16 Gait features in parkinsonian patients with or without mild cognitive impairment

Abstract

Background In the last decade, the relationship between cognitive function and gait performances has received increasing attention. The present study aimed to describe the gait pattern in patients affected by Parkinson’s disease (PD) with or without mild cognitive impairment (MCI+, MCI−). We also sought to find an association between gait pattern and specific cognitive profiles. Methods Forty-three patients with PD (19 MCI+ and 24 MCI−) and 20 age- and gender-matched healthy subjects (HS) were enrolled. We compared the gait pattern among MCI+ vs MCI− vs HS in the following conditions: (1) normal gait; (2) motor dual task; (3) cognitive dual task, by means of a gait analysis system. In PD patients, gait patterns were evaluated in both off and on state. Memory, executive and visuospatial domains were evaluated with an extensive neuropsychological battery. Results Compared with MCI− and HS, MCI+ PD patients displayed reduced step length and swing time and impairment of measures of dynamic stability, which were only partially reverted by levodopa. We also found that dual task conditions affected several walking parameters in MCI+ PD at off and on state with respect to MCI− and HS . Factor analysis revealed two independent factors, namely pace and stability. The latter was strongly and directly correlated with the visuospatial domain. Conclusions Dysfunctions on specific gait parameters, which are poorly responsive to levodopa and highly sensitive to dual tasks, are associated with MCI in PD patients. Importantly, visuospatial impairment is strongly associated with the development of instability and more generally with the progression of PD.