Upper Extremity-Cognitive Dual-Task Capacity Post-Stroke

Evaluation of Static and Dynamic Balance Tests in Single and Dual Task Conditions in Participants With Nonspecific Chronic Low Back Pain

Multitasking measures, such as dual task assessments, are particularly useful in detecting subtle deficits that can influence occupational performance after injuries, like sports-related concussion (SRC). In past work, our research team developed and revised a dual task assessment, the Dual Task Screen (DTS). Here, we evaluated nineteen healthy athletes using the revised DTS to address two specific research objectives. First, to replicate pilot study findings and demonstrate that the revised DTS is sensitive to dual task motor costs (i.e. poorer motor performance under dual task conditions, compared to single task conditions). Second, to evaluate if the revised DTS is sensitive to dual task cognitive costs (i.e. poorer cognitive performance under dual task conditions, compared to single task conditions). We confirmed that the revised DTS was sensitive to both dual task motor and cognitive costs; thus it is a valid measure of dual task performance. These positive findings support its prospective, future use by occupational therapists to evaluate multitasking performance after injuries, like SRC, or other injuries and illnesses that elicit deficits affecting optimal occupational performance.

Schizophrenia is known to be associated with attentional deficits. Few studies have examined whether the disorder is also associated with a deficit in the ability to divide attention, and they have given contradictory results. Some have reported that patients show greater loss of performance than healthy controls when moving from single tasks to dual tasks, and others have reported that performance loss is similar in both groups or even that patients perform the dual task better than either task on its own. To help resolve this controversy, we performed a first study in which we designed a dual task paradigm with a group of 36 healthy participants. This dual task involves 2 tasks of equivalent difficulty that make use of different sensory modalities. In the second study, we gave this dual task to 23 patients with schizophrenia and 25 healthy participants. Both groups decreased similarly their performance in dual tasks, but the patients showed lower baseline performance in the single task. Our findings suggest that patients with schizophrenia and healthy participants use similar strategies to divide their attention, but in a high-degrading stimuli condition patients perform below the controls in a single task.

Does Coronary Angiography and Percutaneous Coronary Intervention Affect Cognitive Function?

BackgroundResponsiveness and minimal clinically important difference (MCID) are critical indices to understand whether observed improvement represents a meaningful improvement after intervention. Although simultaneous cognitive-exercise training (SCET; e.g., performing memory tasks while cycling) has been suggested to enhance the cognitive function of older adults, responsiveness and MCID have not been established. Hence, we aimed to estimate responsiveness and MCIDs of two dual task performance involving cognition and hand function in older adults with and without cognitive impairment and to compare the differences in responsiveness and MCIDs of the two dual task performance between older adults with and without cognitive impairment.MethodsA total of 106 older adults completed the Montreal Cognitive Assessment and two dual tasks before and after SCET. One dual task was a combination of Serial Sevens Test and Box and Block Test (BBT), and the other included frequency discrimination and BBT. We used effect size and standardized response mean to indicate responsiveness and used anchor- and distribution-based approaches to estimating MCID ranges. When conducting data analysis, all participants were classified into two cognitive groups, cognitively healthy (Montreal Cognitive Assessment ≥ 26) and cognitively impaired (Montreal Cognitive Assessment < 26) groups, based on the scores of the Montreal Cognitive Assessment before SCET.ResultsIn the cognitively healthy group, Serial Seven Test performance when tasked with BBT and BBT performance when tasked with Serial Seven Test were responsive to SCET (effect size = 0.18–0.29; standardized response mean = 0.25–0.37). MCIDs of Serial Seven Test performance when tasked with BBT ranged 2.09–2.36, and MCIDs of BBT performance when tasked with Serial Seven Test ranged 3.77–5.85. In the cognitively impaired group, only frequency discrimination performance when tasked with BBT was responsive to SCET (effect size = 0.37; standardized response mean = 0.47). MCIDs of frequency discrimination performance when tasked with BBT ranged 1.47–2.18, and MCIDs of BBT performance when tasked with frequency discrimination ranged 1.13–7.62.ConclusionsCurrent findings suggest that a change in Serial Seven Test performance when tasked with BBT between 2.09 and 2.36 corrected number (correct responses – incorrect responses) should be considered a meaningful change for older adults who are cognitively healthy, and a change in frequency discrimination performance when tasked with BBT between 1.47 and 2.18 corrected number (correct responses – incorrect responses) should be considered a meaningful change for older adults who are cognitively impaired. Clinical practitioners may use these established MCIDs of dual tasks involving cognition and hand function to interpret changes following SCET for older adults with and without cognitive impairment.Trial registrationNCT04689776, 30/12/2020.

