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Stephan Y, Sutin AR, Luchetti M, Aschwanden D, Karakose S, Terracciano A. Balance, Strength, and Risk of Dementia: Findings From the Health and Retirement Study and the English Longitudinal Study of Ageing. J Gerontol A Biol Sci Med Sci 2024; 79:glae165. [PMID: 38918945 PMCID: PMC11249972 DOI: 10.1093/gerona/glae165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Slow gait speed has been consistently associated with an increased risk of dementia. This study examined whether measures of balance and lower limb strength are similarly related to the risk of developing dementia. METHODS Participants from the Health and Retirement Study (HRS, N = 5 658, mean age = 73.23, standard deviation [SD] = 6.22) and the English Longitudinal Study of Ageing (ELSA, N = 3667, mean age = 69.90, SD = 7.02) completed measures of gait speed, semi-tandem balance, chair stand (ELSA only), and cognitive status at baseline. Cognitive status was assessed over up to 15 years. RESULTS Baseline slower gait speed (hazard ratio [HR]HRS = 1.52, 95% confidence interval [CI] = 1.32-1.75, p < .001; HRELSA = 1.73, 95% CI = 1.37-2.18, p < .001); and balance impairment (HRHRS = 1.58, 95% CI = 1.26-1.96, p < .001; HRELSA = 1.97, 95% CI = 1.24-3.14, p < .01) were related to a higher risk of incident dementia, adjusting for demographic factors. The combination of slower gait and impaired balance was associated with a two-to-three times higher risk of dementia in HRS and ELSA. Worse performance on the chair stand at baseline was associated with a higher risk of dementia in ELSA (HR = 1.56, 95% CI = 1.23-1.99, p < .001). All performance measures remained significant when entered simultaneously and accounted for obesity, diabetes, blood pressure, physical activity, smoking, and depressive symptoms. There was little evidence that age, sex, or APOE ε4 moderated the association. CONCLUSIONS Similar to gait speed, measures of balance and strength are associated with a higher risk of incident dementia. The findings have implications for clinical practice, given that these routinely used geriatric assessment tools are similarly related to dementia risk.
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Affiliation(s)
| | - Angelina R Sutin
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Martina Luchetti
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Damaris Aschwanden
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
- Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Selin Karakose
- Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Antonio Terracciano
- Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, Florida, USA
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2
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Ferreira DA, Macedo LBC, Foss MP. Neuropsychiatric symptoms as a prodromal factor in Alzheimer's type neurodegenerative disease: A scoping review. Clin Neuropsychol 2024; 38:1031-1059. [PMID: 37881945 DOI: 10.1080/13854046.2023.2273574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023]
Abstract
Objective: Identifying neuropsychiatric symptoms (NPS) can aid in the early detection of Alzheimer's disease (AD); however, there is still a need for a greater consensus. This review aims to delineate the predominant NPS, compile a comprehensive list of the most commonly employed NPS assessment tools, and corroborate the principal findings regarding the link between NPS and neuropsychological assessment and neurobiological substrates. Methods: To conduct this scoping review, we followed the Preferred Reporting Items for Systematic Reviews guidelines and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We searched for relevant articles published between 2017 and 2023 in MEDLINE, PsycINFO, PubMed, Web of Science, and Cochrane Library. Results: Of the 61 eligible articles, depression, anxiety, and apathy were the main NPSs. The Neuropsychiatric Inventory Questionnaire and Neuropsychiatric Inventory were the primary assessment tools used to evaluate NPS. Correlations between NPS severity and neurobiological markers were considered clinically significant. Furthermore, clinical procedures prioritized the use of global cognitive screening tools, assessments of executive functions, and functionality evaluations. Conclusion: Standardization of procedures is necessary because of the diversity of methods. The data show that NPS can predict the etiology, severity, form, and type of disease progression, serving as a precursor sign of AD. The results of the most common cognitive screening tools and NPS instruments provided an interesting overview of future clinical approaches.
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Affiliation(s)
- Diego Alves Ferreira
- Department of Neuroscience and Behavior Science, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Lorena Barbosa Cunha Macedo
- Faculty of Philosophy, Sciences, and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Maria Paula Foss
- Department of Neuroscience and Behavior Science, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Faculty of Philosophy, Sciences, and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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3
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Chen Y, Al-Nusaif M, Li S, Tan X, Yang H, Cai H, Le W. Progress on early diagnosing Alzheimer's disease. Front Med 2024; 18:446-464. [PMID: 38769282 PMCID: PMC11391414 DOI: 10.1007/s11684-023-1047-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/15/2023] [Indexed: 05/22/2024]
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disorder that affects both cognition and non-cognition functions. The disease follows a continuum, starting with preclinical stages, progressing to mild cognitive and behavioral impairment, ultimately leading to dementia. Early detection of AD is crucial for better diagnosis and more effective treatment. However, the current AD diagnostic tests of biomarkers using cerebrospinal fluid and/or brain imaging are invasive or expensive, and mostly are still not able to detect early disease state. Consequently, there is an urgent need to develop new diagnostic techniques with higher sensitivity and specificity during the preclinical stages of AD. Various non-cognitive manifestations, including behavioral abnormalities, sleep disturbances, sensory dysfunctions, and physical changes, have been observed in the preclinical AD stage before occurrence of notable cognitive decline. Recent research advances have identified several biofluid biomarkers as early indicators of AD. This review focuses on these non-cognitive changes and newly discovered biomarkers in AD, specifically addressing the preclinical stages of the disease. Furthermore, it is of importance to explore the potential for developing a predictive system or network to forecast disease onset and progression at the early stage of AD.
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Affiliation(s)
- Yixin Chen
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, 116021, China
| | - Murad Al-Nusaif
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, 116021, China
| | - Song Li
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, 116021, China
| | - Xiang Tan
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, 116021, China
| | - Huijia Yang
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, 116021, China
| | - Huaibin Cai
- Transgenic Section, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Weidong Le
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, 116021, China.
- Institute of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China.
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Saini M, Subramanian MS, Rao AR, Thakral M, Singh V, Chakrawarty A, Chatterjee P, Dey AB. Gait Parameters Change can be an Early Marker of Cognitive Impairment. Neurol India 2024; 72:603-609. [PMID: 39041980 DOI: 10.4103/ni.ni_148_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 12/17/2022] [Indexed: 07/24/2024]
Abstract
BACKGROUND AND OBJECTIVE Gait impairment leads to increased dependence, morbidity, institutionalization, and mortality in older people. We intended to assess gait parameters with the continuum of cognitive impairment and observe variation with the severity of cognitive impairment. MATERIALS AND METHODS This cross-sectional, observational study was conducted at the memory clinic of a tertiary care center. One hundred and twelve subjects were recruited, and cognition was assessed by the Clinical Dementia Rating scale. Usual gait was assessed by a 6-m walk test, and the dynamic gait was assessed using Biodex Gait Trainer™. Apart from crude analysis, adjusted linear regression was used to find the association of spatiotemporal gait parameters with cognitive decline. RESULTS Subjects were divided into subjective cognitive decline (SCD; n = 38), mild cognitive impairment (MCI; n = 40), and major neurocognitive disorder (MNCD; n = 34) groups. History of falls (23.7% vs. 30.0% vs. 67.7%, P < 0.001) and impaired activities of daily living (ADLs) (5.3% vs. 15.0% vs. 100%, P < 0.001) were significantly higher with cognitive decline. Age- and gender-adjusted regression analysis revealed that usual gait speed (0.8 vs. 0.6 vs. 0.5, P < 0.001) (m/s), total time (3.9 vs. 2.9 vs. 2.6, P = 0.022) (min), total distance (65.6 vs. 55.8 vs. 46.6, P = 0.025) (m), step cycle time (0.6 vs. 0.8 vs. 0.8, P = 0.020) (cycles/s), and step lengths were significant. CONCLUSION Gait speed and other parameters worsened with increasing cognitive impairment. Changes in gait parameters might be a useful marker of declining cognition, though a long-term follow-up study is required to establish this association. Early intervention could be beneficial in preserving autonomy in patients with cognitive impairment.
