1
|
Lau CI, Liu MN, Cheng FY, Wang HC, Walsh V, Liao YY. Can transcranial direct current stimulation combined with interactive computerized cognitive training boost cognition and gait performance in older adults with mild cognitive impairment? a randomized controlled trial. J Neuroeng Rehabil 2024; 21:26. [PMID: 38365761 PMCID: PMC10874043 DOI: 10.1186/s12984-024-01313-0] [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: 11/22/2022] [Accepted: 01/24/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Older adults with Mild Cognitive Impairment (MCI) are often subject to cognitive and gait deficits. Interactive Computerized Cognitive Training (ICCT) may improve cognitive function; however, the effect of such training on gait performance is limited. Transcranial Direct Current Stimulation (tDCS) improves cognition and gait performance. It remains unclear whether combining tDCS with ICCT produces an enhanced synergistic effect on cognition and complex gait performance relative to ICCT alone. This study aimed to compare the effects of tDCS combined with ICCT on cognition and gait performance in older adults with MCI. METHOD Twenty-one older adults with MCI were randomly assigned to groups receiving either anodal tDCS and ICCT ( tDCS + ICCT ) or sham tDCS and ICCT ( sham + ICCT ). Participants played Nintendo Switch cognitive games for 40 min per session, simultaneously receiving either anodal or sham tDCS over the left dorsolateral prefrontal cortex for the first 20 min. Cognitive and gait assessments were performed before and after 15 training sessions. RESULTS The global cognition, executive function, and working-memory scores improved in both groups, but there were no significant interaction effects on cognitive outcomes. Additionally, the group × time interactions indicated that tDCS + ICCT significantly enhanced dual-task gait performance in terms of gait speed (p = 0.045), variability (p = 0.016), and dual-task cost (p = 0.039) compared to sham + ICCT. CONCLUSION The combined effect of tDCS and ICCT on cognition was not superior to that of ICCT alone; however, it had a significant impact on dual-task gait performance. Administering tDCS as an adjunct to ICCT may thus provide additional benefits for older adults with MCI. TRIAL REGISTRATION This trial was registered at http://www. CLINICALTRIALS in.th/ (TCTR 20,220,328,009).
Collapse
Affiliation(s)
- Chi Ieong Lau
- Dementia Center, Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- Applied Cognitive Neuroscience Group, Institute of Cognitive Neuroscience, University College London, London, UK
- Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei, Taiwan
- College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Mu-N Liu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fang-Yu Cheng
- Institute of Long-Term Care, MacKay Medical College, New Taipei, Taiwan
| | - Han-Cheng Wang
- Dementia Center, Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Vincent Walsh
- Applied Cognitive Neuroscience Group, Institute of Cognitive Neuroscience, University College London, London, UK
| | - Ying-Yi Liao
- Department of Gerontological Health Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
| |
Collapse
|
2
|
Poosri T, Boripuntakul S, Sungkarat S, Kamnardsiri T, Soontornpun A, Pinyopornpanish K. Gait smoothness during high-demand motor walking tasks in older adults with mild cognitive impairment. PLoS One 2024; 19:e0296710. [PMID: 38241332 PMCID: PMC10798528 DOI: 10.1371/journal.pone.0296710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/16/2023] [Indexed: 01/21/2024] Open
Abstract
Early signs of Mild Cognitive Impairment (MCI)-related gait deficits may be detected through the performance of complex walking tasks that require high gait control. Gait smoothness is a robust metric of overall body stability during walking. This study aimed to explore gait smoothness during complex walking tasks in older adults with and without MCI. Participants were 18 older adults with MCI (mean age = 67.89 ± 4.64 years) and 18 cognitively intact controls (mean age = 67.72 ± 4.63 years). Gait assessment was conducted under four complex walking tasks: walking a narrow path, walking around an obstacle, horizontal head turns while walking, and vertical head turns while walking. The index of harmonicity (IH), representing gait smoothness associated with overall body stability, was measured in anteroposterior, mediolateral, and vertical directions. A multivariate analysis was employed to compare the differences in IH between groups for each complex walking task. The MCI group demonstrated a reduction of IH in the mediolateral direction during the horizontal head turns than the control group (MCI group = 0.64 ± 0.16, Control group = 0.74 ± 0.12, p = 0.04). No significant differences between groups were found for the IH in other directions or walking conditions. These preliminary findings indicate that older adults with MCI have a decline in step regularity in the mediolateral direction during walking with horizontal head turns. Assessment of the smoothness of walking during head turns may be a useful approach to identifying subtle gait alterations in older adults with MCI, which may facilitate timely gait intervention.
