Table 2.
Summary of dual-task testing protocols in the prodromal and clinical phases of Parkinson’s disease
| Studies | Populations | Cognitive tasks | Gait tasks | Instruments | Cognitive parameters | Gait parameters | Dual-task cost analysis | Dual-task findings |
|---|---|---|---|---|---|---|---|---|
| O’Shea et al. 2002 | PD (n = 15) HOA (n = 15) |
Coin transference Serial substraction task (by threes from 125 or 250) |
Walking 10 m at usual pace | Footswitches based on force sensitive resistors placed on the hallux and the first, second, and fourth metatarsal heads | Not measured | Gait speed Stride length Cadence Double support time |
Paired t test | ↑ double support time, ↓ stride length, ↓ gait speed, ↓ cadence in PD (with either a motor or cognitive secondary task) |
| Hausdorff et al. 2003 | PD (n = 10) | Serial substraction task (by threes from 200, 193, and 186) | Walking 20 m at usual pace | Footswitches based on force sensitive resistors | Not measured | Stride time Stride time variability |
Wilcoxon signed-rank test | ↑ stride time variability |
| Yogev et al. 2005 | PD (n = 30) HOA (n = 28) |
Serial substraction task (by sevens from 500) Listening through ear phones to a text |
Walking 20 m at usual pace | Footswitches based on force sensitive resistors | Not measured | Stride time Swing time Stride time variability |
Repeated measures ANOVA | ↑ stride time variability in PD compared to HOA |
| Plotnik et al. 2009 | PD (n = 21) HOA (n = 13) |
Serial substraction task (by sevens) | Walking at usual pace for 2 min | Footswitches based on force sensitive resistors | Not measured | Gait speed Stride time variability Swing time variability Stride time asymmetry Left-right stepping coordination |
Repeated measures ANOVA | ↓ left-right stepping coordination, ↑ swing time variability, ↑ stride time variability in PD compared to HOA |
| Plotnik et al. 2011 | PD (n = 30) | Serial substraction task (by threes and sevens) | Walking 80 m at usual pace | Footswitches based on force sensitive resistors | Not measured | Gait speed Stride length Stride time variability Swing time variability Swing time asymmetry Left-right stepping coordination |
Paired t test | ↓ left-right stepping coordination, ↓ stride length, ↓ gait speed, ↑ swing time asymmetry, ↑ swing time variability - Gait changes are more pronounced with concomitant serial subtraction task by sevens |
| Mirelman et al. 2011 | LRRK2 (n = 25) HOA (n = 27) |
Serial substraction task (by sevens) | Walking 20 m at usual and maximal pace | Accelerometer | Not measured | Gait speed Stride time Stride length Stride time variability |
Paired t test | ↑ stride time variability in LRRK2 compared to HOA at both paces |
| Tseng et al. 2012 | PD (n = 30) HOA (n = 28) |
Serial substraction task (from 100) | Walking forward and backward 6 m at usual pace | GAITRite® system | Not measured | Gait speed Stride length - Stride time Double support time Gait variability for each |
Paired t test | ↓ gait speed, ↓ swing time, ↓ stride length, in both walking directions in PD compared to HOA |
| Yogev-Seligmann et al. 2012 | PD (n = 18) HOA (n = 15) |
Verbal fluency task | Walking 30 m at usual pace | Ambulatory recorder Footswitches based on force sensitive resistors |
Not measured | Stride time Swing time Stride time variability Gait speed Swing time variability |
Repeated measures ANOVA | ↓ gait speed, ↑ stride time variability, ↑ swing time variability, in both groups |
| Fuller et al. 2013 | PD (n = 154) | Phonemic fluency (letters: “F”, “A”, and “S”) | Walking 15 m at usual pace | Not indicated | Number of words verbally enumerated | Gait speed | Hierarchical regression | ↓ gait speed - Decreased cognitive performance |
| Panyakaew and Bhidayasiri 2013 | PD (n = 21) HOA (n = 21) |
Serial substraction task (by threes from 200) | Walking 7.82 m at usual pace | GAITRite® system | Not measured | Gait speed Cadence Stride length Stride time Swing time Double support time Stride width Gait variability for each parameter |
Paired t test | ↑ cadence, ↑ stride width, ↓ swing time, ↑ stride time in PD compared to HOA |
| Wild et al. 2013 | PD (n = 18) HOA (n = 18) |
Serial substraction task (by sevens from 500) Text comprehension task Phoneme counting task |
