Motor-cognitive Dual-task Performance Research Articles

A Comparative Study of Cognitive and Motor Performance in Liver Recipients.

Introduction: Neurocognitive and motor impairments are often observed both before and after liver transplantation, resulting in inefficiencies in dual-task performance. Specific aim: The aim of this study was to evaluate the motor-cognitive dual-task performance in liver recipients, with a particular emphasis on cognition, performance status, and the impact of the COVID-19 pandemic. Design: A prospective, cross-sectional, web-based design with a control group was used. The study included 22 liver transplant recipients and 23 controls. Participants completed a motor-cognitive dual-task test (timed up and go test, TUG), a cognitive assessment (mini mental state examination), and a physical performance test (5-repetition sit-to-stand test). The study also used a functional performance status scale (The Karnofsky performance status) and assessed fear of coronavirus disease (fear of COVID-19 scale). Dual-task interference was assessed and the rate of correct responses per second was calculated to assess cognitive performance. Results: The results indicated no statistically significant difference in TUG time and TUG correct responses per second between the groups (group × condition interactions; P > 0.05). There was no significant difference in cognitive and motor dual-task interference during the TUG test between the two groups (P > 0.05). The Karnofsky Performance Status score was significantly correlated with TUG motor dual-task interference (r = -0.424 and P = 0.049). Conclusion: This study suggests that dual-task performance does not differ in cognitive or motor performance between liver recipients and healthy controls under the same dual-task condition. However, further controlled studies are needed to improve the generalizability of these findings.

Fully immersive virtual reality exergames with dual-task components for patients with Parkinson’s disease: a feasibility study

BackgroundDual-task training in Parkinson’s disease (PD) improves spatiotemporal gait parameters, cognition, and quality of life. Virtual reality (VR) has been used as a therapeutic tool for patients to participate in activities in a safe environment, engage in multisensory experiences, and improve motivation and interest in rehabilitation. This study aimed to investigate the feasibility of fully immersive VR exergames with dual-task components in patients with PD.MethodsWe developed VR exergames (go/no-go punch game, go/no-go stepping game, and number punch game) to improve habitual behavior control using motor–cognitive dual-task performance in patients with PD. The participants underwent 10 sessions 2–3 times a week, consisting of 30 min per session. The Unified Parkinson’s Disease Rating Scale, Timed Up and Go test (TUG) under single- and dual-task (cognitive and physical) conditions, Berg balance scale (BBS), Stroop test, trail-making test, and digit span were evaluated before and after intervention. The Simulator Sickness Questionnaire (SSQ) was used to assess VR cybersickness. Usability was assessed using a self-reported questionnaire.ResultsTwelve patients were enrolled and completed the entire training session. The mean age of participants was 73.83 ± 6.09 years; mean disease duration was 128.83 ± 76.96 months. The Hoehn and Yahr stages were 2.5 in seven patients and 3 in five patients. A significant improvement was observed in BBS and Stroop color–word test (p = 0.047 and p = 0.003, respectively). TUG time and dual-task interferences showed positive changes, but these changes were not statistically significant. The median SSQ total score was 28.05 (IQR: 29.92), 13.09 (IQR: 11.22), and 35.53 (IQR: 52.36) before, after the first session, and after the final session, respectively; the differences were not significant. Overall satisfaction with the intervention was 6.0 (IQR: 1.25) on a 7-point Likert-type scale.ConclusionsFully immersive VR exergames combined with physical and cognitive tasks may be used for rehabilitation of patients with PD without causing serious adverse effects. Furthermore, the exergames using dual-task components improved executive function and balance. Further development of VR training content may be needed to improve motor and dual-task performances.Trial registration NCT04787549 (https://clinicaltrials.gov/ct2/show/NCT04787549)

Effects of a 6-Min Treadmill Walking Test on Dual-Task Gait Performance and Prefrontal Hemodynamics in People With Multiple Sclerosis.

