Dementia and Neurocognitive Disorders (대한치매학회지)

Korean Dementia Association (대한치매학회)
권호 표지
DOI QR코드

DOI QR Code

Gait Patterns in Parkinson's Disease with or without Cognitive Impairment

  • Kim, Seung Min (Department of Neurology, Veterans Health Service Medical Center) ;
  • Kim, Dae Hyun (Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center) ;
  • Yang, YoungSoon (Department of Neurology, Veterans Health Service Medical Center) ;
  • Ha, Sang Won (Department of Neurology, Veterans Health Service Medical Center) ;
  • Han, Jeong Ho (Department of Neurology, Veterans Health Service Medical Center)
  • Received : 2018.06.15
  • Accepted : 2018.07.05
  • Published : 2018.06.30
⟨ Previous Next ⟩

Abstract

Background and Purpose: Cognitive and gait disturbance are common symptoms in Parkinson's disease (PD). Although the relationship between cognitive impairment and gait dysfunction in PD has been suggested, specific gait patterns according to cognition are not fully demonstrated yet. Therefore, the aim of this study was to investigate gait patterns in PD patients with or without cognitive impairment. Methods: We studied 86 patients at an average of 4.8 years after diagnosis of PD. Cognitive impairment was defined as scoring 1.5 standard deviation below age- and education-specific means on the Korean version of the Mini-Mental State Examination (K-MMSE). Three-dimensional gait analysis was conducted for all patients and quantified gait parameters of temporal-spatial data were used. Relationships among cognition, demographic characteristics, clinical features, and gait pattern were evaluated. Results: Cognitive impairment was observed in 41 (47.7%) patients. Compared to patients without cognitive impairment, patients with cognitive impairment displayed reduced gait speed, step length, and stride length. Among K-MMSE subcategories, "registration," "attention/calculation," and "visuospatial function" were significantly associated with speed, step length, and stride length. However, age, disease duration, Hoehn-Yahr (HY) stage, or Unified Parkinson's Disease Rating Scale (UPDRS) motor score was not significantly related to any gait analysis parameter. Conclusions: Our present study shows that cognitive impairment is associated with slow and short-stepped gait regardless of HY stage or UPDRS motor score, suggesting that cognitive impairment may serve as a surrogate marker of gait disturbance or fall in PD patients.

