Multi-limb Control in Parkinson's Disease: Implicit and Explicit Control of Attention

摘要 开车和步行是日常生活中的重要方面，但车祸和摔倒对公众健康构成严重威胁 担忧。开车或走路时分心或同时处理多项任务往往会导致灾难性的结果，这表明 注意和认知社区安全出行的重要性。帕金森病(PD)影响超过 100万美国人，每年花费250亿美元，特别是影响注意力和双重- 任务。患有帕金森病的司机特别有可能因以下方面的进行性困难而停止驾驶或撞车 运动功能和认知会导致丧失独立性、抑郁、孤立感和较少参与 在社区里。帕金森病患者认知障碍的一个特征是难以开始或改变自我 根据隐含的暗示发起移动。帕金森病患者更多地依赖外部线索来克服 他们缓慢而细小的动作。例如，踩着节拍器的节拍或踩着线条 地板可以改善走路的效果。我们将检验帕金森病会降低灵活分配注意力的能力的假设 基于精度约束的手臂和脚任务之间的关系。目标1：比较显性教学的效果 具有隐含准确性的任务优先级要求在同时伸手和徒步时注意力转移- 帕金森病患者和年龄匹配的健康老年人的踏板跟踪任务。目标2：比较两种方法的效果 内隐精确度任务优先级外显指令对车道保持过程中注意转移的要求 驾驶员模拟驾驶过程中的转向(转向)和跟车(制动/加速)行为 帕金森病患者和年龄匹配的健康老年人。目的3：确定多巴胺能药物状态对脑血管紧张素转换酶的影响 驾驶类任务和模拟驾驶过程中注意向外显和内隐线索的切换 成人帕金森病患者的行为。这项研究的长期目标是描述双重任务中的损伤 驾驶能力和制定和实施干预计划，以减少人们的驾驶困难 和警察在一起。

ABSTRACT Driving and walking are important aspects of everyday life, yet car crashes and falls pose serious public health concerns. Distraction and multi-tasking while driving or walking often lead to disastrous results, indicating the importance of attention and cognition for safe mobility in the community. Parkinson disease (PD) affects over 1 million Americans at an annual cost of $25 billion, and specifically impacts attention and the ability to dual- task. Drivers with PD are at particular risk for driving cessation or crashes due to progressive difficulties in motor function and cognition that can lead to loss of independence, depression, isolation, and less participation in the community. A characteristic feature of cognitive impairment in PD is difficulty to begin or change self- initiated movement based on implicit cues. People with PD rely more heavily on external cues to overcome their slowed and small movements. For example, stepping to the beat of a metronome or stepping to lines on the floor improves walking. We will test the hypothesis that PD reduces the ability to flexibly allocate attention between arm and foot tasks based on accuracy constraints. Aim 1: Compare the effects of explicit instruction of task prioritization with implicit accuracy demands on shifts in attention during concurrent reaching and foot- pedal tracking tasks in participants with PD and age-matched healthy old adults. Aim 2: Compare the effects of explicit instruction of task prioritization with implicit accuracy demands on shifts in attention during lane-keeping (steering) and car-following (braking/accelerating) behavior during simulated driving performance in drivers with PD and in age-matched healthy old adults. Aim 3: Identify the effect of dopaminergic medication state on attention switching to explicit and implicit cues during driving-like tasks and simulated driving performance behavior in adults with PD. The long-term goal of this research is to characterize impairments in dual task abilities for driving and develop and implement intervention programs to reduce driving difficulties for people with PD.