Objective: Determine the impact of dual task (DT) cognitive interference and fast paced walking on gait and the relationship between cognition, gait and falls in FXTAS.

Background: Gait deficits are among the most debilitating symptoms of FXTAS, leading to falls and progressive disability. However, no studies have examined the impact of gait stress tests such as DT cognitive interference or fast paced walking in FXTAS. This is relevant because walking while performing cognitive tasks and fast walking reflect activities performed in everyday life and may be associated with fall risk. DT during gait may also be more problematic in FXTAS patients because many have executive dysfunction which might not allow them to compensate for gait deficits.

Methods: Twenty-five individuals with FXTAS (12 men/13 women; age 67.1 ± 10.1 yrs) and 27 healthy controls (14 men/13 women; age 63.5 + 7.7 yrs) underwent gait analysis using a reliable, valid inertial sensor based 25-meter two-minute walk test (APDMTM). Gait was tested under a 1) self-selected (SS) typical pace, 2) fast as possible (FAP) pace and 3) DT cognitive interference condition asking subjects to perform a concurrent verbal memory task while walking at SS pace. Dual task costs (DTC) for gait measures was calculated as (ST – DT/ST value) x100. A neurocognitive test battery was administered and one year retrospective fall history was recorded.

Results: FXTAS subjects had significantly worse gait at SS speeds than controls in the gait domains of (1) pace (stride length and velocity; p < 0.01) and (2) variability (p=0.018 to 0.002). Number of steps to turn (p=0.014) and turn duration (p=0.011) were also significantly greater at SS speeds in FXTAS. In the FAP condition, the gait of FXTAS subjects further deteriorated in rhythm (p=0.002) and gait phase cycle (less time in swing and more time in double support; p=0.02). While several gait domains were significantly worse with DT walking in FXTAS compared to controls, there were no differences in DTC for gait and turn measures between the 2 groups. In general, lower cognition was associated with worse gait and turning in FXTAS and many DT gait measures correlated with a higher number of falls (p=0.02 to <0.001).

Conclusions: Fast paced gait may have more discriminatory ability than DT to reveal the severity of gait deficits in FXTAS. Gait and cognitive markers may be useful to detect fall risk in FXTAS.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/fast-paced-gait-may-be-more-discriminating-than-dual-tasking-for-detecting-severity-of-gait-and-turn-deficits-in-fxtas/