BACKGROUND Chimeric antigen receptor T-cell (CAR-T) therapy has revolutionised the landscape of cancer treatment, particularly in haematological malignancies, and while these therapies have demonstrated significant efficacy against malignancies, they are associated with a spectrum of side effects. Cytokine Release Syndrome (CRS) and Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) are unique to CAR-T cell therapy and distinguish it from other forms of autoimmune toxicity. Predicting which patients will develop neurotoxicity remains a challenge. The pattern of ICANS is cognitive dysfunction, suggesting a plausible relationship between cognitive status and neurotoxicity. Understanding the interplay between cognitive function and neurotoxicity may provide valuable insights for early detection. The primary endpoint of this study was to investigate whether the cognitive performance of patients at the time of leukapheresis is associated with the subsequent development of ICANS. MATERIAL AND METHODS We report here on a prospective study of an adult patient population with aggressive B-cell lymphoma treated with CAR-T cell therapy at our centre between May 2020 and November 2023. All patients underwent neurological examination, cerebral MRI and global cognitive assessment using the Montreal Cognitive Assessment (MoCA) test with a cut-off of less than 26 points. We retrospectively recorded total metabolic tumour volume (TMTV) and International Prognostic Index (IPI) at lymphodepletion. Biological data including lactate dehydrogenase (LDH), albumin, ferritin and C-reactive protein (CRP) were also collected at the time of treatment. A retrospective analysis of pre-infusion serum neurofilament light chain (NfL) levels at the time of the decision to proceed with CAR-T cell therapy and at the time of treatment was performed. RESULTS 156 patients, median age 64 years (range 21 to 79 years), 55 females / 101 males, all treated for lymphoma, were included in this study. The mean MoCA score was 26 (range 12 to 30 points), 63 patients (40%) had a MoCA test below the cut-off at baseline. Following infusion of CAR T cells, 32% of patients developed ICANS within 6 days (grade 1-2: 72%; grade 3-4: 30%). The most common sign of neurotoxicity was cognitive impairment. In univariate analyses, the occurrence of ICANS was not significantly associated with baseline cognitive performance (p 0.58). As the study is ongoing, an update on the results will be available at the EANO meeting. CONCLUSION Neurotoxicity associated with CAR-T therapies occurs in one third of patients. This study does not suggest an association between the occurrence of ICANS and baseline cognitive performance. Despite progress in understanding the mechanisms underlying neurotoxicity, predicting its occurrence remains a challenge.

Although cognitive deficits are frequent in multiple sclerosis (MS), screening for them with tools such as the Montreal Cognitive Assessment (MoCA) test is usually not performed unless there is a subjective complaint. The Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) is among the instruments most commonly used to assess self-reported subjective complaints in MS. Nonetheless, it does not always accurately reflect cognitive status; many patients with cognitive deficits thus fail to receive appropriate referral for detailed neuropsychological evaluation. The objective of this study was to examine the validity of the MoCA test to detect the presence of objective cognitive deficits among patients with MS without subjective complaints using the Minimal Assessment of Cognitive Function in MS (MACFIMS) as the gold standard. The sample included 98 patients who were recruited from a university hospital MS clinic. The MSNQ was used to select patients without subjective cognitive complaints who also completed the MACFIMS, MoCA test and MSQOL-54. 23.5% of patients without subjective cognitive complaints had evidence of objective cognitive impairment on the MACFIMS (z score < -1.5 on two or more tests). The MoCA had a sensitivity of 87% and a specificity of 68% for detecting objective cognitive impairment in this patient population using a cut-off score of 27. A significant proportion of patients without self-reported cognitive impairment do have evidence of cognitive deficits on more exhaustive cognitive assessment. The MoCA is a rapid screening test that could be used to target patients for whom a more detailed neuropsychological assessment would be recommended.

