Barts-MS rose-tinted-odometer: zero-★s (Blue Monday; Italian or Azzurri blue #0A36AF)
Have you noticed that you battle with multitasking? As MS progresses and damages the brain people with MS develop cognitive problems and have difficulty multitasking. This is because MS reduces your brain reserve and hence you have to concentrate on doing one task at a time. This is why pwMS have problems in the knowledge economy that requires cognitive multitasking and why so many pwMS have difficulty at work and often have to stop working relatively early in the course of their disease.
The study below shows this is not limited to cognition but physical activities as well. In the so-called walking-while-talking task they show how doing a mental task whilst walking causes your walking to deteriorate. I actually know of several patients who have had falls when taking on a mental task whilst walking. So please be careful if you are at risk of falls and have noticed problems with multitasking; don’t try to do two things at once, the consequences could be a fall and a fractured bone.
Have any of you noticed problems with multitasking affecting your walking ability and balance?
Henning et al. Validating the walking while talking test to measure motor, cognitive, and dual-task performance in ambulatory individuals with multiple sclerosis. Mult Scler Relat Disord. 2021 Jun 30;54:103123.
Introduction: Multiple Sclerosis (MS) is associated with demyelination of the central nervous system that negatively impacts both motor and cognitive function, resulting in difficulty performing simultaneous motor and cognitive tasks, or dual-tasks. Declines in dual-tasking have been linked with falls in MS; thus, dual-task assessment with the Walking While Talking Test (WWTT) is commonly utilized in the clinical setting. However, the validity and minimal detectable change (MDC) of the WWTT has not been established for persons with MS. The primary objective of the study was to establish the WWTT as a valid measure of dual-task function by examining concurrent validity with other motor, cognitive and dual-task measures, and to establish the MDC for both the simple and complex conditions of the WWTT.
Methods: In a single visit, 38 adults (34 female, mean (SD) age 49.8(±9.1), Patient Determined Disease Steps (PDDS) mean 3, range 1-6) completed the WWTT simple (walk while reciting the alphabet) and complex (walk while reciting every other letter of the alphabet) conditions as well as a battery of cognitive and motor tests. Spearman correlations were used to examine concurrent validity. The sample was divided into low and high disability groups to determine the impact of disability severity on relationships among WWTT and cognitive and motor function.
Results: Excellent concurrent validity (r ≥ 0.79; p < 0.001) was observed for the WWTT simple and complex with both motor (Timed Up-and-Go, Timed 25-Foot Walk, forward and backward walking velocity, Six-Spot Step Test) and dual-task measures (Timed Up-and-Go Cognitive). The WWTT-simple demonstrated moderate concurrent validity with measures of processing speed (Symbol Digit Modalities Test, p = 0.041) and was related to all motor and dual-task measures across disability levels. The WWTT complex was only related to complex motor tasks in the low disability group. Within the low disability group, WWTT was associated with processing speed (p = 0.045) and working memory (California Verbal Learning Test, p = 0.012). The MDC values were established for WWTT simple (6.9 s) and complex (8 s) conditions.
Discussion: The WWTT is a quick, easy-to-administer clinical measure that captures both motor and cognitive aspects of performance for persons with MS. Clinicians should consider adding the WWTT to the evaluation of persons with MS to examine dual-task performance.
General Disclaimer: Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust and are not meant to be interpreted as personal clinical advice.