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Effects of 6-Month Multimodal Physical Exercise Program on Bone Mineral Density, Fall Risk, Balance, and Gait in Patients with Alzheimer's Disease: A Controlled Clinical Trial. Brain Sci 2021; 11:brainsci11010063. [PMID: 33419016 PMCID: PMC7825330 DOI: 10.3390/brainsci11010063] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 12/14/2022] Open
Abstract
We aimed to determine the short- and medium-term effects of a multimodal physical exercise program (MPEP) on bone health status, fall risk, balance, and gait in patients with Alzheimer’s disease. A single-blinded, controlled clinical trial was performed where 72 subjects were allocated in a 3:1 ratio to an intervention group (IG; n = 53) and control group (CG; n = 19), where the IG’s subjects were admitted to live in a State Reference Center of Alzheimer’s disease, which offers the targeted exercise program, while the CG’s subjects resided in independent living. A multidisciplinary health team assessed all patients before allocation, and dependent outcomes were again assessed at one, three, and six months. During the study, falls were recorded, and in all evaluations, bone mineral density was measured using a calcaneal quantitative ultrasound densitometer; balance and gait were measured using the performance-oriented mobility assessment (POMA), the timed up and go test (TUG), the one-leg balance test (OLB), and the functional reach test (FR). There were no differences between groups at baseline for all outcome measures. The prevalence of falls was significantly lower in the IG (15.09%) than in the CG (42.11%) (χ2 = 5.904; p = 0.015). We also found that there was a significant time*group interaction, with a post hoc Šidák test finding significant differences of improved physical function, especially in gait, for the IG, as assessed by POMA-Total, POMA-Gait, and TUG with a large effect size (ƞ2p = 0.185–0.201). In balance, we found significant differences between groups, regardless of time, and a medium effect size as assessed by POMA-Balance and the OLB (ƞ2p = 0.091–0.104). Clinically relevant effects were observed, although without significant differences in bone health, with a slowing of bone loss. These results show that a multimodal physical exercise program reduces fall risk and produces an improvement in gait, balance, and bone mineral density in the short and medium term in institutionalized patients with Alzheimer’s disease.
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Midorikawa M, Suzuki H, Suzuki Y, Yamauchi K, Sato H, Nemoto K, Sugano Y, Iwasaki H, Sekiya M, Yatoh S, Yahagi N, Hada Y, Arai T, Shimano H. Relationships between Cognitive Function and Odor Identification, Balance Capability, and Muscle Strength in Middle-Aged Persons with and without Type 2 Diabetes. J Diabetes Res 2021; 2021:9961612. [PMID: 34660814 PMCID: PMC8516531 DOI: 10.1155/2021/9961612] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 09/07/2021] [Indexed: 11/24/2022] Open
Abstract
AIM We investigated the relationship between cognitive function and olfactory and physical functions in middle-aged persons with and without type 2 diabetes (T2D) to examine the potential of olfactory and physical functions as biomarkers for early cognitive impairment. METHODS Enrolled were 70 T2D patients (age 40 to <65 y) and 81 age-matched control participants without diabetes. Cognitive function was assessed by the Montreal Cognitive Assessment (MoCA), Trail Making Test parts A and B (TMT-A/-B), Wisconsin Card Sorting Test (WCST), Quick Inventory of Depressive Symptomatology Self-Report (QIDS), and Starkstein Apathy Scale (SAS). Multiple linear regression analyses were performed. RESULTS Odor identification was an independent determinant shown in the results of the TMT-A in the entire participant group and was independently associated with the MoCA and TMT-B in the T2D group. Balance capability assessed with a stabilometer was independently associated with all cognitive function tests except for QISD and SAS in the entire participant group and the T2D group and was independently associated with TMT-A in the control group. Knee extension strength was independently associated with the SAS in the entire participant group and the T2D group. CONCLUSIONS Odor identification, balance capability, and knee extension strength were potential markers for cognitive decline in middle-aged persons with T2D.
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Affiliation(s)
- Manabu Midorikawa
- Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba 305-8575, Japan
- Department of Internal Medicine (Endocrinology and Metabolism), Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Hiroaki Suzuki
- Department of Internal Medicine (Endocrinology and Metabolism), Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Yasuhiro Suzuki
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba 305-8596, Japan
| | - Kazuyoshi Yamauchi
- Department of Laboratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Hiroyuki Sato
- Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba 305-8575, Japan
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Kiyotaka Nemoto
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Yoko Sugano
- Department of Internal Medicine (Endocrinology and Metabolism), Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Hitoshi Iwasaki
- Department of Internal Medicine (Endocrinology and Metabolism), Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Motohiro Sekiya
- Department of Internal Medicine (Endocrinology and Metabolism), Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Shigeru Yatoh
- Department of Internal Medicine (Endocrinology and Metabolism), Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Naoya Yahagi
- Department of Internal Medicine (Endocrinology and Metabolism), Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Tetsuaki Arai
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Hitoshi Shimano
- Department of Internal Medicine (Endocrinology and Metabolism), Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba 305-8575, Japan
- Life Science Center of Tsukuba Advanced Research Alliance (TARA), University of Tsukuba, Tsukuba 305-8575, Japan
- Japan Agency for Medical Research and Development-Core Research for Evolutional Science and Technology (AMED-CREST), Chiyoda-ku 100-0004, Japan
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Thaiyanto J, Sittichoke C, Phirom K, Sungkarat S. Effects of Multicomponent Exercise on Cognitive Performance and Fall Risk in Older Women with Mild Cognitive Impairment. J Nutr Health Aging 2021; 25:160-164. [PMID: 33491029 DOI: 10.1007/s12603-020-1458-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Emerging evidence suggests that multicomponent exercise provides greater benefits for physical and cognitive function than single component exercise. However, few studies have been conducted to determine these effects in older adults with mild cognitive impairment (MCI) and findings have been less conclusive. It has been reported that older women have a greater risk of falls and a higher incidence of dementia than men. OBJECTIVES To examine the effects of multicomponent exercise on cognitive performance and fall risk in older women with MCI. DESIGN An experimental design comparing the exercise and control groups. SETTING AND PARTICIPANTS Forty community-dwelling older women with MCI were allocated to the exercise (n = 20) and control (n = 20) groups. INTERVENTION Twelve weeks of multicomponent exercise program (aerobic, resistance, and balance exercise) 60 mins/day, 3 days/week. MEASUREMENT Cognitive performance including the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) and Trail Making Test (TMT) and fall risk including the Timed Up and Go (TUG) single-, dual-task, and Physiological Profile Assessment (PPA) were administered before and after the 12-week exercise program. RESULTS At the end of the 12-week training, participants in the exercise group had a significantly greater improvement in TMT part A (p < 0.05), TUG dual-task (p < 0.05), and PPA composite score (p < 0.05) when compared to the control group. The exercise group also demonstrated significant improvement in TUG dual-task, PPA composite score, PPA subcomponents including postural sway and reaction time when compared to baseline (p < 0.05). In contrast, at 12-week, the control group showed a decline in TUG dual-task performance as compared to baseline (p < 0.05). CONCLUSION The 12-week multicomponent exercise improved attention, dual-task ability, and reduced risk of falling in older women with mild cognitive impairment.
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Affiliation(s)
- J Thaiyanto
- Somporn Sungkarat, Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand, 50200; E-mail address: ; Tel. + 66 53 949 249; Fax. +66 53 946 042
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Kuan YC, Huang LK, Wang YH, Hu CJ, Tseng IJ, Chen HC, Lin LF. Balance and gait performance in older adults with early-stage cognitive impairment. Eur J Phys Rehabil Med 2020; 57:560-567. [PMID: 33258361 DOI: 10.23736/s1973-9087.20.06550-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND People with cognitive impairment are susceptible to fall. Previous studies regarding balance and gait enrolled patients with various severity of dementia. Quantification of the balance and gait performance of people with cognitive impairment may help identify their postural instability and fall risks. AIM We investigated the differences in balance and gait among older adults with preserved cognition, amnestic mild cognitive impairment, and mild dementia due to Alzheimer's disease. DESIGN Prospective observational study. SETTING Outpatient department of neurology or psychology. POPULATION Older adults (aged ≥65 years) with independent gait were evaluated using the Mini-Mental State Examination and Clinical Dementia Rating scale. People with other neurological or musculoskeletal disorders were excluded. METHODS Participants were classified into three groups: 30 healthy controls, 30 mild cognitive impairment and 30 mild dementia. Balance were evaluated through functional test (Berg Balance Scale [BBS]) and laboratory test (posturography). Gait was assessed by wearable device. Muscle strength and mass were measured through grip force, calf circumstance, and body composition. RESULTS The BBS (P=0.04), posturography of fall risk index (FR, P=0.01) and sensory integration indices in eyes open and firm surface (EOFIS, P=0.009), eyes open and foam surface (EOFOS, P=0.003) were substantially different among three groups. EOFIS and EOFOS indices of balance in mild dementia were significantly worse than in MCI. The gait speed (P=0.04) and stride length (P=0.04) were significantly different among three groups. The post-hoc analyses revealed that all above balance and gait indices in subjects with cognitive impairments were significantly worse than in healthy controls. The grip force, calf circumstance and body composition-muscle mass did not significantly differ among three groups. CONCLUSIONS It is a piece of evidence that cognitive dysfunction, even in early stage of memory decline, may have some bad impact on balance and gait regardless of the effect of musculoskeletal problems. CLINICAL REHABILITATION IMPACT Understanding the difference of specific indices of balance and gait among different severity of cognitive impairments and healthy controls could help to develop better balance-oriented rehabilitation programs in older adults at early-stage cognitive impairment.
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Affiliation(s)
- Yi-Chun Kuan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.,Department of Neurology and Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.,Center for Evidence-Based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan, Taiwan
| | - Li-Kai Huang
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.,Department of Neurology and Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan.,Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan.,College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, Taipei, Taiwan
| | - Yuan-Hung Wang
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan
| | - Chaur-Jong Hu
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.,Department of Neurology and Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ing-Jy Tseng
- School of Gerontology Health Management College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Hung-Chou Chen
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan.,Department of Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li-Fong Lin
- School of Gerontology Health Management College of Nursing, Taipei Medical University, Taipei, Taiwan - .,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan.,Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan.,Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
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Postural Control Dysfunction and Balance Rehabilitation in Older Adults with Mild Cognitive Impairment. Brain Sci 2020; 10:brainsci10110873. [PMID: 33227910 PMCID: PMC7699138 DOI: 10.3390/brainsci10110873] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/03/2020] [Accepted: 11/18/2020] [Indexed: 12/04/2022] Open
Abstract
Older adults with mild cognitive impairment (MCI) are at an increased risk for falls and fall-related injuries. It is unclear whether current balance rehabilitation techniques largely developed in cognitively intact populations would be successful in older adults with MCI. This mapping review examined the available balance rehabilitation research conducted in older adults with MCI. Databases Medline, Cinahl, Cochrane, PubMed, Scopus, and PsycINFO were systematically searched from inception to August 2020. Twenty-one studies with 16 original randomized controlled trials (RCTs) involving 1201 older adults with MCI (>age 60) met the inclusion criteria, of which 17 studies showed significant treatment effects on balance functions. However, only six studies demonstrated adequate quality (at least single-blind, no significant dropouts, and intervention and control groups are equivalent at baseline) and evidence (medium or large effect size on at least one balance outcome) in improving balance in this population, and none of them are double- or triple-blind. Therefore, more high-quality RCTs are needed to inform future balance rehabilitation program development for older adults with MCI. Moreover, few studies examined the incidence of falls after the intervention, which limits clinical utility. Future RCTs should prospectively monitor falls or changes in risk of falls after the intervention.
