Dual tasking in Parkinson’s disease: should we train hazardous behavior?

Abstract

Dual-task (DT) circumstances aggravate gait disorders in Parkinson’s disease (PD) and are associated with an increased risk of falling and reduced functional mobility. Clinical rehabilitation guidelines for PD consider DT interventions as potentially hazardous and recommend avoiding them in daily life. The current article challenges this notion and addresses the necessity of implementing DT training in PD. First, underlying reasons for DT interference in PD and current theoretical models are discussed. Subsequently, different training approaches to tackle DT difficulties are put forward. Finally, the effectiveness and limitations of DT training in PD are reviewed. We conclude that there is a need for DT interventions in PD and recommend randomized, power-based studies to further test their efficacy.

Keywords:

• cognition
• dual task
• dual-task training
• falls
• Parkinson’s disease
• rehabilitation

Financial & competing interests disclosure

This work was supported by a research grant of the Jacques and Gloria Gossweiler Foundation. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Dual-task (DT) interference is an important problem in people with Parkinson’s disease.

• Residual neural capacity appears to determine the extent of DT interference in Parkinson’s disease.

• Consecutive, integrated and hybrid DT training approaches may be relevant for different subgroups of Parkinson’s disease.

• Evidence on the efficacy of DT training is scarce and is methodologically weak.

• Integrated dual-task training needs to be considered as part of rehabilitation for Parkinson’s disease to generate awareness of difficulties with dual tasking, including fall risk.