BackgroundPrevious research demonstrated that manipulation of the extremities was associated with changes in multisegmental postural sway as well as improvement in a lower extremity balancing task. We were interested if these effects would extend to an upper extremity task. Our aim in this study was to investigate whether extremity manipulation could influence dual task performance where the explicit suprapostural task was balancing a water filled tube in the frontal plane.MethodsParticipants were healthy volunteers (aged 21–32 years). Upper- or lower-extremity manipulations were delivered in a participant and assessor blinded, randomized crossover, clinical trial. Postural (center of pressure) and suprapostural (tube motion) measurements in the frontal plane were made pre-post manipulation under eyes open and eyes closed conditions using a BTrackS™ force plate and a Shimmer inertial measurement unit, respectively. Pathlength, range, root mean square and sample entropy were calculated to describe each signal during the dual task performance.ResultsThere was no main effect of manipulation or vision for the suprapostural task (tube motion). However, follow-up to interaction effects indicates that roll pathlength, range and root means square of tube motion all decreased (improvement) following lower extremity manipulation with eyes open. Regarding the postural task, there was a main effect of manipulation on mediolateral center of pressure such that pathlength reduced with both upper and lower extremity manipulation with larger decreases in pathlength values following upper extremity manipulation.ConclusionOur findings show that manipulation of the extremities enhanced stability (e.g. tube stabilization and standing balance) on performance of a dual task. This furthers the argument that site-specific manipulations influence context specific motor behavior/coordination. However, as this study focused only on the immediate effects of extremity manipulation, caution is urged in generalizing these results to longer time frames until more work has been done examining the length of time these effects last.Trial registrationClinicaltrials.gov, NCT03877367, Registered 15 March 2019. Data collection took place July 2019.

Functional tests have been performed to predict cognitive decline in postmenopausal women and may be an important tool to identify early reductions in cognitive performance in this population. However, it is still unclear which functional test is more sensitive for detecting cognitive decline in the investigated sample. The aim of this study was to verify the association between functional performance and cognitive function in postmenopausal women and to analyze whether the gait speed of 400 meters (400wt) and Timed Up and Go (TUG) tests are predictors of cognitive function in this sample. One hundred and twenty eight postmenopausal women (60.8 ± 7.9 years) participated in this cross-sectional study. Body composition was assessed using Dual Energy X-ray Absorptiometry (DXA), functional performance by the TUG and 400wt tests, cognitive performance by the Montreal Cognitive Assessment (MoCA) test and muscle strength by maximum voluntary isometric contraction (MVIC) in lower limbs. An association between functional performance and cognitive function was observed in middle-aged postmenopausal women. The TUG test was associated with the MoCA test (B = -0.79; SE = 0.29; p = 0.008). However, no association was observed between 400wt with the MoCA test (B = 3.03; SE = 1.92; p = 0.117). These results show that the TUG test is a good predictor of cognitive decline in postmenopausal middle-aged women.

Introduction: Falling during walking is a common occurrence in people with Parkinson's disease and is closely associated with severe social and medical consequences. Recent evidence demonstrates that arm swing affects dynamic balance in healthy young adults; however, it remains unexamined what its effect is in people with Parkinson's disease, particularly when combined with a secondary dual task.Methods: Twenty people with Parkinson's disease (63.78 ± 8.97) walked with two arm swing conditions (absent and normal) with and without a secondary dual task. Data were collected on a split-belt treadmill CAREN Extended-System (Motek Medical, Amsterdam, NL). Average and standard deviations for trunk linear and angular velocity were calculated along with their instantaneous values (during foot strikes) in all three axes. Averages and coefficient of variations for step length, time, and width; margin of stability; and harmonic ratios were also calculated.Results: Compared with normal arm swing, absent arm swing reduced the least affected leg's average step length and increased its step length coefficient of variation while increasing step time coefficient of variation in the most affected leg. Further, absent arm swing reduced trunk anteroposterior instantaneous angular velocity (least affected leg) and reduced anteroposterior instantaneous linear velocity (bilaterally). For the vertical axis, absent arm swing increased the trunk's average angular velocity but reduced its instantaneous linear velocity and angular velocity standard deviation (least affected leg). Additionally, the margin of stability increased when the arms were absent (least affected leg). Alternatively, dual tasking reduced average step time (most affected leg) and increased the step width coefficient of variation (bilaterally). Additionally, dual tasking increased the mediolateral average angular velocity, instantaneous linear velocity standard deviation (bilaterally), and instantaneous angular velocity standard deviation (least affected leg). For the vertical axis, dual tasking increased average linear and angular velocity standard deviation as well as instantaneous angular velocity standard deviation (bilaterally).Conclusion: Findings suggest that participants attempted to control extraneous trunk movement (due to absent arm swing) through compensatory responses in both lower and upper extremities. However, participants appeared to predominately compensate on their least affected side. Contrastingly, modifying mediolateral foot placement appeared to be the main means of maintaining walking stability while dual tasking.

