The association between cognition and gait disturbance in central nervous system demyelinating disorder with mild disability

Min Cheol Chang; Byung Joo Lee; Dongseok Yang; Chung Reen Kim; Donghwi Park; Sunyoung Kim

doi:10.1186/s12883-023-03210-w

The association between cognition and gait disturbance in central nervous system demyelinating disorder with mild disability

BMC Neurol. 2023 Apr 29;23(1):177. doi: 10.1186/s12883-023-03210-w.

Authors

Min Cheol Chang^#¹, Byung Joo Lee^#², Dongseok Yang³, Chung Reen Kim³, Donghwi Park⁴, Sunyoung Kim⁵

Affiliations

¹ Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea.
² Department of Physical Medicine and Rehabilitation, Daegu Fatima Hospital, Ayang-Ro 99 Gil, Dong-Gu, Daegu, 41199, Republic of Korea.
³ Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea.
⁴ Department of Physical Medicine and Rehabilitation, Daegu Fatima Hospital, Ayang-Ro 99 Gil, Dong-Gu, Daegu, 41199, Republic of Korea. bdome@hanmail.net.
⁵ Department of Neurology, Ulsan University Hospital, Ulsan University College of Medicine, 877 Bangeojin sunhwando-ro, Dong-gu, 44033, Ulsan, Korea. sykim@uuh.ulsan.kr.

^# Contributed equally.

Abstract

Introduction: Gait disturbance in central nervous system (CNS) demyelinating disorders, including multiple sclerosis (MS) and neuromyelitis optica (NMO) is one of the most troublesome problems that has a direct impact on the quality of life. However, the associations between gait disturbance and other clinical variables of these two diseases have not been fully elucidated.

Objective: This study aimed to evaluate gait disturbance using a computerized gait analysis system and its association with various clinical variables in patients with MS and NMO.

Methods: A total of 33 patients (14 with MS and 19 with NMO) with minor disabilities, who were able to walk independently and had passed their acute phase, were enrolled in the study. Gait analysis were performed using a computer-based instrumented walkway system. (Walk-way MG-1000, Anima, Japan) Clinical variables, such as disease duration, medication, body mass index (BMI), hand grip power, and muscle mass were recorded. The Montreal Cognitive Assessment (MOCA), Beck Depression Inventory score-II (BDI), and fatigue scale were measured using the Functional Assessment of Chronic Illness Therapy-fatigue scale (FACIT-fatigue) scale. A trained neurologist scored the Expanded Disability Status Scale (EDSS).

Results: Gait speed was the single parameter that showed a significant positive correlation with MOCA (p < 0.001). The stance phase time was the single parameter that showed a significant negative correlation with EDSS (p < 0.001). Hand grip strength showed a significant positive correlation with skeletal muscle mass as assessed by bioimpedance analysis (p < 0.05). The FACIT-fatigue scale score showed a significant negative correlation with the BDI (p < 0.001).

Conclusion: In our patients with MS/NMO with mild disability, cognitive impairment was significantly correlated with gait speed, and the degree of disability was significantly correlated with stance phase time. Our findings may imply that early detection of a decrease in gait speed and an increase in stance phase time can predict the progression of cognitive impairment in patients with MS/NMO with mild disability.

Keywords: Cognitive function; Gait; Gait analysis; Multiple sclerosis; Neuromyelitis optica.

MeSH terms

Central Nervous System
Central Nervous System Diseases* / complications
Cognition
Fatigue
Gait Analysis
Hand Strength
Humans
Multiple Sclerosis* / psychology
Neuromyelitis Optica* / diagnosis
Quality of Life