Objective: To investigate the use of the GG to predict impairment in gait performance under complex conditions in PPD and compare its predictive power with the one of the Montreal Cognitive Assessment (MoCA) test.

Background: Currently, gait control is regarded a complex brain process in which cognitive resources are continuously demanded in order to monitor the complex motor-perceptual integration. Gait performance is strongly affected by the overlap between motor and cognitive impairments due to dysfunction of both cholinergic and dopaminergic pathways in people with Parkinson’s disease (PPD). PPD display poorer gait performance when walking under complex conditions than under simple conditions. Screening tests that evaluate gait performance changes under complex walking conditions may be valuable tools for early intervention, especially if allowing for massive data collection. The Goalkeeper Game (GG) has been recently introduced as a tool to investigate the conjecture that the brain does statistical model selection.

Method: 74 PPD (HY stages: 23 in stage 1; 31 in stage 2; 20 in stage 3), without dementia (MoCA cut-off 21), tested in ON period with dopaminergic medication (40-120 min. after their L-dopa dose) and able to ambulate independently, were submitted to single individual cognitive/motor evaluation sessions. MoCA and GG were used to assess cognition, and the Dynamic Gait Index (DGI) test was used to assess gait performance under complex condition. GG test resulted in 9 measures extracted via a statistical model. The predictive power of the GG measures and the MoCA score with respect to gait performance, as assessed by DGI, were compared.

Results: The predictive models based on GG obtained a better score of prediction (65%) then MoCA (56%) for DGI scores (at a 50% specificity).

Conclusion: Considering the PD prevalence (1% in the general population), the use of cognitive and motor assessment instruments for an early screening of gait alterations is expensive and not feasible for most countries. Hence, a free and friendly game like GG, which allows for massive data collection and is able to detect early abnormal decline in gait performance may be extremely useful. GG is a novel tool for noninvasive screening that showed a superior predictive power in assessing gait performance under complex condition in people with PD than the well-established MoCA test.

References: Yogev G, Giladi N, Peretz C, Springer S, Simon ES, Hausdorff JM. (2005). Dual tasking, gait rhythmicity, and Parkinson’s disease: which aspects of gait are attention demanding? Eur. J. Neurosci. 22, 1248–1256. doi: 10.1111/j.1460-9568.2005.04298.x Yogev-Seligmann G, Hausdorff JM, Giladi N. (2008). The role of executive function and attention in gait. Movem. Disord. 23, 329–342. doi: 10.1002/mds.21720. Amboni M, Barone P, Hausdorff JM. (2013). Cognitive contributions to gait and falls: evidence and implications. Movem. Disord. 28, 1520–1533. doi: 10.1002/mds.25674 Kelly VE, Johnson CO, McGough EL, Shumway-Cook A, Horak FB, Chung KA, et al. (2015). Association of cognitive domains with postural instability/gait disturbance in Parkinson’s disease. Parkinson. Relat. Disord. 21, 692–697. doi: 10.1016/j.parkreldis.2015.04.002. de Castro, B. M. (2016). Processos estocáticos conduzidos por cadeias com memória de alcance variável e o jogo do goleiro. (Ph.D. thesis). Universidade de São Paulo.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/goalkeeper-game-a-new-assessment-tool-for-prediction-of-gait-performance-under-complex-condition-in-people-with-parkinsons-disease/