Review Article

A Review of Dual-Task Walking Deficits in People with Parkinson's Disease: Motor and Cognitive Contributions, Mechanisms, and Clinical Implications

Table 1

Summary of studies examining dual-task walking in people with PD. Relevant individual, task, and environmental aspects of each study are included. Dual-task costs for walking and the concurrent task are included where they could be calculated.

Individual CharacteristicsTask and Environmental CharacteristicsResults
Study
(PD sample)
Age
(yrs)
Disease
severity
Cog.Walking task &
environment
Concurrent taskInstruct.Walking DTCConcurrent
task DTC

Bond and Morris, 2000
[40]
( )
65 (10)Webster
score:
13 (5)
STMS:
30 (4)
Walk 10 m
(comfortable pace)
Motor: (1) carry tray;
(2) carry tray with empty glasses
No prioritizationSpeed: (1) −2%; (2) −11%
Stride length:
(1) +1%; (2) −1%
DLS: (1) −2%; (2) −2%

Brown et al.,
2009 [41]
( )
67 (7)UPDRS:
28 (2)
H&Y:
2.3 (0.3)
MMSE:
≥26
Walk 10 m (self-
selected pace,
unobstructed
walkway)
Cognitive: serial-3
subtraction (data
presented for no music
trials)
None
provided
Speed: −20%
Stride length: −6%
DLS: −12%

Camicioli et
al., 1998 [53]
( )
67 (9)
Off-med
On-med
UPDRS:
15 (4)
UPDRS:
12 (6)
MMSE:
27 (1)
Walk 4.6 m, turn
180°, walk 4.6 m
(self-selected pace)
Cognitive: verbal fluency (recite male names)Not specifiedSteps: −40%
Time: −50%
Steps: −16%
Time: −31%


Campbell et
al., 2003 [54]
( )
74 (7)H&Y:
2.8 (0.8)
Timed Up and Go (3 m;
comfortable pace)
Cognitive: (1) repeat
phrase; (2) repeat days
of the week backwards
Not specifiedSteps: (1) +1%; (2) −13%
Time: (1) −1%; (2) −31%

Galletly and Brauer, 2005 [42] ( )65 (10)UPDRS:
14 (6)
MMSE:
28 (3)
Walk 10 m
(comfortable pace)
Motor: (1) button press
Cognitive: (2) serial-3
subtraction; (3) verbal
fluency
“Concentrate
on both
tasks”
Speed: (1) −7%;
(2) −21%; (3) −21%
Stride length: (1) −4%;
(2) −16%; (3) −16%
Motor:
(1) +16%
Cognitive:
(2) +31%;
(3) +73%

Hackney and
Earhart, 2009
[55]
( )
65 (10)UPDRS:
28 (9)
Walk 5 m
(comfortable pace)
both forward and
backward
Cognitive: mental
arithmetic (serial-3, 4,
and 6 subtraction)
Not specified *Speed: −33%
*Stride length: −14%

Hausdorff et al., 2003 [49] ( )Range: 52–82UPDRS: 14 H&Y: 3.1MMSE: 27Walk 20 m (normal pace; level ground)Cognitive: serial-7 subtraction“Walk while performing subtractions” Stride time: −10% Stride time variability: −154%

LaPointe et al., 2010 [56] ( )67H&Y: 2.4 (7)DRS-2: 136 (7)Walk 4.3 mCognitive: (1) count by 1’s; (2) serial-3 subtraction; (3) recite alpha-numeric sequenceNot specified **Speed: (1) −2%; (2) −12%; (3) −19%
**Stride length: (1) −1%; (2) −6%; (3) −10%
DLS: (1) −4%; (2) −9%; (3) −10%

Lord et al., 2010 [43] ( )71 (7)
Off-med
UPDRS: 39 (15)MMSE: 27 (3)Stand from a chair, walk 5–11 m (preferred speed; examined in home & distance varied by home)Motor: (1) carry tray with 2 beakers of water
Cognitive: (2) count auditory tones
(3) Motor + Cognitive
“Concentrate equally on walking and task(s)”Speed: (1) −24%;
(2) −14%; (3) −32%

