Effects of Cognitive Demand on Functional Mobility in Multiple Sclerosis.

TitleEffects of Cognitive Demand on Functional Mobility in Multiple Sclerosis.
Publication TypeJournal Article
AuthorsKhurana SR, Cline MJ, DiGiacomo A, Bowen JD, Wadhwani R, Kraft GH
JournalInternational Journal of MS Care

Background: Multiple sclerosis (MS) is an unpredictable and disabling condition that has been associated with decreased mobility, balance problems, and cognitive dysfunction. It has been speculated that people with MS also have more difficulty multitasking than healthy age-matched adults. We hypothesize that ambulation in people with MS is adversely affected by cognitive distractions more than in the control group. Research Design: A prospective case-control study conducted at the University of Washington. Methods: Sixty ambulatory (Expanded Disability Status Scale score 6.0) community-dwelling adults (30 with MS, 30 age- and sex-matched controls) were enrolled. Two ambulation measures were being used: the timed up and go (TUG) test and a 100-foot walking test. These measures were performed under three conditions: no cognitive task; a simple cognitive task: reciting the alphabet; a more difficult cognitive task: counting backward by three. In addition, subjects counted backward by three while seated and completed the paced auditory serial addition test. Results: In MS (n = 7) and control (n = 2) subjects studied to date, both simple and complex cognitive tasks adversely affected motor performance. MS subjects showed trends toward greater differences in speed between TUG alone and TUG with a cognitive task. The control group was 9% slower when performing TUG with a cognitive task; MS subjects were 30% slower. Similar results were seen in the 100-foot walking tests while performing the more difficult cognitive task. Conclusions: This study is highly relevant to MS in that it addressed the interplay between two areas that are commonly affected by MS: cognition and motor function. The results enable us to better understand the impact of distraction on common motor functions. By better understanding the conditions under which falls occur, the treating physician will be able to use rehabilitation strategies more effectively, thus minimizing morbidity in this population.


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