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Hunter SW, Divine A, Omana H, Madou E, Holmes J. Development, reliability and validity of the Safe Use of Mobility Aids Checklist (SUMAC) for 4-wheeled walker use in people living with dementia. BMC Geriatr 2020; 20:468. [PMID: 33176695 PMCID: PMC7659047 DOI: 10.1186/s12877-020-01865-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Balance and gait problems are common and progressive in dementia. Use of a mobility aid provides physical support and confidence. Yet, mobility aid use in people with dementia increases falls three-fold. An assessment tool of mobility aid safety in people with dementia does not currently exist. The objectives of this study were: 1) to develop a tool for the evaluation of physical function and safe use of a 4-wheeled walker in people with dementia, and 2) to evaluate its construct and criterion validity, inter-rater and test-retest reliability and minimal detectable change. METHODS Healthcare professionals (HCP) experienced in rehabilitation of people with dementia participated in focus groups for item generation of the new tool, The Safe Use of Mobility Aid Checklist (SUMAC). The SUMAC evaluates physical function (PF) and safe use of the equipment (EQ) on nine tasks of daily life. Reliability was evaluated by HCP (n = 5) scored participant videos of people with dementia (n = 10) using a 4-wheeled walker performing the SUMAC. Inter-rater and test-retest reliability was assessed using intra-class correlation coefficients (ICC). Construct validity evaluated scores of the HCPs to a consensus HCP panel using Spearman's rank-order correlations. Criterion validity evaluated SUMAC-PF to the Performance-Oriented Mobility Assessment (POMA) gait subscale using Spearman's rank-order correlations. RESULTS Three focus groups (n = 17) generated a tool comprised of nine tasks and the components within each task for physical function and safe use. Inter-rater reliability was statistically significant for SUMAC-PF (ICC = 0.92, 95%CI (0.81, 0.98), p < 0.001) and SUMAC-EQ. (ICC = 0.82, 95%CI (0.54, 0.95), p < 0.001). Test-retest reliability was statistically significant for SUMAC-PF (ICC = 0.89, 95%CI (0.81, 0.94), p < 0.001) and SUMAC-EQ. (ICC = 0.88, 95%CI (0.79, 0.93), p < 0.001). As hypothesized, the POMA gait subscale correlated strongly with the SUMAC-PF (rs = 0.84), but not EQ (rs = 0.39). CONCLUSIONS The focus groups and research team developed a tool of nine tasks with evaluation on physical function and safe use of a 4-wheeled walker for people with dementia. The SUMAC tool has demonstrated content validity for the whole scale and good construct and criterion validity for the SUMAC-PF and SUMAC-EQ. The subscores of the SUMAC demonstrated excellent to good inter-rater and test-retest reliability.
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Affiliation(s)
- Susan W Hunter
- School of Physical Therapy, University of Western Ontario, Room 1588, Elborn College, London, ON, N6G 1H1, Canada.
| | - Alison Divine
- Faculty of Biological Sciences, Sport and Exercise Science, University of Leeds, Leeds, England
| | - Humberto Omana
- Faculty of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada
| | - Ed Madou
- School of Physical Therapy, University of Western Ontario, Room 1588, Elborn College, London, ON, N6G 1H1, Canada
| | - Jeffrey Holmes
- School of Occupational Therapy, University of Western Ontario, London, Ontario, Canada
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Na S, Im JJ, Jeong H, Lee ES, Lee TK, Chung YA, Song IU. Altered Regional Cerebral Blood Perfusion in Mild Cognitive Impairment Patients with Dizziness. Diagnostics (Basel) 2020; 10:diagnostics10100777. [PMID: 33008120 PMCID: PMC7599883 DOI: 10.3390/diagnostics10100777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 11/16/2022] Open
Abstract
Dizziness is a common symptom among the general population, especially in the elderly. Previous studies have reported that dizziness may be associated with various cognitive functions including memory impairment. However, few studies have investigated the neural correlates of dizziness in patients with cognitive impairment. The aim of this study was to examine regional cerebral blood flow (rCBF) in mild cognitive impairment (MCI) patients with or without dizziness using single photon emission computed tomography (SPECT). A total of 50 patients with MCI were recruited. All participants underwent technetium-99m ethyl cysteinate dimer brain SPECT and a neuropsychological battery and completed the Dizziness Handicap Inventory (DHI). Participants were divided into a dizziness group (DHI ≥ 1, n = 18) and a non-dizziness group (DHI = 0, n = 32). Voxel wise differences in rCBF between the groups were estimated. SPECT analysis revealed decreased rCBF in the left superior temporal gyrus, left lateral orbital gyrus, and right middle frontal gyrus in the dizziness group compared with the non-dizziness group (p < 0.005). No significant clusters of increased rCBF were observed in the dizziness group compared with the non-dizziness group. Results of the neuropsychological tests showed a significant difference in Controlled Oral Word Association Test performance between MCI patients with and without dizziness. In conclusion, MCI patients with dizziness showed multifocal frontal and left temporal hypoperfusion compared with patients without dizziness. Our results suggest that hypoperfusion in the frontal and temporal cortices might be reflecting the negative impact of dizziness in MCI patients.
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Affiliation(s)
- Seunghee Na
- Department of Neurology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 21431, Korea;
| | - Jooyeon Jamie Im
- Department of Nuclear Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 21431, Korea; (J.J.I.); (H.J.)
| | - Hyeonseok Jeong
- Department of Nuclear Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 21431, Korea; (J.J.I.); (H.J.)
- Department of Radiology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 21431, Korea
| | - Eek-Sung Lee
- Department of Neurology, Soonchunhyang University College of Medicine, Bucheon 14584, Korea; (E.-S.L.); (T.-K.L.)
| | - Tae-Kyeong Lee
- Department of Neurology, Soonchunhyang University College of Medicine, Bucheon 14584, Korea; (E.-S.L.); (T.-K.L.)
| | - Yong-An Chung
- Department of Nuclear Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 21431, Korea; (J.J.I.); (H.J.)
- Department of Radiology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 21431, Korea
- Correspondence: (Y.-A.C.); (I.-U.S.); Tel.: +82-32-280-5243 (Y.-A.C.); +82-32-280-5010 (I.-U.S.)
| | - In-Uk Song
- Department of Neurology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 21431, Korea;
- Correspondence: (Y.-A.C.); (I.-U.S.); Tel.: +82-32-280-5243 (Y.-A.C.); +82-32-280-5010 (I.-U.S.)
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Puente-González AS, Sánchez-González F, Hernández-Xumet JE, Sánchez-Sánchez MC, Barbero-Iglesias FJ, Méndez-Sánchez R. Short and medium-term effects of a multicomponent physical exercise program with a Mediterranean diet on bone mineral density, gait, balance, and fall risk for patients with Alzheimer disease: Randomized controlled clinical trial study protocol. Medicine (Baltimore) 2020; 99:e22385. [PMID: 32957420 PMCID: PMC7505369 DOI: 10.1097/md.0000000000022385] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Reduced bone mineral density and increased risk of falls are related with Alzheimer disease, and these increase likelihood of bone osteoporotic fractures causing serious complications such as disability, fear of falling, loss autonomy, decreased quality of life, and anticipated mortality in elderly patients. Gait and balance disturb are 2 factors to favor falls in elderly, and in patients with cognitive impairment, the risk of falls increases to double. Exercise and Mediterranean diet produce beneficial effects for aging, cognitive decline, and are widely recommended to reduce the effects of osteoporosis, fall risk, and related fragility fractures. The primary objective of this study is to evaluate the short and medium-term effects during 6 months, of a multicomponent physical exercise program with a Mediterranean diet on bone mineral density, fall risk, balance, and gait by a controlled clinical trial in patients with Alzheimer disease. METHODS The study is a 6-month, randomized controlled parallel-group, single-blinded clinical trial. Institutionalized patients with Alzheimer disease will be included. The intervention group will perform a multicomponent physical exercise program in reduced groups, with a frequency of 3 sessions per week, associated with a Mediterranean diet. This program includes strength, balance, and aerobic resistance exercises, and in the main part of the session, also ludic exercises to improve agility, coordination, and balance. The control group will receive usual care. The outcomes to assess are the change of physical functions, such as gait and balance, and the change of bone mineral density by calcaneal quantitative ultrasound, during the study follow-up at 1, 3, and 6 months. This clinical trial will generate more and new evidence on the effects of a multicomponent physical exercise program and Mediterranean diet in patients with Alzheimer disease on risk of falls and osteoporotic fractures, the relation of these with bone mineral density, gait and balance, and the correlations between them. ETHICS AND DISSEMINATION This study protocol has been approved by the Ethics Committee of the University of Salamanca. The results will be published in peer-reviewed journals and disseminated in national and international conferences, to the participants and their families, and the general public through the associations of people with AD. TRIAL REGISTRATION ID ClínicalTrials.gov ID: NCT04439097.
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Affiliation(s)
- Ana Silvia Puente-González
- Department of Nursing and Physical Therapy. University of Salamanca, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | | | | | - María Carmen Sánchez-Sánchez
- Department of Nursing and Physical Therapy. University of Salamanca, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Fausto José Barbero-Iglesias
- Department of Nursing and Physical Therapy. University of Salamanca, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Roberto Méndez-Sánchez
- Department of Nursing and Physical Therapy. University of Salamanca, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
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Dove E, Wang R, Zabjek K, Astell A. Impacts of Motion-Based Technology on Balance, Movement Confidence, and Cognitive Function Among People With Dementia or Mild Cognitive Impairment: Protocol for a Quasi-Experimental Pre- and Posttest Study. JMIR Res Protoc 2020; 9:e18209. [PMID: 32945780 PMCID: PMC7532457 DOI: 10.2196/18209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 11/21/2022] Open
Abstract
Background While exercise can benefit the health and well-being of people with dementia or mild cognitive impairment, many exercise programs offered to this population are passive, unengaging, and inaccessible, resulting in poor adherence. Motion-based technologies are increasingly being explored to encourage exercise participation among people with dementia or mild cognitive impairment. However, the impacts of using motion-based technologies with people with dementia or mild cognitive impairment on variables including balance, movement confidence, and cognitive function have yet to be determined. Objective The purpose of this study is to examine the impacts of a group motion-based technology intervention on balance, movement confidence, and cognitive function among people with dementia or mild cognitive impairment. Methods In this quasi-experimental pre- and posttest design, we will recruit 24 people with dementia or mild cognitive impairment from 4 adult day programs and invite them to play Xbox Kinect bowling in a group setting, twice weekly for 10 weeks. We will require participants to speak and understand English, be without visual impairment, and be able to stand and walk. At pretest, participants will complete the Mini-Balance Evaluation Systems Test (Mini-BESTest) and the Montreal Cognitive Assessment (MoCA). We will video record participants during weeks 1, 5, and 10 of the intervention to capture behavioral indicators of movement confidence (eg, fluency of motion) through coding. At posttest, the Mini-BESTest and MoCA will be repeated. We will analyze quantitative data collected through the Mini-BESTest and the MoCA using an intent-to-treat analysis, with study site and number of intervention sessions attended as covariates. To analyze the videos, we will extract count and percentage data from the coded recordings. Results This study will address the question of whether a group motion-based technology intervention, delivered in an adult day program context, has the potential to impact balance, movement confidence, and cognitive function among people with dementia or mild cognitive impairment. The project was funded in 2019 and enrollment was completed on February 28, 2020. Data analysis is underway and the first results are expected to be submitted for publication in 2021. Conclusions This study will assess the feasibility and potential benefits of using motion-based technology to deliver exercise interventions to people with dementia or mild cognitive impairment. This work can also be used as the basis for developing specific software and future exercise programs using motion-based technology for people with dementia or mild cognitive impairment, as well as understanding some of the conditions in which these programs can be delivered. International Registered Report Identifier (IRRID) DERR1-10.2196/18209
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Affiliation(s)
- Erica Dove
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Rosalie Wang
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Karl Zabjek
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Arlene Astell
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
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Almeida CABD, Figueiredo LFDS, Plácido J, Silva FDO, Maciel-Pinheiro PDT, Monteiro-Junior RS, Deslandes AC, Laks J. Floor Maze Test as a predictor of cognitive decline in older adults living in nursing homes. JORNAL BRASILEIRO DE PSIQUIATRIA 2020. [DOI: 10.1590/0047-2085000000271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
ABSTRACT Objective Long-term care facilities (LTCF) are associated with an increased risk of cognitive decline and impairment in spatial navigation abilities. Recent studies have demonstrated that spatial navigation as a complex skill, involving cognitive and motor functions, emerging as a new marker for the progression of dementia. The present study aims to compare spatial navigation in healthy, institutionalized, and AD elderly subjects. Methods In a cross-sectional study, we evaluated 78 elderly individuals (healthy = 37, AD = 22, institutionalized = 19) using the Mini-Mental State Examination (MMSE), Floor Maze Test (FMT) and 8-foot-up-and-gotest (8UG) to assess global cognitive function, spatial navigation and motor function, respectively. Results In the FMT, the immediate maze time (IMT) and delay maze time (DMT) were significantly shorter in the healthy group than those of the institutionalized and AD groups ( X 2 = 31.23; p < 0.01) and ( X 2 = 41.21; p < 0.01), while there were no significant differences between the AD and institutionalized groups in terms of the DMT and MMSE results. However, the institutionalized group showed worse results in terms of IMT (p < 0.01) and 8UG (p < 0.01) than those in the dementia group. Conclusion Our results indicate that both institutionalized older people and patients with Dementia have a deficit in the spatial navigation ability, cognitive functions and motor skills. We should consider that there might be a possibility of underdiagnosis in institutionalized older people.
