Investigation of Perceived and Real-Time Dual-Task Performance Under Different Motor-Cognitive Dual-Task Combinations in Patients with Parkinson's Disease

Abstract

Objective: In individuals with Parkinson’s disease, dual-task difficulties can be assessed either through self-reported perception scales or objective performance-based tests. However, the relationship between these two evaluation methods remains unclear. The aim of this study was to examine the association between perceived and actual dual-task performance in individuals with Parkinson’s disease and to evaluate performance differences across various types of dual-task conditions. Methods: A total of 117 participants diagnosed with idiopathic Parkinson’s disease, classified between Hoehn and Yahr stages 1 to 3, with a Mini-Mental State Examination score of at least 21 and no history of dementia, were included. Actual dual-task performance was assessed using the Timed Up and Go test with additional motor and cognitive secondary tasks, as well as the Six Spot Step Test. Perceived dual-task performance was measured using the Dual-Task Questionnaire. Statistical analyses were performed using Spearman’s correlation coefficient and the Friedman test. Results: The mean age of the participants was 62.44 ± 10.06 years, and the average disease duration was 6.34 ± 4.69 years. A statistically significant but weak correlation was found between perceived performance and the cognitive dual-task condition of the Timed Up and Go test (r=0.214; p=0.02), as well as the motor dual-task condition (r=0.277; p=0.002). No significant relationship was observed between perceived performance and the Six Spot Step Test (r=0.165; p=0.075). Additionally, the dual-task cost in the motor condition of the Timed Up and Go test was significantly higher than that in the cognitive condition (Z= -4.4; p<0.001). Conclusion: The weak association between perceived and real-time dual-task performance suggests that these two domains should be evaluated separately. Furthermore, the type of secondary task accompanying the walking task may lead to different outcomes in individuals’ dual-task performance. A detailed examination of these effects in patients with Parkinson’s disease could provide valuable guidance for developing more effective rehabilitation plans.

Keywords

• parkinson’s disease
• dual-task performance
• motor-cognitive interference

Parkinson Hastalarında Algılanan ve Gerçek-Zamanlı Çift-Görev Performansının Farklı Motor-Kognitif Çift-Görev Eşleşmeleri Altında İncelenmesi

Abstract

Amaç: Parkinson hastalarında çift görev koşulları altında ortaya çıkan zorluklar, bireylerin öznel algılarına dayalı ölçekler ile ya da performans testleri aracılığıyla değerlendirilebilmektedir. Ancak bu iki değerlendirme yöntemi arasındaki ilişki henüz yeterince açıklığa kavuşmamıştır. Bu çalışmanın amacı, Parkinson hastalarında algılanan çift görev performansı ile gerçek zamanlı performans testleri arasındaki ilişkiyi incelemek ve farklı çift görev türlerine bağlı olarak gözlemlenen performans farklılıklarını değerlendirmekti. Yöntem: Çalışmaya, İdiyopatik Parkinson hastalığı tanısı almış, Hoehn-Yahr evre 1 ila 3 arasında olan, Mini-Mental Durum Değerlendirme puanı en az 21 olan ve demans öyküsü bulunmayan toplam 117 birey dahil edilmiştir. Gerçek zamanlı çift görev performansı, Zamanlı Kalk Yürü Testi'ne entegre edilen motor ve bilişsel ikincil görevler ile Altı Nokta Adım Testi kullanılarak değerlendirilmiştir. Algılanan performans düzeyi ise İkili Görev Anketi ile ölçülmüştür. İstatistiksel analizlerde Spearman korelasyon katsayısı ve Friedman testi kullanılmıştır. Bulgular: Katılımcıların yaş ortalaması 62,44 ± 10,06 yıl, hastalık süresi ortalaması ise 6,34 ± 4,69 yıldır. Algılanan performans ile Zamanlı Kalk Yürü Testi’nin bilişsel görevli versiyonu arasında (r=0,214; p=0,02) ve motor görevli versiyonu arasında (r=0,277; p=0,002) istatistiksel olarak anlamlı fakat zayıf düzeyde ilişkiler saptanmıştır. Altı Nokta Adım Testi ile algılanan performans arasında anlamlı bir ilişki gözlenmemiştir (r=0,165; p=0,075). Ayrıca, Zamanlı Kalk Yürü Testi’ne entegre edilen motor görevli koşulda gözlemlenen çift görev yükü, bilişsel görevli koşula kıyasla anlamlı düzeyde daha yüksek bulunmuştur (Z=-4,4; p<0,001). Sonuç: Algılanan ve gerçek-zamanlı çift-görev performansı arasındaki zayıf ilişki değerlendirmede bu iki alanın ayrı ayrı gözden geçirilmesi gerektiğini göstermektedir. Ayrıca, yürüme görevine eşlik eden ikincil görevin türü bireylerin çift görev performansı üzerinde farklı sonuçlara neden olabilir. Parkinson hastalarında bu etkilerin ayrıntılı olarak incelenmesi daha etkin rehabilitasyon planı için yol gösterici olacaktır.