Fatigue is one of the most limiting symptoms in people with multiple sclerosis (pwMS) and can be subdivided into trait and state fatigue. Activity-induced state fatigue describes the temporary decline in motor and/or cognitive performance (motor and cognitive performance fatigability, respectively) and/or the increase in the perception of fatigue (perceived fatigability) in response to motor or cognitive tasks. To the best of our knowledge, the effects of a 6-min walk test (6MWT), which was often used to assess motor performance fatigability in pwMS, on motor-cognitive dual-task performance (i.e., walking + arithmetic task) and prefrontal cortex (PFC) hemodynamics are not well-known. This is of importance, since daily activities are often performed as multitasks and a worse dual-task walking performance is associated with an increased risk of falling. Consequently, we investigated the effect of a fast 6MWT (comfort velocity + 15%) performed on a treadmill on motor-cognitive performance fatigability (spatio-temporal gait parameters/accuracy during the arithmetic task) and perceived fatigability measures (rating of perceived exhaustion; RPE) as well as PFC hemodynamics recorded during dual-task walking in pwMS and healthy controls (HCs). Twenty pwMS (48.3 ± 9.0 years; 13 females/7 males; expanded disability status scale 2.7 ± 1.0, first diagnosis 13.8 ± 8.8 years) and 24 HC with similar age and sex (48.6 ± 7.9 years; 17 females/7 males) were included. Only cognitive performance fatigability (increased error rate) during dual-task walking was found after the fast 6MWT on the treadmill in pwMS. However, the changes in gait parameters did not indicate motor performance fatigability, although both the groups reported perceived fatigability (increased RPE) after the fast 6MWT. Moreover, no change in the PFC activation was detected in both groups. Our results suggest that the intensity and/or duration of the fast 6MWT was not sufficient to induce motor performance fatigability in pwMS. These factors should be addressed by future studies on this topic, which should also consider further parameters, e.g., muscular oxygenation and/or myoelectrical activity, to verify that exercise intensity and/or duration was appropriate to induce motor performance fatigability in pwMS.Clinical Trial RegisterDRKS00021057.

Cross-Sectional Study Using Virtual Reality to Measure Cognition.

Dual-task research is limited in its transferability to authentic contexts because laboratory conditions do not replicate real-world physical activity and decision-making scenarios. Creating valid, reliable methodologies to assess physiological and behavioral responses under varying physical and cognitive demands using virtual reality (VR) environment addresses this limitation. This study determined the feasibility of using VR to investigate the effects of dual-tasking on healthy young adults' cognitive performance. Three dual-tasking conditions (i.e., standing, preferred-paced walking, and fast-paced walking, each with blocked congruent and incongruent tasks) were developed. Using a within-subjects, randomized design, thirty-two young adults (17 female, mean age = 21.03 ± 2.86) were randomly assigned to a starting condition but experienced all three conditions. Physiological responses of heart rate (HR) and accelerometry data measured energy expenditure as the physical demand. Behavioral responses of reaction time and error rate quantified cognitive performance. Results indicated that (a) each condition verified independent physiological and behavioral responses; (b) reaction time and error rate during preferred walking or fast-paced walking dual-tasking conditions was significantly lower than standing condition; and surprisingly, (c) congruent tasks showed lower reaction time than the incongruent tasks. These findings suggest that it is feasible to use VR to assess the effects of dual-task conditions. Specifically, walking can optimize the motor-cognitive dual-task performance, compared to standing. These findings may be attributed to the dose-response effects of exercise intensity. Future studies should incorporate advanced technology such as the VR exercise.

Motor-cognitive dual-task performance of older women evaluated using Wii Balance Board.

Single- and dual-tasks are influenced by age-related impaired postural balance. Aim of this study was to analyze the Center of Pressure (CoP) oscillation during static balance in the presence or absence of cognitive task on older women. Thirty-one healthy older women were assessed in a stand quiet position with open/closed eyes (single-task, OE and CE) and with cognitive task (dual-task, DT) through Wii Balance Board. Sway area, total displacement and CoP oscillation (CO) based on the number of times that CoP traveled through anteroposterior and mediolateral directions. Friedman test was used to compare OE, CE and DT. Dual-task interference percentage was used to quantify the cognitive load on balance whereas Spearman correlation coefficient was used to assess the association of cognitive domains and CO. The CO was significantly higher in DT than in single-tasks and participants were unable to maintain their limits of stability in mediolateral direction. The cost of DT interference was 30.5%, which is partially explained by the deviation of attention from postural control to spatial and temporal orientation. Our findings show that cognitive load during DT impairs balance in mediolateral direction, thus indicating the use of WBB to assess cognitive interference on postural control.