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Affiliation(s)
- Mamta Saini
- Department of Geriatric Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Abhijith R Rao
- Fellow in Geriatric Oncology, Department of Medical Oncology, Tata Memorial Centre, Mumbai
| | - Meenal Thakral
- Department of Geriatric Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vishwajeet Singh
- Department of Geriatric Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Avinash Chakrawarty
- Department of Geriatric Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Prasun Chatterjee
- Department of Geriatric Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Aparajit B Dey
- Department of Geriatric Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Bonassi G, Zhao M, Samogin J, Mantini D, Marchese R, Contrino L, Tognetti P, Putzolu M, Botta A, Pelosin E, Avanzino L. Brain Networks Modulation during Simple and Complex Gait: A "Mobile Brain/Body Imaging" Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:2875. [PMID: 38732980 PMCID: PMC11086305 DOI: 10.3390/s24092875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024]
Abstract
Walking encompasses a complex interplay of neuromuscular coordination and cognitive processes. Disruptions in gait can impact personal independence and quality of life, especially among the elderly and neurodegenerative patients. While traditional biomechanical analyses and neuroimaging techniques have contributed to understanding gait control, they often lack the temporal resolution needed for rapid neural dynamics. This study employs a mobile brain/body imaging (MoBI) platform with high-density electroencephalography (hd-EEG) to explore event-related desynchronization and synchronization (ERD/ERS) during overground walking. Simultaneous to hdEEG, we recorded gait spatiotemporal parameters. Participants were asked to walk under usual walking and dual-task walking conditions. For data analysis, we extracted ERD/ERS in α, β, and γ bands from 17 selected regions of interest encompassing not only the sensorimotor cerebral network but also the cognitive and affective networks. A correlation analysis was performed between gait parameters and ERD/ERS intensities in different networks in the different phases of gait. Results showed that ERD/ERS modulations across gait phases in the α and β bands extended beyond the sensorimotor network, over the cognitive and limbic networks, and were more prominent in all networks during dual tasks with respect to usual walking. Correlation analyses showed that a stronger α ERS in the initial double-support phases correlates with shorter step length, emphasizing the role of attention in motor control. Additionally, β ERD/ERS in affective and cognitive networks during dual-task walking correlated with dual-task gait performance, suggesting compensatory mechanisms in complex tasks. This study advances our understanding of neural dynamics during overground walking, emphasizing the multidimensional nature of gait control involving cognitive and affective networks.
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Affiliation(s)
- Gaia Bonassi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy;
| | - Mingqi Zhao
- Research Center for Motor Control and Neuroplasticity, KU Leuven, 3001 Leuven, Belgium; (M.Z.); (J.S.); (D.M.)
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou 730000, China
| | - Jessica Samogin
- Research Center for Motor Control and Neuroplasticity, KU Leuven, 3001 Leuven, Belgium; (M.Z.); (J.S.); (D.M.)
| | - Dante Mantini
- Research Center for Motor Control and Neuroplasticity, KU Leuven, 3001 Leuven, Belgium; (M.Z.); (J.S.); (D.M.)
| | - Roberta Marchese
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (R.M.); (A.B.); (L.A.)
| | - Luciano Contrino
- S.C. Medicina Fisica e Riabilitazione Ospedaliera, Azienda Sanitaria Locale Chiavarese, 16043 Chiavari, Italy; (L.C.); (P.T.)
| | - Paola Tognetti
- S.C. Medicina Fisica e Riabilitazione Ospedaliera, Azienda Sanitaria Locale Chiavarese, 16043 Chiavari, Italy; (L.C.); (P.T.)
| | - Martina Putzolu
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Viale Benedetto XV 3, 16132 Genoa, Italy;
| | - Alessandro Botta
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (R.M.); (A.B.); (L.A.)
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy;
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (R.M.); (A.B.); (L.A.)
| | - Laura Avanzino
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (R.M.); (A.B.); (L.A.)
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Viale Benedetto XV 3, 16132 Genoa, Italy;
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Bagg MK, Hicks AJ, Hellewell SC, Ponsford JL, Lannin NA, O'Brien TJ, Cameron PA, Cooper DJ, Rushworth N, Gabbe BJ, Fitzgerald M. The Australian Traumatic Brain Injury Initiative: Statement of Working Principles and Rapid Review of Methods to Define Data Dictionaries for Neurological Conditions. Neurotrauma Rep 2024; 5:424-447. [PMID: 38660461 PMCID: PMC11040195 DOI: 10.1089/neur.2023.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
The Australian Traumatic Brain Injury Initiative (AUS-TBI) aims to develop a health informatics approach to collect data predictive of outcomes for persons with moderate-severe TBI across Australia. Central to this approach is a data dictionary; however, no systematic reviews of methods to define and develop data dictionaries exist to-date. This rapid systematic review aimed to identify and characterize methods for designing data dictionaries to collect outcomes or variables in persons with neurological conditions. Database searches were conducted from inception through October 2021. Records were screened in two stages against set criteria to identify methods to define data dictionaries for neurological conditions (International Classification of Diseases, 11th Revision: 08, 22, and 23). Standardized data were extracted. Processes were checked at each stage by independent review of a random 25% of records. Consensus was reached through discussion where necessary. Thirty-nine initiatives were identified across 29 neurological conditions. No single established or recommended method for defining a data dictionary was identified. Nine initiatives conducted systematic reviews to collate information before implementing a consensus process. Thirty-seven initiatives consulted with end-users. Methods of consultation were "roundtable" discussion (n = 30); with facilitation (n = 16); that was iterative (n = 27); and frequently conducted in-person (n = 27). Researcher stakeholders were involved in all initiatives and clinicians in 25. Importantly, only six initiatives involved persons with lived experience of TBI and four involved carers. Methods for defining data dictionaries were variable and reporting is sparse. Our findings are instructive for AUS-TBI and can be used to further development of methods for defining data dictionaries.
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Affiliation(s)
- Matthew K. Bagg
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health Sciences, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Amelia J. Hicks
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Sarah C. Hellewell
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
| | - Jennie L. Ponsford
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Natasha A. Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Terence J. O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Peter A. Cameron
- National Trauma Research Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - D. Jamie Cooper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Nick Rushworth
- Brain Injury Australia, Sydney, New South Wales, Australia
| | - Belinda J. Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, United Kingdom
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
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Fujita K, Sugimoto T, Noma H, Kuroda Y, Matsumoto N, Uchida K, Kishino Y, Sakurai T. Postural Control Characteristics in Alzheimer's Disease, Dementia With Lewy Bodies, and Vascular Dementia. J Gerontol A Biol Sci Med Sci 2024; 79:glae061. [PMID: 38412449 PMCID: PMC10949438 DOI: 10.1093/gerona/glae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Dementia often results in postural control impairment, which could signify central nervous system dysfunction. However, no studies have compared postural control characteristics among various types of dementia. This study aimed to compare static postural control in patients with Alzheimer's disease (AD), dementia with Lewy bodies (DLB), and vascular dementia (VaD). METHODS Cross-sectional relationship between the clinical diagnoses (AD, DLB, VaD, or normal cognition [NC]) of outpatients at a memory clinic and their upright postural control characteristics were examined. In the postural control test, participants were instructed to maintain a static upright standing on a stabilometer for 60 seconds under the eyes-open and eyes-closed conditions. Forty postural control parameters, including distance, position, and velocity in the anterior-posterior and medio-lateral directions, derived from the trajectory of the center of mass sway, were calculated. The characteristics of each type of dementia were compared to those of NC, and the differences among the 3 types of dementia were evaluated using linear regression models. RESULTS The study included 1 789 participants (1 206 with AD, 111 with DLB, 49 with VaD, and 423 with NC). Patients with AD exhibited distinct postural control characteristics, particularly in some distance and velocity parameters, only in the eyes-closed condition. Those with DLB exhibited features in the mean position in the anterior-posterior direction. In patients with VaD, significant differences were observed in most parameters, except the power spectrum. CONCLUSIONS Patients with AD, DLB, and VaD display disease-specific postural control characteristics when compared to cognitively normal individuals.
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Affiliation(s)
- Kosuke Fujita
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Morioka, Obu, Aichi, Japan
- Japan Society for the Promotion of Science, Kojimachi, Chiyoda, Tokyo, Japan
| | - Taiki Sugimoto
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Morioka, Obu, Aichi, Japan
| | - Hisashi Noma
- Department of Data Science, Institute of Statistical Mathematics, Midori-cho, Tachikawa, Tokyo, Japan
| | - Yujiro Kuroda
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Morioka, Obu, Aichi, Japan
| | - Nanae Matsumoto
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Morioka, Obu, Aichi, Japan
| | - Kazuaki Uchida
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Morioka, Obu, Aichi, Japan
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Tomogaoka, Suma, Kobe, Hyogo, Japan
| | - Yoshinobu Kishino
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Morioka, Obu, Aichi, Japan
- Department of Cognition and Behavior Science, Nagoya University Graduate School of Medicine, Furo, Chikusa, Nagoya, Aichi, Japan
| | - Takashi Sakurai
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Morioka, Obu, Aichi, Japan
- Department of Cognition and Behavior Science, Nagoya University Graduate School of Medicine, Furo, Chikusa, Nagoya, Aichi, Japan
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Sakurai R, Pieruccini‐Faria F, Cornish B, Fraser J, Binns MA, Beaton D, Dilliott AA, Kwan D, Ramirez J, Tan B, Scott CJM, Sunderland KM, Tartaglia C, Finger E, Zinman L, Freedman M, McLaughlin PM, Swartz RH, Symons S, Lang AE, Bartha R, Black SE, Masellis M, Hegele RA, McIlroy W, Montero‐Odasso M. Link among apolipoprotein E E4, gait, and cognition in neurodegenerative diseases: ONDRI study. Alzheimers Dement 2024; 20:2968-2979. [PMID: 38470007 PMCID: PMC11032526 DOI: 10.1002/alz.13740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/08/2023] [Accepted: 12/14/2023] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Apolipoprotein E E4 allele (APOE E4) and slow gait are independently associated with cognitive impairment and dementia. However, it is unknown whether their coexistence is associated with poorer cognitive performance and its underlying mechanism in neurodegenerative diseases. METHODS Gait speed, APOE E4, cognition, and neuroimaging were assessed in 480 older adults with neurodegeneration. Participants were grouped by APOE E4 presence and slow gait. Mediation analyses were conducted to determine if brain structures could explain the link between these factors and cognitive performance. RESULTS APOE E4 carriers with slow gait had the lowest global cognitive performance and smaller gray matter volumes compared to non-APOE E4 carriers with normal gait. Coexistence of APOE E4 and slow gait best predicted global and domain-specific poorer cognitive performances, mediated by smaller gray matter volume. DISCUSSION Gait slowness in APOE E4 carriers with neurodegenerative diseases may indicate extensive gray matter changes associated with poor cognition. HIGHLIGHTS APOE E4 and slow gait are risk factors for cognitive decline in neurodegenerative diseases. Slow gait and smaller gray matter volumes are associated, independently of APOE E4. Worse cognition in APOE E4 carriers with slow gait is explained by smaller GM volume. Gait slowness in APOE E4 carriers indicates poorer cognition-related brain changes.