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Affiliation(s)
| | | | | | | | | | | | | | - Jerson Laks
- Federal University of Rio de Janeiro, Brazil; University Center UniCBE, Brazil
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Hamre C, Fure B, Helbostad JL, Wyller TB, Ihle-Hansen H, Vlachos G, Ursin M, Tangen GG. Balance and Gait After First Minor Ischemic Stroke in People 70 Years of Age or Younger: A Prospective Observational Cohort Study. Phys Ther 2020; 100:798-806. [PMID: 31944247 DOI: 10.1093/ptj/pzaa010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 11/22/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Two-thirds of patients with stroke experience only mild impairments in the acute phase, and the proportion of patients <70 years is increasing. Knowledge about balance and gait and predictive factors are scarce for this group. OBJECTIVE The objective of this study was to explore balance and gait in the acute phase and after 3 and 12 months in patients ≤70 years with minor ischemic stroke (National Institutes of Health Stroke Scale score ≤3). This study also explored factors predicting impaired balance after 12 months. DESIGN This study was designed as an explorative longitudinal cohort study. METHODS Patients were recruited consecutively from 2 stroke units. Balance and gait were assessed with the Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go, and preferred gait speed. Predictors for impaired balance were explored using logistic regression. RESULTS This study included 101 patients. Mean (SD) age was 55.5 (11.4) years, 20% were female, and mean (SD) National Institutes of Health Stroke Scale score was 0.6 (0.9) points. The Mini-BESTest, gait speed, and Timed Up and Go improved significantly from the acute phase to 3 months, and gait speed also improved from 3 to 12 months. At 12 months, 26% had balance impairments and 33% walked slower than 1.0 m/s. Poor balance in the acute phase (odds ratio = 0.92, 95% confidence interval = 0.85-0.95) was the only predictor of balance impairments (Mini-BESTest score ≤22) at 12 months poststroke. LIMITATIONS Limitations include lack of information about pre-stroke balance and gait impairment and poststroke exercise. Few women limited the generalizability. CONCLUSION This study observed improvements in both balance and gait during the follow-up; still, about one-third had balance or gait impairments at 12 months poststroke. Balance in the acute phase predicted impaired balance at 12 months.
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Affiliation(s)
- Charlotta Hamre
- Department of Physiotherapy, Oslo University Hospital, Postboks 4956 Nydalen, Oslo 0424 Norway.,Department of Geriatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital
| | - Brynjar Fure
- Department of Internal Medicine and Department of Neurology, Central Hospital, Karlstad and School of Medical Sciences, Örebro University, Karlstad, Sweden
| | - Jorunn L Helbostad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torgeir B Wyller
- Department of Geriatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hege Ihle-Hansen
- Department of Geriatric Medicine, Oslo University Hospital and Department of Neurology, Oslo University Hospital
| | - Georgios Vlachos
- Department of Geriatric Medicine, Oslo University Hospital and Department of Neurology, Oslo University Hospital
| | - Marie Ursin
- Department of Geriatric Medicine, Bærum Hospital, Vestre Viken Trust, Drammen, Norway
| | - Gro Gujord Tangen
- Department of Geriatric Medicine, Oslo University Hospital.,Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tonsberg, Norway.,Department of Interdisciplinary Health Sciences, University of Oslo
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Sparto PJ, Rosso AL, Divecha AA, Metti AL, Rosano C. Shared neural substrates of cognitive function and postural control in older adults. Alzheimers Dement 2020; 16:621-629. [PMID: 32147950 DOI: 10.1002/alz.12053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 10/04/2019] [Accepted: 12/05/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Poor cognitive function and postural control co-occur in older adults. It is unclear whether they share neural substrates. METHODS Postural sway error during a novel visual tracking (VT) condition and gray matter volume (GMV) were compared between participants with normal cognition (NC), mild cognitive impairment (MCI), or dementia (n = 179, mean age 82, 56% females, 56% white). Associations between VT error, cognitive function, and GMV were examined. RESULTS Greater VT error was associated with having dementia compared to NC or MCI (odds ratio [95% CI] = 2.15 [1.38, 3.36] and 1.58 [1.05, 2.38]). Regions with lower GMV related to greater VT error and worse cognition were: bilateral hippocampi, parahippocampi, entorhinal, and parietal cortices (all P ≤0.05). GMV of bilateral hippocampi and left parahippocampus explained >20% of VT error between dementia and NC. DISCUSSION Postural control during visuospatial tasks and dementia may share neural substrates, specifically memory-related regions.
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Affiliation(s)
- Patrick J Sparto
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrea L Rosso
- Department of Epidemiology, Graduate School, of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ayushi A Divecha
- Department of Epidemiology, Graduate School, of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrea L Metti
- Department of Epidemiology, Graduate School, of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Caterina Rosano
- Department of Epidemiology, Graduate School, of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Yoon B, Choi SH, Jeong JH, Park KW, Kim EJ, Hwang J, Jang JW, Kim HJ, Hong JY, Lee JM, Kang JH, Yoon SJ. Balance and Mobility Performance Along the Alzheimer’s Disease Spectrum. J Alzheimers Dis 2020; 73:633-644. [DOI: 10.3233/jad-190601] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Bora Yoon
- Department of Neurology, Konyang University College of Medicine, Daejeon, Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Korea
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kyung Won Park
- Department of Neurology, Dong-A Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Eun-Joo Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Korea
| | - Jihye Hwang
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jae-Won Jang
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Yong Hong
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, Korea
| | - Ju-Hee Kang
- Department of Pharmacology, Inha University School of Medicine, Incheon, Korea
| | - Soo Jin Yoon
- Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
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Wadsworth PA, Chen NW, Raji M, Markides KS, Downer B. Mobility but Not Balance Limitations Are Associated With Cognitive Decline among Older Hispanics. Gerontol Geriatr Med 2020; 6:2333721420947952. [PMID: 32851118 PMCID: PMC7427021 DOI: 10.1177/2333721420947952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 11/29/2022] Open
Abstract
Aging is associated with changes in lower-body functioning. The extent to which lower-body function is associated with cognitive changes over time is unclear, especially among older Hispanics, a high-risk population for declines in physical and cognitive functioning. We sought to determine if the association between lower-body functioning and cognitive decline over 9-years differentially varied with respect to balance, gait speed, lower-body strength (chair stands), or a summary score of the three measures. This retrospective cohort study used clinical performance data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE). Cognitive function was measured using the Mini-Mental Status Exam. Linear mixed modeling was used to investigate the association between lower-body function and cognitive decline, controlling for patients' demographic and health characteristics. We found that gait speed and timed chair stands but not balance were associated with accelerated cognitive decline in Mexican-Americans age 75 years and older. These parameters of lower-body function can be feasibly measured in any clinic. As limitations in lower-body functioning may be an early marker of cognitive decline, this suggests an opportunity for the development of interventions to slow cognitive and physical disablement and promote successful aging among persons older than 75 years.
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Affiliation(s)
| | - Nai-Wei Chen
- The University of Texas Medical Branch, Galveston, TX, USA
| | - Mukaila Raji
- The University of Texas Medical Branch, Galveston, TX, USA
| | | | - Brian Downer
- The University of Texas Medical Branch, Galveston, TX, USA
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The Transverse Gravitational Deviation Index, a Novel Gravity Line-Related Spinal Parameter, Relates to Balance Control and Health-Related Quality of Life in Adults With Spinal Deformity. Spine (Phila Pa 1976) 2020; 45:E25-E36. [PMID: 31842109 DOI: 10.1097/brs.0000000000003301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cross-sectional case-control study design. OBJECTIVE This study aims to analyze the relation between balance control as well as health-related quality of life (HRQOL) in patients with adult spinal deformity (ASD), with a novel gravity line (GL)-related 3D spinal alignment parameter, the transverse gravitational deviation index (TGDI), defined to quantify the transverse plane position of any vertebra with respect to the GL. SUMMARY OF BACKGROUND DATA Demographic data and balance control have both been identified as important determinants of HRQOL in ASD patients during a preoperative setting. Therefore, a better understanding of the relation between spinal alignment and balance is required. METHODS After informed consent, 15 asymptomatic healthy volunteers (mean age 60.1 ± 11.6 years old) and 55 ASD patients (mean age 63.5 ± 10.1 years old) were included. Relation between performance on BESTest as well as core outcome measures index (COMI) with spinopelvic alignment was explored using General Linear Modeling (GLM). A P-value ≤0.05 was considered statistically significant. RESULTS The L3 TGDI was identified to relate to balance control in the total ASD population after correction for confounding demographic factors (P = 0.001; adjusted R = 0.500) and explained 19% of the observed variance in balance performance. In addition, COMI is related to L3 TGDI in a subgroup of ASD patients with combined coronal and sagittal malalignment of L3 (P = 0.027; slope B = 0.047), despite significant influence of age (P = 0.020). CONCLUSION In ASD patients with a combined coronal and sagittal malalignment of the L3 vertebra, both the level of balance impairment as well as HRQOL are related to the distance component of the L3 TGDI, that is, the offset between the center of the L3 vertebral body and the GL in the transverse plane. LEVEL OF EVIDENCE 2.
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Carr S, Pichora-Fuller MK, Li KZ, Phillips N, Campos JL. Multisensory, Multi-Tasking Performance of Older Adults With and Without Subjective Cognitive Decline. Multisens Res 2019; 32:797-829. [DOI: 10.1163/22134808-20191426] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/28/2019] [Indexed: 11/19/2022]
Abstract
Abstract
As the population ages, it is increasingly important to detect non-normative cognitive declines as early as possible. Measures of combined sensory–motor–cognitive functioning may be early markers for identifying individuals who are at increased risk of developing dementia. Further, older adults experiencing subjective cognitive decline (SCD) may have elevated risk of dementia compared to those without SCD. Tasks involving complex, multisensory interactions reflective of everyday challenges may be particularly sensitive to subjectively perceived, pre-clinical declines. In the current study, older adults with and without SCD were asked to simultaneously perform a standing balance task and a listening task under increasingly challenging sensory/cognitive/motor conditions using a dual-task paradigm in a realistic, immersive virtual environment. It was hypothesized that, compared to older adults without SCD, those with SCD would exhibit greater decrements in postural control and listening response accuracy as sensory/motor/cognitive loads increased. However, counter to predictions, older adults with SCD demonstrated greater reductions in postural sway under more challenging dual-task conditions than those without SCD. Across both groups, poorer postural task performance was associated with poorer cognitive function and speech-in-noise thresholds measured with standard baseline tests. Poorer listening task performance was associated with poorer global cognitive function, poorer mobility, and poorer speech-in-noise detection. Overall, the results provide additional support for the growing evidence demonstrating associations between sensory, motor, and cognitive functioning and contribute to an evolving consideration of how best to categorize and characterize SCD in a way that guides strategies for screening, assessment, and intervention.
