AUTHOR=Geritz Johanna , Welzel Julius , Hansen Clint , Maetzler Corina , Hobert Markus A. , Elshehabi Morad , Sobczak Alexandra , Kudelka Jennifer , Stiel Christopher , Hieke Johanne , Alpes Annekathrin , Bunzeck Nico , Maetzler Walter 

TITLE=Does Executive Function Influence Walking in Acutely Hospitalized Patients With Advanced Parkinson's Disease: A Quantitative Analysis

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.852725

DOI=10.3389/fneur.2022.852725

ISSN=1664-2295

ABSTRACT=Introduction: It is well known that, in Parkinson’s disease (PD), executive function (EF) and motor deficits lead to reduced walking performance. As previous studies investigated mainly patients during compensated phases of the disease, the aim of this study was to investigate the above associations in acutely hospitalized patients with PD.
Methods: Seventy-four acutely hospitalized patients with PD were assessed with the delta Trail Making Test (ΔTMT, TMT-B minus TMT-A) and the Movement Disorder Society-revised version of the motor part of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS III). Walking performance was assessed with wearable sensors under single (ST; fast and normal pace) and dual task (DT; walking and checking boxes as motor secondary task, walking and subtracting serial 7s as cognitive secondary task) conditions over 20 meters. Multiple linear regression and Bayes factor BF10 were performed for each walking parameter and their dual task costs while walking (DTC) as dependent variables, and also included ΔTMT, MDS-UPDRS III, age and gender.
Results: Under ST, significant negative effects of the use of a walking aid and MDS-UPDRS III on gait speed and for fast pace on number of steps were observed. Moreover, depending on the pace, the use of a walking aid, age and gender affected step time variability. Under walking-cognitive DT, a resolved variance of 23% was observed in the overall model for step time variability DTC, driven mainly by age (β=0.26, p=0.09). Under DT, no other significant effects could be observed. ΔTMT showed no significant associations with any of the walking conditions.
Discussion: The results of this study suggest that in acutely hospitalized patients with PD reduced walking performance is mainly explained by use of a walking aid, motor symptoms, age and gender, and EF deficits surprisingly do not seem to play a significant role. However, these patients with PD should avoid walking-cognitive DT situations, as under this condition especially step time variability -a parameter associated with risk of falling in PD- worsens.