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Affiliation(s)
- Ryota Sakurai
- Research Team for Social Participation and Healthy AgingTokyo Metropolitan Institute for Geriatrics and GerontologyItabashi‐kuTokyoJapan
- Gait & Brain Lab, St. Joseph' Health Care London, Lawson Health Research, Western University, Division of Geriatric MedicineLondonOntarioCanada
| | - Frederico Pieruccini‐Faria
- Gait & Brain Lab, St. Joseph' Health Care London, Lawson Health Research, Western University, Division of Geriatric MedicineLondonOntarioCanada
- Department of MedicineDivision of Geriatric MedicineParkwood HospitalWestern University, Parkwood InstituteLondonOntarioCanada
| | - Benjamin Cornish
- Neuroscience, Mobility and Balance Lab, Department of Kinesiology and Health SciencesUniversity of WaterlooWaterlooOntarioCanada
| | - Julia Fraser
- Neuroscience, Mobility and Balance Lab, Department of Kinesiology and Health SciencesUniversity of WaterlooWaterlooOntarioCanada
| | - Malcolm A. Binns
- Rotman Research Institute, Baycrest Health SciencesTorontoOntarioCanada
| | - Derek Beaton
- Data Science and Advanced Analytics, St. Michael's Hospital, Unity Health TorontoTorontoOntarioCanada
| | - Allison Ann Dilliott
- Department of Neurology and NeurosurgeryMontreal Neurological Institute, McGill UniversityMontréalQuebecCanada
| | - Donna Kwan
- Centre for Neuroscience Studies, Queen's UniversityKingstonOntarioCanada
| | - Joel Ramirez
- L.C. Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Program, Department of Medicine (Neurology)Sunnybrook Research Institute, Sunnybrook HSC, University of TorontoTorontoOntarioCanada
| | - Brian Tan
- Rotman Research Institute, Baycrest Health SciencesTorontoOntarioCanada
| | | | | | - Carmela Tartaglia
- Krembil Brain InstituteUniversity Health Network Memory Clinic, Toronto Western HospitalTorontoOntarioCanada
- Tanz Centre for Research in Neurodegenerative Diseases, University of TorontoTorontoOntarioCanada
| | - Elizabeth Finger
- Department of Clinical Neurological SciencesSchulich School of Medicine and Dentistry, Western UniversityLondonOntarioCanada
| | - Lorne Zinman
- Sunnybrook Research Institute, Sunnybrook Health Sciences CentreTorontoOntarioCanada
- Department of Medicine (Neurology)University of TorontoTorontoOntarioCanada
| | - Morris Freedman
- Rotman Research Institute, Baycrest Health SciencesTorontoOntarioCanada
- Department of Medicine (Neurology)University of TorontoTorontoOntarioCanada
- Division of NeurologyBaycrest Health SciencesTorontoOntarioCanada
| | - Paula M. McLaughlin
- Halifax Clinical Psychology Residency ProgramNova Scotia Health AuthorityHalifaxNova ScotiaCanada
| | - Richard H. Swartz
- Sunnybrook Research Institute, Sunnybrook Health Sciences CentreTorontoOntarioCanada
- Department of Medicine (Neurology)University of TorontoTorontoOntarioCanada
| | - Sean Symons
- L.C. Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Program, Department of Medicine (Neurology)Sunnybrook Research Institute, Sunnybrook HSC, University of TorontoTorontoOntarioCanada
| | - Anthony E. Lang
- Division of NeurologyDepartment of MedicineEdmond J Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders ClinicToronto Western HospitalUniversity of TorontoTorontoOntarioCanada
| | - Robert Bartha
- Department of Medical BiophysicsSchulich School of Medicine and Dentistry, Robarts Research Institute, Western UniversityLondonOntarioCanada
| | - Sandra E. Black
- L.C. Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Program, Department of Medicine (Neurology)Sunnybrook Research Institute, Sunnybrook HSC, University of TorontoTorontoOntarioCanada
| | - Mario Masellis
- L.C. Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Program, Department of Medicine (Neurology)Sunnybrook Research Institute, Sunnybrook HSC, University of TorontoTorontoOntarioCanada
| | - Robert A. Hegele
- Schulich School of Medicine and Dentistry, Western UniversityLondonOntarioCanada
- Robarts Research Institute, Western UniversityLondonOntarioCanada
| | - William McIlroy
- Neuroscience, Mobility and Balance Laboratory, Department of Kinesiology and Health SciencesUniversity of WaterlooWaterlooOntarioCanada
| | - ONDRI Investigators
- Research Team for Social Participation and Healthy AgingTokyo Metropolitan Institute for Geriatrics and GerontologyItabashi‐kuTokyoJapan
| | - Manuel Montero‐Odasso
- Gait & Brain Lab, St. Joseph' Health Care London, Lawson Health Research, Western University, Division of Geriatric MedicineLondonOntarioCanada
- Gait and Brain Lab, Division of Geriatric Medicineand Lawson Health Research InstituteParkwood Institute, Western UniversityLondonOntarioCanada
- Division of Geriatric MedicineDepartment of MedicineSchulich School of Medicine and Dentistry, Western University, Parkwood InstituteLondonOntarioCanada
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Juengling F, Wuest F, Schirrmacher R, Abele J, Thiel A, Soucy JP, Camicioli R, Garibotto V. PET Imaging in Dementia: Mini-Review and Canadian Perspective for Clinical Use. Can J Neurol Sci 2024:1-13. [PMID: 38433571 DOI: 10.1017/cjn.2024.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
PET imaging is increasingly recognized as an important diagnostic tool to investigate patients with cognitive disturbances of possible neurodegenerative origin. PET with 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG), assessing glucose metabolism, provides a measure of neurodegeneration and allows a precise differential diagnosis among the most common neurodegenerative diseases, such as Alzheimer's disease, frontotemporal dementia or dementia with Lewy bodies. PET tracers specific for the pathological deposits characteristic of different neurodegenerative processes, namely amyloid and tau deposits typical of Alzheimer's Disease, allow the visualization of these aggregates in vivo. [18F]FDG and amyloid PET imaging have reached a high level of clinical validity and are since 2022 investigations that can be offered to patients in standard clinical care in most of Canada.This article will briefly review and summarize the current knowledge on these diagnostic tools, their integration into diagnostic algorithms as well as perspectives for future developments.
