Dual-task training to improve cognitive impairment and walking function in Parkinson's disease patients: A brief review

Abstract

In daily functional activities, the body needs the ability to perform two or more tasks at the same time (such as talking while walking). However, the gait disorder of patients with Parkinson's disease is aggravated when performing dual tasks, which seriously affects their quality of life. Therefore, the medical management plan should offer effective exercise training programming to improve Parkinson's disease patients' ability to perform dual tasks. Most traditional exercise intervention methods only focus on the perspective of exercise or cognition, ignoring their interaction, and fail to adequately resolve the dual task obstacles associated with Parkinson's disease. Some scholars put forward the concept of dual-task training and have applied dual-task training to patients with neurological disorders and have achieved good therapeutic effects. Therefore, this article summarizes the research literature concerning dual-task training to improve cognitive impairment and walking function of Parkinson's disease patients, to evaluate and discuss possible mechanisms of action, and provide a basis for adjuvant treatment and rehabilitation of Parkinson's disease patients.

Keywords

Parkinson's disease / Dual-task training / Cognitive impairment / Walking function

Authors’ contributions

Yanpei Zheng: Writing - review &; editing. Zhaoli Meng: Writing - review &; editing. Xiao Zhi: Writing - review &; editing. Zhanghua Liang: Writing - review &; editing, All authors read and approved the final manuscript.

Conflict of interest

The authors declare no financial or other conflicts of interest that could influence the interpretations of this work.

References

[1] A. Elbaz, L. Carcaillon, S. Kab, et al.. Epidemiology of Parkinson's disease. Rev Neurol (Paris), 172 (1) ( 2016), pp. 14-26, DOI: 10.1016/j.neurol.2015.09.012

[2] M. Poletti, M. Emre, U. Bonuccelli, et al.. Mild cognitive impairment and cognitive reserve in Parkinson's disease. Park Relat Disord, 17 (8) ( 2011), pp. 579-586, DOI: 10.1016/j.parkreldis.2011.03.013

[3] A. McKinlay, R.C. Grace, J.C. Dalrymple-Alford, et al.. Cognitive characteristics associated with mild Cognitive impairment in Parkinson's Disease. Dement Geriatr Cognit Disord, 28 (2) ( 2009), pp. 121-129, DOI: 10.1159/000235247

[4] A. Sauerbier, P. Jenner, A. Todorova, et al.. Non motor subtypes and Parkinson's disease. Park Relat Disord, 22 (Suppl 1) ( 2016), pp. S41-S46, DOI: 10.1016/j. parkreldis.2015.09.027

[5] A. Elbaz, J.H. Bower, M.M. Demetrius, et al.. Risk tables for parkinsonism and Parkinson's disease. J Chronic Epidemiol, 55 (1) ( 2002), pp. 25-31, DOI: 10.1016/S0895-4356(01)00425-5

[6] G. Santangelo, C. Vitale, M. Picillo, et al.. Mild cognitive impairment in newly diagnosed Parkinson's disease: a longitudinal prospective study. Park Relat Disord, 21 (10) ( 2015), pp. 1219-1226, DOI: 10.1016/j.parkreldis.2015.08.024

[7] M.G. Li, T.F. Liu, T.H. Zhang, et al.. Alterations of regional homogeneity in Parkinson's disease with mild cognitive impairment: a preliminary resting-state fMRI study. Neuroradiology, 62 (3) ( 2020), pp. 327-334, DOI: 10.1007/s00234-019-02333-7

[8] L.M. de Lau, M.M. Breteler. Epidemiology of Parkinson's disease. Lancet Neurol, 5 (6) ( 2006), pp. 525-535, DOI: 10.1016/S1474-4422(06)70471-9

[9] D.K. Simon, C.M. Tanner,P. Brundin. Parkinson disease epidemiology, pathology, genetics, and pathophysiology. Clin Geriatr Med, 36 (1) ( 2020), pp. 1-12, DOI: 10.1016/j.cger.2019.08.002

