Assessment Of Cognitive Impairment Effects On Gait And Neural Mechanisms In Patients With Wilson’s Disease Based On Dual Task With TUG

Objectives(1)The effect of cognitive load on gait in Wilson’s disease(WD)patients was assessed based on TUG dual tasking.(2)Combined with the results of cranial MRI examination of WD patients,the influence of different lesions on cognition was analyzed,so as to further understand the possible neural mechanism of cognitive gait influencing,and provide a theoretical basis for clinical improvement of gait abnormalities in WD patients.(3)To analyze the relationship between different TCM symptom types and cognition in WD patients,and provide direction for clinical TCM treatment.Methods(1)The study subjects were 63 WD patients hospitalized in the Institute of Neurology,Affiliated Hospital of Anhui University of Chinese Medicine from June 2021 to August 2022,and were divided into cognitive impairment group(ACE-III total score <88 points)and non cognitive impairment group(ACE-III total score ≥88points)according to the total score of the Chinese Addenbrooke’s cognitive examination-III.At the same time,the enrolled subjects were evaluated by the Tinetti Balance and Gait Scale and the Berg Balance Scale,and the scores of each scale were recorded.(2)The subjects were all subjected to Time up and go test(TUG)tests,dual task 1(TUG tandem 100-7 continuous meus)and dual task 2(TUG tandem animal naming).At the same time,during the test,a tripod was placed in the direction of 3o’clock,9 o’clock and 12 o’clock on the trail to shoot the walking situation from multiple angles.In addition,a tester records the time each time each participant walks with a timer.The relevant indicators of gait,such as step speed,step lengthand step frequency,were extracted by video analysis,and then the influence of WD patients’ cognition on gait was analyzed.(3)The subjects underwent cranial MRI1.5T examination,and the corresponding lesion brain regions of each study subject were recorded in detail,and multiple linear regression analysis was used to analyze the correlation between different lesion brain regions and cognition.(4)According to the dialectical classification criteria of TCM,the research subjects were mainly divided into four TCM syndrome types: liver and kidney yin deficiency,humid heat connotation type,qi and blood deficiency type and phlegm and clear trick type,and the correlation between the total cognitive score and different TCM symptom types was analyzed.Results(1)Among the 63 patients with WD,there were 30 cases of gait abnormality,indicating that the incidence of gait abnormalities in WD patients was 47.6%.(2)Among the 63 patients with WD,28 were in the cognitive impairment group,indicating that the incidence of cognitive impairment in WD patients was 44.4%.(3)The scores of Tinetti Balance and Gait Scale and Berg Balance Scale in the WD cognitive impairment group were lower than those in the non cognitive impairment group,and the differences were statistically significant(p<0.05).(4)The dual-task TUG1 stride speed was lower than TUG and the step length was shorter than TUG in the WD cognitive impairment group(p<0.05).The difference between dual-task TUG1 and TUG cadence was not statistically significant(p>0.05).The cognitive impairment group had a statistically significant difference in the dual-task TUG2 stride speed lower than TUG,shorter step length than TUG,and higher step frequency than TUG(p<0.05).The dual-task TUG1 DTC was greater than that of the dual-task TUG2 in the cognitive impairment group,and the difference was statistically significant(p<0.05).(5)The WD non cognitive impairment group had a statistically significant difference in the dual-task TUG1 stride speed lower than TUG,shorter step length than TUG,and step frequency higher than TUG(p<0.05).The stride speed of dual-task TUG2 was lower than TUG,the step length was shorter than TUG,and the step frequency was higher than TUG,and the difference was statistically significant(p<0.05).The dual-task TUG1 DTC was greater than that of the dual-task TUG2 in the non cognitive impairment group,and the difference was statistically significant(p<0.05).(6)In the case of single-task TUG,the stride speed and step length of the cognitive impairment group were smaller than those in the non cognitive impairment group,the step frequency of the cognitive impairment group was higher than the non cognitive impairment group.The difference between the cognitive impairment group and the non cognitive impairment group was statistically significant(p<0.05).In the case of dual-task TUG1,the stride speed and step length of the cognitive impairment group were smaller than those in the non cognitive impairment group,the step frequency of the cognitive impairment group was higher than the non cognitive impairment group.The difference between the cognitive impairment group and the non cognitive impairment group was statistically significant(p<0.05).In the case of dual-task TUG2,the stride speed and step length of the cognitive impairment group were smaller than those in the non cognitive impairment group,and the difference was statistically significant(p<0.05).The difference between the two groups in cadence and DTC was not statistically significant(p>0.05).(7)The correlation between cognition and regional,gait parameters in WD patients was analyzed.Step speed was mainly related to total cognitive score,memory,language fluency,language and visuospatial scores(p<0.05).Step length was mainly related to total cognitive score,memory,language fluency,language and visual space scores(p<0.05).Step frequency is mainly related to memory and language scores(p<0.05).(8)Multiple linear regression analyzed the correlation between different brain regions and cognitive scores,and the effects of brain atrophy and thalamic lesions on cognitivescores were statistically significant(p<0.05).The equation was obtained by Y=73.44+6.103X1(brain atrophy)+ 3.658X2(thalamic lesions),indicating that cognition is related to brain atrophy and thalamic lesions.(9)Among WD patients,liver and kidney yin deficiency syndrome accounted for 33%,followed by Damp-heat mixed syndrome accounted for 27%,qi and blood deficiency syndrome accounted for 26% and phlegm-mongolia clear syndrome accounted for 14%.The total score of ACE-III was statistically significant(p<0.05)between different TCM symptom types in WD patients,and the total cognitive scores of liver and kidney yin deficiency syndrome were higher than those of qi and blood deficiency syndrome and phlegm-mongolia clear syndrome,and the difference was statistically significant(p<0.05).The total cognitive scores of Damp-heat mixed syndrome were higher than those of qi and blood deficiency syndrome and phlegm-mongolia clear syndrome,and the difference was statistically significant(p<0.05).Conclusions(1)Cognitive impairment in WD patients affects gait,and cognitive function can be predicted clinically by the two gait indicators of step speed and step length,and different cognitive loads interfere with the dual tasks of WD patients to different degrees.(2)Brain atrophy and thalamic lesions in WD patients affect cognitive function and thus gait may be affected.(3)The cognition of WD patients was related to different TCM symptom types,and the cognitive functions of phlegm-mongolia clear syndrome and Qi and blood deficiency syndrome were lower than those of liver and kidney yin deficiency syndrome and Damp-heat mixed syndrome.