Objective: Determine the relationship between the Montreal Cognitive Assessment (MoCA) and the commonly used clinical gait assessments including 10-meter walk test (10 MWT), 4-meter walk test (4 MWT), and 3 meter backwards walk test (3 MBW) in individuals with Parkinson disease (PD).

Background: Individuals diagnosed with PD frequently experience gait abnormalities, postural instability, and cognitive changes resulting in a propensity for falls. Clinicians have access to tools that can capture the cognitive decline, gait impairments, and postural instability in individuals with PD. Specifically, the MoCa can capture cognitive changes before they are overtly apparent.¹ However, the relationship between cognitive status and walking ability needs to be further explored in PD. The 10 MWT has been deemed a reliable measure of gait speed in individuals with PD.² while the 4 MWT and 3 MBW have established reliability for individuals with stroke.^3,4,5 This study aims to explore the relationship between the MoCA and clinical gait assessments in individuals with PD.

Method: 18 participants diagnosed with PD (Hoehn & Yahr I-IV) mean age 72 years old (m=10, f=8) completed the MoCA and three trials of each condition (self-selected (SS), fastest comfortable (FC), and dual task (DT)) for the 10 MWT and 4 MWT and three trials of the 3 MBW during one testing session. To examine the relationship between cognitive status (MoCA) and walking ability, a Pearson’s correlation was calculated using the mean of the three trials for each condition (SS, FC, DT). A p-value <.05 was used to indicate significance.

Results: There were no significant relationships between the MoCA and the commonly used clinical assessments of walking ability. The relationship between the MoCA and the 10 MWT was SS (r=.64, p=.09), FC (r=.25, p=.55), DT (r = .63, p=.09). The relationship between the 4 MWT and the MoCA was SS (r=.35, p=.16), FC (r=.27, p=.27), DT (r =.05, p=.85). The relationship between the MoCA and 3 MBW was SS (r=.57, p=.14).

Conclusion: While the relationship between the MoCA and 10 MWT (SS, DT) and the 3 MBW showed a moderate relationship, these findings were not significant (p >.05).  Clinicians should be aware that using the MoCA may not inform clinical decisions about walking ability based on the results of this study.

References: 1. Fengler S, Kessler J, Timmermann L, et al. Screening for Cognitive Impairment in Parkinson’s Disease: Improving the Diagnostic Utility of the MoCA through Subtest Weighting. PLoS One. 2016;11(7):e0159318. Published 2016 Jul 20. doi:10.1371/journal.pone.0159318

2. Lang JT, Kassan TO, Devaney LL, Colon-Semenza C, Joseph MF. Test-Retest Reliability and Minimal Detectable Change for the 10-Meter Walk Test in Older Adults With Parkinson’s disease. J Geriatr Phys Ther. 2016;39(4):165-170. doi:10.1519/JPT.0000000000000068

3. Cabanas-Valdés R, García-Rueda L, Salgueiro C, Pérez-Bellmunt A, Rodríguez-Sanz J, López-de-Celis C. Assessment of the 4-meter walk test test-retest reliability and concurrent validity and its correlation with the five sit-to-stand test in chronic ambulatory stroke survivors [published online ahead of print, 2023 Jan 20]. Gait Posture. 2023;101:8-13. doi:10.1016/j.gaitpost.2023.01.014

4. DeMark LA, Fox EJ, Manes MR, Conroy C, Rose DK. The 3-Meter Backward Walk Test (3MBWT): Reliability and validity in individuals with subacute and chronic stroke [published online ahead of print, 2022 Jun 5]. Physiother Theory Pract. 2022;1-8. doi:10.1080/09593985.2022.2085638

5. Abit Kocaman A, Aydoğan Arslan S, Uğurlu K, Katırcı Kırmacı Zİ, Keskin ED. Validity and Reliability of The 3-Meter Backward Walk Test in Individuals with Stroke. J Stroke Cerebrovasc Dis. 2021;30(1):105462. doi:10.1016/j.jstrokecerebrovasdis.2020.105462

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MDS Abstracts - https://www.mdsabstracts.org/abstract/relationship-between-the-montreal-cognitive-assessment-and-clinical-gait-assessments-in-individuals-with-parkinson-disease/