AimsTo investigate the effects of concurrent training (resistance and endurance) associated with moderate walnut consumption on isokinetic strength, subjective sleep quality, cognitive performance and postural balance in physically active elderly men.MethodsTwenty healthy elderly men were divided into two matched groups, in a randomized controlled experiment. They have participated in three training sessions per week: concurrent (strength and endurance) training + ad libitum diet with walnuts (15 g/day for 6 weeks, CTW: n = 10) and concurrent training + ad libitum diet (CT: n = 10). Isokinetic strength, Spiegel questionnaire, Montreal cognitive assessment and postural balance parameters were assessed 48 h pre- and post-intervention.ResultsAbsolute peak torque of knee extensors and knee flexors significantly increased compared to pre-training in CTW (15.2% ± 6.7; 13.2% ± 2.3, p < 0.05, respectively) and CT (10.6% ± 6.8; 7.4% ± 2.9, p < 0.05, respectively). Subjective sleep quality increased compared to pre-training for CTW and CT (24% ± 14.4; 10.5% ± 9.4, p < 0.05, respectively) with a significantly greater increase in CTW (p < 0.05). Cognitive performance measured by Montreal cognitive assessment (MoCA) increased only in CTW compared to baseline (7.7% ± 2.5, p < 0.05). Postural balance parameters with dual task decreased only in CTW compared to baseline.ConclusionsThe present study clearly revealed that concurrent training alone or associated with daily walnut (15 g) consumption for 6 weeks significantly increased knee isokinetic strength, support leg standing parameters and sleep quality. Meanwhile, cognitive performance evaluated by MoCA test and postural balance with dual task were improved for CTW group only.

