Gait Characteristics Better Predict Cognitive Decline in Early Parkinson's
The standard MoCA evaluation was unable to predict decline in fluctuating attention and visual memory.
Gait characteristics at diagnosis may be a simple, cost-effective biomarker of cognitive decline in patients with early Parkinson's disease (PD), according to data presented at the 2016 World Parkinson Congress, held September 20-23, 2016 in Portland, Oregon.
Because of the significant burden that cognitive decline and dementia create in PD, Rosie Morris, MSc, of Newcastle University in the UK, and colleagues explored the diagnostic utility of gait and how it compared to global cognitive assessments for the prediction of cognitive decline in PD.
A total of 119 participants with idiopathic PD were recruited from the ICICLE study for inclusion in the ICICLE-Gait sub-study. Participants' gait and cognition were assessed at diagnosis (baseline), and 18 and 36 months using the 7m GaitRite instrumented walkway and the Montreal Cognitive Assessment (MoCA) cognitive battery. Gate characteristics represented 5 domains: pace, variability, rhythm, asymmetry, and postural control. The cognitive battery assessed global cognition, attention, fluctuating attention, executive function, working memory, visual memory, and visuospatial.
Participants showed significant cognitive worsening in attention, fluctuating attention, executive function, and visual memory, and gait was found to be associated with several deficits. Gait pace, variability, and postural control all predicted fluctuating attention deterioration (all P <.01), while pace predicted decline in visual memory (P <.01). Notably, MoCA was unable to predict decline in visual memory (P =.15) and fluctuating attention (P =.04). “Forced entry of the basic model plus gait characteristics and MoCA yielded the strongest model with most gait characteristics retaining significance,” the authors concluded.
The findings may ultimately contribute to the creation of a more sensitive prognostic model of cognitive deterioration in PD.
Morris R, Lord S, Lawson RA, Yarnall AJ, Burn DJ, Rochester L. Gait at diagnosis, rather than cognition, predicts cognitive decline over three years in Parkinson's disease. Presented at: World Parkinson Congress 2016. September 20-23, 2016; Portland, OR. Poster 26.14.