Keywords

Acknowledgement

Supported by : VHS Medical Center

References

  1. Morris ME, Iansek R, Matyas TA, Summers JJ. The pathogenesis of gait hypokinesia in Parkinson's disease. Brain 1994;117:1169-1181. https://doi.org/10.1093/brain/117.5.1169
  2. Blin O, Ferrandez AM, Serratrice G. Quantitative analysis of gait in Parkinson patients: increased variability of stride length. J Neurol Sci 1990;98:91-97. https://doi.org/10.1016/0022-510X(90)90184-O
  3. Allen NE, Schwarzel AK, Canning CG. Recurrent falls in Parkinson's disease: a systematic review. Parkinsons Dis 2013;2013:906274.
  4. Amboni M, Barone P, Hausdorff JM. Cognitive contributions to gait and falls: evidence and implications. Mov Disord 2013;28:1520-1533. https://doi.org/10.1002/mds.25674
  5. van Iersel MB, Hoefsloot W, Munneke M, Bloem BR, Olde Rikkert MG. Systematic review of quantitative clinical gait analysis in patients with dementia. Z Gerontol Geriatr 2004;37:27-32. https://doi.org/10.1007/s00391-004-0176-7
  6. Abe N, Mori E. Cognitive impairment in patients with Parkinson disease. Brain Nerve 2012;64:321-331.
  7. Williams-Gray CH, Evans JR, Goris A, Foltynie T, Ban M, Robbins TW, et al. The distinct cognitive syndromes of Parkinson's disease: 5 year follow-up of the CamPaIGN cohort. Brain 2009;132:2958-2969. https://doi.org/10.1093/brain/awp245
  8. Hausdorff JM, Doniger GM, Springer S, Yogev G, Simon ES, Giladi N. A common cognitive profile in elderly fallers and in patients with Parkinson's disease: the prominence of impaired executive function and attention. Exp Aging Res 2006;32:411-429. https://doi.org/10.1080/03610730600875817
  9. Mak MK, Wong A, Pang MY. Impaired executive function can predict recurrent falls in Parkinson's disease. Arch Phys Med Rehabil 2014;95:2390-2395. https://doi.org/10.1016/j.apmr.2014.08.006
  10. Maetzler W, Liepelt I, Berg D. Progression of Parkinson's disease in the clinical phase: potential markers. Lancet Neurol 2009;8:1158-1171. https://doi.org/10.1016/S1474-4422(09)70291-1
  11. Schache AG, Baker R, Vaughan CL. Differences in lower limb transverse plane joint moments during gait when expressed in two alternative reference frames. J Biomech 2007;40:9-19. https://doi.org/10.1016/j.jbiomech.2005.12.003
  12. Kang YW. A normative study of the Korean-Mini Mental State Examination (K-MMSE) in the elderly. Korean J Psychol Gen 2006;25:1-12.
  13. Yogev-Seligmann G, Hausdorff JM, Giladi N. The role of executive function and attention in gait. Mov Disord 2008;23:329-342. https://doi.org/10.1002/mds.21720
  14. Amboni M, Barone P, Iuppariello L, Lista I, Tranfaglia R, Fasano A, et al. Gait patterns in Parkinsonian patients with or without mild cognitive impairment. Mov Disord 2012;27:1536-1543. https://doi.org/10.1002/mds.25165
  15. Kelly VE, Johnson CO, McGough EL, Shumway-Cook A, Horak FB, Chung KA, et al. Association of cognitive domains with postural instability/gait disturbance in Parkinson's disease. Parkinsonism Relat Disord 2015;21:692-697. https://doi.org/10.1016/j.parkreldis.2015.04.002
  16. Verbaan D, Marinus J, Visser M, van Rooden SM, Stiggelbout AM, Middelkoop HA, et al. Cognitive impairment in Parkinson's disease. J Neurol Neurosurg Psychiatry 2007;78:1182-1187. https://doi.org/10.1136/jnnp.2006.112367
  17. Poletti M, Frosini D, Pagni C, Baldacci F, Nicoletti V, Tognoni G, et al. Mild cognitive impairment and cognitive-motor relationships in newly diagnosed drug-naive patients with Parkinson's disease. J Neurol Neurosurg Psychiatry 2012;83:601-606. https://doi.org/10.1136/jnnp-2011-301874
  18. Williams-Gray CH, Foltynie T, Brayne CE, Robbins TW, Barker RA. Evolution of cognitive dysfunction in an incident Parkinson's disease cohort. Brain 2007;130:1787-1798. https://doi.org/10.1093/brain/awm111
  19. Domellof ME, Elgh E, Forsgren L. The relation between cognition and motor dysfunction in drug-naive newly diagnosed patients with Parkinson's disease. Mov Disord 2011;26:2183-2189. https://doi.org/10.1002/mds.23814
  20. Braak H, Del Tredici K. Invited article: nervous system pathology in sporadic Parkinson disease. Neurology 2008;70:1916-1925. https://doi.org/10.1212/01.wnl.0000312279.49272.9f
  21. Kehagia AA, Barker RA, Robbins TW. Neuropsychological and clinical heterogeneity of cognitive impairment and dementia in patients with Parkinson's disease. Lancet Neurol 2010;9:1200-1213. https://doi.org/10.1016/S1474-4422(10)70212-X
  22. Blin O, Ferrandez AM, Pailhous J, Serratrice G. Dopa-sensitive and dopa-resistant gait parameters in Parkinson's disease. J Neurol Sci 1991;103:51-54. https://doi.org/10.1016/0022-510X(91)90283-D
  23. Rochester L, Baker K, Nieuwboer A, Burn D. Targeting dopa-sensitive and dopa-resistant gait dysfunction in Parkinson's disease: selective responses to internal and external cues. Mov Disord 2011;26:430-435. https://doi.org/10.1002/mds.23450
  24. Stolze H, Klebe S, Zechlin C, Baecker C, Friege L, Deuschl G. Falls in frequent neurological diseases--prevalence, risk factors and aetiology. J Neurol 2004;251:79-84. https://doi.org/10.1007/s00415-004-0276-8
  25. Mak MK. Reduced step length, not step length variability is central to gait hypokinesia in people with Parkinson's disease. Clin Neurol Neurosurg 2013;115:587-590. https://doi.org/10.1016/j.clineuro.2012.07.014
  26. Verghese J, Wang C, Lipton RB, Holtzer R, Xue X. Quantitative gait dysfunction and risk of cognitive decline and dementia. J Neurol Neurosurg Psychiatry 2007;78:929-935. https://doi.org/10.1136/jnnp.2006.106914
  27. Verghese J, Robbins M, Holtzer R, Zimmerman M, Wang C, Xue X, et al. Gait dysfunction in mild cognitive impairment syndromes. J Am Geriatr Soc 2008;56:1244-1251. https://doi.org/10.1111/j.1532-5415.2008.01758.x
  28. Lord S, Rochester L, Hetherington V, Allcock LM, Burn D. Executive dysfunction and attention contribute to gait interference in 'off' state Parkinson's disease. Gait Posture 2010;31:169-174. https://doi.org/10.1016/j.gaitpost.2009.09.019
  29. Hausdorff JM, Balash J, Giladi N. Effects of cognitive challenge on gait variability in patients with Parkinson's disease. J Geriatr Psychiatry Neurol 2003;16:53-58. https://doi.org/10.1177/0891988702250580
  30. Brauer SG, Woollacott MH, Lamont R, Clewett S, O'Sullivan J, Silburn P, et al. Single and dual task gait training in people with Parkinson's disease: a protocol for a randomised controlled trial. BMC Neurol 2011;11:90. https://doi.org/10.1186/1471-2377-11-90
  31. Almeida QJ, Lebold CA. Freezing of gait in Parkinson's disease: a perceptual cause for a motor impairment? J Neurol Neurosurg Psychiatry 2010;81:513-518. https://doi.org/10.1136/jnnp.2008.160580
  32. Cowie D, Limousin P, Peters A, Day BL. Insights into the neural control of locomotion from walking through doorways in Parkinson's disease. Neuropsychologia 2010;48:2750-2757. https://doi.org/10.1016/j.neuropsychologia.2010.05.022
  33. Rochester L, Hetherington V, Jones D, Nieuwboer A, Willems AM, Kwakkel G, et al. Attending to the task: interference effects of functional tasks on walking in Parkinson's disease and the roles of cognition, depression, fatigue, and balance. Arch Phys Med Rehabil 2004;85:1578-1585. https://doi.org/10.1016/j.apmr.2004.01.025
  34. van der Marck MA, Klok MP, Okun MS, Giladi N, Munneke M, Bloem BR, et al. Consensus-based clinical practice recommendations for the examination and management of falls in patients with Parkinson's disease. Parkinsonism Relat Disord 2014;20:360-369. https://doi.org/10.1016/j.parkreldis.2013.10.030
  35. Chung KA, Lobb BM, Nutt JG, Horak FB. Effects of a central cholinesterase inhibitor on reducing falls in Parkinson disease. Neurology 2010;75:1263-1269. https://doi.org/10.1212/WNL.0b013e3181f6128c
  36. Henderson EJ, Lord SR, Brodie MA, Gaunt DM, Lawrence AD, Close JC, et al. Rivastigmine for gait stability in patients with Parkinson's disease (ReSPonD): a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet Neurol 2016;15:249-258. https://doi.org/10.1016/S1474-4422(15)00389-0
  37. Kucinski A, Sarter M. Modeling Parkinson's disease falls associated with brainstem cholinergic systems decline. Behav Neurosci 2015;129:96-104. https://doi.org/10.1037/bne0000048
  38. Chou KL, Amick MM, Brandt J, Camicioli R, Frei K, Gitelman D, et al. A recommended scale for cognitive screening in clinical trials of Parkinson's disease. Mov Disord 2010;25:2501-2507. https://doi.org/10.1002/mds.23362