Behavioral and Neural Correlates of Cognitive-Motor Interference during Multitasking in Young and Old Adults.

The concurrent performance of cognitive and postural tasks is particularly impaired in old adults and associated with an increased risk of falls. Biological aging of the cognitive and postural control system appears to be responsible for increased cognitive-motor interference effects. We examined neural and behavioral markers of motor-cognitive dual-task performance in young and old adults performing spatial one-back working memory single and dual tasks during semitandem stance. On the neural level, we used EEG to test for age-related modulations in the frequency domain related to cognitive-postural task load. Twenty-eight healthy young and 30 old adults participated in this study. The tasks included a postural single task, a cognitive-postural dual task, and a cognitive-postural triple task (cognitive dual-task with postural demands). Postural sway (i.e., total center of pressure displacements) was recorded in semistance position on an unstable surface that was placed on top of a force plate while performing cognitive tasks. Neural activation was recorded using a 64-channel mobile EEG system. EEG frequencies were attenuated by the baseline postural single-task condition and demarcated in nine Regions-of-Interest (ROIs), i.e., anterior, central, posterior, over the cortical midline, and both hemispheres. Our findings revealed impaired cognitive dual-task performance in old compared to young participants in the form of significantly lower cognitive performance in the triple-task condition. Furthermore, old adults compared with young adults showed significantly larger postural sway, especially in cognitive-postural task conditions. With respect to EEG frequencies, young compared to old participants showed significantly lower alpha-band activity in cognitive-cognitive-postural triple-task conditions compared with cognitive-postural dual tasks. In addition, with increasing task difficulty, we observed synchronized theta and delta frequencies, irrespective of age. Task-dependent alterations of the alpha frequency band were most pronounced over frontal and central ROIs, while alterations of the theta and delta frequency bands were found in frontal, central, and posterior ROIs. Theta and delta synchronization exhibited a decrease from anterior to posterior regions. For old adults, task difficulty was reflected by theta synchronization in the posterior ROI. For young adults, it was reflected by alpha desynchronization in bilateral anterior ROIs. In addition, we could not identify any effects of task difficulty and age on the beta frequency band. Our results shed light on age-related cognitive and postural declines and how they interact. Modulated alpha frequencies during high cognitive-postural task demands in young but not old adults might be reflective of a constrained neural adaptive potential in old adults. Future studies are needed to elucidate associations between the identified age-related performance decrements with task difficulty and changes in brain activity.

Motor-cognitive dual-task performance: effects of a concurrent motor task on distinct components of visual processing capacity

Dual tasking, or the simultaneous execution of two continuous tasks, is frequently associated with a performance decline that can be explained within a capacity sharing framework. In this study, we assessed the effects of a concurrent motor task on the efficiency of visual information uptake based on the ‘theory of visual attention’ (TVA). TVA provides parameter estimates reflecting distinct components of visual processing capacity: perceptual threshold, visual processing speed, and visual short-term memory (VSTM) storage capacity. Moreover, goodness-of-fit values and bootstrapping estimates were derived to test whether the TVA-model is validly applicable also under dual task conditions, and whether the robustness of parameter estimates is comparable in single- and dual-task conditions. 24 subjects of middle to higher age performed a continuous tapping task, and a visual processing task (whole report of briefly presented letter arrays) under both single- and dual-task conditions. Results suggest a decline of both visual processing capacity and VSTM storage capacity under dual-task conditions, while the perceptual threshold remained unaffected by a concurrent motor task. In addition, goodness-of-fit values and bootstrapping estimates support the notion that participants processed the visual task in a qualitatively comparable, although quantitatively less efficient way under dual-task conditions. The results support a capacity sharing account of motor-cognitive dual tasking and suggest that even performing a relatively simple motor task relies on central attentional capacity that is necessary for efficient visual information uptake.

