive indicator, especially for early-stage PD.
Parkinson’s disease (PD) can be classified into different subtypes, such as PIGD, tremor dominant, and indeterminate [60]. These subtypes are classified according to their crucial feature of locomotor functions, which affected their risk of falls [61]. A recent study conducted by Onder et al., found that the completion time of a time-up-and-go task (TUG) under a cognitive dual task condition was positively correlated with the UPDRS motor scores and FOG scores [62]. Therefore, it is reasonable to suspect that the results of a cognitive–walking test would be influenced by different subtypes of PD patients. However, the subtypes did not influence the results of our study. This may be due to the fact that all the patients enrolled in our study were early-stage PIGD subtypes. A detailed discussion of the influence of subtypes is suggested in a future study with a different design.
The results of our study showed that with the task priority assigned to either walking or cognitive tasks, the between-group difference in walking performance disappeared. Previous studies reported that a gait prioritization strategy could ameliorate gait deficits immediately [63,64] and after short-term training [65]. Our study further showed that, in early-stage PIGD patients, prioritizing attention diminishes the difference between PD and control groups. This could be explained by the task prioritization ability not being impaired in PD patients. Yogev-Seligmann et al., studied PD patients with advanced motor symptoms and found the task prioritization abilities were similar to non-PD controls. They suggested that PD patients without significant cognitive impairment could utilize their cognitive resources in the same manner as healthy comparisons [66]. Therefore, prioritizing attention to gait, or posture-first strategy, could be used clinically to overcome gait deficits but is not appropriate in discriminating gait deficits from PD to non-PD groups. While assigning task priority to walking, the PD group showed lower response accuracy than the PD group. The phenomenon could be explained by the capacity sharing model that PD subjects had limited total capacity to allocate attention to the secondary task, leading to a decline in the secondary task. On the contrary, when priority was assigned to cognitive tasks, the group differences in both walking and cognitive performance were insignificant and the walking performance was worse than that while priority was assigned to walking. This phenomenon suggests that assigning priority to cognitive is inappropriate for both PD and non-PD people.
Our approach has some inherent potential limitations. First, the PD patients enrolled in the study had the PIGD subtype and were in the early stage, so the results could not be inferred for other subtypes or different stages (ex. preclinical or advanced stage). Whether the dual cognitive–walking paradigm is essential to distinguish preclinical PD patients requires further study. Second, patients with PD were evaluated under the clinical “ON” state; whether the drug withdrawal state has a similar impact remains to be investigated. Third, patients with PD are prone to fatigue [67]. Although this study could not fully control the fatigue factors, rest periods were given during the test, and all subjects had the same test sequence in each assessment so that the test results could be compared at different times. Thus, we believe that the risk of bias was small.

5. Conclusions

In conclusion, our study showed that gait performance in the single walking task and the dual task can distinguish the healthy group from the early-stage Parkinson’s disease group. The dual task paradigm, considering the speed–accuracy trade-off, could sharpen the cognitive test and detect the cognitive deficits in early-stage PD patients. Moreover, the task priority assignment might not be recommended while testing gait deficits for early-stage PD patients.

Author Contributions

Conceptualization, Y.-J.C.; Data curation, I.-I.L., W.-D.C. and H.-C.C.; Formal analysis, Y.-P.L., I.-I.L. and W.-D.C.; Funding acquisition, Y.-J.C.; Methodology, Y.-J.C.; Project administration, Y.-J.C.; Resources, R.-S.C. and C.-S.L.; Supervision, R.-S.C. and C.-S.L.; Writing—original draft, Y.-P.L. and Y.-J.C.; Writing—review and editing, Y.-P.L. and Y.-J.C. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan (Grant no. CMRPD1M0231 and BMRP610), and the National Science and Technology Council, Taiwan (Grant no. 111-2221-E-182-014).

Institutional Review Board Statement

The protocol of this study was approved by the Research Ethics Committee of the Chang Gung Medical Foundation in accordance with the Helsinki Declaration.

Informed Consent Statement

All participants gave written informed consent.

Data Availability Statement

The data presented in this study are available on request from the corresponding author.