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Affiliation(s)
- Sophie Carr
- 1KITE—Toronto Rehabilitation Institute, University Health Network, Canada
- 2Department of Psychology, University of Toronto, Canada
| | - M. Kathleen Pichora-Fuller
- 2Department of Psychology, University of Toronto, Canada
- 4Centre for Research in Human Development, Concordia University, Canada
| | - Karen Z. H. Li
- 3Department of Psychology, Concordia University, Canada
- 4Centre for Research in Human Development, Concordia University, Canada
| | - Natalie Phillips
- 3Department of Psychology, Concordia University, Canada
- 4Centre for Research in Human Development, Concordia University, Canada
| | - Jennifer L. Campos
- 1KITE—Toronto Rehabilitation Institute, University Health Network, Canada
- 2Department of Psychology, University of Toronto, Canada
- 4Centre for Research in Human Development, Concordia University, Canada
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McMullan II, Bunting BP, McDonough SM, Tully MA, Casson K. Changes in physical activity predict changes in a comprehensive model of balance in older community-dwelling adults. A longitudinal analysis of the TILDA study. J Frailty Sarcopenia Falls 2019; 4:102-110. [PMID: 32300724 PMCID: PMC7155306 DOI: 10.22540/jfsf-04-102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2019] [Indexed: 12/18/2022] Open
Abstract
Objective: Falls due to poor balance can cause injury, disability, and death in older adults. The relationship between free-living physical activity (PA) and balance over time is poorly understood. The aim of this study is to explore the association between PA and balance in older adults over time Methods: Using two waves of data from the TILDA study (n=8,504 participants) a structural equation model was used to identify a composite measure of balance that incorporated measures of Timed Up and Go; handgrip strength; Mini Mental State Exam; vision; hearing; and steadiness. The patterns of change in PA and balance were then compared over time (controlling for covariates) Results: The results showed that one extra metabolic equivalent of task (MET) minute of PA improves balance by 4% over one week (Est=-0.10, SE=0.12), and by 5% cumulatively over two years (Est=-0.13, SE=0.02). Medication, alcohol consumption, sex, age, fear of falling, education, pain, and problems performing activities of daily living (ADL) were risk factors for balance Conclusion: This study provides a novel and robust model that should guide comprehensive balance assessment. PA promotion should engage older adults in more free-living PA that may be more relevant to them.
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Affiliation(s)
- Ilona I McMullan
- UKCRC Centre of Excellence for Public Health (NI), Ulster University, UK
| | - Brendan P Bunting
- UKCRC Centre of Excellence for Public Health (NI), Ulster University, UK
| | - Suzanne M McDonough
- Institute of Nursing and Health Research, Ulster University, UK.,School of Physiotherapy, University of Otago, New Zealand.,School of Physiotherapy, Royal College of Surgeons in Dublin, Ireland
| | - Mark A Tully
- UKCRC Centre of Excellence for Public Health (NI), Ulster University, UK.,Institute of Mental Health Services, Ulster University, UK
| | - Karen Casson
- Institute of Nursing and Health Research, Ulster University, UK
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Taylor ME, Boripuntakul S, Toson B, Close JCT, Lord SR, Kochan NA, Sachdev PS, Brodaty H, Delbaere K. The role of cognitive function and physical activity in physical decline in older adults across the cognitive spectrum. Aging Ment Health 2019; 23:863-871. [PMID: 29798680 DOI: 10.1080/13607863.2018.1474446] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The aim of this study was to investigate physical decline over 1-year in a cohort of older people across the cognitive spectrum. METHODS Physical function was assessed using the Physiological Profile Assessment (PPA) in 593 participants (cognitively normal [CN]: n = 342, mild cognitive impairment [MCI]: n = 77, dementia: n = 174) at baseline and in 490 participants available for reassessment 1-year later. Neuropsychological performance and physical activity (PA) were assessed at baseline. RESULTS Median baseline PPA scores for CN, MCI and dementia groups were 0.41 (IQR = -0.09-1.02), 0.66 (IQR = -0.06-1.15) and 2.37 (IQR = 0.93-3.78) respectively. All baseline neuropsychological domains and PA were significantly associated with baseline PPA. There were significant interaction terms (Time × Cognitive Group, Global Cognition, Processing Speed, Executive Function and PA) in the models investigating PPA decline. In multivariate analysis the Time × Executive Function and PA interaction terms were significant, indicating that participants with poorer baseline executive function and reduced PA demonstrated greater physical decline when compared to individuals with better executive function and PA respectively. DISCUSSION Having MCI or dementia is associated with greater physical decline compared to CN older people. Physical inactivity and executive dysfunction were associated with physical decline in this sample, which included participants with MCI and dementia. Both factors influencing physical decline are potentially amenable to interventions e.g. exercise.
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Affiliation(s)
- Morag E Taylor
- a Falls, Balance and Injury Research Centre, Neuroscience Research Australia , University of New South Wales , Sydney , Australia.,b Prince of Wales Clinical School, Medicine , University of New South Wales , Sydney , Australia.,c Cognitive Decline Partnership Centre, Sydney Medical School , The University of Sydney , Sydney , Australia
| | - Sirinun Boripuntakul
- d Department of Physical Therapy , Chiang Mai University , Chiang Mai , Thailand
| | - Barbara Toson
- a Falls, Balance and Injury Research Centre, Neuroscience Research Australia , University of New South Wales , Sydney , Australia
| | - Jacqueline C T Close
- a Falls, Balance and Injury Research Centre, Neuroscience Research Australia , University of New South Wales , Sydney , Australia.,b Prince of Wales Clinical School, Medicine , University of New South Wales , Sydney , Australia
| | - Stephen R Lord
- a Falls, Balance and Injury Research Centre, Neuroscience Research Australia , University of New South Wales , Sydney , Australia
| | - Nicole A Kochan
- e Neuropsychiatric Institute , Prince of Wales Hospital , Randwick , New South Wales , Australia.,f Centre For Healthy Brain Ageing (CHeBA), School of Psychiatry, Medicine , University of New South Wales , Sydney , Australia
| | - Perminder S Sachdev
- e Neuropsychiatric Institute , Prince of Wales Hospital , Randwick , New South Wales , Australia.,f Centre For Healthy Brain Ageing (CHeBA), School of Psychiatry, Medicine , University of New South Wales , Sydney , Australia.,g Dementia Centre for Research Collaboration, School of Psychiatry, Medicine , University of New South Wales , Sydney , Australia
| | - Henry Brodaty
- f Centre For Healthy Brain Ageing (CHeBA), School of Psychiatry, Medicine , University of New South Wales , Sydney , Australia.,g Dementia Centre for Research Collaboration, School of Psychiatry, Medicine , University of New South Wales , Sydney , Australia
| | - Kim Delbaere
- a Falls, Balance and Injury Research Centre, Neuroscience Research Australia , University of New South Wales , Sydney , Australia
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Do Age and Disease Stage Impact Cognition and Balance in Older Adults and Persons With Parkinson Disease? TOPICS IN GERIATRIC REHABILITATION 2019. [DOI: 10.1097/tgr.0000000000000238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Van Deun B, Van Den Noortgate N, Van Bladel A, De Weerdt K, Cambier D. Managing Paratonia in Persons With Dementia: Short-term Effects of Supporting Cushions and Harmonic Techniques. J Am Med Dir Assoc 2019; 20:1521-1528. [PMID: 31227470 DOI: 10.1016/j.jamda.2019.04.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 01/29/2019] [Accepted: 04/30/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Paratonia, a form of hypertonia typically seen in dementia, is often associated with difficulties in positioning and daily care. No evidence-based therapy or clinical guideline for management is available. In this study, the short-term effect of harmonic techniques (HT) and supporting cushions (SC) on paratonia was explored. DESIGN This was a multicenter interventional clinical trial with AB/BA crossover design. Each intervention (SC or HT) was subsequently implemented over 1 week in each of the participants. SETTING AND PARTICIPANTS The study included 22 participants with moderate to severe paratonia from 9 different nursing homes in Flanders, Belgium. METHODS Measurements of biceps brachii and rectus femoris muscle tone (MyotonPRO), maximal elbow and knee extension (goniometer), and pain (Pain Assessment Checklist for Seniors With Limited Ability to Communicate) were performed on 3 different days within 1 week. The effect of HT on nursing care was evaluated with the Pain Assessment Checklist for Seniors With Limited Ability to Communicate and visual analog scale ratings of discomfort items. RESULTS After 30 minutes of positioning with SC, participants had lower biceps brachii muscle tone (P = .041) and higher maximal elbow extension (P = .006) than without SC. After a 30-minute session of HT, a significant increase in biceps brachii muscle tone (P = .032) and maximal extension of elbow (P < .001) and knee (P = .028) was found. Pain (P = .003) and discomfort (P = .001 to P = .019) during morning care were significantly lower when care was preceded by 30 minutes of HT. CONCLUSIONS/IMPLICATIONS This explorative study revealed beneficial short-term effects on range of motion for both SC and HT and a positive effect of SC on upper limb muscle tone. Beneficial effects of HT were found on resident's pain and caregiver's discomfort during care. The results of the present study are encouraging and can contribute to the development of evidence-based interventions for paratonia.
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Affiliation(s)
- Bieke Van Deun
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
| | | | - Anke Van Bladel
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Koen De Weerdt
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Dirk Cambier
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Zhou S, Zhang Y, Kong Z, Loprinzi PD, Hu Y, Ye J, Liu S, Yu JJ, Zou L. The Effects of Tai Chi on Markers of Atherosclerosis, Lower-limb Physical Function, and Cognitive Ability in Adults Aged Over 60: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050753. [PMID: 30832288 PMCID: PMC6427726 DOI: 10.3390/ijerph16050753] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/23/2019] [Accepted: 02/26/2019] [Indexed: 01/23/2023]
Abstract
Objective: The purpose of this study was to investigate the effects of Tai Chi (TC) on arterial stiffness, physical function of lower-limb, and cognitive ability in adults aged over 60. Methods: This study was a prospective and randomized 12-week intervention trial with three repeated measurements (baseline, 6, and 12 weeks). Sixty healthy adults who met the inclusion criteria were randomly allocated into three training conditions (TC-24, TC-42, and TC-56) matched by gender, with 20 participants (10 males, 10 females) in each of the three groups. We measured the following health outcomes, including markers of atherosclerosis, physical function (leg power, and static and dynamic balance) of lower-limb, and cognitive ability. Results: When all three TC groups (p < 0.05) have showed significant improvements on these outcomes but overall cognitive ability at 6 or 12 weeks training period, TC-56 appears to have superior effects on arterial stiffness and static/dynamic balance in the present study. Conclusions: Study results of the present study add to growing body of evidence regarding therapeutic TC for health promotion and disease prevention in aging population. Future studies should further determine whether TC-42 and TC-56 are beneficial for other non-Chinese populations, with rigorous research design and follow-up assessment.
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Affiliation(s)
- Shengwen Zhou
- Department of Chinese Martial Arts, College of Sport Science, Hunan University of Science and Technology, Yongzhou 425100, China.
| | - Yanjie Zhang
- Health and Exercise Science Laboratory, Institute of Sports Science, Seoul National University, Seuoul 08826, Korea.
| | - Zhaowei Kong
- Faculty of Education, University of Macau, Macao, China.
| | - Paul D Loprinzi
- Department of Health, Exercise Science and Recreation Management School of Applied Sciences, The University of Mississippi, Oxford, MS 36877, USA.
| | - Yang Hu
- Sports Science Research Center, Beijing Sport University, Beijing 100084, China.
| | - Jiajie Ye
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hunghom, Hong Kong, China.
| | - Shijie Liu
- Department of Physical Education, Wuhan University of Technology, Wuhan 430070, China.
| | - Jane Jie Yu
- Sports and Exercise Psychology Laboratory, Department of Sports, Science and Physical Education, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China.
| | - Liye Zou
- Lifestyle (Mind-Body Movement) Research Center, College of Sports Science, Shenzhen University, Shenzhen 518060, China.