Walking 9 m at usual pace | Kinemetric with a fixed camera | Total correct serial subtractions Percent of correct responses (text comprehension) Percent of total phonemes |
Stride length Cadence Swing time Stance time |
Gait DTC formulaa | ↑ cadence, ↓ swing time, ↓ stance time in PD compared to HOA - Decreased cognitive performance in PD in all conditions compared to HOA |
| Yogev-Seligmann et al. 2012 | PD (n = 18) YA (n = 21) HOA (n = 15) |
Verbal fluency task | Walking 30 m at usual pace | Ambulatory recorder Footswitches based on force sensitive resistors Accelerometer located on posterior distal part of the shin above the malleoli |
Number of words verbally enumerated | Gait speed Stride time Stride time variability |
Repeated measures ANOVA | ↓ gait speed, ↑ stride time, ↑ stride time variability in PD compared to YA and HOA |
| Rochester et al. 2014 | PD (n = 44) HOA (n = 55) |
Working memory task (participants listened to strings of digits and repeated them back) | alking for 2 min at usual pace | GAITRite® system | Error rate | Gait speed Stride length Stride time Stride width variability Stride time variability Stride width variability Stance time asymmetry |
Gait DTC formulab | ↓ gait speed, ↑ stride length, ↑ stride time, ↑ stride width Variability, ↑ stride time variability, ↑ stride width variability, ↑ stance time asymmetry in both HOA and PD |
| Kelly and Shumway-Cook 2014 | PD (n = 11) HOA (n = 12) |
Auditory Stroop task | Usual-base and narrow-base walking over a distance of 8.8 m | Motion capture system (Qualisys) | Response latency Response accuracy |
Stride length Stride width Cadence Stride width variability Stride time variability Center of mass |
Repeated measures ANOVA | ↓ gait speed in PD compared to HOA - Decreased cognitive performance in PD compared to HOA |
| Lerche et al. 2014 | PD (n = 27) MPS (n = 73) HOA (n = 892) |
Box-checking task Serial substraction task (by sevens) |
Walking 20 m at usual and maximal paces | Accelerometer | Not measured | Gait speed | Gait DTC formulac | ↓ gait speed in both conditions |
| Stegemöller et al. 2014 | PD (n = 35) | Serial substraction task (by threes) | Walking 12 m at usual pace | Motion capture system | Not measured | Gait speed Stride time Stride length Stride width Swing time Variability for each parameter |
Repeated measures ANOVA | ↓ gait speed, ↑ stride length, ↑ stride time, ↑ stride width, ↑ variability for each parameter |
| Strouwen et al. 2016 | PD (n = 121) | Serial substraction task Auditory Stroop task Mobile phone task |
Walking 10 m at usual pace | GAITRite® system | Reaction time Number of errors |
Gait speed | Regression models | ↓ gait speed - A strong correlation between gait speed and cognitive flexibility |
| Vervoort et al. 2016 | PD (n = 73) HOA (n = 20) |
Auditory Stroop task | Walking 6 m at usual pace | Motion capture system (Vicon) | Reaction time (average and variability) | Gait speed Stride length Stride width Stride time Stance time Swing time Double support time Gait variability for each gait parameter |
MANOVA | ↑ stance time, ↑ stride length asymmetry, ↓ swing time in PD compared to HOA - Decreased cognitive performance in PD compared to HOA - A strong correlation between gait speed and cognitive flexibility |
| Mirelman et al. 2016 | PD (n = 194) LRRK2 (n = 122) HOA (n = 64) |
Serial substraction task (by threes) | Walking 15 m at usual pace | Lightweight body-fixed sensor Velcro straps |
Arm swing amplitude Arm swing variability Arm swing asymmetry Stride time variability Axial rotation smoothness |
Paired t test | ↑ stride time variability, ↑ arm swing variability, ↑ arm swing asymmetry, ↓ axial rotation smoothness in LRRK2 compared to HOA |
HOA healthy older adults, YA younger adults, PD Parkinson’s disease, LRRK2 carriers of the LRRK2-G2019S mutation, MPS mild Parkinsonian signs in older adults, IRBD patients with REM idiopathic behavioral disorder, ↑ increased, ↓ decreased
aGait DTC = [(single-task gait performance − dual-task gait performance)/single-task gait performance × 100
bGait DTC = dual-task gait performance − single-task gait performance
cGait DTC = (1 − dual-task speed/single-task speed) × 100