title: Secondary task performance during challenging walking tasks and freezing episodes in Parkinson's disease.
abstract: Parkinson's disease (PD) patients likely use attentional strategies to compensate for their gait deficits, which increases the cognitive challenge of walking. The interplay between cognitive functions and gait can be investigated by evaluating the subject's attendance to a secondary task during walking. We hypothesized that the ability to attend to a secondary task decreases during challenging walking conditions in PD, particularly during freezing of gait (FOG)-episodes. Twenty-nine PD patients and 14 age-matched controls performed a simple reaction task that involved squeezing a ball as fast as possible in response to an auditory stimulus. Participants performed this reaction task during four conditions: (1) walking at preferred speed; (2) walking with short steps at preferred speed; (3) walking with short steps, as rapidly as possible; (4) making rapid full turns. We used surface electromyography to determine reaction times, and a pressure sensor located within the ball to determine movement onset. Reaction times of PD patients were slower (on average by 42 ms) compared to controls, regardless of the walking task. In both groups, reaction times were significantly longer during the turning condition compared to all other conditions. FOG-episodes were most often seen during the turning condition. In PD patients, reaction times were significantly longer during FOG-episodes compared to trials without FOG. Our results suggest that turning requires more attentional resources than other walking tasks. The observation of delayed reaction times during FOG-episodes compared to trials without FOG suggests that freezers use additional resources to overcome their FOG-episodes.
authors.affiliation: Department of Rehabilitation, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.|Department GF Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Dibilio
authors.affiliation: Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
authors.forename: Claudia
authors.initials: C
authors.lastname: Stummer
authors.affiliation: Department of Rehabilitation, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
authors.forename: Linda
authors.initials: L
authors.lastname: Drenthen
authors.affiliation: Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
authors.forename: Bastiaan R
authors.initials: BR
authors.lastname: Bloem
authors.affiliation: Department of Rehabilitation, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
authors.forename: Jorik
authors.initials: J
authors.lastname: Nonnekes
authors.affiliation: Department of Rehabilitation, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands. vivian.weerdesteyn@radboudumc.nl.|Sint Maartenskliniek Research, Development and Education, Nijmegen, The Netherlands. vivian.weerdesteyn@radboudumc.nl.
authors.forename: Vivian
authors.initials: V
authors.lastname: Weerdesteyn
mesh_terms: D000161:Acoustic Stimulation; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000704:Analysis of Variance; D004576:Electromyography; D005260:Female; D046352:Freezing Reaction, Cataleptic / Q000502:physiology*; D020233:Gait Disorders, Neurologic / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications*; D011597:Psychomotor Performance / Q000502:physiology*; D011930:Reaction Time / Q000502:physiology; D012720:Severity of Illness Index; D016138:Walking / Q000502:physiology*
keywords: Executive functions; Freezing of gait; Gait disorders; Parkinson’s disease