Postural stability in early Parkinson’s disease: effect of cognitive dual-tasking

Year 2022, Volume: 47 Issue: 4, 1539 - 1546, 28.12.2022

Miray Erdem , Mehmet Balal , Meltem Demirkıran

https://doi.org/10.17826/cumj.1126396

Abstract

Purpose: The primary aim of this study is to evaluate postural stability by using a static posturography in patients with early Parkinson’s disease (PD). Secondly, this paper addresses the need for illustrating the effect of dual-tasking on postural stability in early PD patients.
Materials and Methods: Twenty-nine early PD patients with maximum 5 years of disease duration were included in this study. The selected group had no clinical PI while their age- and sex-matched healthy controls were carried out. Neurological examination and mini-mental state examination (MMSE) were performed in all subjects. Unified Parkinson Disease Rating Scale (UPDRS) and modified Hoehn and Yahr (H&Y) scores were recorded in PD patients. Postural stability was assessed in all subjects on a static posturography platform under three different conditions: eyes open, eyes closed and a cognitive task of producing words with given letters.
Results: The mean age of the PD was 59.2±10.5 whereas the control groups mean age was 56.3±7.6 (p>0.05). The female-male ratio was 9/20 in the PD and 12/17 in the control group. There was no important difference between the two groups in terms of demographic characteristics. In the PD group, the mean UPDRS was 12.8±4.9. The patients were mostly receiving polytherapy.
Eye closure and cognitive task caused an increase in most sway parameters in both groups.
Conclusion: Early PD patients on medication, postural stability is preserved and cognitive dual-tasking does not affect postural stability in these patients in the early stage.

Keywords

Dual-task interference, cognitive task, Parkinson’s disease, postural instability, static posturography

Erken evre Parkinson hastalığında postural stabilite: kognitif ikili görevin etkisi

Abstract

Amaç: Bu çalışmanın temel amacı, erken evre Parkinson hastalığında (PH)’da statik posturografi cihazı kullanarak postural stabiliteyi değerlendirmektir. İkincil amaç ise erken evre PH’da ikili görevin postural stabilite üzerindeki etkisini incelemektir.
Gereç ve Yöntem: Bu prospektif çalışmaya hastalık süresi en fazla beş yıl olan, klinik PI'sı olmayan, yirmi dokuz erken evre PH ile yaş ve cinsiyet uyumlu yirmi dokuz sağlıklı kontrol grubu alındı. Tüm olgulara hareket bozukluğu uzmanı eşliğinde nörolojik muayene ve mini-mental durum muayenesi (MMSE) yapıldı. Parkinson hastalarında Birleşik Parkinson Hastalığı Değerlendirme Ölçeği (BPHDÖ) ve modifiye Hoehn ve Yahr (H&Y) skorları kaydedildi. Postural stabilite, tüm deneklerde statik posturografi cihazında gözler açık, gözler kapalı ve verilen harflerle kelimeler türetmesi istenerek kognitif görev esnasında olmak üzere üç farklı koşul altında değerlendirildi.
Bulgular: PH yaş ortalaması 59,2±10,5 ve kontrol grubunun yaş ortalaması 56,3±7,6 (p>0,05), kadın-erkek oranı PH'da 9/20 ve kontrol grubunda 12/17 olup, demografik özellikler açısından her iki grup arasında anlamlı fark saptanmadı. PH grubunda BPHDÖ ortalama skoru 12,8±4,9 idi. Olgular çoğunlukla politerapi almakta idi. Her iki grupta da göz kapalı tüm ölçümlerde salınım değerlerinin, göz açık ölçümlere göre belirgin olarak arttığı gözlendi.
Sonuç: İlaç kullanan erken evre PH’da postural stabilitenin korunduğunu ve kognitif görevin bu hastalarda erken evrede postural stabiliteyi etkilemediğini göstermektedir.

Keywords

Çift görev çatışması, kognitif görev, Parkinson hastalığı, postural instabilite, postural stabilite, statik posturografi, Dual-task interference, cognitive task, Parkinson’s disease, postural instability, static posturography

