Objective: To determine the effect of baseline cognition on gait outcomes after a gait training and aerobic exercise program in people with Parkinson’s disease (PD).

Background: With disease progression, people with PD increasingly rely on cognition to compensate for gait impairments. However, mild cognitive impairment (MCI) is common in PD and may limit the ability to compensate for gait dysfunction and improve gait with training.

Method: Participants were diagnosed with PD and classified as having no cognitive impairment (NCI) or MCI at a consensus diagnosis conference. Baseline executive function (Flanker Inhibitory Control and Attention, Dimensional Change Card Sort, Pattern Comparison Processing Speed) and memory (Story Recall) were assessed. The intervention was a 10-week aerobic exercise program, consisting of twice-weekly 1-hour gait training sessions on a treadmill, with structured speed and distance progression and verbal cues for improved gait quality. Gait speed was the primary outcome, measured with inertial sensors (APDM Inc., Portland, OR, USA). Short-term effects were assessed after week 2, and long-term effects were assessed after week 10.

Results: Participants (n=19) had a mean (standard deviation) age of 66.5 (6.3) years, disease duration of 8.8 (6.3) years, and MDS-UPDRS Motor Exam score of 21.3 (10.7). Participants with NCI (n=12) and MCI (n=7) completed the intervention. Gait speed and stride length increased at short-term (by 0.06 m/s) and long-term (by 0.08 m/s) assessments compared to baseline, and did not differ between MCI and NCI groups. Better baseline memory performance (delayed Story Recall) was associated with greater long-term increases in gait speed in unadjusted and age-adjusted models, with no associations between executive function and gait outcomes.

Conclusion: Clinically meaningful improvements in gait speed were observed in response to gait training, and improvements were comparable between cognitive groups. Across groups, better baseline memory performance was associated with larger gait speed improvements. Determining the effects of cognitive status on gait training is critical to better understand factors influencing the response to training and to guide interventions optimized for the cognitive status of persons with PD. Further research is needed to develop gait training strategies optimized for people with PD and cognitive dysfunction.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/associations-between-baseline-cognitive-function-and-gait-outcomes-after-treadmill-training-in-parkinsons-disease/