Lord et al., 2011 [57] ( )69 (7)
Off-med
On-med
UPDRS:
35 (9)
UPDRS: 23 (9)
MMSE: 28 (2)Walk 6 m, turn 180°, walk 6 m (examined in home)Motor: carrying a tray with 2 cups of water“Concentrate on task as a whole” Speed: −13% Stride time Variability: −8%
Speed: −11% Stride time Variability: −21%

O’Shea et al., 2002 [44] ( )68 (7)Modified Webster Scale:12 (6)STMS:
30 (3)
Walk 10 m (preferred pace)Motor: (1) coin transfer
Cognitive: (2) serial-3 subtraction
Not specifiedSpeed: (1) −18%; (2) −19%
Stride length: (1) −14%; (2) −12%
DLS: (1) −3%; (2) −6%
Motor: (1) −17.4%
Cognitive: (2) −5%

Plotnik et al., 2009 [48] ( )72 (7)UPDRS:
20 (8)
MMSE: 28 (1)Walk 2 min in a level, 25 m corridor (comfortable pace)Cognitive: serial-7 subtractionNo prioritizationPhase coordination index: −47%

Plotnik et al., 2011 [45] ( )66 (7)UPDRS: 35 (10)
H&Y: 2.1 (0.6)
MMSE: 29 (1)Walk ~80 m in a level, ~20 m corridor (comfortable pace)Cognitive: (1) serial-3 subtraction;
(2) serial-7 subtraction
Not specifiedSpeed: (1) −17%; (2) −23% Stride length: (1) −11%; (2) −15% Stride time variability: (1) −39%; (2) −51%

Rochester et al., 2004 [46]( )65 (8)H&Y:
2.7 (0.7)
MMSE: 27 (2)Stand from a chair, walk 6.6 (1.5) m, return (preferred speed, examined in home & distance varied by home)Motor: (1) carrying tray with 2 cups of water; Cognitive: (2) autobiographical memory task;(3) Motor + CognitiveNot specifiedSpeed: (1) −9%; (2) −21%; (3) −23%
Step length: (1) −9%; (2) −16%; (3) −21%

Rochester et al., 2008 [58] ( )67 (8)UPDRS:
33 (11)
MMSE: 28 (2)Walk 6 m, turn 180°, walk 6 m (preferred pace)Motor: carrying a tray with 2 cups of water“Concentrate equally on all tasks”Speed: −13%

Spildooren et al., 2010 [59]
Freezers ( )69 (7)
Off-med
UPDRS: 38 (14) H&Y: 2.5 (0.5)MMSE: 28 (1) Walk 5 m: (1) straight; (2) turn 180°; (3) turn 360° Cognitive: color identification (auditory attentional task) No prioritizationSteps: (1) −25%; (2) −16%; (3) −13%
Time: (1) −23%; (2) −13%; (3) −10%
Non-freezers ( )67 (7)
Off-med
UPDRS: 34 (10) H&Y: 2.4 (0.3)MMSE: 29 (1)Steps: (1) −7%; (2) +1%; (3) −2%
Time: (1) −9%; (2) −1%; (3) −3%

Yogev et al., 2005 [50] ( )71 (8)UPDRS: 18 (8) H&Y: 2.3 (0.4)MMSE: 28 (2)Walk 2 min in a level, 25 m corridor (comfortable pace)Cognitive: (1) listen to a tape & answer questions; (2) above task + phoneme monitoring;
(3) serial-7 subtraction
No prioritizationSpeed: (1) −10%; (2) −13%; (3) −19%Stride time variability: (1) −1%; (2) −6%; (3) −27%Cognitive: (1) −42%

Yogev et al., 2007 [47] ( )72 (7)UPDRS:
20 (8) H&Y: range 2-3
MMSE: 28 (1)Walk 2 min in a level, 25 m corridor(comfortable pace)Cognitive: serial-7 subtractionNo prioritizationGait asymmetry: −43%

*: data collapsed across forward & backward walking; **: data collapsed across PD & control groups; Cog.: cognitive status; DLS: double limb support; DRS-2: Dementia Rating Scale-2; DTC: dual-task cost; H&Y: Hoehn & Yahr stage; Instruct.: instructions provided during dual-task conditions; MMSE: Mini-Mental State Examination; MoCA: Montreal Cognitive Assessment; STMS: Short Test of Mental Status; Steps: number of steps required to complete walking task; Time: time required to complete walking task; UPDRS: Unified Parkinson Disease Rating Scale, motor examination.