Acknowledgments

Special thanks to the Neuroscience Research Center of Chang Gung Memorial Hospital, Linkou, and Ying-Zu Huang, a neurologist at Chang Gung Medical Foundation.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Beitz, J.M. Parkinson’s disease: A review. Front. Biosci. 2014, 6, 65–74. [Google Scholar] [CrossRef] [PubMed]
  2. Tysnes, O.B.; Storstein, A. Epidemiology of Parkinson’s disease. J. Neural. Transm. 2017, 124, 901–905. [Google Scholar] [CrossRef] [PubMed]
  3. de Lau, L.M.; Breteler, M.M. Epidemiology of Parkinson’s disease. Lancet Neurol. 2006, 5, 525–535. [Google Scholar] [CrossRef] [PubMed]
  4. Foltynie, T.; Brayne, C.E.; Robbins, T.W.; Barker, R.A. The cognitive ability of an incident cohort of Parkinson’s patients in the UK. The CamPaIGN study. Brain 2004, 127, 550–560. [Google Scholar] [CrossRef] [PubMed]
  5. Zgaljardic, D.J.; Borod, J.C.; Foldi, N.S.; Mattis, P. A review of the cognitive and behavioral sequelae of Parkinson’s disease: Relationship to frontostriatal circuitry. Cogn. Behav. Neurol. 2003, 16, 193–210. [Google Scholar] [CrossRef] [PubMed]
  6. Lima, M.M.; Martins, E.F.; Delattre, A.M.; Proenca, M.B.; Mori, M.A.; Carabelli, B.; Ferraz, A.C. Motor and non-motor features of Parkinson’s disease-a review of clinical and experimental studies. CNS Neurol. Disord. Drug Targets 2012, 11, 439–449. [Google Scholar] [CrossRef] [PubMed]
  7. Hiura, M.; Nemoto, H.; Nishisaka, K.; Higashi, K.; Katoh, T. The association between walking ability and falls in elderly Japanese living in the community using a path analysis. J. Community Health 2012, 37, 957–962. [Google Scholar] [CrossRef] [PubMed]
  8. Nilsson, M.H.; Hariz, G.M.; Iwarsson, S.; Hagell, P. Walking ability is a major contributor to fear of falling in people with Parkinson’s disease: Implications for rehabilitation. Park. Dis. 2012, 2012, 713236. [Google Scholar] [CrossRef] [PubMed]
  9. Yogev-Seligmann, G.; Hausdorff, J.M.; Giladi, N. The role of executive function and attention in gait. Mov. Disord. 2008, 23, 329–342; quiz 472. [Google Scholar] [CrossRef]
  10. Kimura, N.; van Deursen, R. The Effect Of Visual Dual-Tasking Interference On Walking In Healthy Young Adults. Gait Posture 2020, 79, 80–85. [Google Scholar] [CrossRef] [PubMed]
  11. Chawla, H.; Walia, S.; Behari, M.; Noohu, M.M. Effect of type of secondary task on cued gait on people with idiopathic Parkinson’s disease. J. Neurosci. Rural. Pract. 2014, 5, 18–23. [Google Scholar] [CrossRef] [PubMed]
  12. Kelly, V.E.; Eusterbrock, A.J.; Shumway-Cook, A. A review of dual-task walking deficits in people with Parkinson’s disease: Motor and cognitive contributions, mechanisms, and clinical implications. Park. Dis. 2012, 2012, 918719. [Google Scholar] [CrossRef] [PubMed]
  13. Lord, S.; Baker, K.; Nieuwboer, A.; Burn, D.; Rochester, L. Gait variability in Parkinson’s disease: An indicator of non-dopaminergic contributors to gait dysfunction? J. Neurol. 2011, 258, 566–572. [Google Scholar] [CrossRef] [PubMed]
  14. Yogev-Seligmann, G.; Giladi, N.; Gruendlinger, L.; Hausdorff, J.M. The contribution of postural control and bilateral coordination to the impact of dual tasking on gait. Exp. Brain Res. 2013, 226, 81–93. [Google Scholar] [CrossRef] [PubMed]
  15. Zirek, E.; Ersoz Huseyinsinoglu, B.; Tufekcioglu, Z.; Bilgic, B.; Hanagasi, H. Which cognitive dual-task walking causes most interference on the Timed Up and Go test in Parkinson’s disease: A controlled study. Neurol. Sci. 2018, 39, 2151–2157. [Google Scholar] [CrossRef]
