Relationship Between Executive Function and Dual-Task Walking in People with Parkinson's Disease

Jun-Hong Zhou¹Ray-Yau Wang¹Yo-Tsen Liu^2,3Shih-Jung Cheng^1,4Hsin-Hsuan Liu^1,5Yea-Ru Yang^1*

• ¹Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
• ²Department of Neurology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
• ³Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
• ⁴Department of Neurology, MacKay Memorial Hospital, Taipei, Taiwan
• ⁵Department of Physical Therapy, Chung Shan Medical University, Taichung, Taichung County, Taiwan

Background: Cognitive impairment may present early in people with Parkinson's disease (PwPD), with deficits in executive function potentially impacting gait performance. Previous studies have investigated the association between dual-task walking and executive function in PwPD; however, the results were inconsistent, and the correlation between dual-task walking and subdomains of executive function has not been explored. This study aims to examine the correlation between dual-task walking and subdomains of executive function in PD and assess the predictive power of different subdomains of executive function on dual-task walking performance. Methods: This cross-sectional study included 30 PwPD. Gait was assessed under single-task walking, cognitive dual-task walking, and motor dual-task walking conditions. Executive function was evaluated using the Trail Making Test (TMT), Stroop Color and Word Test (SCWT), and Digit Span Test (DST). Correlation analyses (Pearson or Spearman, as appropriate) and linear regression analyses were used to examine the contribution of executive function subdomains to gait variables that showed significant correlations.Results: Walking speeds under both dual-task conditions were moderately correlated with performance on the TMT Part A and the SCWT. In contrast, stride length during dual-task walking showed broader associations, demonstrating significant correlations with multiple executive function measures. Stepwise linear regression analysis revealed that the SCWT was the only significant predictor of walking speed under both dual-task conditions. For stride length during cognitive dual-task walking, the SCWT remained a significant predictor, while in the motor dual-task condition, both the SCWT and the Forward DST contributed significantly. Specifically, two regression models were significant for stride length during motor dual-task walking: Model 1 included only the SCWT, while Model 2 incorporated both the SCWT and Forward DST. Among dual-task cost outcomes, only the cost of stride length during cognitive dual-task walking was significantly correlated with TMT Part A; however, this association did not remain significant in subsequent regression analyses. This study indicates that, among various executive function assessments, the SCWT shows the strongest correlation with dual-task gait performance in PwPD.This suggests that inhibitory control plays a key role in regulating dual-task walking in individuals with PD.