Gait characteristics of individuals with Parkinson's disease with different mild cognitive impairment subtypes

Abstract

Approximately 25% of individuals with Parkinson's Disease (PD) without dementia have Mild Cognitive Impairment (MCI) and it can be divided into PD-MCI single domain and PD-MCI multiple domain subtypes. There are some evidences, and also controversial findings, that MCI subtypes differently interfere in the gait symptoms of PD, which can be associated with the different brain structural changes. Thus, the objective of the present study is to compare the single-task and dual-task gait among individuals with PD, PD-MCI single domain and PD-MCI multiple domain and to examine associations between dual-task gait cost (DTC) and structural changes in fronto-subcortical pathways in PD-MCI subtypes. We will test the hypothesis that gait performance in individuals with PD-MCI multiple domain would have accentuated gait impairment when compared to single-domain, and PD no-MCI, mainly during dual-task walking. We also hypothesize that PD-MCI subtypes will present larger burden of brain lesion beyond the nigrostriatal pathway, which will reflect in high DTC. Hundred and forty individuals with PD of ONDRI protocol will be included. Demographics, clinical, neuropsychological performance for different cognitive domains, neuroimaging, gait parameters will be included. The gait is evaluated using the GAITRite Portable Walkway System during two situations: usual gait and cognitive dual-task gait, which will allow the calculation of DTC. Neuroimaging data will include white matter hyperintensities (WMH) and diffusion tensor imaging (DTI) from cortical and subcortical areas. Univariate analyses of variance (one-way ANOVA) will be done to compare the gait variables and DTC between three groups, followed by Tukey post-hoc test. Multivariate linear regression will be done to examine associations between the DTC and structural brain alterations of frontal subcortical circuits. Basic adjustments for age, sex, years of education, number of comorbidities, age of onset, disease duration, levodopa equivalent daily dose (LEDD), disease severity (UPDRS Part III and Hoehn & Yahr stage) and history of falls will be included as covariates. (AU)