مقاله انگلیسی تاثیر افسردگی بر تنوع راه رفتن در بیماری پارکینسون
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ABSTRACT
Objective: The goal of this study was to analyze how depression associated with Parkinson’s disease (PD) affected gait variability in these patients using a dual-task paradigm. Additionally, the dependency of the executive functions and the impact of depression on gait variability were analyzed. Patients and Methods: Three subject groups were included: patients with PD, but no depression (PD-NonDep; 14 patients), patients with both PD and depression (PD-Dep; 16 patients) and healthy controls (HC; 15 subjects). Gait was recorded using the wireless sensors. The participants walked under four conditions: single-task, motor dual- task, cognitive dual-task, and combined dual-task. Variability of stride length, stride duration, and swing time was calculated and analyzed using the statistical methods. Results: Variability of stride duration and stride length were not significantly different between PD-Dep and PDNonDep patients. The linear mixed model showed that swing time variability was statistically significantly higher in PD-Dep patients compared to controls (p = 0.001). Hamilton Disease Rating Scale scores were significantly correlated with the swing time variability (p = 0.01). Variability of all three parameters of gait was significantly higher while performing combined or cognitive task and this effect was more pronounced in PD-Dep group of patients. Conclusions: Depression in PD was associated with swing time variability, and this effect was more prominent while performing a dual-task. Significance: Diagnosing and treating depression might be important for gait improvement and fall reduction in PD patients.
Introduction
Gait disturbance is one of the particularly incapacitating signs of Parkinson’s disease (PD). It is characterized by slowness, variability, and postural instability, related to impaired spinal and supraspinal locomotor networks (premotor cortical, motor cortical, basal ganglia, cerebellar, and brain stem structures). Peterson and Horak suggested that slow gait in PD might be related to a dysfunction of the basal gangliathalamocortical loop, while gait variability appeared when a shift from automatic to voluntary control of walking occurred [1]. Gait has been increasingly understood as a complex “higher-order” form of motor behavior, with prominent influences of mental processes (executive function, attention, a judgement of external/internal cues) [2]. Such impact is particularly evident under the dual-task (DT) conditions, which changes gait parameters, including stride-to-stride variability, both in healthy individuals and in PD patients [2–5].