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Loomer L, Downer B, Thomas KS. Relationship between Functional Improvement and Cognition in Short-Stay Nursing Home Residents. J Am Geriatr Soc 2018; 67:553-557. [PMID: 30548843 DOI: 10.1111/jgs.15708] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Improving function is an important outcome of postacute care in skilled nursing facilities (SNFs), but cognitive impairment can limit a resident's ability to improve during a postacute care stay. Our objective was to examine the association between residents' cognitive status on admission and change in self-care and mobility during a Medicare-covered SNF stay. DESIGN Retrospective analysis of Medicare beneficiaries who had a new SNF stay between January and June 2017. SETTING SNFs in the United States. PARTICIPANTS Newly admitted residents with Medicare-covered SNF stays between January and June 2017 (n = 246 395). MEASUREMENTS Residents' self-care and mobility at SNF admission and discharge were determined using items from Section GG (eating, oral hygiene, toileting hygiene, sit to lying, lying to sitting, sit to stand, chair/bed transfer, and toilet transfer) of the Minimum Data Set. Residents were classified as cognitively intact, mildly impaired, moderately impaired, or severely impaired, according to the Cognitive Function Scale. Multivariable regression models controlling for residents' demographic and clinical characteristics and SNF fixed effects were used to identify residents whose discharge scores for self-care and mobility were better or the same as expected according to their cognitive status on admission. RESULTS Residents who were cognitively impaired on admission had lower functional status on admission and were less likely to improve in self-care and mobility compared with residents who were cognitively intact. Approximately 63% of residents who were cognitively intact had discharge scores for self-care and mobility that were better or the same as expected compared with 45% of residents with severe cognitive impairment. CONCLUSIONS Cognitive impairment is associated with poorer self-care and mobility function among SNF residents. These findings have important implications for clinicians, who may need additional support when caring for residents with cognitive impairment to make the same improvements in functional status as residents who are cognitively intact. J Am Geriatr Soc 67:553-557, 2019.
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Affiliation(s)
- Lacey Loomer
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island
| | - Brian Downer
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas
| | - Kali S Thomas
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island.,Department of Veterans Affairs Medical Center, Providence, Rhode Island
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The Impact of Paratonia on Fine and Gross Motor Function in Older Adults With Mild and Moderate Dementia. Alzheimer Dis Assoc Disord 2018; 33:54-61. [PMID: 30371515 DOI: 10.1097/wad.0000000000000278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Dementia is associated with impairment in gait, balance, and fine motor function. Paratonia, a form of hypertonia, is often present in severe dementia. However, little is known about muscle tone in early dementia, and the eventual relation between muscle tone abnormalities and changes in fine and gross motor function. METHODS Three groups of participants were included in the study: healthy controls (n=60), participants with mild dementia (MiD) (n=31), and participants with moderate dementia (n=31). Measurements of fine motricity (Purdue pegboard test), balance and gait (Dynaport Hybrid), the presence of paratonia (PAI), and muscle tone measurements (MyotonPRO) were performed. RESULTS Paratonia was present in 42% of participants with MiD and in 58% of participants with moderate dementia. Participants with paratonia had lower Purdue Pegboard scores (P<0.001), lower balance coordination in semitandem stance (P<0.001), lower walking speed at a fast pace (P=0.001), and lower step regularity at normal (P=0.025) and fast (P<0.001) pace. CONCLUSIONS Paratonia is already present in participants with MiD and is associated with a decline in both fine and gross motor performance. Early detection of paratonia might be helpful to detect persons at higher risk of motor deterioration and falls.
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Htut TZC, Hiengkaew V, Jalayondeja C, Vongsirinavarat M. Effects of physical, virtual reality-based, and brain exercise on physical, cognition, and preference in older persons: a randomized controlled trial. Eur Rev Aging Phys Act 2018; 15:10. [PMID: 30305852 PMCID: PMC6169073 DOI: 10.1186/s11556-018-0199-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 09/24/2018] [Indexed: 12/25/2022] Open
Abstract
Background Physical exercise (PE), virtual reality-based exercise (VRE), and brain exercise (BE) can influence physical and cognitive conditions in older persons. However, it is not known which of the three types of exercises provide the best effects on physical and cognitive status, and which exercise is preferred by older persons. This study compared the effects of PE, VRE, and BE on balance, muscle strength, cognition, and fall concern. In addition, exercise effort perception and contentment in older persons was evaluated. Methods Eighty-four older persons (n = 84) were randomly selected for PE, VRE, BE, and control groups. The exercise groups received 8-week training, whereas the control group did not. Balance was assessed by Berg Balance Scale (BBS) and Timed Up and Go test (TUG), muscle strength by 5 Times Sit to Stand (5TSTS) and left and right hand grip strength (HGS), cognition by Montreal Cognitive Assessment (MoCA) and Timed Up and Go test Cognition (TUG-cog), fall concern by Fall Efficacy Scale International (FES-I), exercise effort perception by Borg category ratio scale (Borg CR-10), and exercise contentment by a questionnaire. Results After exercise, PE significantly enhanced TUG and 5TSTS to a greater extent than VRE (TUG; p = 0.004, 5TSTS; p = 0.027) and BE (TUG; p = 0,012, 5TSTS; p < 0.001). VRE significantly improved MoCA (p < 0.001) and FES-I (p = 0.036) compared to PE, and 5TSTS (p < 0.001) and FES-I (p = 0.011) were improved relative to BE. MoCA was significantly enhanced by BE compared to PE (p < 0.001) and both MoCA and TUG-cog were improved compared to VRE (p = 0.04). PE and VRE significantly (p < 0.001) increased Borg CR-10 in all exercise sessions, whereas BE showed a significant improvement (p < 0.001) in the first 4 sessions. Participants had a significantly greater satisfaction with BE than controls (p = 0.006), and enjoyed VRE and BE more than PE (p < 0.001). Subjects in all exercise groups exhibited benefits compared to the control group (p < 0.001). Conclusions PE provided the best results in physical tests, VRE produced measurable improvements in physical and cognition scores, while BE enhanced cognition ability in older persons. Older persons preferred VRE and BE compared to PE. Both exercises are suggested to older persons to improve physical and cognitive conditions.
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Affiliation(s)
- Thwe Zar Chi Htut
- Faculty of Physical Therapy, Mahidol University, 999 Phutthamonthon 4 Rd., Salaya, Phutthamonthon, Nakhon Pathom, 73170 Thailand
| | - Vimonwan Hiengkaew
- Faculty of Physical Therapy, Mahidol University, 999 Phutthamonthon 4 Rd., Salaya, Phutthamonthon, Nakhon Pathom, 73170 Thailand
| | - Chutima Jalayondeja
- Faculty of Physical Therapy, Mahidol University, 999 Phutthamonthon 4 Rd., Salaya, Phutthamonthon, Nakhon Pathom, 73170 Thailand
| | - Mantana Vongsirinavarat
- Faculty of Physical Therapy, Mahidol University, 999 Phutthamonthon 4 Rd., Salaya, Phutthamonthon, Nakhon Pathom, 73170 Thailand
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75
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Lipardo DS, Tsang WWN. Falls prevention through physical and cognitive training (falls PACT) in older adults with mild cognitive impairment: a randomized controlled trial protocol. BMC Geriatr 2018; 18:193. [PMID: 30143002 PMCID: PMC6109308 DOI: 10.1186/s12877-018-0868-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/31/2018] [Indexed: 11/29/2022] Open
Abstract
Background The presence of mild cognitive impairment (MCI) in older adults increases their fall risk. While physical exercise is effective in reducing falls rate and risk of falls, and cognitive training in improving cognitive functioning in healthy older adults, their effectiveness in preventing falls and reducing risks of falls in MCI when administered simultaneously is not yet established. Therefore, this study aims to determine the effectiveness of combined physical and cognitive training in preventing falls and decreasing risks of falls among community-dwelling older persons with MCI. Methods/design This is a single-blind, multicentre, randomized controlled trial. At least ninety-three community-dwelling older adults with MCI aged 60 or above will be recruited. They will be randomly allocated into four groups: Physical Training alone (PT), Cognitive Training alone (CT), combined Physical And Cognitive Training (PACT) and Waitlist Group (WG). The PT group will perform exercises (flexibility, endurance, strengthening, and balance training) for 60–90 min three times per week for 12 weeks. The CT group will be involved in a paper-based training focusing on orientation, memory, attention and executive functioning for 60–90 min per session, once a week for 12 weeks. The PACT group will undergo cognitive training incorporated in physical exercise for 60–90 min three times per week for 12 weeks. The WG will receive the intervention, combined physical and cognitive training, at a later date. Assessors blinded to participant allocation will conduct pre-intervention, post-intervention, and 6-month follow-up assessments. The primary outcome measure will be falls rate. The secondary outcome measures will be Physiologic Profile Assessment and Falls Risk for Older Persons in the Community, and assessments that evaluate cognitive, physical and psychological factors related to falls. Discussion Considering the possible physical, social, financial and psychological consequences of a fall, we hope to provide insights on the effectiveness of combining physical and cognitive training on falls and fall-related factors for older adults with MCI. It is projected that the combined interventions will lead to significantly lower falls rate and reduced risk of falls compared to using single or no intervention. Trial registration ClinicalTrials.gov NCT03167840. Registered on May 30, 2017.
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Affiliation(s)
- Donald S Lipardo
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, SAR, China.,Department of Physical Therapy, College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines
| | - William W N Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, SAR, China.
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Performance on Balance Evaluation Systems Test (BESTest) Impacts Health-Related Quality of Life in Adult Spinal Deformity Patients. Spine (Phila Pa 1976) 2018; 43:637-646. [PMID: 28858190 DOI: 10.1097/brs.0000000000002390] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective single-center study. OBJECTIVE Study investigates how dynamic balance performance complements 2D static radiographic measurements and demographics in terms of understanding health-related quality of life in adult spinal deformity (ASD) patients. SUMMARY OF BACKGROUND DATA Recent insights suggest that demographic variables have a stronger impact on health-related quality of life than 2D radiographic spinopelvic parameters in ASD patients. METHODS Nine healthy volunteers and 36 ASD patients following inclusion criteria were recruited. Demographics, Scoliosis Research Society Score-22r (SRS-22r), Oswestry Disability Index (ODI), Core Outcome Measures Index (COMI), 2D radiographic spinopelvic measurements, and performance on Balance Evaluation Systems Test (BESTest), and Trunk Control Measurement Scale (TCMS) were determined for each subject. Nonparametric tests, Spearman correlations, univariate, and stepwise-like linear multivariate regression analysis were performed. RESULTS BESTest and TCMS had significant lower values in the ASD group versus the control group (P = 0.000). In the ASD group, Cumulative Illness Rating Scale (CIRS) correlated fair to ODI, COMI (0.441 ≥ r ≥ 0.383, P < 0.021) and to SRS-22-r (r = -0.335, P = 0.046), Mini Mental State Examination correlated fair to COMI (r = -0.352, P = 0.035), "Pelvic Incidence minus Lumbar Lordosis" correlated fair to ODI (r = 0.361, P = 0.031), BESTest correlated moderate to ODI and COMI (r ≤ -0.505; P ≤ 0.002), TCMS correlated fair to ODI (r = -0.356; P = 0.033). CIRS and BESTest were significant predictive variables for COMI based on univariate analysis in ASD patients. Multivariate regression analysis including demographics, 2D static radiographic parameters, and dynamic balance scales identified BESTest as single independent variable (P = 0.000) to predict COMI (adjusted R = 0.285) in ASD patients. CONCLUSION BESTest has a higher potential than demographic and 2D radiographic spinopelvic parameters to predict quality of life in ASD patients. Further research is necessary to identify the impact of ASD on quality of life. LEVEL OF EVIDENCE 3.
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Ellis AW, Schöne CG, Vibert D, Caversaccio MD, Mast FW. Cognitive Rehabilitation in Bilateral Vestibular Patients: A Computational Perspective. Front Neurol 2018; 9:286. [PMID: 29755404 PMCID: PMC5934854 DOI: 10.3389/fneur.2018.00286] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/13/2018] [Indexed: 01/27/2023] Open
Abstract
There is evidence that vestibular sensory processing affects, and is affected by, higher cognitive processes. This is highly relevant from a clinical perspective, where there is evidence for cognitive impairments in patients with peripheral vestibular deficits. The vestibular system performs complex probabilistic computations, and we claim that understanding these is important for investigating interactions between vestibular processing and cognition. Furthermore, this will aid our understanding of patients’ self-motion perception and will provide useful information for clinical interventions. We propose that cognitive training is a promising way to alleviate the debilitating symptoms of patients with complete bilateral vestibular loss (BVP), who often fail to show improvement when relying solely on conventional treatment methods. We present a probabilistic model capable of processing vestibular sensory data during both passive and active self-motion. Crucially, in our model, knowledge from multiple sources, including higher-level cognition, can be used to predict head motion. This is the entry point for cognitive interventions. Despite the loss of sensory input, the processing circuitry in BVP patients is still intact, and they can still perceive self-motion when the movement is self-generated. We provide computer simulations illustrating self-motion perception of BVP patients. Cognitive training may lead to more accurate and confident predictions, which result in decreased weighting of sensory input, and thus improved self-motion perception. Using our model, we show the possible impact of cognitive interventions to help vestibular rehabilitation in patients with BVP.
