Longitudinal assessment of gait variability to predict falls in Parkinson's disease

项目摘要 这项研究项目的主要目标是提高对帕金森病患者福尔斯跌倒的预测 (PD)通过包括步行纵向测量的综合多学科方法， 认知和功能表现。PD是一种改变生活的疾病，影响着100万美国人， 每年报告的新病例超过6万例。在诊断后的3年内，超过85%的人 临床上可能的PD会出现步态问题，进而导致福尔斯跌倒，造成严重损伤， 生活质量迫切需要在第一次跌倒发生前识别跌倒风险因素， 更好地理解导致PD患者福尔斯跌倒的行为和认知变化。步态变异性 稳态步行可以深入了解中枢神经肌肉系统维持 稳定但适应性强的运动步态变异性与PD的严重程度、功能障碍的程度、 可以回顾性地区分PD跌倒者和非跌倒者。然而，步态的演变 PD进展的变异性以及步幅间（的幅度和顺序）的关系 PD的波动和未来的福尔斯下降尚不清楚。此外，步态水平存在较大的个体差异 与特定疾病严重程度相对应的性能。认知和感觉运动缺陷 与PD相关的功能也损害了在进行另一项任务时行走的能力（即，双重任务）。当 PD患者的注意力资源被分配到一个以上的任务，步态异常增加。这 提示认知双任务期间的步态变异性可能对预测未来的福尔斯具有更高的敏感性。 PD患者与常规的单任务步行相比。步态变异性预测未来福尔斯的潜力 PD患者已被建议，但缺乏前瞻性证据来确定个体步态的变化 变异性对应于认知和功能表现变化以及未来的福尔斯。我们的中央 一种假设是，PD相关的认知功能障碍影响双任务行走期间的步态变异性， 预测PD患者未来的福尔斯和接近福尔斯。我们的具体目标是：1）确定 需要注意力的任务（即，音素监测）对PD患者步态变异性时间顺序的影响 和年龄匹配的对照组，2）描述6个月内参与者步态变异性的变化 间隔及其与认知和功能表现变化的关系，以及3）预测近福尔斯， 基于基线，PD患者在1年随访期内发生的福尔斯和移动障碍 步态变异性本研究的纵向设计将包括收集单次和多次步态变异性。 在PD患者和对照组中，每6个月进行一次双任务地面行走，并收集有关 福尔斯和福尔斯附近。该项目将改善使用步态对PD患者跌倒风险的客观评估 在认知挑战性条件下的参数，类似于患者日常生活中经历的参数。

Project Summary The broad goal of this research project is to improve the prediction of falls in patients with Parkinson’s disease (PD) through a comprehensive multidisciplinary approach that includes longitudinal measurements of walking, cognitive and functional performances. PD is a life-changing disorders affecting one million Americans, with more than 60,000 new cases reported every year. Within 3 years of diagnosis, more than 85% of people with clinically probable PD develop gait problems, which in turn lead to falls resulting in serious injury and reduced quality of life. There is a pressing need to identify fall risk factors before the occurrence of the first fall, and to better understand behavioral and cognitive changes leading to falls in PD patients. Gait variability during steady-state walking gives insights into the ability (and inability) of the central neuromuscular system to sustain stable but adaptive locomotion. Gait variability is related to PD severity, to the degree of functional impairments, and can retrospectively distinguish PD fallers and non-fallers. However, the evolution of gait variability with PD progression and the relationship between (the magnitude and the ordering of) stride-to-stride fluctuations and future falls in PD are unclear. In addition, large individual variations exist at the level of gait performances corresponding to specific levels of disease severity. Deficits in cognitive and sensory-motor functions associated with PD also impair the ability to walk while doing another task (i.e., dual-tasking). When attention resources in PD patients are allocated to more than one task, gait abnormalities increase. This suggests that gait variability during cognitive dual-task may present a higher sensitivity to predict future falls in PD patients compared to regular, single-task walking. The potential of gait variability to predict future falls in PD patients has been suggested, but prospective evidence is lacking to identify how individual changes in gait variability correspond to changes in cognition and functional performances, and to future falls. Our central hypothesis is that PD-related cognitive dysfunctions affecting gait variability during dual-task walking will predict future falls and near falls in PD patients. Our specific aims are 1) to determine the effects of an attention-demanding task (i.e., phoneme monitoring) on the temporal ordering of gait variability in PD patients and age-matched controls, 2) to characterize within-participant changes of gait variability over six-month intervals and their relationship to changes in cognition and functional performance, and 3) to predict near falls, falls and mobility impairments occurring during a one-year follow-up period in PD patients based on baseline gait variability. The longitudinal design of this study will consist in collecting gait variability during single and dual-task over-ground walking every six months, in PD patients and controls, and to collect information about falls and near falls. This project will improve the objective assessment of fall risk in PD patients using gait parameters during cognitively challenging conditions, similar to those experienced in patients’ daily lives.