Data_Sheet_1_Dual vs. Single Tasking During Circular Walking: What Better Reflects Progression in Parkinson's Disease?.xlsx

Background and Aim: Reliable, valid and sensitive measures of dual-task-associated impairments in patients with Parkinson's disease (PD) may reveal progressive deficits unnoticed under single-task walking. The aim of this study was to quantitatively identify markers of progressive gait deficits in idiopathic PD while walking over a circular trajectory condition in single-task walking and in different dual-task conditions: (1) circular walking while checking boxes on a paper sheet as fast as possible and (2) circular walking while performing subtraction of 7 as fast as possible. In addition, we aimed to study the added value of dual-tasking assessment over single (circular) walking task assessment in the study of PD progression.Methods: The assessments were performed every 6 months over a (up to) 5 years period for 22 patients in early-stage PD, 27 patients in middle-stage PD and 25 healthy controls (HC). Longitudinal changes of 27 gait features extracted from accelerometry were compared between PD groups and HCs using generalized estimating equations analysis, accounting for gait speed, age, and levodopa medication state confounders when required. In addition, dual-task-interference with gait and cognitive performance was assessed, as well as their combination.Results: The results support the validity and robustness of some of the gait features already identified in our previous work as progression markers of the disease in single-task circular walking. However, fewer gait features from dual-task than from single-task assessments were identified as markers of progression in PD. Moreover, we did not clearly identify progressive worsening of dual-task-interference in patients with PD, although some group differences between early and middle stages of PD vs. the control group were observed for dual-task interference with the gait task and with the concurrent tasks.Conclusions: Overall, the results showed that dual-tasking did not have added value in the study of PD progression from circular gait assessments. Our analyses suggest that, while single-task walking might be sensitive enough, dual-tasking may introduce additional (error) variance to the data and may represent complex composite measures of cognitive and motor performance.

背景与目标：对帕金森病（PD）患者双任务相关损害的可靠、有效且敏感的测量，可能揭示在单任务行走过程中未被察觉的渐进性缺陷。本研究的目标是在单任务行走和不同的双任务条件下，即：（1）在圆形轨迹上行走的同时尽可能快地在纸上勾选方框；（2）在圆形轨迹上行走的同时尽可能快地进行7的减法运算，定量识别原发性PD患者渐进性步态缺陷的标志。此外，本研究旨在探讨双任务评估相对于单任务（圆形）行走任务评估在PD进展研究中的附加价值。方法：对早期PD的22名患者、中期PD的27名患者和25名健康对照者（HC）在（长达）5年的（至）5年期间每6个月进行一次评估。使用广义估计方程分析比较PD组和HC组中从加速度计中提取的27个步态特征的纵向变化，并在必要时考虑步速、年龄和左旋多巴药物状态混杂因素。此外，评估了双任务对步态和认知表现的干扰，以及它们的组合。结果：结果支持了我们在先前工作中已确定的某些步态特征作为单任务圆形行走中疾病进展标志的有效性和稳健性。然而，与单任务评估相比，在双任务评估中识别出的步态特征作为PD进展标志的较少。此外，尽管在早期和中期PD与对照组的双任务干扰方面观察到一些组间差异，但我们并未明显识别出PD患者双任务干扰的渐进性恶化。结论：总体而言，结果表明，双任务在PD进展的圆形步态评估研究中没有增加价值。我们的分析表明，虽然单任务行走可能足够敏感，但双任务可能会向数据中引入额外的（错误）变异性，并可能代表认知和运动表现的复杂综合指标。