  16. Johansson, H.; Ekman, U.; Rennie, L.; Peterson, D.S.; Leavy, B.; Franzén, E. Dual-Task Effects During a Motor-Cognitive Task in Parkinson’s Disease: Patterns of Prioritization and the Influence of Cognitive Status. Neurorehabil. Neural. Repair 2021, 35, 356–366. [Google Scholar] [CrossRef]
  17. Clark, D.J. Automaticity of walking: Functional significance, mechanisms, measurement and rehabilitation strategies. Front. Hum. Neurosci. 2015, 9, 246. [Google Scholar] [CrossRef] [PubMed]
  18. Poldrack, R.A.; Sabb, F.W.; Foerde, K.; Tom, S.M.; Asarnow, R.F.; Bookheimer, S.Y.; Knowlton, B.J. The neural correlates of motor skill automaticity. J. Neurosci. 2005, 25, 5356–5364. [Google Scholar] [CrossRef]
  19. Yogev, G.; Giladi, N.; Peretz, C.; Springer, S.; Simon, E.S.; Hausdorff, J.M. Dual tasking, gait rhythmicity, and Parkinson’s disease: Which aspects of gait are attention demanding? Eur. J. Neurosci. 2005, 22, 1248–1256. [Google Scholar] [CrossRef]
  20. Hausdorff, J.M.; Schweiger, A.; Herman, T.; Yogev-Seligmann, G.; Giladi, N. Dual-task decrements in gait: Contributing factors among healthy older adults. J. Gerontol. A Biol. Sci. Med. Sci. 2008, 63, 1335–1343. [Google Scholar] [CrossRef]
  21. O’Shea, S.; Morris, M.E.; Iansek, R. Dual task interference during gait in people with Parkinson disease: Effects of motor versus cognitive secondary tasks. Phys. Ther. 2002, 82, 888–897. [Google Scholar] [CrossRef] [PubMed]
  22. Pashler, H. Dual-task interference in simple tasks: Data and theory. Psychol. Bull. 1994, 116, 220–244. [Google Scholar] [CrossRef] [PubMed]
  23. Ruthruff, E.; Pashler, H.E.; Klaassen, A. Processing bottlenecks in dual-task performance: Structural limitation or strategic postponement? Psychon. Bull. Rev. 2001, 8, 73–80. [Google Scholar] [CrossRef]
  24. Salazar, R.D.; Ren, X.; Ellis, T.D.; Toraif, N.; Barthelemy, O.J.; Neargarder, S.; Cronin-Golomb, A. Dual tasking in Parkinson’s disease: Cognitive consequences while walking. Neuropsychology 2017, 31, 613–623. [Google Scholar] [CrossRef] [PubMed]
  25. Plotnik, M.; Dagan, Y.; Gurevich, T.; Giladi, N.; Hausdorff, J.M. Effects of cognitive function on gait and dual tasking abilities in patients with Parkinson’s disease suffering from motor response fluctuations. Exp. Brain Res. 2011, 208, 169–179. [Google Scholar] [CrossRef] [PubMed]
  26. Giladi, N.; McDermott, M.P.; Fahn, S.; Przedborski, S.; Jankovic, J.; Stern, M.; Tanner, C. Freezing of gait in PD: Prospective assessment in the DATATOP cohort. Neurology 2001, 56, 1712–1721. [Google Scholar] [CrossRef] [PubMed]
  27. Muslimović, D.; Schmand, B.; Speelman, J.D.; de Haan, R.J. Course of cognitive decline in Parkinson’s disease: A meta-analysis. J. Int. Neuropsychol. Soc. 2007, 13, 920–932. [Google Scholar] [CrossRef]
  28. Watson, G.S.; Leverenz, J.B. Profile of cognitive impairment in Parkinson’s disease. Brain Pathol. 2010, 20, 640–645. [Google Scholar] [CrossRef] [PubMed]
  29. Springer, S.; Giladi, N.; Peretz, C.; Yogev, G.; Simon, E.S.; Hausdorff, J.M. Dual-tasking effects on gait variability: The role of aging, falls, and executive function. Mov. Disord. 2006, 21, 950–957. [Google Scholar] [CrossRef] [PubMed]
  30. Gauggel, S.; Rieger, M.; Feghoff, T.A. Inhibition of ongoing responses in patients with Parkinson’s disease. J. Neurol. Neurosurg. Psychiatry 2004, 75, 539–544. [Google Scholar] [CrossRef] [PubMed]
