Study on gait automaticity in patients with Parkinson's disease under dual⁃task paradigm

Objective To investigate the effect of cognitive⁃motor dual⁃task on gait automaticity in patients with Parkinson's disease (PD). Methods A total of 45 patients with primary PD in Tianjin Huanhu Hospital were selected from June 2020 to December 2021. Cognitive single task, motor single task and cognitive⁃motor dual⁃task in the "off" and "on" states of dopaminergic medication were performed. The correct number of subtractions was recorded to measure cognitive performance. A three⁃dimensional gait analyzer was used to extract the parameters of stride length and gait velocity, and the dual⁃task cost (DTC) was calculated to measure gait automaticity. Results Compared with single task, patients with PD showed slower gait velocity (t=11.909, P=0.000; t=11.621, P=0.000), shortened stride length (t=9.027, P=0.000; t=9.991, P=0.000), while there was no significant difference in the correct number of subtraction (t=0.651, P=0.519; t=1.205, P=0.234) during both "off" and "on" states. In patients with PD, the DTC of gait velocity (Z=⁃4.148, P=0.000) and stride length (Z=⁃4.114, P=0.000) in the "off" state was higher than that in the "on" state, while the DTC for subtraction had no significant difference (Z=⁃1.005, P=0.315). The DTC of gait velocity in the "off" and "on" states of patients with PD was negatively correlated with the Mini⁃Mental State Examination (MMSE) score (rs=⁃0.474, P=0.000; rs=⁃0.461, P=0.000), but positively correlated with Unified Parkinson's Disease Rating Scale Ⅲ (UPDRS Ⅲ) score (rs=0.446, P=0.002; rs=0.428, P=0.003). Conclusions Patients with PD have a significant decrease in stride length and gait velocity, and higher risk of falling when performing dual⁃task. Dopaminergic medication can improve the gait automaticity of patients, and cognitive decline may lead to gait automaticity disorder in patients with PD.