Objective: The purpose of this study was to compare the effects of consecutive and integrated postural-cognitive training on dual-task walking performance and its related cortical activity in Parkinson’s disease with mild cognitive impairment (PD-MCI).

Background: People with PD often have difficulties in dual-task walking, especially for whom combined with MCI. [1] Task-specific training with dual-task walking paradigm has been proved as an effective treatment to improve dual-task walking control in patients with PD. [2-4] However, PD-MCI might not necessarily beneficial to dual-task training paradigm due to insufficient brain attentional resources and impaired cognitive function. [5-6]

Method: Twenty patients with PD-MCI were randomly allocated to the consecutive or the integrated group. Each participant completed a 70-minutes postural-cognitive training with 2 sessions per week for 6 weeks. In training sessions, the consecutive group practiced postural task and cognitive task separately, whereas the integrated group practiced two tasks simultaneously (i.e. dual-task paradigm). Dual-task walking (i.e. performed an auditory memory task during walking) was tested at baseline (pre-test), after training (post-test), and 8 weeks after post-test (follow-up test). Gait velocity, cadence, step length, stride time variability, accuracy of auditory memory task, and EEG relative power of theta (4-8 Hz) bands in frontal area were measured. A mixed analysis of variance (ANOVA) was used for testing the training effects of each parameter. Post-hoc test was performed when necessary. The level of significant was set at p<0.05.

Results: Both consecutive and integrated groups increased gait velocity and step length after training. However, both groups decreased step length at follow-up test comparing to post-test. Only the consecutive group decreased stride time variability after training and lasted to follow-up task. The cortical findings revealed that theta power decreased in the consecutive group, but increased in the integrated group. [Figure 1]

Conclusion: Continuous training is crucial for PD-MCI to sustain the training benefits. In contrast to integrated training (i.e. dual-task) paradigm, consecutive training paradigm could improve walking stability for PD-MCI with effective resource utilization.

References: 1.Amboni M, Barone P, Iuppariello L, Lista I, Tranfaglia R, Fasano A, et al. Gait patterns in Parkinsonian patients with or without mild cognitive impairment. Mov Disord. 2012;27:1536-43.
2.Hubbard IJ, Parsons MW, Neilson C, Carey LM. Task-specific training: evidence for and translation to clinical practice. Occup Ther Int. 2009;16:175-89.
3.De Freitas TB, Leite PHW, Doná F, Pompeu JE, Swarowsky A, Torriani-Pasin C. The effects of dual task gait and balance training in Parkinson’s disease: a systematic review. Physiother Theory Pract. 2020;36:1088-1096.
4.Yang YR, Cheng SJ, Lee YJ, Liu YC, Wang RY. Cognitive and motor dual task gait training exerted specific training effects on dual task gait performance in individuals with Parkinson’s disease: a randomized controlled pilot study. PLoS One. 2019;14:e0218180.
5.Wang Z, Jia X, Chen H, Feng T, Wang H. Abnormal spontaneous brain activity in early Parkinson’s disease with mild cognitive impairment: A resting-state fMRI study. Front Physiol. 2018;9:1093.
6.Strouwen C, Molenaar EALM, Münks L, Broeder S, Ginis P, Bloem BR, et al. Determinants of dual-task training effect size in Parkinson disease: who will benefit most? J Neurol Phys Ther. 2019;43:3-11.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-effects-of-consecutive-and-integrated-postural-cognitive-training-on-dual-task-walking-in-parkinsons-disease-with-mild-cognitive-impairment-eeg-relative-power-and-clinical-implication/