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Affiliation(s)
- Andrew W Ellis
- Department of Psychology, University of Bern, Bern, Switzerland.,Center for Cognition, Learning and Memory, University of Bern, Bern, Switzerland
| | - Corina G Schöne
- Department of Psychology, University of Bern, Bern, Switzerland.,Center for Cognition, Learning and Memory, University of Bern, Bern, Switzerland.,Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Dominique Vibert
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Marco D Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Fred W Mast
- Department of Psychology, University of Bern, Bern, Switzerland.,Center for Cognition, Learning and Memory, University of Bern, Bern, Switzerland
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79
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Sverdrup K, Bergh S, Selbæk G, Røen I, Kirkevold Ø, Tangen GG. Mobility and cognition at admission to the nursing home - a cross-sectional study. BMC Geriatr 2018; 18:30. [PMID: 29378518 PMCID: PMC5789666 DOI: 10.1186/s12877-018-0724-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 01/23/2018] [Indexed: 11/25/2022] Open
Abstract
Background Earlier studies show that the main reasons for admission to long-term nursing home care are cognitive impairment and functional impairments of activities of daily life. However, descriptive evidence of mobility is scant. The aims of this study were to describe mobility at admission to nursing homes and to assess the association between mobility and degree of dementia. Methods We included 696 residents at admission to 47 nursing homes in Norway. Inclusion criteria were expected stay for more than 4 weeks and 65 years or older. In addition, younger residents with dementia were included. Residents with life expectancy shorter than six weeks were excluded. Mobility was assessed using the Short Physical Performance Battery (SPPB) and the Nursing Home Life Space Diameter (NHLSD). The Clinical Dementia Rating Scale (CDR) was used to describe the degree of dementia. The associations between mobility and degree of dementia was analysed using the Chi-square and the Kruskal-Wallis test (KW-test). When the KW-test indicated a statistical significant difference, we proceeded with planned group comparisons with the Mann-Whitney U-test. In addition, we performed multiple linear regression analyses to control for potential confounders. Results Forty-three percent of the residents were not able to perform the balance test in SPPB. Twenty-four percent of the residents were not able to walk four meters, while only 17.6% had a walking speed of 0.83 m/s or higher. Sixty-two percent of the residents were not able to rise from a chair or spent more than 60 s doing it. The median score on NHLSD area was 22 (IQR 17) and the median score on NHLSD dependency was 36 (IQR 26). Residents with severe dementia had significantly lower levels of mobility than residents with moderate dementia. Cognitive function was associated with SPPB and NHLSD dependency in the adjusted models. Conclusion Nursing home residents form a frail, but heterogeneous group both in terms of cognition and mobility at admission. Mobility was negatively associated with cognitive function, and residents with severe dementia had significantly lower levels of mobility than residents with moderate dementia.
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Affiliation(s)
- Karen Sverdrup
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway. .,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
| | - Sverre Bergh
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Irene Røen
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Øyvind Kirkevold
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.,Department of Health Science, Norwegian University of Science and Technology, Gjøvik, Trondheim, Norway
| | - Gro Gujord Tangen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
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80
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Middleton LE, Black SE, Herrmann N, Oh PI, Regan K, Lanctot KL. Centre- versus home-based exercise among people with mci and mild dementia: study protocol for a randomized parallel-group trial. BMC Geriatr 2018; 18:27. [PMID: 29370756 PMCID: PMC5785893 DOI: 10.1186/s12877-017-0684-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 12/12/2017] [Indexed: 11/29/2022] Open
Abstract
Background Worldwide, almost 50million people lived with dementia in 2016. A cure or disease modifying pharmaceutical treatment for dementia remains elusive so alternative therapies are of critical importance. Mounting evidence supports exercise in the prevention and therapy of dementia. However, the cognitive, physical, and psychological challenges common to dementia along with a poor understanding and accommodation of dementia in the community are major barriers to exercise. Consequently, effective delivery options need to be identified. The primary objective of this study is to compare the effectiveness of center-based (CB) exercise versus home-based (HB) exercise for achievement of physical activity guidelines among people with MCI or mild dementia. Methods This is a randomized parallel-group trial comparing the effects of CB and HB exercise adherence among community-dwelling adults ≥50 years with a clinical diagnosis of MCI or mild dementia. Participants will be randomized to either CB or HB exercise. The CB group will meet weekly for small group exercise and will be prescribed additional exercise to be completed independently. Participants in the HB group will be given a physical activity prescription to be completed independently in the community. Participants in HB will also be contacted by phone monthly to adjust exercise prescriptions. The primary outcome will be achievement of exercise guidelines (150 min/wk. of moderate activity) assessed using an activity monitor. Secondary objectives will evaluate cost-effectiveness and the influence of individual and environmental factors on the primary outcome. Tertiary outcomes include physical function, cognition, mood, and quality of life. Discussion There is scant research to indicate the most effective way to deliver exercise to people with MCI and mild dementia, which is needed specifically because these groups face significant barriers to exercise. To capitalize on the benefits of exercise, feasible exercise delivery options need to be identified. The results of this study will directly complement ongoing clinical trials and will be essential to implementing exercise recommendations specific to the prevention and therapy of dementia in a feasible and cost-effective manner when they emerge. Trial registration. Clinicatrials.gov; Identifier: NCT02774720 (version updated December 12, 2016).
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Affiliation(s)
- Laura E Middleton
- University of Waterloo, 200 University Ave W (BMH 1114), Waterloo, ON, N2L 3G1, Canada.
| | - Sandra E Black
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Nathan Herrmann
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Paul I Oh
- University Health Network, 347 Rumsey Rd, Toronto, ON, M4G 2V6, Canada
| | - Kayla Regan
- University of Waterloo, 200 University Ave W (BMH 1114), Waterloo, ON, N2L 3G1, Canada
| | - Krista L Lanctot
- Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
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Abstract
Dementia is a syndrome seen most commonly in older people and characterized by a decline in cognitive performance which impacts on the person's ability to function. There are approximately 47 million people worldwide with dementia and there are 10 million new cases every year. It is a major cause of disability and dependence and impacts on the physical, psychologic, and social well-being of families and carers. Alzheimer's disease is the most common form of dementia. Gait and balance impairments are common in people with dementia and contribute to the significantly elevated risk of falls. Older people with dementia are at increased risk of injury, institutionalization, hospitalization, morbidity, and death after a fall. There is preliminary evidence, predominantly from relatively small studies, that falls and disability can be prevented in this population. However, more good-quality research is needed, both to provide some certainty around the existing evidence base as well as to explore alternate approaches to prevention, including combined cognitive-motor training and cognitive pharmacotherapy.
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Affiliation(s)
- Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia; Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia; Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, NSW, Australia
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Frequency and subgroups of neuropsychiatric symptoms in mild cognitive impairment and different stages of dementia in Alzheimer's disease. Int Psychogeriatr 2018; 30:103-113. [PMID: 28927477 DOI: 10.1017/s1041610217001879] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS), such as depression, apathy, agitation, and psychotic symptoms are common in mild cognitive impairment (MCI) and dementia in Alzheimer's disease (AD). Subgroups of NPS have been reported. Yet the relationship of NPS and their subgroups to different stages of cognitive impairment is unclear. Most previous studies are based on small sample sizes and show conflicting results. We sought to examine the frequency of NPS and their subgroups in MCI and different stages of dementia in AD. METHODS This was a cross-sectional study using data from a Norwegian national registry of memory clinics. From a total sample of 4,571 patients, we included those with MCI or AD (MCI 817, mild AD 883, moderate-severe AD 441). To compare variables across groups ANOVA or χ 2-test was applied. We used factor analysis of Neuropsychiatric Inventory Questionnaire (NPI-Q) items to identify subgroups of NPS. RESULTS The frequency of any NPS was 87.2% (AD 91.2%, MCI 79.5%; p < 0.001) and increased with increasing severity of cognitive decline. The most frequent NPS in MCI was depression. Apathy was the most frequent NPS in AD across different stages of severity. The factor analysis identified three subgroups in MCI and mild AD, and a fourth one in moderate-severe AD. We labelled the subgroups "depression," "agitation," "psychosis," and "elation." CONCLUSIONS The frequency of NPS is high in MCI and AD and increases with the severity of cognitive decline. The subgroups of NPS were relatively consistent from MCI to moderate-severe AD. The subgroup elation appeared only in moderate-severe AD.
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83
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Woo MT, Davids K, Liukkonen J, Chow JY, Jaakkola T. Falls, Cognitive Function, and Balance Profiles of Singapore Community-Dwelling Elderly Individuals: Key Risk Factors. Geriatr Orthop Surg Rehabil 2017; 8:256-262. [PMID: 29318089 PMCID: PMC5755848 DOI: 10.1177/2151458517745989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 09/16/2017] [Accepted: 10/26/2017] [Indexed: 11/17/2022] Open
Abstract
Objective: This study compared occurrence of falls, cognitive function, and balance profiles across participants in elderly age categories, investigating associations between the 3 aspects in a sample of Singapore’s elderly population. Method: Community-dwelling elderly individuals (N = 385) were randomly recruited and grouped into “young-old (65-74 years),” “medium-old (75-84 years),” and “oldest-old (above 85 years)” groups. The Fallproof Health and Activity questionnaire, adapted Mini-Mental State Examination (MMSE), and Berg Balance Scale (BBS) tests were used to survey information related to falls, cognition, and balance profiles. Results: Findings revealed significant differences in MMSE and BBS scores across the age groups. Participants with mild cognitive impairment (odds ratio [OR] = 1.87, 95% confidence interval [CI] = 1.08-3.25) and BBS score ≤40 (OR = 0.25, 95% CI = 0.14-0.46) were at the highest risk of falling. Conclusion: Community-dwelling elderly individuals with subtle cognitive impairment and BBS scores ≤40 displayed an increased risk of falling.
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Affiliation(s)
- Mei Teng Woo
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,School of Sports, Health, and Leisure, Republic Polytechnic, Singapore
| | - Keith Davids
- Centre for Sports Engineering Research, Sheffield Hallam University, Sheffield, United Kingdom
| | - Jarmo Liukkonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jia Yi Chow
- Physical Education and Sports Science, National Institute of Education, Nanyang Technological University, Singapore
| | - Timo Jaakkola
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Ansai JH, Andrade LPD, Rossi PG, Almeida ML, Carvalho Vale FA, Rebelatto JR. Association Between Gait and Dual Task With Cognitive Domains in Older People With Cognitive Impairment. J Mot Behav 2017; 50:409-415. [PMID: 28901834 DOI: 10.1080/00222895.2017.1363702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The authors investigated whether impaired gait and dual-task performances are associated with specific cognitive domains among older people with preserved cognition (PC), mild cognitive impairment (MCI), and mild Alzheimer's disease (AD). The sample comprised 40 older adults with PC, 40 with MCI, and 38 with mild AD. The assessment consisted of gait (measured by 10-m walk test and Timed Up and Go Test [TUGT]), dual task (measured by TUGT associated with a cognitive-motor task of calling a phone number), and cognition (domains of the Addenbrooke Cognitive Examination-Revised and Frontal Assessment Battery [FAB]). For data analysis, the Pearson product-moment correlation and the backward stepwise linear regression were conducted. Language, fluency, and visuospatial domains predicted the 10-m walk test measure specifically in PC, MCI, and AD groups. Only the visuospatial domain was independently associated with the TUGT measure in the MCI and AD groups. FAB score, language domain, and FAB score and fluency domain were the strongest predictors for the isolated cognitive-motor task measure in the PC, MCI, and AD groups, respectively. The visuospatial domain was independently associated with the dual-task test measure in all 3 groups. The study findings demonstrate the influence of specific cognitive domains in daily mobility tasks in people with different cognitive profiles.