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Affiliation(s)
- Freimut Juengling
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
- Division of Oncologic Imaging and Radionuclide Therapy, Cross Cancer Institute, Edmonton, AB, Canada
- Medical Faculty, University of Bern, Bern, Switzerland
| | - Frank Wuest
- Division of Oncologic Imaging and Radionuclide Therapy, Cross Cancer Institute, Edmonton, AB, Canada
| | - Ralf Schirrmacher
- Division of Oncologic Imaging and Radionuclide Therapy, Cross Cancer Institute, Edmonton, AB, Canada
- Medical Isotope and Cyclotron Facility, University of Alberta, Edmonton, AB, Canada
| | - Jonathan Abele
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Alexander Thiel
- Department of Neurology and Neurosurgery, Lady Davis Institute for Medical Research, McGill University, Montréal, QC, Canada
| | - Jean-Paul Soucy
- Montréal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Richard Camicioli
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, Division of Neurology, University of Alberta, Edmonton, AB, Canada
| | - Valentina Garibotto
- Diagnostic Department, Nuclear Medicine and Molecular Imaging Division, University Hospitals of Geneva, Geneva, Switzerland
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Wei G, Tian X, Yang H, Luo Y, Liu G, Sun S, Wang X, Wen H. Adjunct Methods for Alzheimer's Disease Detection: A Review of Auditory Evoked Potentials. J Alzheimers Dis 2024; 97:1503-1517. [PMID: 38277292 DOI: 10.3233/jad-230822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
The auditory afferent pathway as a clinical marker of Alzheimer's disease (AD) has sparked interest in investigating the relationship between age-related hearing loss (ARHL) and AD. Given the earlier onset of ARHL compared to cognitive impairment caused by AD, there is a growing emphasis on early diagnosis and intervention to postpone or prevent the progression from ARHL to AD. In this context, auditory evoked potentials (AEPs) have emerged as a widely used objective auditory electrophysiological technique for both the clinical diagnosis and animal experimentation in ARHL due to their non-invasive and repeatable nature. This review focuses on the application of AEPs in AD detection and the auditory nerve system corresponding to different latencies of AEPs. Our objective was to establish AEPs as a systematic and non-invasive adjunct method for enhancing the diagnostic accuracy of AD. The success of AEPs in the early detection and prediction of AD in research settings underscores the need for further clinical application and study.
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Affiliation(s)
- Guoliang Wei
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China
| | - Xuelong Tian
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China
| | - Hong Yang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China
| | - Yinpei Luo
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China
| | - Guisong Liu
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China
| | - Shuqing Sun
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China
| | - Xing Wang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China
| | - Huizhong Wen
- Department of Neurobiology, School of Basic Medicine, Chongqing Key Laboratory of Neurobiology, Army Medical University, Chongqing, China
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Kang B, Ma J, Jeong I, Yoon S, Kim JI, Heo SJ, Oh SS. Behavioral marker-based predictive modeling of functional status for older adults with subjective cognitive decline and mild cognitive impairment: Study protocol. Digit Health 2024; 10:20552076241269555. [PMID: 39193313 PMCID: PMC11348489 DOI: 10.1177/20552076241269555] [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: 09/13/2023] [Accepted: 06/25/2024] [Indexed: 08/29/2024] Open
Abstract
Objective This study describes a research protocol for a behavioral marker-based predictive model that examines the functional status of older adults with subjective cognitive decline and mild cognitive impairment. Methods A total of 130 older adults aged ≥65 years with subjective cognitive decline or mild cognitive impairment will be recruited from the Dementia Relief Centers or the Community Service Centers. Data on behavioral and psychosocial markers (e.g. physical activity, mobility, sleep/wake patterns, social interaction, and mild behavioral impairment) will be collected using passive wearable actigraphy, in-person questionnaires, and smartphone-based ecological momentary assessments. Two follow-up assessments will be performed at 12 and 24 months after baseline. Mixed-effect machine learning models: MErf, MEgbm, MEmod, and MEctree, and standard machine learning models without random effects [random forest, gradient boosting machine] will be employed in our analyses to predict functional status over time. Results The results of this study will be fundamental for developing tailored digital interventions that apply deep learning techniques to behavioral data to predict, identify, and aid in the management of functional decline in older adults with subjective cognitive decline and mild cognitive impairment. These older adults are considered the optimal target population for preventive interventions and will benefit from such tailored strategies. Conclusions Our study will contribute to the development of self-care interventions that utilize behavioral data and machine learning techniques to provide automated analyses of the functional decline of older adults who are at risk for dementia.
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Affiliation(s)
- Bada Kang
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea
| | - Jinkyoung Ma
- Department of Nursing, Yong-In Arts and Science University, Yongin, Republic of Korea
| | - Innhee Jeong
- Department of Nursing, Graduate School of Yonsei University, Seoul, Republic of Korea
- Navy Headquarter, Gyeryong, Republic of Korea
| | - Seolah Yoon
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
- College of Nursing and Brain Korea 21 Four Project, Yonsei University, Seoul, Republic of Korea
| | - Jennifer Ivy Kim
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
| | - Seok-jae Heo
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sarah Soyeon Oh
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
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Li Z, Zhu J, Liu J, Shi M, Liu P, Guo J, Hu Z, Liu S, Yang D. Using dual-task gait to recognize Alzheimer's disease and mild cognitive impairment: a cross-sectional study. Front Hum Neurosci 2023; 17:1284805. [PMID: 38188506 PMCID: PMC10770261 DOI: 10.3389/fnhum.2023.1284805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024] Open
Abstract
Background Gait is a potential diagnostic tool for detecting mild cognitive impairment (MCI) and Alzheimer's disease (AD). Nevertheless, little attention has been paid to arm movements during walking, and there is currently no consensus on gait asymmetry. Therefore, in this study, we aimed to determine whether arm motion and gait asymmetry could be utilized for identifying MCI and AD. Methods In total, 102 middle-aged and elderly individuals were included in the final analysis and were assigned to the following three groups: AD (n = 27), MCI (n = 35), and a normal control group (n = 40). Gait and cognitive assessments were conducted for all participants. Gait detection included a single-task gait with free-speed walking and a dual-task gait with adding a cognitive task of successive minus seven to walking. Original gait parameters were collected using a wearable device featuring the MATRIX system 2.0. Gait parameters were shortened to several main gait domains through factor analysis using principal component extraction with varimax rotation. Subsequently, the extracted gait domains were used to differentiate the three groups, and the area under the receiver operating characteristic curve was calculated. Results Factor analysis of single-task gait identified five independent gait domains: rhythm symmetry, rhythm, pace asymmetry, arm motion, and variability. Factor analysis of the dual-task gait identified four gait domains: rhythm, variability, symmetry, and arm motion. During single-task walking, pace asymmetry was negatively correlated with MoCA scores and could distinguish between the AD group and the other two groups. Arm motion was not associated with MoCA scores, and did not exhibit adequate discrimination in either task. Conclusion Currently, there is no reliable evidence suggesting that arm motion can be used to recognize AD or MCI. Gait asymmetry can serve as a potential gait marker for the auxiliary diagnosis of AD but not for MCI.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Dongdong Yang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Bergman H, Borson S, Jessen F, Krolak-Salmon P, Pirani A, Rasmussen J, Rodrigo J, Taddeo D. Dementia and comorbidities in primary care: a scoping review. BMC PRIMARY CARE 2023; 24:277. [PMID: 38097969 PMCID: PMC10720181 DOI: 10.1186/s12875-023-02229-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND People with dementia (PwD) are known to have more chronic conditions compared to those without dementia, which can impact the clinical presentation of dementia, complicate clinical management and reduce overall quality of life. While primary care providers (PCPs) are integral to dementia care, it is currently unclear how PCPs adapt dementia care practices to account for comorbidities. This scoping review maps recent literature that describes the role for PCPs in the prevention, detection/diagnosis and management of dementia in the context of comorbidities, identifies critical knowledge gaps and proposes potential avenues for future research. METHODS We searched for peer-reviewed literature published between 2017-2022 in MEDLINE, Cochrane Library, and Scopus using key terms related to dementia, primary care, and comorbidity. The literature was screened for relevance by title-abstract screening and subsequent full-text screening. The prioritized papers were categorized as either 'Risk Assessment and Prevention', 'Screening, Detection, and Diagnosis' or 'Management' and were further labelled as either 'Tools and Technologies', 'Recommendations for Clinical Practice' or 'Programs and Initiatives'. RESULTS We identified 1,058 unique records in our search and respectively excluded 800 and 230 publications during title-abstract and full-text screening. Twenty-eight articles were included in our review, where ~ 50% describe the development and testing of tools and technologies that use pre-existing conditions to assess dementia risk. Only one publication provides official dementia screening guidelines for PCPs in people with pre-existing conditions. About 30% of the articles discuss managing the care of PwD, where most were anchored around models of multidisciplinary care and mitigating potentially inappropriate prescribing. CONCLUSION To our knowledge, this is the first scoping review that examines the role for PCPs in the prevention, detection/diagnosis and management of dementia in the context of comorbidities. Given our findings, we recommend that future studies: 1) further validate tools for risk assessment, timely detection and diagnosis that incorporate other health conditions; 2) provide additional guidance into how comorbidities could impact dementia care (including prescribing medication) in primary care settings; 3) incorporate comorbidities into primary care quality indicators for dementia; and 4) explore how to best incorporate dementia and comorbidities into models/frameworks of holistic, person-centred care.