  31. Pillon, B.; Deweer, B.; Vidailhet, M.; Bonnet, A.M.; Hahn-Barma, V.; Dubois, B. Is impaired memory for spatial location in Parkinson’s disease domain specific or dependent on ‘strategic’ processes? Neuropsychologia 1998, 36, 1–9. [Google Scholar] [CrossRef] [PubMed]
  32. Small, G.H.; Neptune, R.R. Task-prioritization and balance recovery strategies used by young healthy adults during dual-task walking. Gait. Posture 2022, 95, 115–120. [Google Scholar] [CrossRef]
  33. Bloem, B.R.; Grimbergen, Y.A.; van Dijk, J.G.; Munneke, M. The “posture second” strategy: A review of wrong priorities in Parkinson’s disease. J. Neurol. Sci. 2006, 248, 196–204. [Google Scholar] [CrossRef]
  34. Longhurst, J.K.; Rider, J.V.; Cummings, J.L.; John, S.E.; Poston, B.; Held Bradford, E.C.; Landers, M.R. A Novel Way of Measuring Dual-Task Interference: The Reliability and Construct Validity of the Dual-Task Effect Battery in Neurodegenerative Disease. Neurorehabil. Neural. Repair 2022, 36, 346–359. [Google Scholar] [CrossRef] [PubMed]
  35. Yogev-Seligmann, G.; Rotem-Galili, Y.; Mirelman, A.; Dickstein, R.; Giladi, N.; Hausdorff, J.M. How does explicit prioritization alter walking during dual-task performance? Effects of age and sex on gait speed and variability. Phys. Ther. 2010, 90, 177–186. [Google Scholar] [CrossRef] [PubMed]
  36. Nazem, S.; Siderowf, A.D.; Duda, J.E.; Have, T.T.; Colcher, A.; Horn, S.S.; Moberg, P.J.; Wilkinson, J.R.; Hurtig, H.I.; Stern, M.B.; et al. Montreal cognitive assessment performance in patients with Parkinson’s disease with “normal” global cognition according to mini-mental state examination score. J. Am. Geriatr. Soc. 2009, 57, 304–308. [Google Scholar] [CrossRef] [PubMed]
  37. Nasreddine, Z.S.; Phillips, N.A.; Bedirian, V.; Charbonneau, S.; Whitehead, V.; Collin, I.; Cummings, J.L.; Chertkow, H. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. J. Am. Geriatr. Soc. 2005, 53, 695–699. [Google Scholar] [CrossRef]
  38. Zadikoff, C.; Fox, S.H.; Tang-Wai, D.F.; Thomsen, T.; de Bie, R.M.; Wadia, P.; Miyasaki, J.; Duff-Canning, S.; Lang, A.E.; Marras, C. A comparison of the mini mental state exam to the Montreal cognitive assessment in identifying cognitive deficits in Parkinson’s disease. Mov. Disord. 2008, 23, 297–299. [Google Scholar] [CrossRef]
  39. Walton, C.C.; Shine, J.M.; Mowszowski, L.; Gilat, M.; Hall, J.M.; O’Callaghan, C.; Naismith, S.L.; Lewis, S.J. Impaired cognitive control in Parkinson’s disease patients with freezing of gait in response to cognitive load. J. Neural. Transm. 2015, 122, 653–660. [Google Scholar] [CrossRef]
  40. Brauer, S.G.; Morris, M.E. Can people with Parkinson’s disease improve dual tasking when walking? Gait Posture 2010, 31, 229–233. [Google Scholar] [CrossRef]
  41. Zanardi, A.P.J.; da Silva, E.S.; Costa, R.R.; Passos-Monteiro, E.; Dos Santos, I.O.; Kruel, L.F.M.; Peyré-Tartaruga, L.A. Gait parameters of Parkinson’s disease compared with healthy controls: A systematic review and meta-analysis. Sci. Rep. 2021, 11, 752. [Google Scholar] [CrossRef] [PubMed]
  42. Welzel, J.; Wendtland, D.; Warmerdam, E.; Romijnders, R.; Elshehabi, M.; Geritz, J.; Berg, D.; Hansen, C.; Maetzler, W. Step Length Is a Promising Progression Marker in Parkinson’s Disease. Sensors 2021, 21, 2292. [Google Scholar] [CrossRef] [PubMed]