Motor-cognitive dual-task deficits in individuals with early-mid stage Huntington disease

BackgroundHuntington disease (HD) results in a range of cognitive and motor impairments that progress throughout the disease stages; however, little research has evaluated specific dual-task abilities in this population, and the degree to which they may be related to functional ability. ObjectivesThe purpose of this study was to a) examine simple and complex motor-cognitive dual-task performance in individuals with HD, b) determine relationships between dual-task walking ability and disease-specific measures of motor, cognitive and functional ability, and c) examine the relationship of dual-task measures to falls in individuals with HD. MethodsThirty-two individuals with HD were evaluated for simple and complex dual-task ability using the Walking While Talking Test. Demographics and disease-specific measures of motor, cognitive and functional ability were also obtained. ResultsIndividuals with HD had impairments in simple and complex dual-task ability. Simple dual-task walking was correlated to disease-specific motor scores as well as cognitive performance, but complex dual-task walking was correlated with total functional capacity, as well as a range of cognitive measures. Number of prospective falls was moderately-strongly correlated to dual-task measures. ConclusionsOur results suggest that individuals with HD have impairments in cognitive-motor dual-task ability that are related to disease progression and specifically functional ability. Dual-task measures appear to evaluate a unique construct in individuals with early to mid-stage HD, and may have value in improving the prediction of falls risk in this population.

The reliability of local dynamic stability in walking while texting and performing an arithmetical problem

In the recent years, local dynamic stability of walking was frequently used to quantify motor control. Particularly, dual-task paradigms are used to assess a shift in gait control strategy to test walking in real life situations. Texting short messages while walking is a common motor-cognitive dual task of daily living. To able to monitor possible intervention effects on motor-cognitive dual-task performance, the test-retest reliability of the measure has to be evaluated. Since the reliability of the effects of cognitive tasks including texting while walking on local dynamic gait stability has not been assessed yet, this will be evaluated in the current study. Eleven young individuals were included. Gait data was registered twice (test-retest interval: seven days) using an inertial sensor fixed on the subjects’ trunks in three conditions: normal walking, walking while texting a message and walking while reciting serials of 7. Short-term finite maximum Lyapunov Exponents were quantified to assess local dynamic stability. The test-retest reliability was calculated using intra-class correlation coefficients and Bland and Altman Plots (bias and limits of agreement). ICC values of the current study show that in normal walking and walking while texting, outcomes are comparable and indicate mostly good to excellent reliability. The reliability values were almost always the lowest in walking while reciting serials of 7. Local dynamic stability derived from kinematic data of walking while cell phone texting can be reliably collected and, in turn, be used as an outcome measure in clinical trials with repeated measures design.

The Effect of a Six-Month Dancing Program on Motor-Cognitive Dual-Task Performance in Older Adults.

Dancing is a complex sensorimotor activity involving physical and mental elements which have positive effects on cognitive functions and motor control. The present randomized controlled trial aims to analyze the effects of a dancing program on the performance on a motor-cognitive dual task. Data of 35 older adults, who were assigned to a dancing group or a health-related exercise group, are presented in the study. In pretest and posttest, we assessed cognitive performance and variability of minimum foot clearance, stride time, and stride length while walking. Regarding the cognitive performance and the stride-to-stride variability of minimum foot clearance, interaction effects have been found, indicating that dancing lowers gait variability to a higher extent than conventional health-related exercise. The data show that dancing improves minimum foot clearance variability and cognitive performance in a dual-task situation. Multi-task exercises (like dancing) might be a powerful tool to improve motor-cognitive dual-task performance.

A cognitive dual task affects gait variability in patients suffering from chronic low back pain.

Chronic pain and gait variability in a dual-task situation are both associated with higher risk of falling. Executive functions regulate (dual-task) gait variability. A possible cause explaining why chronic pain increases risk of falling in an everyday dual-task situation might be that pain interferes with executive functions and results in a diminished dual-task capability with performance decrements on the secondary task. The main goal of this experiment was to evaluate the specific effects of a cognitive dual task on gait variability in chronic low back pain (CLBP) patients. Twelve healthy participants and twelve patients suffering from CLBP were included. The subjects were asked to perform a cognitive single task, a walking single task and a motor-cognitive dual task. Stride variability of trunk movements was calculated. A two-way ANOVA was performed to compare single-task walking with dual-task walking and the single cognitive task performance with the motor-cognitive dual-task performance. We did not find any differences in both of the single-task performances between groups. However, regarding single-task walking and dual-task walking, we observed an interaction effect indicating that low back pain patients show significantly higher gait variability in the dual-task condition as compared to controls. Our data suggest that chronic pain reduces motor-cognitive dual-task performance capability. We postulate that the detrimental effects are caused by central mechanisms where pain interferes with executive functions which, in turn, might contribute to increased risk of falling.