[10] X.L. Liu, S. Chen, Y. Wang.Effects of health Qigong exercises on relieving symptoms of Parkinson's disease. Evid Based Complementary Altern Med, 2016 ( 2016), p. 5935782, DOI: 10.1155/2016/5935782

[11] J. Mehrholz, J. Kugler, A. Storch, et al.. Treadmill training for patients with Parkinson Disease. An abridged version of a Cochrane Review. Eur J Phys Rehabil Med, 52 (5) ( 2016), pp. 704-713

[12] Y.S. Feng, S.D. Yang, Z.X. Tan, et al.. The benefits and mechanisms of exercise training for Parkinson's disease. Life Sci, 245 ( 2020), p. 117345, DOI: 10.1016/j.lfs.2020.117345

[13] L. Liang, L. Jiao-jiao, H. Ling-yan, et al.. Advance in cognitive and postural control dual-task in falls of older people. Chin J Rehabil Med, 22 (11) ( 2016), pp. 1289-1293, DOI: 10.3969/j.issn.1006-9771.2016.11.010

[14] R.M. Daly, R.L. Duckham, J.L. Tait, et al.. Effectiveness of dual-task functional power training for preventing falls in older people: study protocol for a cluster randomized controlled trial. Trials, 16 ( 2015), p. 120, DOI: 10.1186/s13063-015-0652-y

[15] A. Droby, I. Maidan, Y. Jacob, et al.. Distinct Effects of motor training on resting-state functional networks of the brain in Parkinson's disease. Neurorehabilitation Neural Repair, 34 (9) ( 2020), pp. 795-803, DOI: 10.1177/1545968320940985

[16] S. Christian, P. Steffen, K. Annika, et al.. Resistance versus balance training to improve postural control in Parkinson's disease: a randomized rater blinded controlled study. PLoS One, 10 ( 2015), Article e0140584, DOI: 10.1371/journal.pone.0140584

[17] H.C. Chang, C.S. Lu, W.D. Chiou, et al.. An 8-week low-intensity progressive cycling training improves motor functions in patients with early-stage Parkinson's disease. J Clin Neurol, 14 (2) ( 2018), pp. 225-233, DOI: 10.3988/jcn.2018.14.2.225

[18] P. Verhaeghen, D.W. Steitz, M.J. Sliwinski, et al.. Aging and dual-task performance: a meta-analysis. Psychol Aging, 18 (3) ( 2003), pp. 443-460, DOI: 10.1037/0882-7974.18.3.443

[19] M. Rossi-Izquierdo, A. Ernst, A. Soto-Varela, et al.. Vibrotactile neurofeedback balance training in patients with Parkinson's disease: reducing the number of falls. Gait Posture, 37 (2) ( 2013), pp. 195-200, DOI: 10.1016/j.gaitpost.2012.07.002

[20] Y.R. Yang, S.J. Cheng, Y. Lee, et al.. Cognitive and motor dual task gait training exerted specific training effects on dual task gait performance in individuals with Parkinson's disease: a randomized controlled pilot study. PLoS One, 14 (6) ( 2019), Article e0218180, DOI: 10.1371/journal.pone.0218180

[21] Z.L. Li, T. Wang, H. Liu, et al.. Dual-task training on gait, motor symptoms, and balance in patients with Parkinson's disease: a systematic review and meta-analysis. Clin Rehabil, 34 (11) ( 2020), pp. 1355-1367, DOI: 10.1177/0269215520941142

[22] T.B. De Freitas, P.H.W. Leite, F. Doná, J.E. Pompeu, A. Swarowsky, C. Torriani-Pasin. The effects of dual task gait and balance training in Parkinson's disease: a systematic review. Physiother Theory Pract, 36 (10) ( 2020), pp. 1-9, DOI: 10.1080/09593985.2018.1551455

[23] A.F. Kramer, J.F. Larish, D.L. Strayer, et al.. Training for attentional control in dual task settings: a comparison of young and old adults. J Exp Psychol Appl, 1 (1) ( 1995), pp. 50-76, DOI: 10.1037/1076-898X.1.1.50

