Predicting executive functioning from walking features in Parkinson's disease using machine learning

Parkinson's disease is characterized by motor and cognitive deficits. While previous work suggests a relationship between both, direct empirical evidence is scarce or inconclusive. Therefore, we examined the relationship between walking features and executive functioning in patients with Parkinson's disease using state-of-the-art machine learning approaches. A dataset of 103 geriatric Parkinson inpatients, who performed four walking conditions with varying difficulty levels depending on single task walking and additional motor and cognitive demands, was analyzed. Walking features were quantified using an inertial measurement unit (IMU) system positioned at the patient's lower back. The analyses included five imputation methods and four regression approaches to predict executive functioning, as measured using the Trail-Making Test (TMT). Multiple imputation by chained equations (MICE) in combination with support vector regression (SVR) reduce the mean absolute error by about 4.95% compared to baseline. Importantly, predictions solely based on walking features obtained with support vector regression mildly but significantly correlated with Δ-TMT values. Specifically, this effect was primarily driven by step time variability, double limb support time variability, and gait speed in the dual task condition with cognitive demands. Taken together, our data provide direct evidence for a link between executive functioning and specific walking features in Parkinson's disease.