Effects of simultaneously performed cognitive and physical training in older adults

BackgroundWhile many studies confirm the positive effect of cognitive and physical training on cognitive performance of older adults, only little is known about the effects of simultaneously performed cognitive and physical training. In the current study, older adults simultaneously performed a verbal working memory and a cardiovascular training to improve cognitive and motor-cognitive dual task performance. Twenty training sessions of 30 minutes each were conducted over a period of ten weeks, with a test session before, in the middle, and after the training. Training gains were tested in measures of selective attention, paired-associates learning, executive control, reasoning, memory span, information processing speed, and motor-cognitive dual task performance in the form of walking and simultaneously performing a working memory task.ResultsSixty-three participants with a mean age of 71.8 ± 4.9 years (range 65 to 84) either performed the simultaneous training (N = 21), performed a single working memory training (N = 16), or attended no training at all (N = 26). The results indicate similar training progress and larger improvements in the executive control task for both training groups when compared to the passive control group. In addition, the simultaneous training resulted in larger improvements compared to the single cognitive training in the paired-associates task and was able to reduce the step-to-step variability during the motor-cognitive dual task when compared to the single cognitive training and the passive control group.ConclusionsThe simultaneous training of cognitive and physical abilities presents a promising training concept to improve cognitive and motor-cognitive dual task performance, offering greater potential on daily life functioning, which usually involves the recruitment of multiple abilities and resources rather than a single one.

Training effects on motor–cognitive dual-task performance in older adults

Abstract This systematic review investigated whether healthy older adults benefit from training interventions in motor–cognitive dual-task (DT) situations and which specific aspects of the intervention and/or task selection contribute to training benefits. Training effects were analysed with regard to the training programme (e.g., general ST or DT training) and task conditions (e.g., standing or walking, complexity of secondary cognitive task). Literature was searched via OVIDsp (Medline, EMBASE, PsycINFO). DT studies were included by the following criteria: (1) investigation of at least one motor task, (2) assessment of DT performance outcomes on standing or walking, (3) conduction of an intervention, and (4) investigation of older adults in an experimental–control group design or an old–young comparison. Thirteen studies met all inclusion criteria. Four types of interventions were identified: (1) general single-task (ST) motor training, (2) specific ST motor training, (3) general DT training, and (4) task-related (specific) DT training. For DT standing conditions only DT interventions improved motor performance, whereas DT walking also benefits by ST training. Most benefits on motor and cognitive performance seem to be reached by DT training interventions whereas a GST produced lowest effects. Thus, balance orientated motor and cognitive DT performance in healthy older adults can be improved by performance related exercises. Furthermore, to reach beneficial effects, it seems necessary that the training intervention includes a certain level of exercise load such as rising difficulties, appropriate intensity and duration, a certain level of task specificity, and variable task prioritization. The transfer of training effects into everyday situations needs to be further investigated.

O desempenho da dupla tarefa na Doença de Parkinson

The dual task performance in Parkinson's disease Introduction: A capacity to perform two tasks at the same time is a prerequisite for an individual to have a normal life. Under normal circumstances, performing motor and cognitive tasks concomitantly is common. Objective: The aim of this study was investigate the motor-cognitive dual task performance in Parkinson's disease patients. Method: Two groups were studied. One group was composed by 10 healthy individuals and the other by 10 patients with a diagnosis of Parkinson's disease. In both groups, the ages were between 47 and 75 years and the individuals were paired in relation to gender and age. They were asked to put on a button-up shirt as fast as possible as a single task and also while saying girls' names in random order (dual task). Each task was repeated three times. The movement time and errors committed were analyzed. Results: The patients took more time to complete both tasks (p= 0.006) in relation to the healthy group. Both groups committed more errors in the dual task (p= 0.03). There was a reduction in the movement time with the repetition of the task (p= 0.039) for both groups. Conclusion: These results suggest that individuals with Parkinson's disease present a loss in motor performance in relation to healthy individuals. However, the cost of performing the task is independent of motor-cognitive interference and the possibility of performance's improvement with practice is real.