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Affiliation(s)
| | | | - Paulo Giusti Rossi
- a Department of Physiotherapy , Federal University of São Carlos , Brazil
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Abstract
The relationship between postural instability and subcortical structure in AD has received less attention. The aims of this study were to assess whether there are differences in the ability to control balance between Alzheimer's disease (AD) and controls, and to investigate the association between subcortical gray matter volumes and postural instability in AD.We enrolled 107 consecutive AD patients and 37 controls. All participants underwent detailed neuropsychological evaluations, T1-weighted MRI at 3 T, and posture assessment using computerized dynamic posturography. We segmented the volumes of 6 subcortical structures of the amygdala, thalamus, caudate nucleus, putamen, globus pallidus and nucleus accumbens, and of hippocampus, using the FMRIBs integrated registration and segmentation tool.All subcortical structures, except for the globus pallidus, were smaller in AD compared with controls on adjusting for age and gender. Falling frequencies in unilateral stance test (UST) and composite scores in sensory organization test (SOT) were worse in AD than in controls. The motor control test did not reveal any differences between groups. On subgroup analyses in AD, the groups with poor performance in UST or SOT exhibited significantly reduced nucleus accumbens and putamen volumes, and nucleus accumbens volume, respectively. The smaller volume of the nucleus accumbens was associated with postural instability in AD (OR [95% CI] 17.847 [2.59-122.80] for UST, 42.827[6.06-302.47] for SOT, all P < .05).AD patients exhibited reduced ability to control balance compared with controls, and this postural instability was associated with nucleus accumbens volume loss. Furthermore, cognitive dysfunction was more prominent in the group with severe postural instability.
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Affiliation(s)
| | - Hyung Lee
- Department of Neurology
- Brain Research Institute
| | - In-Sung Chung
- Department of Occupational and Environmental Medicine, Keimyung University School of Medicine, Daegu, South Korea
| | - Hyon-Ah Yi
- Department of Neurology
- Brain Research Institute
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86
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Lipardo DS, Aseron AMC, Kwan MM, Tsang WW. Effect of Exercise and Cognitive Training on Falls and Fall-Related Factors in Older Adults With Mild Cognitive Impairment: A Systematic Review. Arch Phys Med Rehabil 2017; 98:2079-2096. [PMID: 28554873 DOI: 10.1016/j.apmr.2017.04.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/09/2017] [Accepted: 04/18/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effect of exercise and cognitive training on falls reduction and on factors known to be associated with falls among community-dwelling older adults with mild cognitive impairment (MCI). DATA SOURCES Seven databases (PubMed, CINAHL, Cochrane Library, Web of Science, ProQuest, ProQuest Dissertations and Theses, Digital Dissertation Consortium) and reference lists of pertinent articles were searched. STUDY SELECTION Randomized controlled trials (RCTs) on the effect of exercise, cognitive training, or a combination of both on falls and factors associated with falls such as balance, lower limb muscle strength, gait, and cognitive function among community-dwelling older adults with MCI were included. DATA EXTRACTION Data were extracted using the modified Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) tool. Study quality was assessed using the JBI-MAStARI appraisal instrument. DATA SYNTHESIS Seventeen RCTs (1679 participants; mean age ± SD, 74.4±2.4y) were included. Exercise improved gait speed and global cognitive function in MCI; both are known factors associated with falls. Cognitive training alone had no significant effect on cognitive function, while combined exercise and cognitive training improved balance in MCI. Neither fall rate nor the number of fallers was reported in any of the studies included. CONCLUSIONS This review suggests that exercise, and combined exercise and cognitive training improve specific factors associated with falls such as gait speed, cognitive function, and balance in MCI. Further research on the direct effect of exercise and cognitive training on the fall rate and incidence in older adults with MCI with larger sample sizes is highly recommended.
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Affiliation(s)
- Donald S Lipardo
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines
| | - Anne Marie C Aseron
- College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines
| | - Marcella M Kwan
- Rural Clinical School, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - William W Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
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87
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Debove L, Bru N, Couderc M, Noé F, Paillard T. Physical activity limits the effects of age and Alzheimer's disease on postural control. Neurophysiol Clin 2017; 47:301-304. [PMID: 28479259 DOI: 10.1016/j.neucli.2017.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 03/23/2017] [Indexed: 10/19/2022] Open
Abstract
The aim was to study the possible influence of physical activity on the postural performance of subjects with Alzheimer's disease (AD). The postural performance (i.e. surface area of the center of foot pressure displacement) of 3 groups was compared: Alzheimer active group (AA), Alzheimer non-active group (ANA) and healthy non-active group (HNA). The AA group's postural performance was superior to that of the ANA and HNA groups. AD disturbed postural performance but participation in regular physical activity made it possible to limit the disturbing effects of AD to a surprising extent, since the postural performance of active AD subjects was also superior to that of healthy subjects.
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Affiliation(s)
- Lola Debove
- Laboratoire mouvement, équilibre, performance et santé, EA 4445, département STAPS, université de Pau et des Pays de l'Adour, ZA Bastillac sud, 11, rue Morane-Saulnier, 65000 Tarbes, France; Service gériatrique, centre hospitalier de Lourdes, rue Labastide, 65100 Lourdes, France
| | - Noelle Bru
- Laboratoire de mathématique et leurs applications, UMR CNRS 5142, université de Pau et des Pays de l'Adour, bâtiment IPRA, avenue de l'Université, BP 1155, 64013 Pau cedex, France
| | - Martine Couderc
- Service gériatrique, centre hospitalier de Lourdes, rue Labastide, 65100 Lourdes, France
| | - Frederic Noé
- Laboratoire mouvement, équilibre, performance et santé, EA 4445, département STAPS, université de Pau et des Pays de l'Adour, ZA Bastillac sud, 11, rue Morane-Saulnier, 65000 Tarbes, France
| | - Thierry Paillard
- Laboratoire mouvement, équilibre, performance et santé, EA 4445, département STAPS, université de Pau et des Pays de l'Adour, ZA Bastillac sud, 11, rue Morane-Saulnier, 65000 Tarbes, France.
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88
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Louis ED, Kellner S, Morgan S, Collins K, Rohl B, Huey ED, Cosentino S. Cognitive Dysfunction Is Associated with Greater Imbalance and Falls in Essential Tremor. Front Neurol 2017; 8:154. [PMID: 28469597 PMCID: PMC5395979 DOI: 10.3389/fneur.2017.00154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/03/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Essential tremor (ET) is not exclusively a tremor disorder; it is also associated with cognitive and gait dysfunction. However, a gap in knowledge is that the relationship between cognitive and gait dysfunction has not been studied in detail in ET. We examined the relationship between cognition and balance and falls in ET and hypothesized that cognitive dysfunction in ET patients would be associated with greater problems with balance and more falls. METHODS ET cases were recruited into the Clinical-pathological Study of Cognition in ET. A comprehensive cognitive assessment was performed. This included the Montreal Cognitive Assessment (MoCA) to measure global cognition, multiple motor-free tests comprehensively assessing performance in each cognitive domain, and an assignment of Clinical Dementia Rating (CDR) scores. We collected data on the number of reported falls in the past year, and balance confidence was assessed using the 6-item Activities of Balance Confidence Scale. These cross-sectional analyses utilized baseline data. RESULTS There were 199 ET cases (mean age 78.6 years). In linear regression models that considered the effects of numerous confounding variables, lower global cognition (poorer cognition) was associated with greater number of falls and reduced balance confidence (p < 0.05). In similar adjusted linear regression models, higher CDR score (poorer functional cognition) was associated with greater number of falls and reduced balance confidence (p < 0.05). We also assessed whether number of falls and balance confidence was associated with performance in specific cognitive domains. Number of falls was most closely linked with performance on tests of executive function, and balance confidence, with executive function, attention, and memory. CONCLUSION These data indicate that a correlate of poorer cognition in ET is greater number of falls and lower balance confidence. Cognition should enter the dialog with ET patients as an issue of clinical significance.
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Affiliation(s)
- Elan D. Louis
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA
- Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Sarah Kellner
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Sarah Morgan
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Kathleen Collins
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Brittany Rohl
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Edward D. Huey
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Division of Geriatric Psychiatry, Department of Psychiatry, College of Physicians and Surgeons and New York Psychiatric Institute, New York, NY, USA
| | - Stephanie Cosentino
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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89
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The importance of parkinsonian signs for gait and balance in patients with Alzheimer's disease of mild degree. Gait Posture 2017; 51:159-161. [PMID: 27770681 DOI: 10.1016/j.gaitpost.2016.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 10/10/2016] [Accepted: 10/13/2016] [Indexed: 02/02/2023]
Abstract
Parkinsonian signs are common in patients with Alzheimer's disease (AD) of mild degree and predict functional decline, but their relationship with gait speed and balance is unclear. The aims of this study were to describe characteristics of patients with parkinsonian signs among 98 patients with AD of mild degree (with no comorbid Parkinson's disease), and to examine associations between parkinsonian signs with gait speed and balance. A cross sectional study at a memory clinic was conducted. Presence of each parkinsonian sign (bradykinesia, rigidity and tremor) was derived from the UPDRS, regular gait speed was recorded over 10m and balance were assessed using the Mini-Balance Evaluation Systems Test (Mini-BESTest). Bradykinesia was present in 30.6% of the sample, rigidity in 13.3% and tremor only in one patient. Patients with bradykinesia were older, had worse cognitive impairment and worse gait and balance performance than those without bradykinesia. More men than women had rigidity. Bradykinesia was significantly associated with mini-BESTest after adjusting for demographic factors (p<0.001, explaining 13.3% of the variance), but was not significantly associated with gait speed. Rigidity was not associated with either gait speed or balance. We conclude that assessment of bradykinesia should be included in examination of balance control in patients with AD of mild degree.
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90
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Miyawaki CE, Bouldin ED, Kumar GS, McGuire LC. Associations between Physical Activity and Cognitive Functioning among Middle-Aged and Older Adults. J Nutr Health Aging 2017; 21:637-647. [PMID: 28537327 PMCID: PMC6149221 DOI: 10.1007/s12603-016-0835-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To describe aerobic physical activity among middle-aged and older adults by their self-reported cognitive decline and their receipt of informal care for declines in cognitive functioning and most common type of physical activity. DESIGN Cross-sectional study using data from the 2011 Behavioral Risk Factor Surveillance System. SETTING Landline and cellular telephone survey. PARTICIPANTS 93,082 respondents aged 45 years and older from 21 US states in 2011. MEASUREMENTS Subjective cognitive decline (SCD) was defined as experiencing confusion or memory loss that was happening more often or getting worse during the past 12 months. Regular care was defined as always, usually, or sometimes receiving care from family or friends because of SCD. Using the 2008 Physical Activity Guidelines for Americans, respondents were classified as being inactive, insufficiently active, or sufficiently active based on their reported aerobic exercise. We calculated weighted proportions and used chi-square tests for differences across categories by SCD status and receipt of care. We estimated the prevalence ratio (PR) for being inactive, insufficiently active, and sufficiently active using separate log-binomial regression models, adjusting for covariates. RESULTS 12.3% of respondents reported SCD and 23.1% of those with SCD received regular care. 29.6% (95%CI: 28.9-30.4) of respondents without SCD were inactive compared to 37.1% (95%CI: 34.7-39.5) of those with SCD who did not receive regular care and 50.2% (95%CI: 45.2-55.1) of those with SCD who received regular care. 52.4% (95%CI: 51.6-53.2) of respondents without SCD were sufficiently active compared to 46.4% (95%CI: 43.8-49.0) of respondents with SCD and received no regular care and 30.6% (95%CI: 26.1-35.6) of respondents with SCD who received regular care. After adjusting for demographic and health status differences, people receiving regular care for SCD had a significantly lower prevalence of meeting aerobic guidelines compared to people without SCD (PR=0.80, 95%CI: 0.69-0.93, p=0.005). The most prevalent physical activity was walking for adults aged ≥ 45 years old (41-52%) regardless of SCD status or receipt of care. CONCLUSION Overall, the prevalence of inactivity was high, especially among people with SCD. These findings suggest a need to increase activity among middle-aged and older adults, particularly those with SCD who receive care. Examining ways to increase walking, potentially by involving informal caregivers, could be a promising way for people with SCD to reduce inactivity and gain the health benefits associated with meeting physical activity guidelines.