References

• 1. Palakurthi B, Burugupally SP. Postural Instability in Parkinson’s Disease: A Review. Brain Sci. 2019 Sep; 18;9(9): 239.
• 2. Viseux FJF, Delval A, Defebvre L, et al. Postural instability in Parkinson's disease: Review and bottom-up rehabilitative approaches. Neurophysiol Clin. 2020 Nov;50(6):479-487.
• 3. Pérez-Sánchez JR, Grandas F. Early Postural Instability in Parkinson's Disease: A Biomechanical Analysis of the Pull Test. Parkinsons Dis. 2019; 2019: 6304842.
• 4. Chastan N, Debono B, Maltête D, et al. Discordance between measured postural instability and absence of clinical symptoms inParkinson's disease patients in the early stages of the disease. Mov Disord, 2008; 23: 366-372.
• 5. You S, Kim HA, Lee H. Association of Postural Instability with Autonomic Dysfunction in Early Parkinson's Disease. J Clin Med. 2020 Nov 23;9(11):3786.
• 6. Panyakaew P, Anan C, Bhidayasiri R. Visual deprivation elicits subclinical postural inflexibilities in early Parkinson's disease. J Neurol Sci. 2015 Feb 15;349(1-2):214-9.
• 7. Tsang WW, Chan VW, Wong HH, et al. The effect of performing a dual-task on postural control and selective attention of older adults when stepping backward. J Phys Ther Sci. 2016;28(10):2806-11.
• 8. Marchese R, Bove M, Abbruzzese G. Effect of cognitive and motor tasks on postural stability in Parkinson’s disease: a posturographic study, Mov Disord, 2003; 18:652-660.
• 9. Bekkers EMJ, Dockx K, Devan S, et al. The Impact of Dual-Tasking on Postural Stability in People With Parkinson's Disease With and Without Freezing of Gait. Neurorehabil Neural Repair. 2018 Feb;32(2):166-174.
• 10. Plotnik M, Giladi N, Dagan Y, et al. Postural instability and fall risk in Parkinson's disease: impaired dual tasking, pacing, and bilateral coordination of gait during the "ON" medication state. Exp Brain Res. 2011 May;210(3-4):529-38.
• 11. Morris M, Iansek R, Smithson F, et al. Postural instability in Parkinson's disease: a comparison with and without a concurrent task. Gait Posture. 2000 Dec;12(3):205-16.
• 12. Ahmed MM, Mosalem DM, Alfeeli AK, et al. Relationship between Gait Parameters and Postural Stability in Early and Late Parkinson's Disease and Visual Feedback-Based Balance Training Effects. Open Access Maced J Med Sci. 2017 Apr 8;5(2):207-214.
• 13. Chen T, Fan Y, Zhuang X, et al. Postural Sway in Patients With Early Parkinson's Disease Performing Cognitive Tasks While Standing. Neurol Res. 2018 Jun;40(6):491-498.
• 14. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189-98.
• 15. Demir T, Balal M, Demirkiran M. The effect of cognitive task on postural stability in cervical dystonia. M. Arquivos de Neuro-psiquiatria, 01 Sep 2020, 78(9):549-555.
• 16. Delafontaine A, Hansen C, Marolleau I, et al. Effect of a Concurrent Cognitive Task, with Stabilizing Visual Information and Withdrawal, on Body Sway Adaptation of Parkinsonian’s Patients in an Off-Medication State: A Controlled Study. Sensors 2020, 20, 5059.
• 17. Lee JM, Koh SB, Chae SW, et al. Postural instability and cognitive dsyfunction in early Parkinson’s disease.Can J Neurol Sci, 2012;39(4):473-82.
• 18. Valkovic P, Abrahámová D, Hlavacka F, et al. Static posturography and infraclinical postural instability in early-stage Parkinson's disease. Mov Disord, 2009 ; 15;24(11):1713-4; author reply 1714.
• 19. Frenklach A, Louie S, Koop MM, et al. Excessive postural sway and the risk of falls at different stages of Parkinson's disease. Mov Disord, 2009: 15;24(3):377-85.
• 20. Holmes JD, Jenkins ME, Johnson AM, et al. Dual-Task Interference: The Effects of Verbal Cognitive Tasks on Upright Postural Stability in Parkinson's Disease. Parkinsons Dis 2010 Feb 14;2010:696492.
• 21. Bloem BR, Grimbergen YAM, Dijk JGV, et al. “The “posture second” strategy: a review of wrong priorities in Parkinson’s disease,” Journal of the Neurological Sciences, vol. 248, no. 1-2, pp. 196–204, 2006.
• 22. Chastan N, Westby GW, Yelnik J, et al. Effects of nigral stimulation on locomotion and postural stability in patientswith Parkinson's disease. Brain, 2009; 132: 172-184.
• 23. Falaki A, Huang X, Lewis MM, et al. Impaired Synergic Control of Posture in Parkinson's Patients Without Postural Instability. Gait Posture. 2016 Feb;44:209-15.
• 24. Pashler H. Dual-task interference in simple tasks: data and theory. Psychol Bull. 1994 Sep;116(2):220-44.
• 25. Ruthruff E, Pashler HE, Klaassen A. Processing bottlenecks in dual-task performance: Structural limitation or strategic postponement? Psychon. Bull. Rev. 2001, 8, 73–80.