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Visuo-cognition in gait in Parkinson’s disease: response to visual cues

Lookup NU author(s): Dr Sam Stuart, Dr Brook Galna, Dr Susan Lord, Professor Lynn Rochester


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BackgroundGait impairment is a core feature of Parkinson’s disease (PD) with implications for falls risk. Visual cues improve gait in PD but the underlying mechanisms are unclear. Evidence suggests that cognitive (attention) and visual processes may play an important role but this has not been previously examined. Cognition and vision are interrelated (termed visuo-cognition), which confounds interpretation. Understanding visuo-cognitive response to cues is key to developing effective therapeutics.ObjectiveThis study examined visuo-cognition during gait in PD in response to a visual cue. We studied; 1) saccade (fast eye movement) frequency under cued and dual task conditions; and 2) relationship between visual function, attention, saccade frequency and gait in PD.MethodsSaccade frequency (SF: a proxy for visuo-cognition) was measured during walking in 55 PD and 32 age-matched control participants using a mobile eye-tracker. Participants walked straight with and without a visual cue under single and dual task (number repetition). Vision and attention assessments were conducted. SF response to visual cue and dual task were assessed using repeat measure ANOVAs. Relationships between SF, visual function, attention and gait (velocity) were explored using bivariate and multivariate analysis (e.g. structural equation modelling (SEM)). ResultsAttention and visual functions were significantly impaired in PD. SF was reduced in PD during non-cued gait compared to controls. For both groups SF increased with a visual cue (p<.001) and was maintained under dual task (p=.008) irrespective of group, with greater increase in PD.Attention and visual function related to SF response in PD, but SEM with hypothesised interrelationships showed that visual function only related indirectly to SF through attention (ß=-.12, p=.008). Attention related to SF, visual function and cued-gait (ß=-.37, p=.036) in PD but not controls. SF was associated with cued-gait in PD but not controls. SEM showed that attention facilitated indirect relationships whereby SF (ß=.10, p=.031) and visual function (ß=-.17, p=.031) were both associated with cued-gait in PD. ConclusionThis novel data indicates the pivotal role that attention plays in facilitating response to cues in PD. These results have implications for future research which must consider the role of attention, and for clinicians using cues to improve performance. Understanding these complex features will help inform intervention development.

Publication metadata

Author(s): Stuart S, Galna B, Lord S, Rochester L

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: 4th World Parkinson's Congress

Year of Conference: 2016

Pages: 205-205

Print publication date: 01/09/2016

Online publication date: 01/09/2016

Acceptance date: 06/06/2016

ISSN: 1877-7171

Publisher: IOS Press


DOI: 10.3233/JPD-169900

Series Title: Journal of Parkinson's Disease