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下降、生活质量下降和跌倒风险增加相关，导致PD患者将活动能力限制视为该疾病最糟糕的方面之一。目前对PD患者行走受限的因素了解尚不完整，这阻碍了该人群有效康复策略的发展。PD患者的行走异常通常被认为是一种运动障碍；然而，运动障碍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。在包括帕金森病在内的许多人群中，行走被并发的认知或运动任务的表现打断，这表明注意过程和认知的相关方面对安全和独立的行动至关重要。PD对注意力分配和行走自动控制的神经机制的影响尚不清楚。因此，本研究的长期目标是：(1)更好地了解PD在行走和执行并发认知任务时对注意力分配和任务优先级的影响；(2)将这些知识转化为改善该人群行走限制的治疗干预措施。本实验旨在研究双重任务条件下PD对注意力分配和行走自动控制的影响（Specific Aim 1），抗帕金森药物（Specific Aim 2）和疾病进展（Specific Aim 3）对注意力和行走相互作用的影响，以及PD患者根据环境要求或明确指示改变注意力分配的能力（Specific Aim 4）。对于所有Aims，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。这项指导研究科学家职业发展奖的目标是通过教学工作、密集指导和集中研究经验的结合，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，以促进PD运动功能障碍相关的机械研究和旨在改善功能运动康复策略的转化研究的独立研究生涯。

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.