- •Relations between DT walking performance and clinical characteristics were analysed.
- •Relations depend on type of motor and cognitive task used in the dual task.
- •Better mobility in MS is related to higher DT walking speed.
- •Faster information processing speed related to lower DTC.
Background: In persons with Multiple Sclerosis (pwMS) performing a simultaneous cognitive task while walking often results in slower gait. Clinical characteristics associated with reduced dual task (DT) performance are not yet entirely clear. This multi-centre study aimed to determine the relationship between clinical and demographical characteristics with dual task (DT) walking performance in pwMS during multiple DT conditions.
Methods: Nine DT conditions were analysed, consisting of combinations of three types of cognitive (‘digit span’, ‘subtraction’, ‘vigilance’) and three types of walking (‘walk’, ‘walk with cup’, ‘walk over obstacles’) conditions. Primary outcomes were DT gait speed (m/s) and motor DT cost of gait speed (DTCmotor, %). Secondary outcomes were clinical tests of physical and cognitive functioning and patient-reported and demographical outcomes. Firstly, univariate analyses and, subsequently, multivariate analyses with backward modelling, were conducted for each type of walking DT condition separately. Cognitive DT conditions were included in the models as main and as interaction effect with the secondary outcomes.
Results: Analysis were performed in 81 pwMS (EDSS 3.3 ± 1.0). In the final models of DTCmotor, the significant main effects were in ‘walk’ DT-conditions the Symbol Digit Modalities Test (SDMT), in ‘cup’ conditions the SDMT and Dynamic Gait Index and in ‘obstacles’ conditions age. For DT gait speed, main effects were found for the 2-Minute Walking Test (2MWT) and the Multiple Sclerosis Walking Scale for all walking conditions. Additionally, interactions between cognitive DT-conditions and SDMT, age and 2MWT were found.
Conclusion: Clinical characteristics related to DT walking performance differed according to cognitive-motor DT-condition used. Still, in general, pwMS with a better mobility demonstrated higher DT gait speed, while a faster information processing speed was related to a lower DTCmotor.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Multiple Sclerosis and Related Disorders
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Balancing the Demands of Two Tasks: an Investigation of Cognitive-Motor Dual-Tasking in Relapsing Remitting Multiple Sclerosis.J. Int. Neuropsychol. Soc. 2018; 24: 247-258
- The dual task-cost of standing balance affects quality of life in mildly disabled MS people.Neurol. Sci. 2016; 37: 673-679
- Cognitive impairment in multiple sclerosis.Lancet Neurol. 2008; 7: 1139-1151
- Dual task cost of cognition is related to fall risk in patients with multiple sclerosis: a prospective study.Clin. Rehabil. 2017; 31: 278-284
- Multiple sclerosis.Nat. Rev. Dis. Primers. 2018; 4: 43
- "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician.J. Psychiatr. Res. 1975; 12: 189-198
- Walking and talking: an investigation of cognitive-motor dual tasking in multiple sclerosis.Mult. Scler. 2009; 15: 1215-1227
- Comparing Three Dual-Task Methods and the Relationship to Physical and Cognitive Impairment in People with Multiple Sclerosis and Controls.Mult Scler Int. 2015; 2015650645
- Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS).Neurology. 1983; 33: 1444-1452
- Impact of walking impairment in multiple sclerosis: perspectives of patients and care partners.Patient. 2011; 4: 189-201
- Measuring the cost of cognitive-motor dual tasking during walking in multiple sclerosis.Mult. Scler. 2015; 21: 123-131
- Cognitive motor interference during walking in multiple sclerosis using an alternate-letter alphabet task.Arch. Phys. Med. Rehabil. 2014; 95: 1498-1503
- Walking and cognition, but not symptoms, correlate with dual task cost of walking in multiple sclerosis.Gait Posture. 2014; 39: 870-874
- Cognitive function in patients with multiple sclerosis.Arch. Neurol. 1980; 37: 577-579
- Measuring treatment effects on dual-task performance: a framework for research and clinical practice.Front Hum Neurosci. 2015; 9: 225
- Cognitive-motor interference during functional mobility after stroke: state of the science and implications for future research.Arch. Phys. Med. Rehabil. 2013; 94 (2565-2574): e2566
- Cognitive-motor interference during gait in patients with Multiple Sclerosis: a mixed methods Systematic Review.Neurosci. Biobehav. Rev. 2018; 94: 126-148
- The effect of prioritization over cognitive-motor interference in people with relapsing-remitting multiple sclerosis and healthy controls.PLoS One. 2019; 14e0226775
- Correlates of dual-task performance in people with multiple sclerosis: a systematic review.Gait Posture. 2020; 81: 172-182
- Nonsignificant associations between measures of inhibitory control and walking while thinking in persons with multiple sclerosis.Arch. Phys. Med. Rehabil. 2015; 96: 1518-1524
- A wearable sensor identifies alterations in community ambulation in multiple sclerosis: contributors to real-world gait quality and physical activity.J. Neurol. 2020;
- Mobility and cognitive correlates of dual task cost of walking in persons with multiple sclerosis.Disabil. Rehabil. 2014; 36: 205-209
- Protocol for a randomized comparison of integrated versus consecutive dual task practice in Parkinson's disease: the DUALITY trial.BMC Neurol. 2014; 14: 61
- Design, Development, and Testing of an App for Dual-Task Assessment and Training Regarding Cognitive-Motor Interference (CMI-APP) in People With Multiple Sclerosis: multicenter Pilot Study.JMIR Mhealth Uhealth. 2020; 8: e15344
- Test-Retest Reliability of Cognitive-Motor Interference Assessments in Walking With Various Task Complexities in Persons With Multiple Sclerosis.Neurorehabil. Neural Repair. 2019; 1545968319856897
- Structured Cognitive-Motor Dual Task Training Compared to Single Mobility Training in Persons with Multiple Sclerosis, a Multicenter RCT.J Clin Med. 2019; 8
- Differential effects and discriminative validity of motor and cognitive tasks varying in difficulty on cognitive-motor interference in persons with multiple sclerosis.Mult. Scler. 2021; 1352458520986960
- Dual task cost of walking is related to fall risk in persons with multiple sclerosis.J. Neurol. Sci. 2013; 335: 160-163
- The Relationship Between Balance Confidence and Cognitive Motor Interference in Individuals With Multiple Sclerosis.J. Mot. Behav. 2016; 48: 66-71
- Influence of the environment on cognitive-motor interaction during walking in people living with and without multiple sclerosis.Gait Posture. 2020; 82: 20-25
- The role of executive function and attention in gait.Mov. Disord. 2008; 23 (quiz 472): 329-342
- Do we always prioritize balance when walking? Towards an integrated model of task prioritization.Mov. Disord. 2012; 27: 765-770
Published online: August 28, 2021
Accepted: August 27, 2021
Received in revised form: August 16, 2021
Received: March 19, 2021
© 2021 Elsevier B.V. All rights reserved.