Introduction: Parkinson’s disease (PD) reduces an individual’s capacity for automaticity which limits their ability to perform two tasks simultaneously, negatively impacting daily function. Understanding the neural correlates of dual tasks (DTs) may pave the way for targeted therapies. To better understand automaticity in PD, we aimed to explore whether individuals with differing DT performances possessed differences in brain morphologic characteristics. Methods: Data were obtained from 34 individuals with PD and 47 healthy older adults including (1) demographics (age, sex), (2) disease severity (Movement Disorder Society – Unified Parkinson’s Disease Rating Scale [MDS-UPDRS], Hoehn and Yahr, levodopa equivalent daily dose [LEDD]), (3) cognition (Montreal Cognitive Assessment), (4) LEDD, (5) single-task and DT performance during a DT-timed-up-and-go test utilizing a serial subtraction task, and (6) cortical thicknesses and subcortical volumes obtained from volumetric MRI. Participants were categorized as low or high DT performers if their combined DT effect was greater than the previously determined mean value for healthy older adults (μ = –74.2). Nonparametric testing using Quade’s ANCOVA was conducted to compare cortical thicknesses and brain volumes between the highDT and lowDT groups while controlling for covariates: age, sex, MDS-UPDRS part III, LEDD, and intracranial volume. Secondarily, similar comparisons were made between the healthy older adult group and the highDT and lowDT groups. Lastly, a hierarchical linear regression model was conducted regressing combined DT effect on covariates (block one) and cortical thicknesses (block 2) in stepwise fashion. Results: The highDT group had thicker cortices than the lowDT group in the right primary somatosensory cortex (p = 0.001), bilateral primary motor cortices (p ≤ 0.001, left; p = 0.002, right), bilateral supplementary motor areas (p = 0.001, left; p < 0.001, right), and mean of the bilateral hemispheres (p = 0.001, left; p < 0.001, right). Of note, left primary cortex thickness (p = 0.002), left prefrontal cortex thickness (p < 0.001), and right supplementary motor area thickness (p = 0.003) differed when adding a healthy comparison group. Additionally, the regression analysis found that the left paracentral lobule thickness explained 20.8% of the variability in combined DT effect (p = 0.011) beyond the influence of covariates. Conclusions: These results suggest regions underlying DT performance, specifically, a convergence of neural control relying on sensorimotor integration, motor planning, and motor activation to achieve higher levels of DT performance for individuals with PD. Introduction: Parkinson’s disease (PD) reduces an individual’s capacity for automaticity which limits their ability to perform two tasks simultaneously, negatively impacting daily function. Understanding the neural correlates of dual tasks (DTs) may pave the way for targeted therapies. To better understand automaticity in PD, we aimed to explore whether individuals with differing DT performances possessed differences in brain morphologic characteristics. Methods: Data were obtained from 34 individuals with PD and 47 healthy older adults including (1) demographics (age, sex), (2) disease severity (Movement Disorder Society – Unified Parkinson’s Disease Rating Scale [MDS-UPDRS], Hoehn and Yahr, levodopa equivalent daily dose [LEDD]), (3) cognition (Montreal Cognitive Assessment), (4) LEDD, (5) single-task and DT performance during a DT-timed-up-and-go test utilizing a serial subtraction task, and (6) cortical thicknesses and subcortical volumes obtained from volumetric MRI. Participants were categorized as low or high DT performers if their combined DT effect was greater than the previously determined mean value for healthy older adults (μ = –74.2). Nonparametric testing using Quade’s ANCOVA was conducted to compare cortical thicknesses and brain volumes between the highDT and lowDT groups while controlling for covariates: age, sex, MDS-UPDRS part III, LEDD, and intracranial volume. Secondarily, similar comparisons were made between the healthy older adult group and the highDT and lowDT groups. Lastly, a hierarchical linear regression model was conducted regressing combined DT effect on covariates (block one) and cortical thicknesses (block 2) in stepwise fashion. Results: The highDT group had thicker cortices than the lowDT group in the right primary somatosensory cortex (p = 0.001), bilateral primary motor cortices (p ≤ 0.001, left; p = 0.002, right), bilateral supplementary motor areas (p = 0.001, left; p < 0.001, right), and mean of the bilateral hemispheres (p = 0.001, left; p < 0.001, right). Of note, left primary cortex thickness (p = 0.002), left prefrontal cortex thickness (p < 0.001), and right supplementary motor area thickness (p = 0.003) differed when adding a healthy comparison group. Additionally, the regression analysis found that the left paracentral lobule thickness explained 20.8% of the variability in combined DT effect (p = 0.011) beyond the influence of covariates. Conclusions: These results suggest regions underlying DT performance, specifically, a convergence of neural control relying on sensorimotor integration, motor planning, and motor activation to achieve higher levels of DT performance for individuals with PD.

Changes in event-related potentials during dual task walking in aging and Parkinson's disease

Cortical Response and Functional Connectivity in Patients With Subacute Stroke During Dual Task: An fNIRS Study.

Purpose: Postural control deficits in people with multiple sclerosis (MS) are common and aggravate in dual tasking. Spinal stabilization approaches like Pilates and aquaplyometric exercises may have a positive effect on postural control. We aimed to determine the effects of combined Pilates and aquaplyometric exercises on postural control with and without dual task and physical functions in people with MS with this study.Materials and Methods: Twelve people with MS were recruited to 8-week combined exercise programme applied twice in a week and evaluated before and after the exercise training. Timed up and go test was performed for functional mobility and Biodex Balance System was used to evaluate the limits of stability (LoS) with and without a cognitive task. Upper limb functions were evaluated with nine-hole peg test (NHPT) and grip strength where 5-Repetition Sit-To-Stand (STS) and timed 25-Foot walk test were used for lower limb functions.Results: Eight-week combined exercise programme improved postural control, upper limb functions and lower limb functions. Additionally, there was no significant difference between LoS tests scores with and without dual task. Conclusion: Eight-week combined aquatic plyometrics and Pilates exercises were effective in improvement of postural control, upper and lower limb functions in people with MS.