[24] P. Silsupaldol, V. Lugade, A. Shumway-Cook, et al.. Training-related changes in dual-task walking performance of elderly persons with balance impairment: a double-blind, randomized controlled trial J. Gait Posture, 29 (4) ( 2009), pp. 634-639, DOI: 10.1016/j.gaitpost.2009.01.006

[25] K.Z.H. Li, E. Roudaia, M. Lussier, et al.. Benefits of cognitive dual-task training on balance performance in healthy older adults. J Gerontol A Biol Sci Med Sci, 65 (12) ( 2010), pp. 1344-1352, DOI: 10.1093/gerona/glq151

[26] A.C. De Souza Fortaleza, M. Mancini, P. Carlson-Kuhta, et al.. Dual task interference on postural sway, postural transitions and gait in people with Parkinson's disease and freezing of gait. Gait Posture, 56 ( 2017), pp. 76-81, DOI: 10.1016/j.gaitpost.2017.05.006

[27] C. Geroin, J. Nonnekes, N.M. de Vries, et al.. Does dual-task training improve spatiotemporal gait parameters in Parkinson's disease?. Park Relat Disord, 55 ( 2018), pp. 86-91, DOI: 10.1016/j.parkreldis.2018.05.018

[28] G. Yogev-Seligmann, N. Giladi, M. Brozgol, J.M. Hausdorff. A training program to improve gait while dual tasking in patients with Parkinson's disease: a pilot study. Arch Phys Med Rehabil, 93 (1) ( 2012), pp. 176-181, DOI: 10.1016/j.apmr.2011.06.005

[29] S.S. Shin, D.H. An. The effect of motor dual-task balance training on balance and gait of elderly women. J Phys Ther Sci, 26 (3) ( 2014), pp. 359-361, DOI: 10.1589/jpts.26.359

[30] C.G. Canning, L. Ada, E. Woodhouse. Multiple-task walking training in people with mild to moderate Parkinson's disease: a pilot study. Clin Rehabil, 22 (3) ( 2008), pp. 226-233, DOI: 10.1177/0269215507082341

[31] O. Beauchet, V. Dubose, G. Allali, et al.. Faster counting while walking' as a predictor of falls in older adults. Age Ageing, 36 (4) ( 2007), pp. 418-423, DOI: 10.1093/ageing/afm011

[32] V.E. Kelly, A.J. Eusterbrock, A. Shumway-Cook.A review of dual-task walking deficits in people with Parkinson's disease: motor and cognitive contributions, mechanisms, and clinical implications. Parkinson's Dis, 2012 ( 2012), p. 918719, DOI: 10.1155/2012/918719

[33] B. Intzandt, E.N. Beck, C.R.A. Silveira. The effects of exercise on cognition and gait in Parkinson's disease: a scoping review. Neurosci Biobehav Rev, 95 ( 2018), pp. 136-169, DOI: 10.1016/j.neubiorev.2018.09.018

[34] N.E. Fritz, F.M. Cheek, D.S. Nichols-Larsen. Motor-cognitive dual-task training in persons with neurologic disorders: a systemic review. J Neurol Phys Ther, 39 (3) ( 2015), pp. 142-153, DOI: 10.1097/NPT.0000000000000090

[35] C. Hsiu-Chen, C. Chiung-Chu, L. Jiunn-Woei, et al.. The effects of dual-task in patients with Parkinson's disease performing cognitive-motor paradigms. J Clin Neurosci, 72 ( 2020), pp. 72-78, DOI: 10.1016/j.jocn.2020.01.024

[36] D. Conradsson, L. Niklas, N. Hoakan, et al.. The effects of highly challenging balance training in elderly with Parkinson's disease. Neurorehabilitation Neural Repair, 29 (9) ( 2015), pp. 827-836, DOI: 10.1177/1545968314567150

[37] B. Wollesen, S. Rudnik, A. Gulberti, et al.. A feasibility study of dual-task strategy training to improve gait performance in patients with Parkinson's disease. Sci Rep, 11 (1) ( 2021), p. 12416, DOI: 10.1038/S41598-021-91858-0

