{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T09:57:34Z","timestamp":1791021454798,"version":"4.1.0"},"reference-count":23,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T00:00:00Z","timestamp":1790985600000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["CNS Neurosci Ther"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Gait impairment in Parkinson's disease (PD), especially under dual\u2010task conditions, contributes to falls and reduced quality of life. Although the impact of cognitive load has been explored, the effect of the cognitive task's initiation timing relative to walking is unclear. We investigated how variations in cognitive load and the timing of task initiation affect gait performance in PD patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twelve PD patients and 11 age\u2010matched healthy controls (HCs) completed single\u2010task walking and two arithmetic cognitive tasks (serial\u20105, serial\u20107). In dual\u2010task trials, the cognitive task either preceded gait initiation (cognitive\u2010first; C5, C7) or followed it (motor\u2010first; M5, M7). Gait speed, cycle parameters, and inter\u2010limb coordination were measured. Cognitive performance was primarily quantified as the answering speed. This exploratory study analyzed the dual\u2010task data using linear mixed\u2010effects models (LMM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In PD patients, gait speed was selectively reduced both by higher cognitive load and by initiating the cognitive task before walking (cognitive\u2010first), whereas HCs showed no such effects. Inter\u2010limb coordination of the lower limbs was reduced by higher cognitive load and, in PD patients, by the cognitive\u2010first condition. The cognitive answering speed differed by task load but not by group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Gait in PD patients is particularly vulnerable when a high\u2010load cognitive task is initiated before walking, suggesting that both the cognitive demand and the timing of task onset modulate dual\u2010task interference. These findings may guide tailored dual\u2010task assessments and rehabilitation strategies for PD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cns.71199","type":"journal-article","created":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T09:24:56Z","timestamp":1791019496000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impacts of Cognitive Load and Task Initiation Timing on Gait Performance in Parkinson's Disease: A Dual\u2010Task Paradigm Study"],"prefix":"10.1002","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6962-6640","authenticated-orcid":false,"given":"Shohei","family":"Okusa","sequence":"first","affiliation":[{"name":"Department of Neurology Keio University School of Medicine  Tokyo Japan"},{"name":"Parkinson's Disease Center Keio University Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8594-7022","authenticated-orcid":false,"given":"Takehide","family":"Kimura","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Graduate School of Human Health Sciences Tokyo Metropolitan University  Tokyo Japan"},{"name":"Department of Rehabilitation Medicine Keio University School of Medicine  Tokyo Japan"},{"name":"Department of Physical Therapy Tsukuba International University  Tsuchiura Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenya","family":"Tanamachi","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Graduate School of Human Health Sciences Tokyo Metropolitan University  Tokyo Japan"},{"name":"Department of Rehabilitation Medicine Keio University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fuminari","family":"Kaneko","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Graduate School of Human Health Sciences Tokyo Metropolitan University  Tokyo Japan"},{"name":"Department of Rehabilitation Medicine Keio University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuka","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Keio University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6459-3325","authenticated-orcid":false,"given":"Michiyuki","family":"Kawakami","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Keio University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5858-0998","authenticated-orcid":false,"given":"Jin","family":"Nakahara","sequence":"additional","affiliation":[{"name":"Department of Neurology Keio University School of Medicine  Tokyo Japan"},{"name":"Parkinson's Disease Center Keio University Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6726-6781","authenticated-orcid":false,"given":"Morinobu","family":"Seki","sequence":"additional","affiliation":[{"name":"Department of Neurology Keio University School of Medicine  Tokyo Japan"},{"name":"Parkinson's Disease Center Keio University Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,3]]},"reference":[{"issue":"5","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1056\/NEJMra2401857","article-title":"Parkinson's Disease","volume":"391","author":"Tanner C. M.","year":"2024","journal-title":"New England Journal of Medicine"},{"issue":"11","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"1520","DOI":"10.1002\/mds.25674","article-title":"Cognitive Contributions to Gait and Falls: Evidence and Implications","volume":"28","author":"Amboni M.","year":"2013","journal-title":"Movement Disorders: Official Journal of the Movement Disorder Society"},{"issue":"1","key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.parkreldis.2010.08.012","article-title":"Determinants of Health\u2010Related Quality of Life in Parkinson's Disease: A Systematic Review","volume":"17","author":"Soh S. 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A.","year":"2014","journal-title":"JAMA Neurology"},{"issue":"9","key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1586\/14737175.2015.1077116","article-title":"Dual Tasking in Parkinson's Disease: Should We Train Hazardous Behavior?","volume":"15","author":"Strouwen C.","year":"2015","journal-title":"Expert Review of Neurotherapeutics"},{"key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.gaitpost.2017.05.006","article-title":"Dual Task Interference on Postural Sway, Postural Transitions and Gait in People With Parkinson's Disease and Freezing of Gait","volume":"56","author":"Souza Fortaleza A. C.","year":"2017","journal-title":"Gait & Posture"},{"issue":"9","key":"e_1_2_11_12_1","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1007\/s40520-017-0862-0","article-title":"Analyzing Gait Variability and Dual\u2010Task Interference in Patients With Parkinson's Disease and Freezing by Means of the Word\u2010Color Stroop Test","volume":"30","author":"Kleiner A. F. 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