Keywords

• parkinson hastalığı
• çift-görev performansı
• motor-kognitif etkileşim

References

1. Abasıyanık, Z., Pedullà, L., Kahraman, T., D'Hooge, M., Santoyo-Medina, C., Soler, B., Tacchino, A., Veldkamp, R., Meza-Murillo, E.-R., Omar, A., Ciampi, E., Özakbaş, S., Kos, D., Kalron, A., & Feys, P. (2025). Reliability and Construct Validity of Three Self-report Questionnaires Assessing Dual-Task Difficulties in People With Multiple Sclerosis: An International Study. Archives of Physical Medicine and Rehabilitation, 106(2), 230-238. https://doi.org/10.1016/j.apmr.2024.08.024
2. Acaröz Candan, S., & Özcan, T. (2019). Dual-task interference during hand dexterity is a predictor for activities of daily living performance in Parkinson's disease. Parkinsonism Relat Disord, 66, 100-104. https://doi.org/10.1016/j.parkreldis.2019.07.017
3. Al-Yahya, E., Dawes, H., Smith, L., Dennis, A., Howells, K., & Cockburn, J. (2011). Cognitive motor interference while walking: a systematic review and meta-analysis. Neurosci Biobehav Rev, 35(3), 715-728. https://doi.org/10.1016/j.neubiorev.2010.08.008
4. Brincks, J., Johnsen, E. L., & Callesen, J. (2023). A study of the reliability and validity of the Six-Spot Step Test Cognitive in ambulatory persons with Parkinson's disease. Parkinsonism & Related Disorders, 111, 105412.
5. Brustio, P. R., Rabaglietti, E., Formica, S., & Liubicich, M. E. (2018). Dual-task training in older adults: The effect of additional motor tasks on mobility performance. Arch Gerontol Geriatr, 75, 119-124. https://doi.org/10.1016/j.archger.2017.12.003
6. Campbell, C. M., Rowse, J. L., Ciol, M. A., & Shumway-cook, A. (2003). The Effect of Cognitive Demand on Timed Up and Go Performance in Older Adults With and Without Parkinson Disease. Neurology Report, 27, 2–7.
7. Evans, J. J., Greenfield, E., Wilson, B. A., & Bateman, A. (2009). Walking and talking therapy: improving cognitive-motor dual-tasking in neurological illness. J Int Neuropsychol Soc, 15(1), 112-120. https://doi.org/10.1017/s1355617708090152
8. Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2009). Statistical power analyses using GPower 3.1: Tests for correlation and regression analyses* [Technical Report]. Universität Kiel. https://doi.org/10.13140/2.1.2840.4160