[38] C. Strouwen, E.A. Molenaar, S.H. Keus, et al.. Are factors related to dual-task performance in people with Parkinson's disease dependent on the type of dual task?. Park Relat Disord, 23 ( 2016), pp. 23-30, DOI: 10.1016/j.parkreldis.2015.11.020

[39] A. Mirelman, L. Rochester, M. Reelick, et al.. V-TIME: a treadmill training program augmented by virtual reality to decrease fall risk in older adults: study design of a randomized controlled trial. BMC Neurol, 13 ( 2013), p. 15, DOI: 10.1186/1471-2377-13-15

[40] A. Fernandes, N. Rocha, R. Santos, et al.. Effects of dual-task training on balance and executive functions in Parkinson's disease: a pilot study. Somatosens Mot Res, 32 (2) ( 2015), pp. 122-127, DOI: 10.3109/08990220.2014.1002605

[41] L. Rennie, A. Opheim, E. Dietrichs, et al.. Highly challenging balance and gait training for individuals with Parkinson's disease improves pace, rhythm and variability domains of gait - a secondary analysis from a randomized controlled trial. Clin Rehabil, 35 (2) ( 2021), pp. 200-212, DOI: 10.1177/0269215520956503

[42] J. Swartz, J. Scholl, C. McNamara, et al.. Is live face-to-face UPDRS part III training more effective than remote training methodology in Parkinson'/INS;s disease clinical trials?. J Neurol Sci, 333 (1) ( 2013), p. E136, DOI: 10.1016/j.jns.2013.07.454

[43] T. Wu, M. Hallett. Neural correlates of dual task performance in patients with Parkinson's disease. J Neurol Neurosurg Psychiatry, 79 (7) ( 2008), pp. 760-766, DOI: 10.1136/jnnp.2007.126599

[44] J. Tan, S. Wu, L. Xu, et al.. Prefrontal cortex with executive functions involved in dual-task performance. Prog Psychol Sci, 21 (12) ( 2013), pp. 2127-2135. https://doi:10.3724/SP.J.1042.2013.02127

[45] A.B. Rosenfeldt, A.L. Penko, M.C. Streicher, et al.. Improvements in temporal and postural aspects of gait vary following single- and multi-modal training in individuals with Parkinson's disease. Park Relat Disord, 64 ( 2019), pp. 280-285, DOI: 10.1016/j.parkreldis.2019.05.021

[46] A. Szameitat, J. Lepsien, D.Y. von Cramon, et al.. Task-order coordination in dual-task performance and the lateral prefrontal cortex: an event-related fMRI study. Psychol Res, 70 (6) ( 2006), pp. 541-552, DOI: 10.1007/s00426-005-0015-5

[47] G.M. Petzinger, B.E. Fisher, S. McEwen, et al.. Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson's disease. Lancet Neurol, 12 (7) ( 2013), pp. 716-726, DOI: 10.1016/S1474-4422(13)70123-6

[48] I. Maidan, K. Rosenberg-Katz, Y. Jacob, et al.. Altered brain activation in complex walking conditions in patients with Parkinson's disease. Park Relat Disord, 25 ( 2016), pp. 91-96, DOI: 10.1016/j.parkreldis.2016.01.025

[49] K.H. Binda, T.P. Lillethorup, C. Real, et al.. Exercise protects synaptic density in a rat model of Parkinson's disease. Exp Neurol, 342 ( 2021), p. 113741, DOI: 10.1016/j.expneurol.2021.113741

[50] M.S. Shin, H.Y. Jeong. An Da-In, et al. Treadmill exercise facilitates synaptic plasticity on dopaminergic neurons and fibers in the mouse model with Parkinson's disease. Neurosci Lett, 621 (16) ( 2016), pp. 28-33, DOI: 10.1016/j.neulet.2016.04.015

[51] S.D. Viana, I.R. Pita, C. Lemos, et al.. The effects of physical exercise on nonmotor symptoms and on neuroimmune RAGE network in experimental parkinsonism. J Appl Physiol, 123 (1) ( 2017), pp. 161-171, DOI: 10.1152/japplphysiol.01120.2016