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Affiliation(s)
- Howard Bergman
- Department of Family Medicine, McGill University, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montreal, QC, H3S 1Z1, Canada.
| | - Soo Borson
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Frank Jessen
- Department of Psychiatry, Medical Faculty, University of Cologne, Cologne, Germany
| | | | | | | | - Jesus Rodrigo
- Spanish Alzheimer's Confederation (Confederación Española de Alzheimer), Pamplona, Spain
| | - Daiana Taddeo
- Italian College of General Practitioners and Primary Care (SIMG - Società Italiana Di Medicina Genrale E Cure Primarie), Florence, Italy
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Bohn L, Drouin SM, McFall GP, Rolfson DB, Andrew MK, Dixon RA. Machine learning analyses identify multi-modal frailty factors that selectively discriminate four cohorts in the Alzheimer's disease spectrum: a COMPASS-ND study. BMC Geriatr 2023; 23:837. [PMID: 38082372 PMCID: PMC10714519 DOI: 10.1186/s12877-023-04546-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Frailty indicators can operate in dynamic amalgamations of disease conditions, clinical symptoms, biomarkers, medical signals, cognitive characteristics, and even health beliefs and practices. This study is the first to evaluate which, among these multiple frailty-related indicators, are important and differential predictors of clinical cohorts that represent progression along an Alzheimer's disease (AD) spectrum. We applied machine-learning technology to such indicators in order to identify the leading predictors of three AD spectrum cohorts; viz., subjective cognitive impairment (SCI), mild cognitive impairment (MCI), and AD. The common benchmark was a cohort of cognitively unimpaired (CU) older adults. METHODS The four cohorts were from the cross-sectional Comprehensive Assessment of Neurodegeneration and Dementia dataset. We used random forest analysis (Python 3.7) to simultaneously test the relative importance of 83 multi-modal frailty indicators in discriminating the cohorts. We performed an explainable artificial intelligence method (Tree Shapley Additive exPlanation values) for deep interpretation of prediction effects. RESULTS We observed strong concurrent prediction results, with clusters varying across cohorts. The SCI model demonstrated excellent prediction accuracy (AUC = 0.89). Three leading predictors were poorer quality of life ([QoL]; memory), abnormal lymphocyte count, and abnormal neutrophil count. The MCI model demonstrated a similarly high AUC (0.88). Five leading predictors were poorer QoL (memory, leisure), male sex, abnormal lymphocyte count, and poorer self-rated eyesight. The AD model demonstrated outstanding prediction accuracy (AUC = 0.98). Ten leading predictors were poorer QoL (memory), reduced olfaction, male sex, increased dependence in activities of daily living (n = 6), and poorer visual contrast. CONCLUSIONS Both convergent and cohort-specific frailty factors discriminated the AD spectrum cohorts. Convergence was observed as all cohorts were marked by lower quality of life (memory), supporting recent research and clinical attention to subjective experiences of memory aging and their potentially broad ramifications. Diversity was displayed in that, of the 14 leading predictors extracted across models, 11 were selectively sensitive to one cohort. A morbidity intensity trend was indicated by an increasing number and diversity of predictors corresponding to clinical severity, especially in AD. Knowledge of differential deficit predictors across AD clinical cohorts may promote precision interventions.
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Affiliation(s)
- Linzy Bohn
- Department of Psychology, University of Alberta, P217 Biological Sciences Building, Edmonton, AB, T6G 2E9, Canada.
- Neuroscience and Mental Health Institute, University of Alberta, 2-132 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada.
| | - Shannon M Drouin
- Department of Psychology, University of Alberta, P217 Biological Sciences Building, Edmonton, AB, T6G 2E9, Canada
- Neuroscience and Mental Health Institute, University of Alberta, 2-132 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
| | - G Peggy McFall
- Department of Psychology, University of Alberta, P217 Biological Sciences Building, Edmonton, AB, T6G 2E9, Canada
- Neuroscience and Mental Health Institute, University of Alberta, 2-132 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
| | - Darryl B Rolfson
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, 13-135 Clinical Sciences Building, Edmonton, AB, T6G 2G3, Canada
| | - Melissa K Andrew
- Department of Medicine, Division of Geriatric Medicine, Dalhousie University, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada
| | - Roger A Dixon
- Department of Psychology, University of Alberta, P217 Biological Sciences Building, Edmonton, AB, T6G 2E9, Canada
- Neuroscience and Mental Health Institute, University of Alberta, 2-132 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
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Mudalige D, Guan DX, Ghahremani M, Ismail Z. Longitudinal Associations Between Mild Behavioral Impairment, Sleep Disturbance, and Progression to Dementia. J Alzheimers Dis Rep 2023; 7:1323-1334. [PMID: 38143778 PMCID: PMC10741901 DOI: 10.3233/adr-230086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/07/2023] [Indexed: 12/26/2023] Open
Abstract
Background Clinical guidelines recommend incorporating non-cognitive markers like mild behavioral impairment (MBI) and sleep disturbance (SD) into dementia screening to improve detection. Objective We investigated the longitudinal associations between MBI, SD, and incident dementia. Methods Participant data were from the National Alzheimer's Coordinating Center in the United States. MBI was derived from the Neuropsychiatric Inventory Questionnaire (NPI-Q) using a published algorithm. SD was determined using the NPI-Q nighttime behaviors item. Cox proportional hazard regressions with time-dependant variables for MBI, SD, and cognitive diagnosis were used to model associations between baseline 1) MBI and incident SD (n = 11,277); 2) SD and incident MBI (n = 10,535); 3) MBI with concurrent SD and incident dementia (n = 13,544); and 4) MBI without concurrent SD and incident dementia (n = 11,921). Models were adjusted for first-visit age, sex, education, cognitive diagnosis, race, and for multiple comparisons using the Benjamini-Hochberg method. Results The rate of developing SD was 3.1-fold higher in older adults with MBI at baseline compared to those without MBI (95% CI: 2.8-3.3). The rate of developing MBI was 1.5-fold higher in older adults with baseline SD than those without SD (95% CI: 1.3-1.8). The rate of developing dementia was 2.2-fold greater in older adults with both MBI and SD, as opposed to SD alone (95% CI:1.9-2.6). Conclusions There is a bidirectional relationship between MBI and SD. Older adults with SD develop dementia at higher rates when co-occurring with MBI. Future studies should explore the mechanisms underlying these relationships, and dementia screening may be improved by assessing for both MBI and SD.
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Affiliation(s)
| | | | - Maryam Ghahremani
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, Department of Community Health Sciences, Department of Clinical Neurosciences, Hotchkiss Brain Institute, O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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Rudd KD, Lawler K, Callisaya ML, Alty J. Investigating the associations between upper limb motor function and cognitive impairment: a scoping review. GeroScience 2023; 45:3449-3473. [PMID: 37337026 PMCID: PMC10643613 DOI: 10.1007/s11357-023-00844-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/26/2023] [Indexed: 06/21/2023] Open
Abstract
Upper limb motor function is a potential new biomarker of cognitive impairment and may aid discrimination from healthy ageing. However, it remains unclear which assessments to use. This study aimed to explore what methods have been used and to describe associations between upper limb function and cognitive impairment. A scoping review was conducted using PubMed, CINAHL and Web of Science. A systematic search was undertaken, including synonyms for key concepts 'upper limb', 'motor function' and 'cognitive impairment'. Selection criteria included tests of upper limb motor function and impaired cognition in adults. Analysis was by narrative synthesis. Sixty papers published between 1998 and 2022, comprising 41,800 participants, were included. The most common assessment tasks were finger tapping, Purdue Pegboard Test and functional tasks such as writing. Protocols were diverse in terms of equipment used and recording duration. Most participants were recruited from clinical settings. Alzheimer's Disease was the most common cause of cognitive impairment. Results were mixed but, generally, slower speed, more errors, and greater variability in upper limb movement variables was associated with cognitive impairment. This review maps the upper limb motor function assessments used and summarises the available evidence on how these associate with cognitive impairment. It identifies research gaps and may help guide protocols for future research. There is potential for upper limb motor function to be used in assessments of cognitive impairment.
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Affiliation(s)
- Kaylee D Rudd
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Katherine Lawler
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Michele L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Peninsula Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jane Alty
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia.
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
- Neurology Department, Royal Hobart Hospital, Hobart, Tasmania, Australia.
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Diao Y, Lanz B, Jelescu IO. Subject classification and cross-time prediction based on functional connectivity and white matter microstructure features in a rat model of Alzheimer's using machine learning. Alzheimers Res Ther 2023; 15:193. [PMID: 37936236 PMCID: PMC10629161 DOI: 10.1186/s13195-023-01328-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/09/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND The pathological process of Alzheimer's disease (AD) typically takes decades from onset to clinical symptoms. Early brain changes in AD include MRI-measurable features such as altered functional connectivity (FC) and white matter degeneration. The ability of these features to discriminate between subjects without a diagnosis, or their prognostic value, is however not established. METHODS The main trigger mechanism of AD is still debated, although impaired brain glucose metabolism is taking an increasingly central role. Here, we used a rat model of sporadic AD, based on impaired brain glucose metabolism induced by an intracerebroventricular injection of streptozotocin (STZ). We characterized alterations in FC and white matter microstructure longitudinally using functional and diffusion MRI. Those MRI-derived measures were used to classify STZ from control rats using machine learning, and the importance of each individual measure was quantified using explainable artificial intelligence methods. RESULTS Overall, combining all the FC and white matter metrics in an ensemble way was the best strategy to discriminate STZ rats, with a consistent accuracy over 0.85. However, the best accuracy early on was achieved using white matter microstructure features, and later on using FC. This suggests that consistent damage in white matter in the STZ group might precede FC. For cross-timepoint prediction, microstructure features also had the highest performance while, in contrast, that of FC was reduced by its dynamic pattern which shifted from early hyperconnectivity to late hypoconnectivity. CONCLUSIONS Our study highlights the MRI-derived measures that best discriminate STZ vs control rats early in the course of the disease, with potential translation to humans.