9. Fuller, R. L., Van Winkle, E. P., Anderson, K. E., Gruber-Baldini, A. L., Hill, T., Zampieri, C., Weiner, W. J., & Shulman, L. M. (2013). Dual task performance in Parkinson's disease: a sensitive predictor of impairment and disability. Parkinsonism Relat Disord, 19(3), 325-328. https://doi.org/10.1016/j.parkreldis.2012.11.011
10. Hausdorff, J. M., Cudkowicz, M. E., Firtion, R., Wei, J. Y., & Goldberger, A. L. (1998). Gait variability and basal ganglia disorders: stride-to-stride variations of gait cycle timing in Parkinson's disease and Huntington's disease. Mov Disord, 13(3), 428-437. https://doi.org/10.1002/mds.870130310
11. Kang, G. A., Bronstein, J. M., Masterman, D. L., Redelings, M., Crum, J. A., & Ritz, B. (2005). Clinical characteristics in early Parkinson's disease in a central California population-based study. Mov Disord, 20(9), 1133-1142. https://doi.org/10.1002/mds.20513
12. Kelly, V. E., Eusterbrock, A. J., & Shumway-Cook, A. (2012). A review of dual-task walking deficits in people with Parkinson's disease: motor and cognitive contributions, mechanisms, and clinical implications. Parkinsons Dis, 2012, 918719. https://doi.org/10.1155/2012/918719
13. Kelly, V. E., Janke, A. A., & Shumway-Cook, A. (2010). Effects of instructed focus and task difficulty on concurrent walking and cognitive task performance in healthy young adults. Exp Brain Res, 207(1-2), 65-73. https://doi.org/10.1007/s00221-010-2429-6
14. Leavy, B., Löfgren, N., Nilsson, M., & Franzén, E. (2018). Patient-reported and performance-based measures of walking in mild-moderate Parkinson's disease. Brain Behav, 8(9), e01081. https://doi.org/10.1002/brb3.1081
15. Leone, C., Feys, P., Moumdjian, L., D'Amico, E., Zappia, M., & Patti, F. (2017). Cognitive-motor dual-task interference: A systematic review of neural correlates. Neurosci Biobehav Rev, 75, 348-360. https://doi.org/10.1016/j.neubiorev.2017.01.010
16. Lindh-Rengifo, M., Jonasson, S. B., Ullén, S., Mattsson-Carlgren, N., & Nilsson, M. H. (2021). Perceived walking difficulties in Parkinson’s disease – predictors and changes over time. BMC Geriatrics, 21(1), 221. https://doi.org/10.1186/s12877-021-02113-0
17. Liu, Y. C., Yang, Y. R., Yeh, N. C., Ku, P. H., Lu, C. F., & Wang, R. Y. (2022). Multiarea Brain Activation and Gait Deterioration During a Cognitive and Motor Dual Task in Individuals With Parkinson Disease. J Neurol Phys Ther, 46(4), 260-269. https://doi.org/10.1097/npt.0000000000000402
18. Löfgren, N., Conradsson, D., Rennie, L., Moe-Nilssen, R., & Franzén, E. (2019). The effects of integrated single- and dual-task training on automaticity and attention allocation in Parkinson's disease: A secondary analysis from a randomized trial. Neuropsychology, 33(2), 147-156. https://doi.org/10.1037/neu0000496
19. Mac-Auliffe, D., Chatard, B., Petton, M., Croizé, A. C., Sipp, F., Bontemps, B., Gannerie, A., Bertrand, O., Rheims, S., Kahane, P., & Lachaux, J. P. (2021). The Dual-Task Cost Is Due to Neural Interferences Disrupting the Optimal Spatio-Temporal Dynamics of the Competing Tasks. Front Behav Neurosci, 15, 640178. https://doi.org/10.3389/fnbeh.2021.640178
20. McIsaac, T. L., Fritz, N. E., Quinn, L., & Muratori, L. M. (2018). Cognitive-Motor Interference in Neurodegenerative Disease: A Narrative Review and Implications for Clinical Management. Front Psychol, 9, 2061. https://doi.org/10.3389/fpsyg.2018.02061
21. Muir-Hunter, S. W., & Wittwer, J. E. (2016). Dual-task testing to predict falls in community-dwelling older adults: a systematic review. Physiotherapy, 102(1), 29-40. https://doi.org/10.1016/j.physio.2015.04.011
22. Plummer, P., & Eskes, G. (2015). Measuring treatment effects on dual-task performance: a framework for research and clinical practice. Front Hum Neurosci, 9, 225. https://doi.org/10.3389/fnhum.2015.00225
23. San Martín Valenzuela, C., Dueñas Moscardó, L., López-Pascual, J., Serra-Añó, P., & Tomás, J. M. (2020). Interference of functional dual-tasks on gait in untrained people with Parkinson’s disease and healthy controls: a cross-sectional study. BMC Musculoskeletal Disorders, 21(1), 396. https://doi.org/10.1186/s12891-020-03431-x
24. Schenkman, M., Cutson, T. M., Zhu, C. W., & Whetten-Goldstein, K. (2002). A longitudinal evaluation of patients' perceptions of Parkinson's disease. Gerontologist, 42(6), 790-798. https://doi.org/10.1093/geront/42.6.790
25. Sertel, M., Kocaman, A. A., Arslan, S. A., Demirci, C. S., & Ayçicek, G. Ş. (2021). Yaşlı Bireylerde İkili Görev Anketinin Türkçe Versiyon, Geçerlik ve Güvenirliğinin Araştırılması. Journal of Adnan Menderes University Health Sciences Faculty doi: 10.46237/amusbfd.870670
26. Tombu, M., & Jolicoeur, P. (2003). A central capacity sharing model of dual-task performance. J Exp Psychol Hum Percept Perform, 29(1), 3-18. https://doi.org/10.1037//0096-1523.29.1.3
27. Uribe, P., Fuentes, N., Álvarez-Ruf, J., Cornejo, I., & Mariman, J. J. (2022). Differentiation of the motor cost associated with cognitive tasks in Parkinson's disease: A dual-task study. European Journal of Neuroscience, 56(7), 5106–5115. https://doi.org/10.1111/ejn.15792
28. Vance, R. C., Healy, D. G., Galvin, R., & French, H. P. (2015). Dual tasking with the timed "up & go" test improves detection of risk of falls in people with Parkinson disease. Phys Ther, 95(1), 95-102. https://doi.org/10.2522/ptj.20130386
29. Warmerdam, E., Hausdorff, J. M., Atrsaei, A., Zhou, Y., Mirelman, A., Aminian, K., Espay, A. J., Hansen, C., Evers, L. J. W., Keller, A., Lamoth, C., Pilotto, A., Rochester, L., Schmidt, G., Bloem, B. R., & Maetzler, W. (2020). Long-term unsupervised mobility assessment in movement disorders. Lancet Neurol, 19(5), 462-470. https://doi.org/10.1016/s1474-4422(19)30397-7
30. Zirek, E., Ersoz Huseyinsinoglu, B., Tufekcioglu, Z., Bilgic, B., & Hanagasi, H. (2018). Which cognitive dual-task walking causes most interference on the Timed Up and Go test in Parkinson's disease: a controlled study. Neurol Sci, 39(12), 2151-2157. https://doi.org/10.1007/s10072-018-3564-2