Attention and the Automatic Control of Walking in People with Parkinson's Disease

描述（由申请人提供）：帕金森病（PD）患者的活动能力受损与独立性降低、生活质量降低和福尔斯风险增加相关，导致PD患者将活动能力受限视为疾病最严重的方面之一。有不完全的理解的因素，有助于PD行走限制，这阻碍了有效的康复策略在这一人群的发展。PD患者的行走异常传统上被认为是运动障碍;然而，运动缺陷只是导致活动受限的众多因素之一。使用双任务范式的研究表明，行走的控制不是完全自动的，而是需要一定程度的注意力。在许多人群（包括PD）中，行走被并发认知或运动任务的表现所干扰，这表明注意力过程和认知的相关方面对于安全和独立的移动性至关重要。PD对参与注意力分配和步行自动控制的神经机制的影响还不清楚。因此，本研究的长期目标是（1）更好地了解PD对步行和执行并发认知任务时注意力分配和任务优先级的影响，以及（2）将这些知识转化为改善该人群步行限制的治疗干预措施。本实验研究了在双重任务条件下，PD对注意分配和步行自动控制的影响（具体目标1），抗帕金森药物的作用（具体目标2）和疾病进展（具体目标3）关于注意力和行走的相互作用，以及PD患者根据不断变化的环境需求或明确的指示来修改注意力分配的能力（具体目标4）。对于所有目标，与年龄和性别匹配的对照组相比，认知任务速度和准确性以及步行速度和稳定性的变化将用于评估PD患者的双重任务干扰。这个指导研究科学家职业发展奖的目标是通过教学工作，密集的指导和集中的研究经验相结合，为候选人提供康复研究领域的全面培训。该奖项将为候选人提供独特的知识和技能，促进与PD运动功能障碍相关的机械研究和旨在改善功能性运动康复策略的转化研究的独立研究生涯。 公共卫生相关性：对于PD患者，步行障碍可能导致行动能力和独立性降低，生活质量下降，跌倒风险增加。更好地了解PD对注意力分配和步行自动控制的影响，对于改善这一人群的步行和功能性活动的康复至关重要。

DESCRIPTION (provided by applicant): Impaired mobility in Parkinson's disease (PD) is associated with decreased independence, reduced quality of life, and increased risk for falls, leading people with PD to identify mobility limitations as one of the worst aspects of the disease. There is incomplete understanding of the factors that contribute to walking limitations in PD, which hampers the development of effective rehabilitation strategies in this population. Walking abnormalities in PD are traditionally considered a motor impairment; however, motor deficits are only one of many factors contributing to limited mobility. Research using dual task paradigms has demonstrated that the control of walking is not completely automatic, but requires some degree of attention. Walking is disrupted by the performance of concurrent cognitive or motor tasks in many populations, including PD, suggesting that attentional processes and related aspects of cognition are critical to safe and independent mobility. The effects of PD on the neural mechanisms involved in the allocation of attention and the automatic control of walking are not well understood. Therefore, the long term goals of this research are (1) to develop a better understanding of the effects of PD on attention allocation and task prioritization when walking and performing a concurrent cognitive task and (2) to translate this knowledge into improved therapeutic interventions for walking limitations in this population. The proposed experiments examine the effects of PD on attention allocation and the automatic control of walking under dual task conditions (Specific Aim 1), the effect of anti-Parkinson medications (Specific Aim 2) and disease progression (Specific Aim 3) on the interaction of attention and walking, and the ability of people with PD to modify attention allocation based on changing environmental demands or explicit instructions (Specific Aim 4). For all Aims, changes in cognitive task speed and accuracy and walking speed and stability will be used to assess dual task interference in people with PD compared to age- and gender-matched controls. The goal of this Mentored Research Scientist Career Development Award is to provide the candidate with comprehensive training in the field of rehabilitation research through a combination of didactic work, intensive mentorship, and focused research experience. This award will provide the candidate with unique knowledge and skills that will promote an independent research career in both mechanistic research related to movement dysfunction in PD and translational research aimed at improved rehabilitation strategies for functional mobility. Public Health Relevance: For people with PD, walking impairments can lead to reduced mobility and independence, poor quality of life, and increased risk of falling. A better understanding of the effects of PD on attention allocation and the automatic control of walking is critical to the development of improved rehabilitation for walking and functional mobility in this population.