Comparisons of forward and backward gait between poorer and better attention capabilities in early Parkinson's disease

This study compared forward and backward gait between Parkinson's disease (PD) patients with poorer and better attention capabilities. PD and healthy control (HC) participants received a dual-stimuli attention task. The results were assessed using principal component analysis to quantify and rank attention capability. Accordingly, 22 PD and 42 HC subjects were equally divided into poorer (14 PD-P, 18 HC-P) and better (8 PD-B, 24 HC-B) attention capabilities. To analyze the spatiotemporal gait parameters, each participant walked forwards and backwards on a GAITRite® walkway. Compared to HC, PD performed worse in the dual task and exhibited slower velocity, less swing, and shorter stride in both walking directions. Notably, PD-P experienced all these gait defects, regardless of directions. PD-B walked worse than HC-B backwards, and displayed comparable gait to HC-P in both directions. In PD and HC, velocity, stride, and swing decreased perceptibly when walking backwards compared to forwards, and the same was true for velocity and stride in PD-P and PD-B. Backward strides were reduced evidently more in PD-P than in PD-B. However, backward swing reductions in PD-P and PD-B were statistically insignificant. Cadence in both directions was similar within the groups and between the groups, and there were little alterations between directions within each group and between groups. These results suggest that attention capability may affect PD gait. Poorer attention exacerbates gait defects and better attention improves gait in both directions. These results may support the application of cuing strategies in PD to enhance attention capability and improve walking gait.