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March 20, 2018; 90 (12) Article

Gait analysis in PSP and NPH

Dual-task conditions make the difference

Charlotte Selge, Florian Schoeberl, Andreas Zwergal, Georg Nuebling, Thomas Brandt, Marianne Dieterich, Roman Schniepp, Klaus Jahn
First published February 21, 2018, DOI: https://doi.org/10.1212/WNL.0000000000005168
Charlotte Selge
From the Department of Neurology (C.S., F.S., A.Z., G.N., M.D., R.S.) and German Center for Vertigo and Balance Disorders (C.S., F.S., A.Z., T.B., M.D., R.S., K.J.), University Hospital, LMU Munich; Schoen Klinik Bad Aibling (K.J.); and SyNergy (M.D.), Munich Cluster of Systems Neurology, Germany.
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Florian Schoeberl
From the Department of Neurology (C.S., F.S., A.Z., G.N., M.D., R.S.) and German Center for Vertigo and Balance Disorders (C.S., F.S., A.Z., T.B., M.D., R.S., K.J.), University Hospital, LMU Munich; Schoen Klinik Bad Aibling (K.J.); and SyNergy (M.D.), Munich Cluster of Systems Neurology, Germany.
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Andreas Zwergal
From the Department of Neurology (C.S., F.S., A.Z., G.N., M.D., R.S.) and German Center for Vertigo and Balance Disorders (C.S., F.S., A.Z., T.B., M.D., R.S., K.J.), University Hospital, LMU Munich; Schoen Klinik Bad Aibling (K.J.); and SyNergy (M.D.), Munich Cluster of Systems Neurology, Germany.
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Georg Nuebling
From the Department of Neurology (C.S., F.S., A.Z., G.N., M.D., R.S.) and German Center for Vertigo and Balance Disorders (C.S., F.S., A.Z., T.B., M.D., R.S., K.J.), University Hospital, LMU Munich; Schoen Klinik Bad Aibling (K.J.); and SyNergy (M.D.), Munich Cluster of Systems Neurology, Germany.
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Thomas Brandt
From the Department of Neurology (C.S., F.S., A.Z., G.N., M.D., R.S.) and German Center for Vertigo and Balance Disorders (C.S., F.S., A.Z., T.B., M.D., R.S., K.J.), University Hospital, LMU Munich; Schoen Klinik Bad Aibling (K.J.); and SyNergy (M.D.), Munich Cluster of Systems Neurology, Germany.
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Marianne Dieterich
From the Department of Neurology (C.S., F.S., A.Z., G.N., M.D., R.S.) and German Center for Vertigo and Balance Disorders (C.S., F.S., A.Z., T.B., M.D., R.S., K.J.), University Hospital, LMU Munich; Schoen Klinik Bad Aibling (K.J.); and SyNergy (M.D.), Munich Cluster of Systems Neurology, Germany.
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Roman Schniepp
From the Department of Neurology (C.S., F.S., A.Z., G.N., M.D., R.S.) and German Center for Vertigo and Balance Disorders (C.S., F.S., A.Z., T.B., M.D., R.S., K.J.), University Hospital, LMU Munich; Schoen Klinik Bad Aibling (K.J.); and SyNergy (M.D.), Munich Cluster of Systems Neurology, Germany.
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Klaus Jahn
From the Department of Neurology (C.S., F.S., A.Z., G.N., M.D., R.S.) and German Center for Vertigo and Balance Disorders (C.S., F.S., A.Z., T.B., M.D., R.S., K.J.), University Hospital, LMU Munich; Schoen Klinik Bad Aibling (K.J.); and SyNergy (M.D.), Munich Cluster of Systems Neurology, Germany.
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Citation
Gait analysis in PSP and NPH
Dual-task conditions make the difference
Charlotte Selge, Florian Schoeberl, Andreas Zwergal, Georg Nuebling, Thomas Brandt, Marianne Dieterich, Roman Schniepp, Klaus Jahn
Neurology Mar 2018, 90 (12) e1021-e1028; DOI: 10.1212/WNL.0000000000005168

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Abstract

Objective To test whether quantitative gait analysis of gait under single- and dual-task conditions can be used for a differential diagnosis of progressive supranuclear palsy (PSP) and idiopathic normal-pressure hydrocephalus (iNPH).

Methods In this cross-sectional study, temporal and spatial gait parameters were analyzed in 38 patients with PSP (Neurological Disorders and Stroke and Society for Progressive Supranuclear Palsy diagnostic criteria), 27 patients with iNPH (international iNPH guidelines), and 38 healthy controls. A pressure-sensitive carpet was used to examine gait under 5 conditions: single task (preferred, slow, and maximal speed), cognitive dual task (walking with serial 7 subtractions), and motor dual task (walking while carrying a tray).

Results The main results were as follows. First, both patients with PSP and those with iNPH exhibited significant gait dysfunction, which was worse in patients with iNPH with a more broad-based gait (p < 0.001). Second, stride time variability was increased in both patient groups, more pronounced in PSP (p = 0.009). Third, cognitive dual task led to a greater reduction of gait velocity in PSP (PSP 34.4% vs iNPH 16.9%, p = 0.002). Motor dual task revealed a dissociation of gait performance: patients with PSP considerably worsened, but patients with iNPH tended to improve.

Conclusion Patients with PSP seem to be more sensitive to dual-task perturbations than patients with iNPH. An increased step width and anisotropy of the effect of dual-task conditions (cognitive vs motor) seem to be good diagnostic tools for iNPH.

Glossary

CERAD=
Consortium to Establish a Registry for Alzheimer's Disease;
CV=
coefficient of variation;
HS=
healthy controls;
iNPH=
idiopathic normal-pressure hydrocephalus;
PD=
Parkinson disease;
PSP=
progressive supranuclear palsy

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received July 13, 2017.
  • Accepted in final form December 22, 2017.
  • © 2018 American Academy of Neurology
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