Measuring the cost of cognitive-motor dual tasking during walking in multiple sclerosis

Purposeful, safe locomotion requires higher-level cortical processes, to meet the real-life demands of walking while performing concurrent cognitive tasks (e.g. recalling a shopping list or attending to a conversation). The assessment of walking and a secondary cognitive task under these 'dual tasking' conditions may represent a more valid outcome measure in multiple sclerosis (MS), by examining the occurrence and magnitude of the cognitive-motor interference of walking. This topical review provides a state-of-the-art overview of research into dual-tasking during walking in persons with MS, based on 14 recent papers. Studies consistently demonstrate a slowing of ambulation under dual tasking, regardless of the cognitive task demand, the stage of the disease and the disability level. The reciprocal effect of walking on the cognitive tasks was rarely assessed. We present our main findings, highlight the different factors contributing to dual-task deficits, identify methodological shortcomings and offer recommendations for constructing dual-tasking paradigms useful in clinical practice and research.