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Affiliation(s)
- Yujian Diao
- Animal Imaging and Technology Section, CIBM Center for Biomedical Imaging, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Laboratory for Functional and Metabolic Imaging, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Bernard Lanz
- Animal Imaging and Technology Section, CIBM Center for Biomedical Imaging, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Ileana Ozana Jelescu
- Animal Imaging and Technology Section, CIBM Center for Biomedical Imaging, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Guan DX, Smith EE, Pike GB, Ismail Z. Persistence of neuropsychiatric symptoms and dementia prognostication: A comparison of three operational case definitions of mild behavioral impairment. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12483. [PMID: 37786862 PMCID: PMC10541800 DOI: 10.1002/dad2.12483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 07/10/2023] [Accepted: 08/30/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION We compared three operational case definitions of mild behavioral impairment (MBI) in the context of MBI prevalence estimates and dementia risk modeling. METHODS Participants were dementia-free older adults (n = 13701) from the National Alzheimer's Coordinating Center. Operational case definitions of MBI were generated based on neuropsychiatric symptoms at one (OV), two-consecutive (TCV), or more than two-thirds (TTV) of dementia-free study visits. Definitions were compared in prevalence and in Cox regressions using MBI to predict incident dementia. RESULTS OV MBI was the most prevalent (54.4%), followed by TCV (32.3%) and TTV (26.7%) MBI. However, OV MBI had the lowest rate of incident dementia (hazard ratio [HR] = 2.54, 95% confidence interval [CI]: 2.33-2.78) and generated poorer model metrics than TCV MBI (HR = 4.06, 95% CI: 3.74-4.40) and TTV MBI (HR = 5.77, 95% CI: 5.32-6.26). DISCUSSION Case ascertainment with longer timeframe MBI operational case definitions may more accurately define groups at risk of dementia in datasets lacking tools designed to detect MBI.Highlights: Mild behavioral impairment (MBI) can identify older adults at risk of dementia.Neuropsychiatric symptom (NPS) assessment tools can be proxy measures for MBI.Hazard for dementia was highest for MBI defined by NPS presence at more than two-thirds of visits.
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Affiliation(s)
| | - Eric E. Smith
- Departments of Clinical Neurosciences and Community Health SciencesHotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - G. Bruce Pike
- Departments of Radiology and Clinical NeurosciencesHotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - Zahinoor Ismail
- Departments of PsychiatryClinical Neurosciences, and Community Health Sciences, Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of CalgaryCalgaryAlbertaCanada
- Clinical and Biomedical SciencesFaculty of Health and Life Sciences, University of ExeterExeterUK
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Salvadori E. Intelligence, cognition, and major neurocognitive disorders: From constructs to measures. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 5:100185. [PMID: 37736144 PMCID: PMC10510085 DOI: 10.1016/j.cccb.2023.100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/15/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
The study of intelligence's role in development of major neurocognitive disorders (MND) is influenced by the approaches used to conceptualize and measure these constructs. In the field of cognitive impairment, the use of single 'intelligence' tests is a common approach to estimate intelligence. Despite being a practical compromise between feasibility and constructs, variance of these tests is only partially explained by general intelligence, and some tools (e.g., lexical tasks for premorbid intelligence) presented inherent limitations. Alternatively, factorial models allow an actual measure of intelligence as a latent factor superintending all mental abilities. Royall and colleagues used structural equation modeling to decompose the Spearman's general intelligence factor g in δ (shared variance across cognitive and functional measures) and g' (shared variance across cognitive measures only). Authors defined δ as the 'cognitive correlates of functional status', and thus a 'phenotype for all cause dementia'. Compared to g', δ explained a little rate of cognitive measures' variance, but it demonstrated a higher accuracy in dementia case-finding. From the methodological perspective, given g 'indifference' to its indicators, further studies are needed to identify the minimal set of tools necessary to extract g, and to test also non-cognitive variables as measures of δ. From the clinical perspective, general intelligence seems to influence MND presence and severity more than domain specific cognitive abilities. Giving δ 'blindness' to etiology, its association with biomarkers and contribution to differential diagnosis might be limited. Classical neuropsychological approaches based on patterns of performances at cognitive tests remained fundamental for differential diagnosis.
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Affiliation(s)
- Emilia Salvadori
- Department of Biomedical and Clinical Sciences, University of Milan, Milan 20157, Italy
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Alty J, Lawler K, Salmon K, McDonald S, Stuart K, Cleary A, Ma J, Rudd K, Wang X, Chiranakorn-Costa S, Collins J, Merl H, Lin X, Vickers JC. A new one-stop interdisciplinary cognitive clinic model tackles rural health inequality and halves the time to diagnosis: Benchmarked against a national dementia registry. Int J Geriatr Psychiatry 2023; 38:e5988. [PMID: 37592719 DOI: 10.1002/gps.5988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/01/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVES Unequal access to cognitive assessments is a major barrier to timely diagnosis, especially for those living in rural or remote areas. 'One-stop' cognitive clinic models are a proposed solution, but few such clinics exist. We evaluate the implementation of a new one-stop State-wide clinic model in Tasmania, Australia, where 27% of people live in rural/remote areas. METHODS A novel single-visit protocol has been developed, comprising interdisciplinary medical and cognitive assessments, research participation, consensus diagnosis and management plan. A cross-sectional evaluation was undertaken using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework and results benchmarked against the national Australian Dementia Network Registry. RESULTS Over the first 52 consecutive weekly clinics: Reach: 130 adults were assessed (mean age [SD] 70.12 years [10.31]; 59.2% female) with 40 (36.8%) from rural/remote areas. EFFECTIVENESS 98.5% (128/130) received a same-day diagnosis: 30.1% (n = 40) Subjective Cognitive Decline, 35.4% (46) Mild Cognitive Impairment, 33.1% (43) dementia and one case inconclusive. Adoption: 22.9% (156) of General Practitioners referred patients. IMPLEMENTATION Nearly all 'ideal' diagnostic clinical practices were met and >90% of surveyed patients reported 'good/very good' clinic experience. The wait from referral to diagnosis was 2 months shorter than other national Registry clinics (78 vs. 133 days). CONCLUSIONS This 'one-stop' model provides an interdisciplinary consensus cognitive diagnosis quickly and is well accepted; this may reduce health inequities especially for people living in rural/remote areas. This cognitive clinic model may be of relevance to other centres worldwide and also provides a rich data source for research studies.
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Affiliation(s)
- Jane Alty
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
- Royal Hobart Hospital, Hobart, Australia
- School of Medicine, University of Tasmania, Hobart, Australia
| | - Katherine Lawler
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Katharine Salmon
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
| | - Scott McDonald
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
- Royal Hobart Hospital, Hobart, Australia
| | - Kimberley Stuart
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
| | - Alison Cleary
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
- Royal Hobart Hospital, Hobart, Australia
| | - Jak Ma
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
- I-Med Radiology Network Hobart, Hobart, Australia
| | - Kaylee Rudd
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
| | - Xinyi Wang
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
| | | | - Jessica Collins
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
| | - Helga Merl
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
| | - Xiaoping Lin
- Monash University, School of Public Health and Preventive Medicine, Melbourne, Australia
| | - James C Vickers
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
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Souza EHEE, Leão LL, de Paula AMB, Rodrigues VD, Deslandes AC, Laks J, Monteiro RS. Floor Maze Test is capable of differentiating spatial navigation between frail and pre-frail institutionalized older persons. Dement Neuropsychol 2023; 17:e20220070. [PMID: 37496523 PMCID: PMC10367969 DOI: 10.1590/1980-5764-dn-2022-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 02/06/2023] [Accepted: 03/29/2023] [Indexed: 07/28/2023] Open
Abstract
Investigation of the association between physical frailty and cognitive performance through spatial navigation is important to enable the identification of individuals with cognitive impairment and physical comorbidity. Objective To analyze the association between spatial navigation and frailty in frail and pre-frail institutionalized older adults. Methods Forty older people of both sexes, aged 60 years or over, residing in four Brazilian Long-Term Care Facilities (LTCFs) participated in this study. The following tests were applied: Mini-Mental State Examination (MMSE), 2.44m Timed Up and Go, Floor Maze Test (FMT), and Fried's frailty criteria. For data analysis, the Mann-Whitney and independent t-tests were used to compare the groups (frail x pre-frail), principal component analysis was used to explore the main variables related to the data variance, and binary logistic regression to estimate associations. Results There was a significant difference in performance in the FMT immediate maze time (IMT) (p=0.02) and in the delayed maze time (DMT) (p=0.009) between the pre-frail and frail older adults. An association between FMT DMT performance and frailty was found, showing that older people with shorter times on the DMT (better performance) had approximately four times the chance of not being frail (odds ratio - OR=4.219, 95% confidence interval - 95%CI 1.084-16.426, p=0.038). Conclusion Frailty is associated with impaired spatial navigation ability in institutionalized older adults, regardless of gait speed performance.
