Don’t walk and talk

D

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.

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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. 

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

23 comments

  • How much cognitive loss on average would a person with rrms have after being diagnosed after 2 years and started on ocrevus 1 year after diagnosis ?

    • Unfortunately, the impact of MS on cognition is linear it affects different domains preferentially. At diagnosis, about 40% of pwMS will have cognitive impairment in two or more domains and this increases with time. Cognitive impairment is even noted in patients with radiologically isolated syndrome or asymptomatic MS; here about 25% have impairment in two or more domains.

  • I notice multitasking has become very difficult for me. Often I need to ‘shut out’ everything, and restart a single task at hand.
    It is incredibly frustrating. I have a Ph.d., was a part-time professor, have published a lot, gave presentations in 3 languages,… I’ve been diagnosed just 8 years ago with RRMS, and would probably be considered a ‘mild’ case. But I know what I was capable of, and although I think I still manage to do a ‘decent’ job, it takes so much effort, and the result is just not near what I used to be able to do.
    Any suggestions to help slow down (or even restore?) this cognitive deterioriation would be so very welcome!

    • Have you talked to your neurologist or a psychiatrist about this? There are some medications that can be used to treat cognitive impairment due to MS. I know someone who had just started medical school when she was diagnosed and was really struggling cognitively and her neurologist was able prescribe her something that helped a lot (sorry, I’m not sure of the details, I think it was an ADHD med of some kind). She’s now doing well in school.

    • I suspect some cognitive loss in MS is reversible; similar to physical disability on highly effective DMTs. However, long-standing loss in advanced disease is usually irreversible. But cognition is like physical function use it or lose it.

      • re: “cognition is like physical function use it or lose it”.
        I think there’s a lot of truth in that. That’s also why I think it’s very important to keep working, especially if you have a mostly intellectual function.

    • Relate very much to your situation. Provigil helped me immensely during work days to focus — 100 mg dose at rising, 100 mg around 11 am, and only if day requires sustained cognitive “lifting” 100 mg at 3 pm. Chunking tasks and Priortizing must do lists, delegating or postponing tasks that tap reserve, stress management, and self acceptance (probably hardest one when you’re an accomplished ambitious professional but important) . Support and understanding from others is important too so do best to explain when possible and seek accommodations such as flexible work schedule . A “mild” case can make cognitive struggles invisible. I hope studies like this lead to more support. Best of luck.

  • “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. ”

    I would point out that there is no such thing as cognitive multitasking, in spite of the term being in common usage and kids thinking they are so good at it. Yes, they switch tasks more easily, but they also more often lack the ability to stay on a task without being distracted, which is also a needed mental skill. There is really only attention switching – mentally dropping one train of thought and picking up another, and that is very age-dependent. The time it takes to switch is also related to the complexity of the task and how many you’re switching amongst.

    That said, I can attest to the difficulty and the leaving work because of it. I was in IT, a field that requires constant switching of gears and constant learning of new software, software-writing paradigms, and languages. Granted I AM older, but for a reasonable number of years prior to dx, I was noticing how I simply could not wrap my head around certain things anymore. Being a high IQ person, this made me feel really inadequate and like WTF?? Why can’t I do this?? Or retain it? I also started to have a lot of issues with the stresses of my job (I worked production support, so fix it NOW was always the order of the minute). The least amount of stress and my ability to concentrate on anything just went into the toilet. I also started experiencing mental fatigue and zoning out if the task was too complex. It was actually a bit of a relief to know that there really WAS something wrong, and I wasn’t just becoming stupid or lazy. Luckily for me, none of this was terribly noticeable and I had a boss who kindly covered for me and reduced my stress until I finally threw in the towel about 2 years after dx.

    Not too long after dx, I had a neuropsych workup that confirmed some of the mental slowing I’d noticed.

    • Re: “.. there is no such thing as cognitive multitasking..”

