Elsevier

Parkinsonism & Related Disorders

Volume 66, September 2019, Pages 100-104
Parkinsonism & Related Disorders

Dual-task interference during hand dexterity is a predictor for activities of daily living performance in Parkinson's disease

https://doi.org/10.1016/j.parkreldis.2019.07.017Get rights and content

Highlights

  • DTI was present during dexterity-related ADL.

  • Disease severity explained 8.5% of the variance in ADL performance.

  • DTI in dominant hand explained 44% of the variance in ADL performance.

  • Bradykinesia explained 7.2% of the variance in ADL performance.

  • Our predictive model accounted for 59.2% of the variance in ADL difficulties.

Abstract

Introduction

Dual-task interference (DTI) leads to impairment of hand dexterity in Parkinson's disease (PD). The performance of activities of daily living (ADL) is negatively affected by dexterity in PD. However, the contribution of DTI to dexterity-related ADL disability remains unclear. This cross-sectional study aimed to investigate the contribution of DTI to ADL performance as well as other factors affecting dexterity.

Methods

One-hundred and eight patients with PD were assessed using the ADL-related dexterity questionnaire-24 to measure dexterity-related ADL performance. Performance in single and dual task conditions was measured with the 9-hole peg test. Disease severity, cardinal symptoms and grip strength were assessed using Hoehn&Yahr, a modified version of the Unified Parkinson Disease Rating Scale, Part-III, and a hand dynamometer. The age and cognitive status were control variables.

Results

Multiple regression analysis revealed that disease severity explained 8.5% of the variance in dexterity-related ADL (p = 0.002). The DTI in the dominant hand was the strongest predictor of ADL performance (R2 change = 0.44, p < 0.001), but DTI in the non-dominant hand did not contribute. When cardinal symptoms were added to the model, bradykinesia contributed to ADL difficulty (R2 change = 0.072, p < 0.001), while tremor and rigidity were not significant in any model. This model accounted for 59.2% of the variance in ADL difficulties in total.

Conclusion

The study demonstrated that disease severity, bradykinesia and DTI in the dominant hand contributed to ADL difficulties in patients with PD, and DTI in the dominant hand is the strongest predictor of ADL performance in PD.

Introduction

Dual task (DT) performance involves achieving concurrent tasks, simultaneously. The execution of two tasks at the same time demands a high level of information processing and allocation of attention which is generally impaired in Parkinson's disease (PD) due to basal ganglia dysfunction [1]. The decrease in DT performance is defined as DT interference (DTI). Studies about DT performance in patients with PD showed that their performance decreases and DTI caused difficulties in their daily life, especially in requiring the concurrent cognitive tasks of postural stability and walking [[2], [3], [4]].

Similar to walking or postural stability ability, hand dexterity is essential for independence in activities of daily living (ADL) and is reduced in patients with PD [5]. Moreover, dexterity difficulties are reported as the second contributor to the impairment of PD following ambulation [6]. It is known that writing, tying shoelaces and buttoning activities are difficult for patients with PD [7]. However, these single-task activities do not exactly represent daily life. Therefore, recent studies have focused on the influence of DT performance on hand function [8]. Proud et al. [8] showed that DTI occurred during hand functions when a concurrent cognitive task was added for patients with mild-moderate PD. In addition, Kalirathinam et al. [9] demonstrated DTI involving hand dexterity with both secondary motor and cognitive tasks. Although DTI during hand dexterity was reported in PD, its contribution to disability in ADL remains unclear. Moreover, the preservation of independence in ADL is affected by several clinical properties (disease severity and duration), and cardinal symptoms of PD such as rigidity, bradykinesia and tremor in the upper extremities. Rahman et al. [10] reported that tremor and rigidity affected simple everyday activities and reduced the quality of life. Other investigators showed that bradykinesia represents the best predictor of dexterity-related ADL deficits [11]. However, the common contribution of all these cardinal symptoms to ADL has not yet been studied in patients with PD.

Since daily life includes multitasking activities involving hand functions, such as taking notes while speaking on the phone, removing money from a wallet while shopping, preparing a meal while reading the recipe or dressing while chatting, there is a need for studies that investigate whether ADL performance is affected by DTI in PD.

Therefore, this study primarily aimed to determine the impact of DTI during hand dexterity on ADL. We also aimed to identify strong indicators of ADL disability in patients with PD. Based on the fact that hand function is crucial for independence in daily life, we hypothesized that DTI during hand dexterity is a significant indicator, as well as cardinal symptoms, of ADL performance in PD.

Section snippets

Participants

The participants were diagnosed with idiopathic PD by a neurologist, as determined by the UK Parkinson's Disease Society Brain Bank Criteria [12]. One hundred and eight patients were recruited at the Movement Disorders Clinic of the Education and Research Hospital in Ordu University. All patients gave written informed consent and this study was approved by the Clinical Research Ethics Committee at the University of Ordu. This study was registered at clinicaltrials.gov (NCT 03589872).

The

Results

One hundred and forty-two subjects with PD were assessed for eligibility. Fifteen subjects declined to participate and nineteen subjects did not meet the inclusion criteria (e.g. irregular drug use, presence of psychiatric problems, having severe tremor, MMSE score <24). A total of one hundred and eight patients with PD were recruited to our study as participants, whose PD duration was mean 4.83 ± 3.24 years. Their mean age ±SD was 69.67 ± 6.62 years and the majority of the participants were

Discussion

This study demonstrated that disease severity, DTI in the dominant hand and bradykinesia contributed significantly to dexterity-related ADL disability in patients with PD. Other cardinal symptoms (rigidity and tremor), grip strength, DTI in the non-dominant hand, cognitive state and age did not contribute significantly to dexterity-related ADL disability. Moreover, our results showed that DTI in the dominant hand is a stronger indicator of dexterity-related ADL performance than bradykinesia and

Funding

None.

Declaration of interests

None.

Author contributors

Sevim Acaröz Candan: Research Project: conceptualization, organization and execution; Statistical Analysis: design, execution, review and critique; Manuscript Preparation: writing, review and critique.

Tuba Şaziye Özcan: Research Project: organization; Statistical Analysis: review and critique; Manuscript Preparation: review and critique.

Acknowledgements

The authors would like to thank all the patients involved in the study.

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