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Affiliation(s)
| | - Luana Lemos Leão
- Universidade Estadual de Montes Claros, Programa de Pós-Graduação em Ciências da Saúde, Montes Claros MG, Brazil
| | | | - Vinícius Dias Rodrigues
- Universidade Estadual de Montes Claros, Programa de Pós-Graduação em Ciências da Saúde, Montes Claros MG, Brazil
| | - Andréa Camaz Deslandes
- Universidade Federal do Rio de Janeiro, Instituto de Psiquiatria, Rio de Janeiro RJ, Brazil
| | - Jerson Laks
- Universidade Federal do Rio de Janeiro, Instituto de Psiquiatria, Rio de Janeiro RJ, Brazil
| | - Renato Sobral Monteiro
- Universidade Estadual de Montes Claros, Programa de Pós-Graduação em Ciências da Saúde, Montes Claros MG, Brazil
- Universidade Federal Fluminense, Programa de Pós-Graduação em Neurologia/Neurociência, Niterói RJ, Brazil
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22
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Knapstad MK, Naterstad I, Bogen B. The association between cognitive impairment, gait speed, and Walk ratio. Front Aging Neurosci 2023; 15:1092990. [PMID: 37273651 PMCID: PMC10233044 DOI: 10.3389/fnagi.2023.1092990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/26/2023] [Indexed: 06/06/2023] Open
Abstract
Background Gait speed has been found to be associated with cognitive function. However, gait speed is an unspecific measure that may not be informative about gait patterns. The Walk ratio (step length divided by step frequency) can be measured without specialized equipment, and has been suggested as an indicator of central gait control. However, the association with cognitive function is unknown. Research question Is there a relationship between Walk ratio and cognitive function, and gait speed and cognitive function? Methods This was a systematic literature review of studies where spatiotemporal gait parameters was reported in populations with cognitive impairment. The search was performed through PubMed, PEDro, AMED, Cochrane, Embase, MEDLINE, and PsycINFO. The studies had to contain either the Walk ratio, or report average step length and average step frequency. In the latter case, the average step length was divided by the average step frequency. The studies also had to report gait speed and the minimal mental state examination (MMSE). Studies testing patients on treadmills or that did not state the exclusion of patients with neurologic or orthopedic diseases, possible affecting gait ability, were excluded. Results A total of 24 studies were included, consisting of 909 patients with cognitive impairment and 4,108 healthy controls. The patient group had a lower Walk ratio (mean difference 0.07, p ≤ 0.001) and gait speed (mean difference 0.26, p ≤ 0.001) than the healthy controls. Using linear regression models, we found an association between the MMSE and the Walk ratio (R2 = 0.29, p < 0.001) and gait speed (R2 = 0.41, p < 0.001) in separate, unadjusted models. In a final model with Walk ratio, gait speed and age, Walk ratio was not significantly associated with MMSE, while gait speed was. Significance Our results suggest that preferred gait speed may be preferable to the Walk ratio when assessing older adults with cognitive impairment.
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Affiliation(s)
- Mari Kalland Knapstad
- Department of Health and Function, Western Norway University of Applied Sciences, Bergen, Hordaland, Norway
- Department of Otorhinolaryngology & Head and Neck Surgery, Haukeland University Hospital, Bergen, Hordaland, Norway
| | - Ingvill Naterstad
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway
| | - Bård Bogen
- Department of Health and Function, Western Norway University of Applied Sciences, Bergen, Hordaland, Norway
- Department of rehabilitation services, Haraldsplass Deaconal Hospital (HDS), Bergen, Hordaland, Norway
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23
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Cai F, Patharkar A, Wu T, Lure FYM, Chen H, Chen VC. STRIDE: Systematic Radar Intelligence Analysis for ADRD Risk Evaluation with Gait Signature Simulation and Deep Learning. IEEE SENSORS JOURNAL 2023; 23:10998-11006. [PMID: 37547101 PMCID: PMC10399976 DOI: 10.1109/jsen.2023.3263071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Abnormal gait is a significant non-cognitive biomarker for Alzheimer's disease (AD) and AD-related dementia (ADRD). Micro-Doppler radar, a non-wearable technology, can capture human gait movements for potential early ADRD risk assessment. In this research, we propose to design STRIDE integrating micro-Doppler radar sensors with advanced artificial intelligence (AI) technologies. STRIDE embeds a new deep learning (DL) classification framework. As a proof of concept, we develop a "digital-twin" of STRIDE, consisting of a human walking simulation model and a micro-Doppler radar simulation model, to generate a gait signature dataset. Taking established human walking parameters, the walking model simulates individuals with ADRD under various conditions. The radar model based on electromagnetic scattering and the Doppler frequency shift model is employed to generate micro-Doppler signatures from different moving body parts (e.g., foot, limb, joint, torso, shoulder, etc.). A band-dependent DL framework is developed to predict ADRD risks. The experimental results demonstrate the effectiveness and feasibility of STRIDE for evaluating ADRD risk.
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Affiliation(s)
- Fulin Cai
- School of Computing and Augmented Intelligence and ASU-Mayo Center for Innovative Imaging, Arizona State University, Tempe, AZ 85287, USA
| | - Abhidnya Patharkar
- School of Computing and Augmented Intelligence and ASU-Mayo Center for Innovative Imaging, Arizona State University, Tempe, AZ 85287, USA
| | - Teresa Wu
- School of Computing and Augmented Intelligence and ASU-Mayo Center for Innovative Imaging, Arizona State University, Tempe, AZ 85287, USA
| | | | - Harry Chen
- MS Technologies Corp, Rockville, MD 20580, USA
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24
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Ismail Z, Babulal GM. Attitudinal adjustment about dementia awareness and assessment: finetuning inclusion, diversity, and measurement of behavioral and psychological symptoms. Int Psychogeriatr 2023; 35:7-10. [PMID: 36193702 PMCID: PMC9905302 DOI: 10.1017/s1041610222000886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, Community Health Sciences, and Pathology and Laboratory Medicine, Hotchkiss Brain Institute & O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Ganesh M Babulal
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
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25
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Saposnik G, Ismail Z, Rivard AM, Knifton D, Bromfield G, Terzaghi M, Montoya A, Menard MC. Decision making under uncertainty in the diagnosis and management of Alzheimer's Disease in primary care: A study protocol applying concepts from neuroeconomics. Front Med (Lausanne) 2022; 9:997277. [PMID: 36330061 PMCID: PMC9623110 DOI: 10.3389/fmed.2022.997277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/20/2022] [Indexed: 09/07/2024] Open
Abstract
Background The current management of patients with Dementia, primarily with Alzheimer's Disease (AD) is rapidly evolving. However, limited information is available about the current gaps and decision-making in primary care. Objectives To evaluate factors associated with gaps, risk preferences regarding diagnostic and therapeutic choices in the management of patients with AD by primary care physicians (PCP) from across Canada. Methods We propose a non-interventional, cross-sectional pilot study involving 120 primary care physicians referred from the College of Family Physicians of Canada to assess diagnostic and therapeutic decisions in the management of ten simulated AD-related case-scenarios commonly encountered in clinical practice. We initially describe the current landscape and gaps regarding diagnostic and therapeutic challenges in the management of patients with AD in primary care. Then, we provide concepts from behavioral economics and neuroeconomics applied to medical decision-making. Specifically, we include standardized tests to measure risk aversion, physicians' reactions to uncertainty, and questions related to risk preferences in different domains. Finally, we summarize the protocol to be implemented to address our goals. The primary study outcome is the proportion of participants that elect to defer initial investigations to the specialist and the associated factors. Secondary outcomes include the proportion of PCP willing to order cerebral spinal fluid studies, PET scans, or initiate treatment according to the simulated case-scenarios. The study will be conducted in English and French. Conclusions The study findings will contribute a better understanding of relevant factors associated with diagnostic and therapeutic decisions of PCP in the management of AD, identifying participant's preferences and evaluating the role of behavioral aspects such tolerance to uncertainty, aversion to ambiguity, and therapeutic inertia.