      Driving and listening to the radio? It is done all the time and I suspect at some cost to the driver and their passengers.

      • No argument that people TRY to divide their attention, to “multitask”. However, the term “multitasking” in the common parlance, doesn’t just mean doing more than one thing at the same time “well enough”, it has connotations of being able to engage in the “mythical activity in which people believe they can perform two or more tasks simultaneously as effectively as one.” That is why I say there is no TRUE multitasking. The term “attention switching” is closer to describing the reality. And as we have both pointed out, it’s a problem even without MS making it worse.

    • I don’t understand, my experience is so like these other posts. While validating, I ask WTF, why was I allowed to twist on the vine struggling all these years trying to be employed with no explanation as to what was happening to me, allowing me to feel I just was failing or mediocre at my jobs when I used to be viewed as a star when all of this appears quite common??? It sucked the life force from me until I threw in the towel like Karen. Now what? And how many of us are dropped by our LTD because they believe we can still work? Why doesn’t the MS society track % of Pwms who are under or unemployed that were dropped by LTD? Umm, I see I give you a peek at my anger, I must want you to see. How can you fix it if you don’t know it? but I know ultimately anger is not helpful, and will be fleeting. At least it should be.

  • I can walk and talk but cannot look at the person I am walking with as I am talking to them because I need to be looking at the ground at all times or I will fall over – this is true even when standing still.

    • Similar for me. Carrying a box that obscures view of the ground is also an issue, talking not so much.

      I did feel like multi tasking got harder pre diagnosis but partially I think I also got more honest with myself that I had never been good at it (more the laser focus person but that diminished, too).

  • The same feeling of helplessness when you can only do one thing at a time in a supermarket. Or look at the shelves or understand what you need to take). This is what shocked me the most after following a series of severe flare-ups.
    Since then I have learned to walk and even run again. But these things with a fog in the brain never passed (

    • Looking at the shelves there is so much choise that while I’m trying to focus on what I need, I actualy see nothing. I’m just staring.

      Also, even in my own language, when I’m typing or writing I sometimes forget which word I need to use and then use a synonym.

  • Well my multitasking is not what it used to be

    What about you Prof Giovannoni is sharp as knife still?What about the others blog members?

    Nice post

  • I have tripped and fallen multiple times. Last time it happened while doing nothing more than standing up from a seated position on the sofa. Suddenly I was on the floor with a twisted ankle & a sharp pain.

    Suspect it’s because I wasn’t paying attention to how I placed my foot down – which isn’t something most people need to do 🙁

  • As a former neuropsychology student, I noticed subtle changes in my cognition well before the flare that lead to my diagnosis last year. I really couldn’t understand what was happening, I guess I do now. My ability to multi-task (and my attention in general) has definitely deteriorated, I struggle with lexical access and anterograde memory… it feels like MCI, and I’m not even 30 yet.
    I haven’t noticed difficulties when walking and performing another task at the same time though.

  • Not noticed so much regarding walking and talking – though I can’t walk and drink something (other people seem to be able to do this, is this normal? lol?)
    But totally the same as the person below re: multitasking.
    In the last few years I can’t listen to music/radio if I’m doing working that requires thought – especially anything written. Never used to be a problem.
    I recently started a new job and a lot of it involves complex technical discussions and I keep struggling with word finding in verbal conversations, even words I know well. In my last job I didn’t notice an issue mentally like this before and it’s freaking me out a bit. I guess because I’m still learning and thinking on the spot a lot more. It’s like my brain just can’t get it out and I try and say it a few times – I have to make a joke out of it to the clients, it’s awful! Calls are recorded (for my own note taking reference) so I can watch it back and it’s weird.

    • Incidentally, the cleaned up fpr public consumption “can’t walk and chew gum” quote was attributed to Lyndon Baines Johnson about the Republican Gerald Ford, both of whom became president under unusual circumstances. The actual quote from LBJ was Ford “couldn’t walk and f**t at the same time”. 😉

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