Objective: This literature review examines current evidence on dual-task cost assessment in PD, focusing on measurement approaches, clinical relevance, and factors influencing performance.

Background: Parkinson’s disease (PD) often manifests progressive decline in motor and cognitive function. Dual-task paradigms, which involve simultaneous performance of motor and cognitive tasks, have emerged as promising tools for assessing functional decline. Dual-task cost reflects performance interference when two tasks are performed together and may provide sensitive markers of disease progression and functional capacity.

Method: This review analyzed peer-reviewed studies investigating dual-task performance in individuals with PD published between 2007 and 2022 examining cognitive-motor dual-task paradigms.Studies were included if they involved participants with clinically diagnosed PD, used cognitive-motor dual-task paradigms, measured quantitative dual-task costs or performance changes, compared results with single-task conditions, and reported specific dual-task outcomes. Included studies had sample sizes ranging from 10 to 263 participants and used cross-sectional or prospective designs. Dual-task combinations commonly involved gait with cognitive tasks such as Stroop, verbal fluency, or arithmetic, as well as functional mobility or motor tasks performed with concurrent cognitive demands. Findings were synthesized narratively and organized into themes including measurement approaches, clinical correlations, disease severity, and cognitive versus motor prioritization strategies.

Results: 10 studies including more than 900 PD subjects showed consistent dual-task interference. Larger studies reported measurable costs in gait parameters. Cognitive costs were more strongly associated with disease impairment than motor costs. Arm range of motion and foot-strike angle were more sensitive than gait speed in distinguishing PD patients from controls. Disease severity and cognitive impairment influenced task prioritization. Cognitively impaired patients showed greater motor costs. Task complexity and cognitive domain also affected outcomes.

Conclusion: Dual-task cost assessment shows promise for detecting PD-related impairment but requires careful selection of measures and cognitive tasks. Future research should prioritize standardized protocols and clearer clinical applications beyond fall-risk assessment.

References: 1. Christofoletti, G., Andrade, L., Beinotti, F., & Borges, G. (2014). Cognition and dual-task performance in older adults with Parkinson’s and Alzheimer’s disease. *International Journal of General Medicine*, 7, 383-393.

2. Freitas, T. B., Silva, K. G., Nuvolini, R. A., Doná, F., Pompéu, J., Swarowsky, A., & Torriani-Pasin, C. (2019). Dual-task demands in various motor skills through Parkinson’s disease progression. *Motriz: Revista de Educacao Fisica*, 25(2), e101909.

3. Fuller, R., Van Winkle, E. P., Anderson, K., Gruber-Baldini, A., Hill, T., Zampieri, C., Weiner, W., & Shulman, L. (2013). Dual task performance in Parkinson’s disease: a sensitive predictor of impairment and disability. *Parkinsonism & Related Disorders*, 19(3), 325-328.

4. Johansson, H., Ekman, U., Rennie, L., Peterson, D., Leavy, B., & Franzén, E. (2021). Dual-task effects during a motor-cognitive task in Parkinson’s disease: Patterns of prioritization and the influence of cognitive status. *Neurorehabilitation and Neural Repair*, 35(4), 356-366.

5. Smulders, K., Esselink, R., Weiss, A., Kessels, R., Geurts, A., & Bloem, B. (2012). Assessment of dual tasking has no clinical value for fall prediction in Parkinson’s disease. *Journal of Neurology*, 259(9), 1840-1847.

6. Swank, C., Mehta, J., & Criminger, C. (2016). Transcranial direct current stimulation lessens dual task cost in people with Parkinson’s disease. *Neuroscience Letters*, 626, 1-6.

7. Teixeira, N. B., & Alouche, S. R. (2007). O desempenho da dupla tarefa na Doença de Parkinson . *Fisioterapia e Pesquisa*, 14(1), 18-23.

8. Uribe, P., Fuentes, N., Álvarez-Ruf, J., Cornejo, I., & Mariman, J. J. (2022). Differentiation of the motor cost associated with cognitive tasks in Parkinson’s disease: A dual‐task study. *European Journal of Neuroscience*, 55(4), 1041- 1052

9. Vitório, R., Hasegawa, N., Carlson-Kuhta, P., Nutt, J., Horak, F., Mancini, M., & Shah, V. V. (2020). Dual-task costs of quantitative gait parameters while walking and turning in people with Parkinson’s disease: Beyond gait speed. *Journal of Parkinson’s Disease*, 10(4), 1583-1593.

10. Wild, L., Lima, D. B., Balardin, J., Rizzi, L., Giacobbo, B., Oliveira, H. B., Argimon, I. I. L., Peyré-Tartaruga, L. A., Rieder, C., & Bromberg, E. (2013). Characterization of cognitive and motor performance during dual-tasking in healthy older adults and patients with Parkinson’s disease. *Journal of Neurology*, 260(2), 580-589.

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