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Affiliation(s)
- Gustavo Saposnik
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Decision Neuroscience Unit, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- NeuroeconSolutions, Neuroeconsolutions.com, Toronto, ON, Canada
| | - Zahinoor Ismail
- Departments of Psychiatry and Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Anne-Marie Rivard
- Policy and Healthcare Ecosystem, Hoffmann-La Roche, Mississauga, ON, Canada
| | - Debbie Knifton
- Policy and Healthcare Ecosystem, Hoffmann-La Roche, Mississauga, ON, Canada
| | - Gillian Bromfield
- Policy and Healthcare Ecosystem, Hoffmann-La Roche, Mississauga, ON, Canada
| | - Maria Terzaghi
- Decision Neuroscience Unit, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- NeuroeconSolutions, Neuroeconsolutions.com, Toronto, ON, Canada
| | - Alonso Montoya
- Medical Affairs Neuroscience, Hoffmann-La Roche, Mississauga, ON, Canada
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26
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O’Toole D. Rapid recommendations: Updates from 2020 guidelines: part 2. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:36-38. [PMID: 35063982 PMCID: PMC9810042 DOI: 10.46747/cfp.680136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Danielle O’Toole
- Practising family physician in Academic Family Medicine and Assistant Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont
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27
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Ramírez F, Gutiérrez M. Dual-Task Gait as a Predictive Tool for Cognitive Impairment in Older Adults: A Systematic Review. Front Aging Neurosci 2021; 13:769462. [PMID: 35002676 PMCID: PMC8740025 DOI: 10.3389/fnagi.2021.769462] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/06/2021] [Indexed: 01/21/2023] Open
Abstract
The use of the dual-task model as a cognitive-motor interface has been extensively investigated in cross-sectional studies as a training task in cognitive impairment. However, few existing longitudinal studies prove the usefulness of this tool as a clinical marker of cognitive impairment in older people. What is the evidence in prospective studies about dual-task gait as a predictor of cognitive impairment in older adults? This study aims to review and discuss the current state of knowledge in prospective studies on the use of dual-task gait as a predictive tool for cognitive impairment in older adults. The methodology used was a systematic review, according to the PRISMA criteria for the search, summarize and report. A search in 3 databases (Pubmed, Web of Science, and Scopus) was carried out until April 2021. The search terms used were: "(gait OR walking) AND (cognitive decline) AND (dual-task) AND (follow-up OR longitudinal OR long-term OR prospective OR cohort OR predict)." We included prospective research articles with older people with cognitive evaluation at the beginning and the end of the follow-up and dual-task gait paradigm as initial evaluation associated with the presentation of cognitive impairment prediction using any dual-task gait parameters. After exclusion criteria, 12 studies were reviewed. The results indicate that eight studies consider dual-task gait parameters a useful cognitive-motor tool, finding that some of the evaluated parameters of dual-task gait significantly correlate with cognitive impairment over time. The most promising DT parameters associated with cognitive impairment prediction seem to be gait speed, speed cost, DT time, numbers of words during DT, among others. In sum, this study reviews the variety of dual-task gait parameters and their relevance as a simple tool for early cognitive impairment screening, opening a diagnostic window for the screening of cognitive impairment in older people.
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Affiliation(s)
- Felipe Ramírez
- Programa Magíster en Kinesiología Gerontológica, Facultad de Ciencias, Universidad Mayor, Santiago, Chile
| | - Myriam Gutiérrez
- Escuela de Kinesiología, Facultad de Ciencias de la Salud, Universidad de Las Américas, Santiago, Chile
- Centro de Estudio del Movimiento Humano, Escuela de Kinesiología, Facultad de Odontología y Salud, Universidad Diego Portales, Santiago, Chile
- Unidad de Cerebro Saludable, Hospital Clínico Universidad de Chile, Santiago, Chile
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Kasiukiewicz A, Magnuszewski L, Swietek M, Wojszel ZB. The Performance of Dual-Task Tests Can Be a Combined Neuro-Psychological and Motor Marker of Mild Cognitive Impairment, Depression and Dementia in Geriatric Patients-A Cross-Sectional Study. J Clin Med 2021; 10:5358. [PMID: 34830639 PMCID: PMC8620119 DOI: 10.3390/jcm10225358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/25/2021] [Accepted: 11/10/2021] [Indexed: 01/10/2023] Open
Abstract
The study aims to assess the performance of dual-task tests in the geriatric population and their association with the cognitive status of the patients. METHODS Patients admitted to the Department of Geriatrics, Hospital of the Ministry of Interior and Administration on Bialystok, Poland, in 2019 and 2020 were enrolled in the study. Data on the patients' clinical, functional, and cognitive status were collected based on the comprehensive geriatric assessment. Dual-task tests included Timed Up and Go (TUG) test while counting backward (CB7), enumerating animals (EA), and holding a cup (TUG M). RESULTS 250 patients were included in the study, with a median age of 81.5 years (IQR 76-86) and most above 75 years of age (80.8%). Only 29 (11.6%) of study participants had no cognitive or mood disorders. Depression was diagnosed in 30.4%, MCI in 12%, and dementia in 38.4% of cases with median Mini-Mental Score Evaluation (MMSE) 17 (12-20) points. Dual-task TUG CB7 results did not differ between cognitive conditions of patients. TUG EA differed between healthy controls and other cognitive groups and TUG between healthy controls and depression and dementia, but not mild cognitive impairment (MCI). The performance of all dual-task tests differed in patients with and without dementia. Ability to finish TUG CB7 was low even in the group without dementia. There were statistically significant differences in median scores of MMSE and Clock Drawing Test (CDT) between patients who were able or not to finish single and dual-task gait tests. CONCLUSION Dual-task test results and the performance of these tasks can differentiate patients with depression, MCI and dementia compared to healthy controls in the geriatric population.
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Affiliation(s)
- Agnieszka Kasiukiewicz
- Department of Geriatrics, Medical University of Bialystok, 15-471 Bialystok, Poland;
- Department of Geriatrics, Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland; (L.M.); (M.S.)
| | - Lukasz Magnuszewski
- Department of Geriatrics, Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland; (L.M.); (M.S.)
- Doctoral Studies, Department of Geriatrics, Faculty of Health Sciences, Medical University of Bialystok, 15-471 Bialystok, Poland
| | - Marta Swietek
- Department of Geriatrics, Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland; (L.M.); (M.S.)
- Doctoral Studies, Department of Geriatrics, Faculty of Health Sciences, Medical University of Bialystok, 15-471 Bialystok, Poland
| | - Zyta Beata Wojszel
- Department of Geriatrics, Medical University of Bialystok, 15-471 Bialystok, Poland;
- Department of Geriatrics, Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland; (L.M.); (M.S.)
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29
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Pieruccini-Faria F, Black SE, Masellis M, Smith EE, Almeida QJ, Li KZH, Bherer L, Camicioli R, Montero-Odasso M. Gait variability across neurodegenerative and cognitive disorders: Results from the Canadian Consortium of Neurodegeneration in Aging (CCNA) and the Gait and Brain Study. Alzheimers Dement 2021; 17:1317-1328. [PMID: 33590967 PMCID: PMC8451764 DOI: 10.1002/alz.12298] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/27/2020] [Accepted: 01/01/2021] [Indexed: 01/01/2023]
Abstract
Introduction Gait impairment is common in neurodegenerative disorders. Specifically, gait variability—the stride‐to‐stride fluctuations in distance and time—has been associated with neurodegeneration and cognitive impairment. However, quantitative comparisons of gait impairments across the cognitive spectrum of dementias have not been systematically investigated. Methods Older adults (N = 500) with subjective cognitive impairment, Parkinson disease (PD), mild cognitive impairment (MCI), PD‐MCI, Alzheimer's disease (AD), PD‐dementia, Lewy body dementia, and frontotemporal dementia, as well cognitive normal controls, who were assessed for their gait and cognitive performance. Results Factor analyses grouped 11 quantitative gait parameters and identified four independent gait domains: rhythm, pace, variability, and postural control, for group comparisons and classification analysis. Among these domains, only high gait variability was associated with lower cognitive performance and accurately discriminated AD from other neurodegenerative and cognitive conditions. Discussion Our findings indicate that high gait variability is a marker of cognitive‐cortical dysfunction, which can help to identify Alzheimer's disease dementia.
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Affiliation(s)
- Frederico Pieruccini-Faria
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada.,Schulich School of Medicine & Dentistry, Department of Medicine and Division of Geriatric Medicine, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, Department of Epidemiology and Biostatistics, University of Western Ontario, London, N6C 0A7, Canada
| | - Sandra E Black
- Department of Medicine and Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mario Masellis
- Department of Medicine and Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Eric E Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Quincy J Almeida
- Movement Disorders Research & Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Karen Z H Li
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
| | - Louis Bherer
- Departments of Medicine, Montreal Heart Institute and Institut Universitaire de Gériatrie de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Richard Camicioli
- Department of Medicine, Division of Neurology and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada.,Schulich School of Medicine & Dentistry, Department of Medicine and Division of Geriatric Medicine, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, Department of Epidemiology and Biostatistics, University of Western Ontario, London, N6C 0A7, Canada
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