Walking and Thinking - Brain Activity During Complex Walking in Aging and Parkinson's Disease

Study Overview
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Brief Summary
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Every-day life means being part of a complex environment and performing complex tasks that usually involve a combination of motor and cognitive skills. However, the process of aging or the sequelae of neurological diseases such as Parkinson's disease (PD) compromises motor-cognitive interaction necessary for an independent lifestyle. While motor-cognitive performance has been identified as an important goal for sustained health across different clinical populations, little is known about underlying brain function leading to these difficulties and how to best target these motor-cognitive difficulties in the context of rehabilitation and exercise interventions. The challenge of improving treatments of motor-cognitive difficulties (such as dual-tasking and navigation) is daunting, and an important step is arriving at a method that accurately portrays these impairments in an ecological valid state. The investigators aim therefore to explore brain function during complex walking in healthy and PD by investigating the effects of age and neurological disease on motor-cognitive performance and its neural correlates during three conditions of complex walking (dual-task walking, navigation and a combination of both) using non-invasive measures of brain activity (functional near infrared spectrometry, fNIRS) and advanced gait analysis in real time in young, older healthy adults and people with PD.

Official Title
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Walking and Thinking - Brain Activity During Complex Walking in Aging and Parkinson's Disease (Part of the ParkMOVE Trial)

Conditions
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Parkinson Disease, Aging, Gait Disorders, Neurologic

Intervention / Treatment
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* Other: No intervention


Participation Criteria
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Eligibility Criteria
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Healthy young: Inclusion criteria: -18 to 50 years Exclusion criteria: Disease or condition that affects cognition, gait or balance. Severe hearing or visual impairments that affects participation in the assessments Healthy elderly: Inclusion criteria: ≥60 years of age, 23 or more on the Montreal Cognitive Assessment (MoCA) Exclusion criteria: Disease or condition that affects gait or balance. Severe hearing or visual impairments that affects participation in the assessments Parkinson cohort: Inclusion criteria: ≥60 years of age a clinical diagnosis of PD≤6 months prior to enrollment with the ability to walk without a mobility device for ≤5 minutes continuously. Exclusion criteria: People with speech difficulties (e.g. aphasia) cognitive difficulties affecting the ability to understand and/or follow verbal/written - instructions severe freezing of gait Severe hearing or visual impairments that affects participation in the assessments Other neurological diseases Other disease that can affect gait or balance.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Healthy young<br>Healthy young adults | Other: No intervention<br>* Assessment of brain activity with fNIRS and behavioural assessments (motor, motor-cognitive and cognitive) during three complex walking conditions. Dual-task walking with the auditory stroop task. Navigational walking - a course consisting of a distribution of 45 and 90 degrees turns to the left and right Navigational and dual-task walking (condition 1 and 2 together)<br>|
| Healthy elderly<br>Healthy elderly adults | Other: No intervention<br>* Assessment of brain activity with fNIRS and behavioural assessments (motor, motor-cognitive and cognitive) during three complex walking conditions. Dual-task walking with the auditory stroop task. Navigational walking - a course consisting of a distribution of 45 and 90 degrees turns to the left and right Navigational and dual-task walking (condition 1 and 2 together)<br>|
| Parkinson's disease<br>Elderly with Parkinson's disease | Other: No intervention<br>* Assessment of brain activity with fNIRS and behavioural assessments (motor, motor-cognitive and cognitive) during three complex walking conditions. Dual-task walking with the auditory stroop task. Navigational walking - a course consisting of a distribution of 45 and 90 degrees turns to the left and right Navigational and dual-task walking (condition 1 and 2 together)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Functional near infrared spectrometry (fNIRS) | The measurement of changes in concentration of HbO and HHb in the prefrontal cortex will be assessed using a NIRSPORT 2 (NIRx Medizintechnik, Berlin, Germany) device | During the test session during all three conditions | 
| Gait performance during all conditions | Gait variables such as stride time and/or velocity will be analyzed with the APDM mobility system. | During the test session during all three conditions | 
| Dual-task performance-reaction time | Cognitive performance of the dual task will be assessed as errors in the response to the Auditory stroop task. | During the test session during dual task conditions | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cognitive function- composite score | The cognitive test battery comprised the following tests: The Color-Word Interference Test (CWIT), Verbal Fluency, Trail Making Test (TMT) and Ray Auditory Verbal Learning Test (RAVLT). Cognitive function will be assessed as a composite measure of these test together. | During the test session, takes about 50 minutes | 
| Cognitive function - verbal fluency | Verbal function, initiation & task-set switching with the Verbal Fluency test from D-KEFS (Delis-Kaplan Executive Function System) | During the test session, takes about 12 minutes | 
| Cognitive function - Attention and psychomotor processing speed | Attention and psychomotor processing speed will be assessed with the Trail Making Test (TMT) from D-KEFS (Delis-Kaplan Executive Function System) | During the test session, takes about 3 minutes | 
| Cognitive function - Episodic memory | Episodic memory will be assessed with the Ray Auditory Verbal Learning Test (RAVLT). | During the test session, takes about 30 minutes | 
| Cognitive function - Inhibition & task-set switching | Inhibition & task-set switching with the The Color-Word Interference Test (CWIT) from D-KEFS (Delis-Kaplan Executive Function System) | During the test session, takes about 5 minutes | 
| Self-reported level of physical activity | Assessed with the Frändin-Grimby Scale (score 1-6, higher score=better) | Through study completion, an average of 1 year | 
| Physical activity level and intensity | Assessed with accelerometers (Actigraph GT3X+) | For one week after the test session | 
| Motor function/disease severity | Assessed with the movement Disorders Society- Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Higher scores = worse/more symptoms | During the test session | 
| Balance performance | Assessed with the Mini-BESTest (Balance Evaluation Systems test), 0-28p, | During the test session | 
| Anxiety and depression | Assessed with Hospital Anxiety and Depression Scale (HADS), 0-24 on the depression and anxiety part respectively. Lower score=better | Will be answered before the test session in the patients home or during the test session | 
| Walking ability | Self assessed walking ability with the WALK-12G | Will be answered before the test session in the patients home or at the test session | 
| Dual-task performance -errors | Cognitive performance of the dual task will be assessed as the reaction time to respond during Auditory stroop | During the test session during dual task conditions | 
| Disability | WHO Disability Assessment Schedule (WHODAS) version 2.0, 12 self-assessed questions (12 to 60) more points=worse | Will be answered before the test session in the patients home or during the test session | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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gait, functional near infrared spectrometry, physical activity