Cited by

  1. Goalkeeper Game: A New Assessment Tool for Prediction of Gait Performance Under Complex Condition in People With Parkinson's Disease vol.12, pp.None, 2020, https://doi.org/10.3389/fnagi.2020.00050
  2. Everyday tasks impair spatiotemporal variables of gait in older adults with Parkinson's disease vol.70, pp.None, 2018, https://doi.org/10.1016/j.humov.2020.102591
  3. The relationship between cognitive decline and motor dysfunction in Parkinson’s disease: A focused mini‐review on cognitive‐locomotor dual‐task interference vol.8, pp.6, 2018, https://doi.org/10.1111/ncn3.12398
  4. Analysis of non-invasive gait recording under free-living conditions in patients with Parkinson’s disease: relationship with global cognitive function and motor abnormalities vol.20, pp.1, 2018, https://doi.org/10.1186/s12883-020-01729-w
  5. Validity and sensitivity of instrumented postural and gait assessment using low-cost devices in Parkinson’s disease vol.17, pp.None, 2018, https://doi.org/10.1186/s12984-020-00770-7
  6. Dual-Task Effects During a Motor-Cognitive Task in Parkinson’s Disease: Patterns of Prioritization and the Influence of Cognitive Status vol.35, pp.4, 2018, https://doi.org/10.1177/1545968321999053
  7. Non-motor impairments affect walking kinematics in Parkinson disease patients: A cross-sectional study vol.49, pp.3, 2018, https://doi.org/10.3233/nre-210146
  8. Gait speed in clinical and daily living assessments in Parkinson’s disease patients: performance versus capacity vol.7, pp.1, 2018, https://doi.org/10.1038/s41531-021-00171-0
  9. Diagnostic value of a vision-based intelligent gait analyzer in screening for gait abnormalities vol.91, pp.None, 2018, https://doi.org/10.1016/j.gaitpost.2021.10.028