Articles
Attending to the task: Interference effects of functional tasks on walking in Parkinson’s disease and the roles of cognition, depression, fatigue, and balance1,

Presented in part at the International Society for Posture and Gait Research Conference, March 2003, Sydney, Australia, and the World Physical Therapy Conference, June 2003, Barcelona, Spain.
https://doi.org/10.1016/j.apmr.2004.01.025Get rights and content

Abstract

Rochester L, Hetherington V, Jones D, Nieuwboer A, Willems A-M, Kwakkel G, Van Wegen E. 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;85:1578–85.

Objective

To evaluate the interference effects on walking of functional activities in the home in people with Parkinson’s disease (PD) and the contribution of clinical symptoms to disturbance of gait.

Design

A repeated-measures trial, using a dual-task paradigm to evaluate the attentional demands of functional activities.

Setting

Participants’ homes and a clinic.

Participants

Twenty subjects with idiopathic PD and 10 age-, sex-, and education-matched controls.

Interventions

Subjects performed a simple walking task, a dual-motor task, a dual-cognitive task, and a multiple task, all of which were real-world activities.

Main outcome measures

Walking speed, mean step length, and step frequency were compared across different tasks for each subject. A battery of clinical outcome measures hypothesized to compete for attention were also conducted: cognition (Hayling and Brixton tests), anxiety and depression (Hospital Anxiety and Depression test), fatigue (Multidimensional Fatigue Inventory), balance (Berg Balance Scale), and disease severity (Hoehn and Yahr score).

Results

PD subjects walked at a significantly slower speed (26.5%, P<.001) and reduced step length (23%, P<.001) than did the controls. Performance of a concurrent cognitive and multitask resulted in significantly slower gait speed (P=.022; P<.015) and reduced mean step length (P=.022; P=.001) in PD subjects. Cognitive function, depression, physical fatigue, and balance were significantly related to walking speed for the functional tasks. Multiple regression analysis showed that the Brixton test, physical fatigue, and depression accounted for up to 39% of the variation in walking speed during functional tasks in PD and control subjects and balance accounted for 54% of variance for walking in PD subjects.

Conclusions

Competition for attention through additional activities, decreased executive function, depression, fatigue, and impaired balance will increase difficulty in walking for PD subjects. Evaluation of performance during complex functional activities in an appropriate environment should be a focus of therapeutic assessment. Furthermore, functional performance may be influenced by several other symptoms that should also be considered.

Section snippets

Participants

Twenty people with idiopathic PD (12 men, 8 women; mean age ± standard deviation, 64.6±7.96y) and 10 healthy controls matched for age and sex (6 men, 4 women; mean age, 63.5±7.03y) were studied. PD subjects had a mean disease severity of 2.7±.69 on the Hoehn and Yahr scale20 and a mean disease duration of 10±6.2 years. Ethics approval for the study was granted by the Newcastle and North Tyneside Health Authority Joint Ethics Committee, UK. All subjects gave informed written consent. Their

Participant details

Subjects’ demographic and clinical details are given in table 1. Two PD subjects were excluded from the analysis because they were unable to perform the functional task at the time of testing. We used independent 2-tailed t tests to compare PD and control subjects. There were no significant differences in age, sex, or premorbid intelligence quotient. There was a significant difference in MMSE scores; however, all subjects scored above 26, indicating the absence of dementia. Compared with

Discussion

Our main findings in this study were that performance of additional tasks resulted in a greater reduction of walking speed and mean step length in PD subjects, compared with control subjects, and this was dependent on the type of task performed. Executive dysfunction, depression, physical fatigue, and balance showed significant relationships with gait speed in the performance of the tasks in the functional test.

Conclusions

Our study extended the findings of others by testing subjects in their home environment, thus increasing ecological validity. In addition, other factors that may compete for attention were evaluated and compared with changes measured in walking speed. Thus, we can gain a better understanding of the role of other clinical symptoms on attention and its subsequent effect on the ability to conduct functional activities. This information is useful in that it may help identify specific advice that

Acknowledgements

We thank Dr. David Burn (Newcastle Upon Tyne Hospitals NHS Trust) and Dr. Richard Walker (Northumbria Health Care NHS Trust) for their help and support with subject recruitment for the study.

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  • Cited by (0)

    Supported by the European Commission Framework V funding (grant no. QLRT-2001-00120).

    1

    No party having a direct interest in the results of the research supporting this article has or will confer a benefit on the author(s) or on any organization with which the author(s) is/are associated.

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