  43. Lai, Y.R.; Lien, C.Y.; Huang, C.C.; Lin, W.C.; Chen, Y.S.; Yu, C.C.; Cheng, B.C.; Kung, C.T.; Kung, C.F.; Chiang, Y.F.; et al. Clinical Disease Severity Mediates the Relationship between Stride Length and Speed and the Risk of Falling in Parkinson’s Disease. J. Pers. Med. 2022, 12, 192. [Google Scholar] [CrossRef] [PubMed]
  44. Gabell, A.; Nayak, U.S. The effect of age on variability in gait. J. Gerontol. 1984, 39, 662–666. [Google Scholar] [CrossRef]
  45. Hausdorff, J.M.; Cudkowicz, M.E.; Firtion, R.; Wei, J.Y.; Goldberger, A.L. Gait variability and basal ganglia disorders: Stride-to-stride variations of gait cycle timing in Parkinson’s disease and Huntington’s disease. Mov. Disord. 1998, 13, 428–437. [Google Scholar] [CrossRef]
  46. Hirata, K.; Hattori, T.; Kina, S.; Chen, Q.; Ohara, M.; Yokota, T. Striatal Dopamine Denervation Impairs Gait Automaticity in Drug-Naïve Parkinson’s Disease Patients. Mov. Disord. 2020, 35, 1037–1045. [Google Scholar] [CrossRef]
  47. Collett, J.; Fleming, M.K.; Meester, D.; Al-Yahya, E.; Wade, D.T.; Dennis, A.; Salvan, P.; Meaney, A.; Cockburn, J.; Dawes, J.; et al. Dual-task walking and automaticity after Stroke: Insights from a secondary analysis and imaging sub-study of a randomised controlled trial. Clin. Rehabil. 2021, 35, 1599–1610. [Google Scholar] [CrossRef]
  48. Palliyath, S.; Hallett, M.; Thomas, S.L.; Lebiedowska, M.K. Gait in patients with cerebellar ataxia. Mov. Disord. 1998, 13, 958–964. [Google Scholar] [CrossRef]
  49. Wu, T.; Hallett, M. Neural correlates of dual task performance in patients with Parkinson’s disease. J. Neurol. Neurosurg. Psychiatry 2008, 79, 760–766. [Google Scholar] [CrossRef]
  50. Martin-Signes, M.; Paz-Alonso, P.M.; Chica, A.B. Connectivity of Frontoparietal Regions Reveals Executive Attention and Consciousness Interactions. Cereb Cortex 2019, 29, 4539–4550. [Google Scholar] [CrossRef]
  51. Chajut, E.; Schupak, A.; Algom, D. Are spatial and dimensional attention separate? evidence from Posner, Stroop, and Eriksen tasks. Mem. Cognit. 2009, 37, 924–934. [Google Scholar] [CrossRef]
  52. Ambrosini, E.; Vallesi, A. Domain-general Stroop Performance and Hemispheric Asymmetries: A Resting-state EEG Study. J. Cogn. Neurosci. 2017, 29, 769–779. [Google Scholar] [CrossRef] [PubMed]
  53. Papanicolaou, A.C.; Schmidt, A.L.; Moore, B.D.; Eisenberg, H.M. Cerebral activation patterns in an arithmetic and a visuospatial processing task. Int. J. Neurosci. 1983, 20, 283–287. [Google Scholar] [CrossRef]
  54. Nolde, S.F.; Johnson, M.K.; D’Esposito, M. Left prefrontal activation during episodic remembering: An event-related fMRI study. Neuroreport 1998, 9, 3509–3514. [Google Scholar] [CrossRef]
  55. Kazui, H.; Kitagaki, H.; Mori, E. Cortical activation during retrieval of arithmetical facts and actual calculation: A functional magnetic resonance imaging study. Psychiatry Clin. Neurosci. 2000, 54, 479–485. [Google Scholar] [CrossRef]
  56. Sanchez-Gomez, J.; Villafaina, S.; Dominguez-Munoz, F.J.; Leon-Llamas, J.L.; Murillo-Garcia, A.; Gusi, N. Comparison between the Impacts of Memory and Arithmetic-Based Dual Tasks on Physical Performance in Women with Fibromyalgia. Biology 2022, 11, 947. [Google Scholar] [CrossRef]
  57. Wild, L.B.; de Lima, D.B.; Balardin, J.B.; Rizzi, L.; Giacobbo, B.L.; Oliveira, H.B.; de Lima, A., II; Peyré-Tartaruga, L.A.; Rieder, C.R.; Bromberg, E. Characterization of cognitive and motor performance during dual-tasking in healthy older adults and patients with Parkinson’s disease. J. Neurol. 2013, 260, 580–589. [Google Scholar] [CrossRef]
