Cognition affects gait adaptation after split-belt treadmill training in Parkinson?s disease

Background: Split-belt treadmill (SBTM) training has been proposed to improve gait symmetry and overall gait performance of patients with Parkinson's disease (PD).Objectives: To determine whether patient's baseline features affect gait adaptation to SBTM in PD with freezing of gait (FOG).Methods: Twenty participants with idiopathic PD and treatment-resistant FOG underwent several clinical as-sessments including the Toronto Cognitive Assessment (TorCA) prior to treadmill training. Velocity of the treadmill was adjusted to over-ground walking speed. During SBTM training, the belt velocity on the least -affected side was reduced by 25%.Results: Participants who adapted to SBTM training demonstrated cognitively intact TorCA scores (p < 0.001), particularly intact working memory (p < 0.001). After-effects correlated with normal total TorCA (p = 0.02), working memory and visuospatial (p < 0.001) function. Conclusions: Cognitive impairment, particularly impaired working memory, reduces gait adaptation and after-effects in PD with FOG. This is informative for trials studying prolonged effects of SBTM training in FOG.