The association between cognition and gait disturbance in central nervous system demyelinating disorder with mild disability

(2023) 23:177 Chang et al. BMC Neurology https://doi.org/10.1186/s12883-023-03210-w BMC Neurology Open Access RESEARCH The association between cognition and gait disturbance in central nervous system demyelinating disorder with mild disability Min Cheol Chang1†, Byung Joo Lee2†, Dongseok Yang3, Chung Reen Kim3, Donghwi Park2* and Sunyoung Kim4* Abstract Introduction Gait disturbance in central nervous system (CNS) demyelinating disorders, including multiple sclerosis (MS) and neuromyelitis optica (NMO) is one of the most troublesome problems that has a direct impact on the quality of life. However, the associations between gait disturbance and other clinical variables of these two diseases have not been fully elucidated. Objective This study aimed to evaluate gait disturbance using a computerized gait analysis system and its association with various clinical variables in patients with MS and NMO. Methods A total of 33 patients (14 with MS and 19 with NMO) with minor disabilities, who were able to walk independently and had passed their acute phase, were enrolled in the study. Gait analysis were performed using a computer-based instrumented walkway system. (Walk-way MG-1000, Anima, Japan) Clinical variables, such as disease duration, medication, body mass index (BMI), hand grip power, and muscle mass were recorded. The Montreal Cognitive Assessment (MOCA), Beck Depression Inventory score-II (BDI), and fatigue scale were measured using the Functional Assessment of Chronic Illness Therapy-fatigue scale (FACIT-fatigue) scale. A trained neurologist scored the Expanded Disability Status Scale (EDSS). Results Gait speed was the single parameter that showed a significant positive correlation with MOCA (p < 0.001). The stance phase time was the single parameter that showed a significant negative correlation with EDSS (p < 0.001). Hand grip strength showed a significant positive correlation with skeletal muscle mass as assessed by bioimpedance analysis (p < 0.05). The FACIT-fatigue scale score showed a significant negative correlation with the BDI (p < 0.001). Conclusion In our patients with MS/NMO with mild disability, cognitive impairment was significantly correlated with gait speed, and the degree of disability was significantly correlated with stance phase time. Our findings may imply that early detection of a decrease in gait speed and an increase in stance phase time can predict the progression of cognitive impairment in patients with MS/NMO with mild disability. Keywords Gait, Gait analysis, Cognitive function, Multiple sclerosis, Neuromyelitis optica † Min Cheol Chang and Byung Joo Lee contributed equally as co-first authors. *Correspondence: Donghwi Park Sunyoung Kim Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Chang et al. BMC Neurology (2023) 23:177 Introduction Demyelinating diseases of the central nervous system (CNS), including multiple sclerosis (MS) and neuromyelitis optica (NMO), are caused by the attack of white blood cells and antibodies on the myeline sheath or the cells that produce and maintain it in the spinal cord or brain [1]. Damage to the myelin sheath interrupts nerve transmission, resulting in various neurological dysfunctions according to the involved part of the nervous system [1]. Deterioration of gait function is one of the most common neurological deficits in patients with CNS demyelinating diseases [2]. Gait function is important for independence in daily activities and is essential for the mobility and maintenance of general health in humans. Demyelinating disease-induced gait disturbances frequently result in falls and fall-related injuries. Therefore, gait disturbance in patients with CNS demyelinating diseases is one of the most critical factors that impairs activities of daily living, general health, and quality of life [2]. CNS demyelinating disease decreases gait speed and endurance, step length, cadence, and joint motion and increases metabolic cost during gait [3]. Some previous studies have evaluated the factors determining gait disturbance in patients with CNS demyelinating disease and reported that various factors, such as fatigue, balance problems, muscle mass and strength, and physical activity are associated with gait dysfunction [4–7]. Accurate and extensive knowledge of the factors associated with gait disturbance following the occurrence of CNS demyelinating diseases will enable clinicians and researchers to have a more accurate and well-balanced understanding of the disease. Moreover, the value of early detection of impairments in patients with CNS demyelinating diseases is highlighted by recent advances in treatment, particularly the availability of disease modifying drugs. The ability to identify gait and balance abnormalities in the early stages of CNS demyelinating diseases may provide a rationale for cohort selection targeting more aggressive therapeutic interventions. Therefore,in the current study, we investigated the association between gait function in patients with MS/NMO with mild disability and various clinical variables, such as disease duration, type of medication used, body mass index (BMI), muscle strength, cognitive deficit, depression, and fatigue. Methods Participant Our study was approved by the Ethics Committee (IRB 2021–03-004) of Ulsan University Hospital and conducted in accordance with the principles of the Declaration of Helsinki for human experiments. All methods were carried out in accordance with relevant guidelines Page 2 of 8 and regulations. Written informed consent was provided by all participants. We recruited consecutive patients with CNS demyelinating diseases between March 2021 and July 2022. The inclusion criteria were as follows: diagnosis of MS or NMO according to the international consensus diagnostic criteria [8, 9], a follow-up period of more than 3 months from acute phase, an (...truncated)