  58. Cooper, J.A.; Sagar, H.J.; Jordan, N.; Harvey, N.S.; Sullivan, E.V. Cognitive impairment in early, untreated Parkinson’s disease and its relationship to motor disability. Brain 1991, 114, 2095–2122. [Google Scholar] [CrossRef] [PubMed]
  59. Fitts, P.M. The information capacity of the human motor system in controlling the amplitude of movement. J. Exp. Psychol. 1954, 47, 381–391. [Google Scholar] [CrossRef] [PubMed]
  60. Burn, D.J.; Rowan, E.N.; Allan, L.M.; Molloy, S.; O’Brien, J.T.; McKeith, I.G. Motor subtype and cognitive decline in Parkinson’s disease, Parkinson’s disease with dementia, and dementia with Lewy bodies. J. Neurol. Neurosurg. Psychiatry 2006, 77, 585–589. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  61. Jankovic, J.; Kapadia, A.S. Functional decline in Parkinson disease. Arch. Neurol. 2001, 58, 1611–1615. [Google Scholar] [CrossRef] [PubMed]
  62. Onder, H.; Ozyurek, O. The impact of distinct cognitive dual-tasks on gait in Parkinson’s disease and the associations with the clinical features of Parkinson’s disease. Neurol. Sci. 2021, 42, 2775–2783. [Google Scholar] [CrossRef] [PubMed]
  63. Baker, K.; Rochester, L.; Nieuwboer, A. The immediate effect of attentional, auditory, and a combined cue strategy on gait during single and dual tasks in Parkinson’s disease. Arch. Phys. Med. Rehabil. 2007, 88, 1593–1600. [Google Scholar] [CrossRef] [PubMed]
  64. Canning, C.G. The effect of directing attention during walking under dual-task conditions in Parkinson’s disease. Park. Relat. Disord. 2005, 11, 95–99. [Google Scholar] [CrossRef]
  65. Fok, P.; Farrell, M.; McMeeken, J. Prioritizing gait in dual-task conditions in people with Parkinson’s. Hum. Mov. Sci. 2010, 29, 831–842. [Google Scholar] [CrossRef] [PubMed]
  66. Yogev-Seligmann, G.; Rotem-Galili, Y.; Dickstein, R.; Giladi, N.; Hausdorff, J.M. Effects of explicit prioritization on dual task walking in patients with Parkinson’s disease. Gait Posture 2012, 35, 641–646. [Google Scholar] [CrossRef] [PubMed]
  67. Siciliano, M.; Trojano, L.; Santangelo, G.; De Micco, R.; Tedeschi, G.; Tessitore, A. Fatigue in Parkinson’s disease: A systematic review and meta-analysis. Mov. Disord. 2018, 33, 1712–1723. [Google Scholar] [CrossRef]
Healthcare 11 00567 g001 550
Figure 1. Experimental environment settings.
Figure 1. Experimental environment settings.
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Figure 2. Flowchart.
Figure 2. Flowchart.
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Healthcare 11 00567 g003a 550Healthcare 11 00567 g003b 550
Figure 3. The walking performance includes (a) Walking speed, (b) Step length, (c) Step time, (d) CV Step length, and (e) CV Step time, under the group single and dual tasks between healthy and PD group. ** p< 0.05.
Figure 3. The walking performance includes (a) Walking speed, (b) Step length, (c) Step time, (d) CV Step length, and (e) CV Step time, under the group single and dual tasks between healthy and PD group. ** p< 0.05.
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Figure 4. The cognitive performance includes (a) Response accuracy, (b) Reaction time, and (c) composite score, under the group single and dual tasks between healthy and PD group. ** p < 0.05.
Figure 4. The cognitive performance includes (a) Response accuracy, (b) Reaction time, and (c) composite score, under the group single and dual tasks between healthy and PD group. ** p < 0.05.