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Affiliation(s)
- C E Miyawaki
- Christina E Miyawaki, University of Houston, Graduate College of Social Work, 3511 Cullen Blvd. Room 110HA, Houston, TX 77204-4013, USA, PHONE: 713-743-0320, FAX: 713-743-8016,
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91
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Perrochon A, Holtzer R, Laidet M, Armand S, Assal F, Lalive PH, Allali G. Postural control is associated with cognition and fear of falling in patients with multiple sclerosis. J Neural Transm (Vienna) 2016; 124:495-500. [DOI: 10.1007/s00702-016-1668-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
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92
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Borges SDM, Radanovic M, Forlenza OV. Correlation between functional mobility and cognitive performance in older adults with cognitive impairment. AGING NEUROPSYCHOLOGY AND COGNITION 2016; 25:23-32. [PMID: 27934540 DOI: 10.1080/13825585.2016.1258035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Association between cognitive impairment and gait performance occurs in mild cognitive impairment (MCI) and Alzheimer's disease (AD), particularly under "divided attention" conditions, leading to a greater risk of falls. We studied 36 controls, 42 MCI, and 26 mild AD patients, using the Timed Up-and-Go test (TUG) under four conditions: TUG single - TUG1; TUG cognitive - TUG2; TUG manual -TUG3; TUG cognitive and manual - TUG4. Cognition was assessed using the MMSE, SKT, Exit25, and TMT (A and B). We found significant correlations between cognitive scores and TUG2 [r values (MMSE: -0.383, TMT-A: 0.430, TMT-B: 0.386, Exit25: 0.455, SKT: 0.563)] and TUG4 [(MMSE: -0.398, TMT-A: 0.384, TMT-B: 0.352,Exit25: 0.466, SKT: 0.525)] in the AD group, and between all TUG modalities and SKT in MCI and AD. Our results revealed that functional mobility impairment in cognitive dual tasks correlated to cognitive decline in AD patients and to attention and memory impairment in MCI.
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Affiliation(s)
- Sheila de Melo Borges
- a Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine , University of São Paulo , São Paulo , Brazil.,b Faculty of Physical Therapy , Santa Cecilia University , Santos , Brazil
| | - Márcia Radanovic
- a Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine , University of São Paulo , São Paulo , Brazil
| | - Orestes Vicente Forlenza
- a Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine , University of São Paulo , São Paulo , Brazil
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93
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Isik AT, Soysal P, Usarel C. Effects of Acetylcholinesterase Inhibitors on Balance and Gait Functions and Orthostatic Hypotension in Elderly Patients With Alzheimer Disease. Am J Alzheimers Dis Other Demen 2016; 31:580-584. [PMID: 27585748 PMCID: PMC10852938 DOI: 10.1177/1533317516666195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The present study was designed to evaluate the effect of acetylcholinesterase inhibitor (AchEI) therapy on balance, gait, and orthostatic hypotension (OH) in elderly patients with Alzheimer's disease (AD). METHODS A total of 102 elderly patients with AD have been recently diagnosed and were treated with AchEI and underwent comprehensive geriatric assessment at baseline and at the end of the sixth month. RESULTS Timed Up and Go test and Tinetti Performance-Oriented Mobility Assessment values and the prevalence of OH were not different at the end of the sixth month versus baseline (P > .05). However, it was determined that changes in balance were better in the patients who showed cognitive improvement at the end of the sixth month (P < .05). CONCLUSION Curative effects of AchEIs, which are used in the treatment of AD, on cognitive performance are reflected also in balance functions. Moreover, it was observed that these drugs do not increase the prevalence of OH.
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Affiliation(s)
- Ahmet Turan Isik
- Department of Geriatric Medicine, Faculty of Medicine, Center for Aging Brain and Dementia, Dokuz Eylul University, Izmir, Turkey
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Center for Aging Brain and Dementia, Dokuz Eylul University, Izmir, Turkey
| | - Cansu Usarel
- Department of Geriatric Medicine, Faculty of Medicine, Center for Aging Brain and Dementia, Dokuz Eylul University, Izmir, Turkey
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94
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Hesseberg K, Bergland A, Rydwik E, Brovold T. Physical Fitness in Older People Recently Diagnosed with Cognitive Impairment Compared to Older People Recently Discharged from Hospital. Dement Geriatr Cogn Dis Extra 2016; 6:396-406. [PMID: 27703472 PMCID: PMC5040949 DOI: 10.1159/000447534] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS There is evidence of an association between cognitive function and physical fitness. The aim of this study was to compare physical fitness in patients with cognitive impairment with a group of older people recently discharged from hospital. METHODS A cross-sectional study with 98 patients recently diagnosed with cognitive impairment and 115 patients recently discharged from hospital. Associations between the study group variable and different components in the Senior fitness test were examined, controlling for demographic factors and comorbidity. RESULTS The group recently diagnosed with cognitive impairment indicated poorer results on three of six physical fitness components (p < 0.05). CONCLUSION Older adults with cognitive impairment are in need of individually tailored physical activity programs to increase the level of physical fitness.
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Affiliation(s)
- Karin Hesseberg
- Division of Physiotherapy, Oslo and Akershus University College of Applied Sciences, Oslo, Norway; Diakonhjemmet Hospital, Oslo, Norway
| | - Astrid Bergland
- Division of Physiotherapy, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Elisabeth Rydwik
- Division of Physiotherapy, Department Neurobiology Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; FOU nu, Jakobsbergs Hospital, Stockholm County Council, Järfälla, Sweden
| | - Therese Brovold
- Division of Physiotherapy, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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95
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Berton B, Cê A, Sanches VS, Medola FO, Tarnhovi EG, Christofoletti G. Postural balance in Alzheimer's disease patients undergoing sensory pitfalls. MOTRIZ: REVISTA DE EDUCACAO FISICA 2016. [DOI: 10.1590/s1980-6574201600030012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Andressa Cê
- Universidade Federal de Mato Grosso do Sul, Brazil
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96
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Cieślik B, Jaworska L, Szczepańska-Gierach J. Postural stability in the cognitively impaired elderly: A systematic review of the literature. DEMENTIA 2016; 18:178-189. [PMID: 27509920 DOI: 10.1177/1471301216663012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The aim of this study was to review the literature and critically analyse publications connecting cognitive impairment with postural stability. METHODS Four electronic databases were searched. The inclusion criteria comprised the relation between the process of maintaining balance and cognitive impairment. RESULTS Of the 153 selected articles, 15 met the inclusion criteria. In 83% of publications, cognitive status was determined with the use of the Mini-Mental State Examination. In eight publications, postural stability was examined using force plates. Other methods used to test the balance were functional tests, i.e. the Berg Balance Scale or the Balance Evaluation Systems Test. CONCLUSION As the choice of methodology varies significantly, it is difficult to attempt an objective comparison between different studies. There is a clear need for the normalisation of methods used to assess the degree of dementia and to assess postural stability among this group of people.
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Affiliation(s)
- Błażej Cieślik
- Institute of Physical Education, Tourism and Physiotherapy, Faculty of Pedagogy, Jan Dlugosz University, Czestochowa, Poland; University School of Physical Education, Poland
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97
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Use of a Virtual Environment to Engage Motor and Postural Abilities in Elderly Subjects With and Without Mild Cognitive Impairment (MAAMI Project). Ing Rech Biomed 2016. [DOI: 10.1016/j.irbm.2016.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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98
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Beauchet O, Barden J, Liu-Ambrose T, Chester VL, Szturm T, Allali G. The relationship between hippocampal volume and static postural sway: results from the GAIT study. AGE (DORDRECHT, NETHERLANDS) 2016; 38:19. [PMID: 26833034 PMCID: PMC5005866 DOI: 10.1007/s11357-016-9883-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/26/2016] [Indexed: 05/24/2023]
Abstract
The role of the hippocampus in postural control, in particular in maintaining upright stance, has not been fully examined in normal aging. This study aims to examine the association of postural sway with hippocampal volume while maintaining upright stance in healthy older individuals. Seventy healthy individuals (mean age 69.7 ± 3.4 years; 41.4 % women) were recruited in this study based on cross-sectional design. Hippocampal volume (quantified from a three-dimensional T1-weighted MRI using semi-automated software), three center of pressure (COP) motion parameters (sway area, path length of anterior-posterior (AP) and medial-lateral (ML) displacement) while maintaining upright stance (eyes open and closed), and the relative difference between open and closed eye conditions were used as outcome measures. Age, sex, body mass index, lower limb proprioception, distance vision, 15-item geriatric depression scale score, total cranial volume, and white matter abnormalities were used as covariates. The sway area decreased from open to closed eye condition but this variation was non-significant (P = 0.244), whereas path length of AP and ML displacement increased significantly (P < 0.003). Increase in sway area from open to closed eyes was associated with greater hippocampal volume (β -18.21; P = 0.044), and a trend for an association of increase in path length of AP displacement (P = 0.075 for open eyes and P = 0.071 for closed eyes) with greater hippocampal volume was reported. The hippocampus is involved in upright postural control in normal aging, such that an increase in sway area of COP motion from open to closed eyes is associated with greater hippocampal volume in healthy older adults.
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Affiliation(s)
- Olivier Beauchet
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada.
- Dr. Joseph Kaufmann Chair in Geriatric Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada.
- Centre of Excellence on Aging and Chronic Diseases of McGill integrated University Health Network, Quebec, Canada.
| | - John Barden
- Neuromechanical Research Centre, Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, Canada
| | - Teresa Liu-Ambrose
- Aging, Mobility and Cognitive Neuroscience Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Victoria L Chester
- Andrew and Marjorie McCain Human Performance Laboratory, Richard J. Currie Center, Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada
| | - Tony Szturm
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Gilles Allali
- Department of Neurology, Geneva University Hospital and University of Geneva, Geneva, Switzerland
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99
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Wu Q, Chan JS, Yan JH. Mild cognitive impairment affects motor control and skill learning. Rev Neurosci 2016; 27:197-217. [DOI: 10.1515/revneuro-2015-0020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 08/03/2015] [Indexed: 12/27/2022]
Abstract
AbstractMild cognitive impairment (MCI) is a transitional phase between normal cognitive aging and dementia. As the world population is aging rapidly, more MCI patients will be identified, posing significant problems to society. Normal aging is associated with cognitive and motor decline, and MCI brings additional impairments. Compared to healthy older adults, MCI patients show poorer motor control in a variety of tasks. Efficient motor control and skill learning are essential for occupational and leisure purposes; degradation of motor behaviors in MCI patients often adversely affects their health and quality of life. In this article, we first define MCI and describe its pathology and neural correlates. After this, we review cognitive changes and motor control and skill learning in normal aging. This section is followed by a discussion of MCI-related degradation of motor behaviors. Finally, we propose that multicomponent interventions targeting both cognitive and motor domains can improve MCI patients’ motor functions. Future research directions are also raised.
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Affiliation(s)
| | | | - Jin H. Yan
- 2Center for Brain Disorders and Cognitive Neuroscience, Shenzhen University, 3688 Nan Hai Ave., Shenzhen, Guangdong 518060, P.R. China
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100
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Techniques and Methods for Testing the Postural Function in Healthy and Pathological Subjects. BIOMED RESEARCH INTERNATIONAL 2015; 2015:891390. [PMID: 26640800 PMCID: PMC4659957 DOI: 10.1155/2015/891390] [Citation(s) in RCA: 266] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/05/2015] [Accepted: 10/21/2015] [Indexed: 12/15/2022]
Abstract
The different techniques and methods employed as well as the different quantitative and qualitative variables measured in order to objectify postural control are often chosen without taking into account the population studied, the objective of the postural test, and the environmental conditions. For these reasons, the aim of this review was to present and justify the different testing techniques and methods with their different quantitative and qualitative variables to make it possible to precisely evaluate each sensory, central, and motor component of the postural function according to the experiment protocol under consideration. The main practical and technological methods and techniques used in evaluating postural control were explained and justified according to the experimental protocol defined. The main postural conditions (postural stance, visual condition, balance condition, and test duration) were also analyzed. Moreover, the mechanistic exploration of the postural function often requires implementing disturbing postural conditions by using motor disturbance (mechanical disturbance), sensory stimulation (sensory manipulation), and/or cognitive disturbance (cognitive task associated with maintaining postural balance) protocols. Each type of disturbance was tackled in order to facilitate understanding of subtle postural control mechanisms and the means to explore them.
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