TY - JOUR
T1 - Impact of sub-thalamic nucleus deep brain stimulation on dual tasking gait in Parkinson's disease
AU - Seri-Fainshtat, Eliraz
AU - Israel, Zvi
AU - Weiss, Aner
AU - Hausdorff, Jeffrey M.
N1 - Funding Information:
The authors are indebted to the participants for their time and effort, to the staff of the Movement Disorders Unit at the Tel-Aviv Sourasky Medical Center, and to Ms. Tamar Muller and Dr. Glen Doniger for their invaluable assistance. ZI received funding from the PATH (Parkinson’s at Hadassah) foundation, London. JMH received funding from the Michael J Fox Foundation for Parkinson’s Research, NIH (AG14100 and AG034227), and the National Parkinson Foundation. The funding agencies were not involved in the design, in the collection, analysis, or interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication.
PY - 2013
Y1 - 2013
N2 - Background: The beneficial effects of bilateral sub-thalamic nucleus deep brain stimulation on motor function and gait in advanced Parkinson's disease are established. Less is known about the effect of stimulation on cognitive function and the capacity to walk while dual tasking, an ability that has been related to fall risk. Everyday walking takes place in complex environments that often require multi-tasking. Hence, dual tasking gait performance reflects everyday ambulation as well as gait automaticity. The purpose of this study was to examine the impact of sub-thalamic nucleus deep brain stimulation on dual task walking in patients with advanced Parkinson's disease. Methods. Gait was assessed using a performance-based test and by quantifying single-task and dual task walking conditions in 28 patients with advanced Parkinson's disease. These tests were conducted in 4 conditions: "OFF" medication, with the stimulator turned on and off, and "ON" medication, with the stimulator turned on and off. A previously validated, computerized neuro-psychological battery assessed executive function, attention and memory "OFF" and "ON" deep brain stimulation, after subjects took their anti-Parkinsonian medications. Results: Stimulation improved motor function and the spatiotemporal parameters of gait (e.g., gait speed) during both single-task and dual task walking conditions. Attention improved, but executive function did not. The dual task effect on gait did not change in response to stimulation. For example, during serial 3 subtractions, gait speed was reduced by -0.20 ± 0.14 m/sec while OFF DBS and OFF meds and by -0.22 ± 0.14 m/sec when the DBS was turned on (p = 0.648). Similarly, ON medication, serial 3 subtractions reduced gait speed by -0.20 ± 0.16 m/sec OFF DBS and by -0.22 ± 0.09 m/sec ON DBS (p = 0.543). Conclusions: Bilateral sub-thalamic nucleus deep brain stimulation improves motor symptoms, certain features of gait and even some aspects of cognitive function. However, stimulation apparently fails to reduce the negative impact of a dual task on walking abilities. These findings provide new insight into the effects of deep brain stimulation on gait during cognitively challenging conditions and everyday walking.
AB - Background: The beneficial effects of bilateral sub-thalamic nucleus deep brain stimulation on motor function and gait in advanced Parkinson's disease are established. Less is known about the effect of stimulation on cognitive function and the capacity to walk while dual tasking, an ability that has been related to fall risk. Everyday walking takes place in complex environments that often require multi-tasking. Hence, dual tasking gait performance reflects everyday ambulation as well as gait automaticity. The purpose of this study was to examine the impact of sub-thalamic nucleus deep brain stimulation on dual task walking in patients with advanced Parkinson's disease. Methods. Gait was assessed using a performance-based test and by quantifying single-task and dual task walking conditions in 28 patients with advanced Parkinson's disease. These tests were conducted in 4 conditions: "OFF" medication, with the stimulator turned on and off, and "ON" medication, with the stimulator turned on and off. A previously validated, computerized neuro-psychological battery assessed executive function, attention and memory "OFF" and "ON" deep brain stimulation, after subjects took their anti-Parkinsonian medications. Results: Stimulation improved motor function and the spatiotemporal parameters of gait (e.g., gait speed) during both single-task and dual task walking conditions. Attention improved, but executive function did not. The dual task effect on gait did not change in response to stimulation. For example, during serial 3 subtractions, gait speed was reduced by -0.20 ± 0.14 m/sec while OFF DBS and OFF meds and by -0.22 ± 0.14 m/sec when the DBS was turned on (p = 0.648). Similarly, ON medication, serial 3 subtractions reduced gait speed by -0.20 ± 0.16 m/sec OFF DBS and by -0.22 ± 0.09 m/sec ON DBS (p = 0.543). Conclusions: Bilateral sub-thalamic nucleus deep brain stimulation improves motor symptoms, certain features of gait and even some aspects of cognitive function. However, stimulation apparently fails to reduce the negative impact of a dual task on walking abilities. These findings provide new insight into the effects of deep brain stimulation on gait during cognitively challenging conditions and everyday walking.
KW - Cognitive impairment
KW - DBS
KW - Dual task
KW - Executive control
KW - Falls
KW - Gait
KW - Parkinson's disease
UR - http://www.scopus.com/inward/record.url?scp=84876120005&partnerID=8YFLogxK
U2 - 10.1186/1743-0003-10-38
DO - 10.1186/1743-0003-10-38
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C2 - 23587168
AN - SCOPUS:84876120005
SN - 1743-0003
VL - 10
JO - Journal of NeuroEngineering and Rehabilitation
JF - Journal of NeuroEngineering and Rehabilitation
IS - 1
M1 - 38
ER -