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Table
Table 1. Characteristics of the 31 patients with or without Parkinson’s.
Table 1. Characteristics of the 31 patients with or without Parkinson’s.
VariableHealthy Group
(n = 15)		PD Group
(n = 16)		p-Value
Male11 (73.33%)11 (68.75%)0.779
Female4 (26.67%)5 (31.25%)
Age (years)60.93 ± 2.8763.13 ± 5.750.241
Height (cm)164.33 ± 8.09163.59 ± 8.220.968
Weight (kg)66.23 ± 10.8564.34 ± 9.860.579
Left Foot Length (cm)96.40 ± 5.1194.50 ± 4.950.405
Right Foot Length (cm)96.37 ± 5.1394.59 ± 4.710.394
Education Level (years)12.93 ± 3.2613.06 ± 3.490.777
Montreal Cognitive Assessment Score27.80 ± 1.4227.81 ± 1.280.855
(Mean ± standard deviation) or number (%).
Table
Table 2. Clinical characteristics of Parkinson’s group.
Table 2. Clinical characteristics of Parkinson’s group.
PD Group No.12345678910111213141516
GenderMMMFMFFMMFMMMMMF
Age (yrs)63637163646164607458585754656174
Height (cm)161169169150168148155165155161172172170163176163
Weight (kg)75686362805157625855806573627246
Left Leg Length (cm)9397978893859194889210299989510298
Right Leg Length (cm)9297988993869294879210298989410199
Education Level (yrs)61414121614616141218141616129
MoCA26282628262827262828292928293029
Modified H&Y2.51.531.51.52.51.52.52.51.52.52.51.5112
Disease Duration (yrs)43657371162464439
Levodopa Equivalent Dosage (mg/day)600500770500600360850750710460400700500360180620
Table
Table 3. The dual tasks in the designated task priority.
Table 3. The dual tasks in the designated task priority.
Control Group
(n = 15)		PD Group
(n = 16)		p-Value
Focus on Walking Task
Walking Speed (cm/s)127.93 ± 14.54120.39 ± 27.900.22
Step Length (cm)63.98 ± 5.4362.49 ± 10.990.519
Step Time(s)0.50 ± 0.040.53 ± 0.060.317
CV Step Length (%)4.12 ± 1.934.78 ± 2.510.401
CV Step Time (%)4.43 ± 1.39%6.25 ± 2.540.093
Response Accuracy (%)95.33 ± 13.5672.50 ± 32.510.037
Reaction Time (ms)1027.29 ± 243.03957.83 ± 347.680.651
Composite Score9.86 ± 3.158.21 ± 4.800.156
Focus on Cognitive Task
Walking Speed (cm/s)106.77 ± 17.3893.60 ± 17.550.106
Step Length (cm)58.26 ± 6.3852.19 ± 8.490.081
Step Time(s)0.55 ± 0.050.56 ± 0.050.561
CV Step Length (%)3.69 ± 2.244.29 ± 1.390.121
CV Step Time (%)4.53 ± 1.05%7.02 ± 3.08%0.053
Response Accuracy (%)100.00 ± 0.0095.00 ± 14.140.171
Reaction Time (ms)1171.15 ± 387.491033.89 ± 290.910.366
Composite Score9.52 ± 3.399.94 ± 3.080.438
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Lin, Y.-P.; Lin, I.-I.; Chiou, W.-D.; Chang, H.-C.; Chen, R.-S.; Lu, C.-S.; Chang, Y.-J. The Executive-Function-Related Cognitive–Motor Dual Task Walking Performance and Task Prioritizing Effect on People with Parkinson’s Disease. Healthcare 2023, 11, 567. https://doi.org/10.3390/healthcare11040567

AMA Style

Lin Y-P, Lin I-I, Chiou W-D, Chang H-C, Chen R-S, Lu C-S, Chang Y-J. The Executive-Function-Related Cognitive–Motor Dual Task Walking Performance and Task Prioritizing Effect on People with Parkinson’s Disease. Healthcare. 2023; 11(4):567. https://doi.org/10.3390/healthcare11040567

Chicago/Turabian Style

Lin, Yen-Po, I-I Lin, Wei-Da Chiou, Hsiu-Chen Chang, Rou-Shayn Chen, Chin-Song Lu, and Ya-Ju Chang. 2023. "The Executive-Function-Related Cognitive–Motor Dual Task Walking Performance and Task Prioritizing Effect on People with Parkinson’s Disease" Healthcare 11, no. 4: 567. https://doi.org/10.3390/healthcare11040567

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