Related Experiment Video
Updated: Jul 24, 2026
Revised and Neuroimaging-Compatible Versions of the Dual Task Screen
Published on: October 5, 2020
The effects of dual-task cognitive interference on gait and turning in Huntington's disease
Nicollette L Purcell1, Jennifer G Goldman2,3, Bichun Ouyang4
1Department of Cell and Molecular Medicine, Rush University Medical Center, Chicago, IL, United States of America.
Insights
Huntington's disease (HD) impairs gait and turning, especially under dual-task conditions. Gait deficits correlate with motor severity but not falls, highlighting the need for better fall prediction in HD.
Area of Science:
- Neuroscience
- Biomedical Engineering
- Movement Science
Background:
- Huntington's disease (HD) causes motor, cognitive, and psychiatric issues, affecting automaticity and increasing attentional demands.
- Dual-task (DT) and fast-paced gait challenges may reveal subtle motor deficits in HD.
- Investigating gait under stress is crucial for understanding HD progression and fall risk.
Purpose of the Study:
- To determine if fast-paced and DT walking reveal gait and turning deficits in HD not apparent during single-task (ST) walking.
- To examine the relationship between cognitive/gait outcomes and fall incidence in HD.
- To correlate gait deficits measured by wearable sensors with motor symptom severity (UHDRS-TMS) in HD.
Main Methods:
- Seventeen HD patients and 17 controls performed a 2-minute walk test with APDM inertial sensors under ST, fast-as-possible (FAP), and verbal fluency DT conditions.
- Participants underwent cognitive testing and the Unified Huntington's Disease Rating Scale-Total Motor Score (UHDRS-TMS).
- Retrospective fall history was collected.
Main Results:
- HD participants exhibited slower gait, shorter stride length, and increased gait variability (lateral step, stride length) across all conditions compared to controls.
- Significant dual-task costs (DTC) were observed for turns in HD, with increased time and steps needed.
- Higher UHDRS-TMS scores correlated with greater stride length variability and altered support/swing phases; processing speed linked to gait variability.
Conclusions:
- Fast-paced and DT walking reveal significant gait and turning deficits in HD.
- Turning deficits under DT conditions are pronounced, suggesting susceptibility to cognitive interference.
- While gait variability correlates with motor severity, current measures do not predict falls in HD.
Abstract:
Huntington's disease (HD) is characterized by motor, cognitive, and psychiatric dysfunction. HD progression causes loss of automaticity, such that previously automatic tasks require greater attentional resources. Dual-task (DT) paradigms and fast-paced gait may stress the locomotor system, revealing deficits not seen under single-task (ST). However, the impact of gait "stress tests" on HD individuals needs further investigation. Therefore, the aims of this study were to investigate whether: 1) fast-paced and dual-task walking uncover deficits in gait and turning not seen under single-task, 2) cognitive and gait outcomes relate to fall incidence, and 3) gait deficits measured with wearable inertial sensors correlate with motor symptom severity in HD as measured by the Unified Huntington's disease Rating Scale-total motor score (UHDRS-TMS). Seventeen HD (55 ± 9.7 years) and 17 age-matched controls (56.5 ± 9.3 years) underwent quantitative gait testing via a 25m, two-minute walk test with APDMTM inertial sensors. Gait was assessed under a 1) ST, self-selected pace, 2) fast-as-possible (FAP) pace, and 3) verbal fluency DT. The UHDRS-TMS and a cognitive test battery were administered, and a retrospective fall history was obtained. During ST, DT, and FAP conditions, HD participants demonstrated slower gait, shorter stride length, and greater lateral step and stride length variability compared to controls (p<0.00001 to 0.034). Significant dual-task costs (DTC) were observed for turns; HD participants took more time (p = 0.013) and steps (p = 0.028) to complete a turn under DT compared to controls. Higher UHDRS-TMS correlated with greater stride length variability, less double-support, and more swing-phase time under all conditions. Decreased processing speed was associated with increased gait variability under ST and FAP conditions. Unexpectedly, participant's self-reported falls did not correlate with any gait or turn parameters. HD participants demonstrated significantly greater DTC for turning, which is less automatic than straight walking, requiring coordination of body segments, anticipatory control, and cortical regulation. Turn complexity likely makes it more susceptible to cognitive interference in HD.
