title: Association of cognitive domains with postural instability/gait disturbance in Parkinson's disease.
abstract: BACKGROUND
  Research suggests an association between global cognition and postural instability/gait disturbance (PIGD) in Parkinson disease (PD), but the relationship between specific cognitive domains and PIGD symptoms is not clear. This study examined the association of cognition (global and specific cognitive domains) with PIGD symptoms in a large, well-characterized sample of individuals with PD.
  
  
  METHODS
  Cognitive function was measured with a detailed neuropsychological assessment, including global cognition, executive function, memory, visuospatial function, and language. PIGD symptoms were measured using the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III, Motor Examination subscale. Multiple linear regression analyses were performed to assess the relationship between cognition and PIGD symptoms with models adjusting for age, sex, education, enrollment site, disease duration, and motor symptom severity.
  
  
  RESULTS
  The analysis included 783 participants, with mean (standard deviation) age of 67.3 (9.7) years and median (interquartile range) MDS-UPDRS Motor Subscale score of 26 (17, 35). Deficits in global cognition, executive function, memory, and phonemic fluency were associated with more severe PIGD symptoms. Deficits in executive function were associated with impairments in gait, freezing, and postural stability, while visuospatial impairments were associated only with more severe freezing, and poorer memory function was associated only with greater postural instability.
  
  
  CONCLUSIONS
  While impairments in global cognition and aspects of executive functioning were associated with more severe PIGD symptoms, specific cognitive domains were differentially related to distinct PIGD components, suggesting the presence of multiple neural pathways contributing to associations between cognition and PIGD symptoms in persons with PD.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States. Electronic address: vekelly@u.washington.edu.
authors.forename: V E
authors.initials: VE
authors.lastname: Kelly
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA, United States. Electronic address: johnsoco@uw.edu.
authors.forename: C O
authors.initials: CO
authors.lastname: Johnson
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States. Electronic address: emcg@uw.edu.
authors.forename: E L
authors.initials: EL
authors.lastname: McGough
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States. Electronic address: ashumway@uw.edu.
authors.forename: A
authors.initials: A
authors.lastname: Shumway-Cook
authors.affiliation: Department of Neurology, Oregon Health and Science University, Portland, OR, United States; Portland Veterans Affairs Medical Center, Portland, OR, United States. Electronic address: horakf@ohsu.edu.
authors.forename: F B
authors.initials: FB
authors.lastname: Horak
authors.affiliation: Department of Neurology, Oregon Health and Science University, Portland, OR, United States; Portland Veterans Affairs Medical Center, Portland, OR, United States. Electronic address: chungka@ohsu.edu.
authors.forename: K A
authors.initials: KA
authors.lastname: Chung
authors.affiliation: Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, United States. Electronic address: alberto.espay@uc.edu.
authors.forename: A J
authors.initials: AJ
authors.lastname: Espay
authors.affiliation: Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, United States; Division of Neurology, Greenville Health System and University of South Carolina Medical School-Greenville, United States. Electronic address: fredy.revilla@uc.edu.
authors.forename: F J
authors.initials: FJ
authors.lastname: Revilla
authors.affiliation: Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, United States. Electronic address: devotoj@ucmail.uc.edu.
authors.forename: J
authors.initials: J
authors.lastname: Devoto
authors.affiliation: Department of Neurology, Emory University, Atlanta, GA, United States. Electronic address: cwoodsi@emory.edu.
authors.forename: C
authors.initials: C
authors.lastname: Wood-Siverio
authors.affiliation: Department of Neurology, Emory University, Atlanta, GA, United States. Electronic address: sfactor@emory.edu.
authors.forename: S A
authors.initials: SA
authors.lastname: Factor
authors.affiliation: Geriatric Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States. Electronic address: bchol@uw.edu.
authors.forename: B
authors.initials: B
authors.lastname: Cholerton
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA, United States; Department of Epidemiology, University of California, Irvine, CA, United States. Electronic address: kedward1@uci.edu.
authors.forename: K L
authors.initials: KL
authors.lastname: Edwards
authors.affiliation: Department of Neurology, Oregon Health and Science University, Portland, OR, United States; Portland Veterans Affairs Medical Center, Portland, OR, United States. Electronic address: peterami@ohsu.edu.
authors.forename: A L
authors.initials: AL
authors.lastname: Peterson
authors.affiliation: Department of Neurology, Oregon Health and Science University, Portland, OR, United States; Portland Veterans Affairs Medical Center, Portland, OR, United States. Electronic address: quinnj@ohsu.edu.
authors.forename: J F
authors.initials: JF
authors.lastname: Quinn
authors.affiliation: Department of Pathology, University of Washington, Seattle, WA, United States. Electronic address: tmontine@uw.edu.
authors.forename: T J
authors.initials: TJ
authors.lastname: Montine
authors.affiliation: Geriatric Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States; Parkinson's Disease Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States; Department of Neurology, University of Washington, Seattle, WA, United States. Electronic address: zabetian@u.washington.edu.
authors.forename: C P
authors.initials: CP
authors.lastname: Zabetian
authors.affiliation: Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, OH, United States. Electronic address: leverej@ccf.org.
authors.forename: J B
authors.initials: JB
authors.lastname: Leverenz
mesh_terms: D000368:Aged; D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000175:diagnosis* / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D020233:Gait Disorders, Neurologic / Q000175:diagnosis* / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000175:diagnosis* / Q000523:psychology*; D004856:Postural Balance / Q000502:physiology
keywords: Balance; Cognition; Executive function; Freezing of gait; Gait