Collapse
Affiliation(s)
- Thanpidcha Poosri
- Faculty of Associated Medical Sciences, Department of Physical Therapy, Chiang Mai University, Chiang Mai, Thailand
| | - Sirinun Boripuntakul
- Faculty of Associated Medical Sciences, Department of Physical Therapy, Chiang Mai University, Chiang Mai, Thailand
| | - Somporn Sungkarat
- Faculty of Associated Medical Sciences, Department of Physical Therapy, Chiang Mai University, Chiang Mai, Thailand
| | - Teerawat Kamnardsiri
- Department of Digital Game, College of Arts, Media and Technology, Chiang Mai University, Chiang Mai, Thailand
| | - Atiwat Soontornpun
- Faculty of Medicine, Department of Internal Medicine, Chiang Mai University and Northern Neuroscience Center, Chiang Mai, Thailand
| | | |
Collapse
|
3
|
Gait variability during abrupt slow and fast speed transitions in older adults with mild cognitive impairment. PLoS One 2022; 17:e0276658. [PMID: 36269750 PMCID: PMC9586342 DOI: 10.1371/journal.pone.0276658] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022] Open
Abstract
Gait speed modulation, including abruptly decreasing or increasing gait speed, is a challenging task and prerequisite for safe mobility in the community. Older adults with Mild Cognitive Impairment (MCI) exhibit gait deficits under challenging walking conditions which may increase their risk of falls. The purpose of this study was to investigate spatiotemporal variability during slow and fast speed transitions in older adults with and without MCI. Twenty-five older adults with MCI (mean age = 68.56 ± 3.79 years) and 25 cognitively intact controls (mean age = 68.72 ± 4.67 years) participated. Gait performance during gait speed transitions was measured in two walking conditions: 1) a slow to fast speed transition in response to a randomly presented cue, and 2) a fast to slow speed condition in response to a randomly presented cue. Means and variability of spatiotemporal parameters during the transitions were measured and mixed model repeated measures ANOVAs were used to assess interaction and main effects. The older adults with MCI exhibited greater variability of step length (MCI = 13.93 ± 5.38, Control = 11.12 ± 3.15, p = 0.03) and swing time (MCI = 13.35 ± 6.01, Control = 10.43 ± 2.87, p = 0.03) than the controls during the fast to slow speed transitions. No other between-group differences were evident for the gait parameters across the two walking conditions. The findings suggest that older adults with MCI have reduced ability to adapt their gait during transitions from fast to slow walking speeds. This impairment may indicate a decline in automated regular rhythmic gait control and explain in part why this group is at increased risk of falls. Slow speed transition task might be incorporated as a fall risk screening in older adults with MCI.
Collapse
|
4
|
Li X, Xia J, Li Y, Xu K, Chen K, Zhang J, Li H, Zhang Z. Risk scores of incident mild cognitive impairment in a Beijing community-based older cohort. Front Aging Neurosci 2022; 14:976126. [PMID: 36262884 PMCID: PMC9574183 DOI: 10.3389/fnagi.2022.976126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: It is very important to identify individuals who are at greatest risk for mild cognitive impairment (MCI) to potentially mitigate or minimize risk factors early in its course. We created a practical MCI risk scoring system and provided individualized estimates of MCI risk. Methods: Using data from 9,000 older adults recruited for the Beijing Ageing Brain Rejuvenation Initiative, we investigated the association of the baseline demographic, medical history, lifestyle and cognitive data with MCI status based on logistic modeling and established risk score (RS) models 1 and 2 for MCI. We evaluated model performance by computing the area under the receiver operating characteristic (ROC) curve (AUC). Finally, RS model 3 was further confirmed and improved based on longitudinal outcome data from the progression of MCI in a sub-cohort who had an average 3-year follow-up. Results: A total of 1,174 subjects (19.8%) were diagnosed with MCI at baseline, and 72 (7.8%) of 849 developed MCI in the follow-up. The AUC values of RS models 1 and 2 were between 0.64 and 0.70 based on baseline age, education, cerebrovascular disease, intelligence and physical activities. Adding baseline memory and language performance, the AUC of RS model 3 more accurately predicted MCI conversion (AUC = 0.785). Conclusion: A combination of risk factors is predictive of the likelihood of MCI. Identifying the RSs may be useful to clinicians as they evaluate their patients and to researchers as they design trials to study possible early non-pharmaceutical interventions to reduce the risk of MCI and dementia.
Collapse
Affiliation(s)
- Xin Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- BABRI Centre, Beijing Normal University, Beijing, China
| | - Jianan Xia
- BABRI Centre, Beijing Normal University, Beijing, China
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing, China
| | - Yumeng Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- BABRI Centre, Beijing Normal University, Beijing, China
| | - Kai Xu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- BABRI Centre, Beijing Normal University, Beijing, China
| | - Kewei Chen
- BABRI Centre, Beijing Normal University, Beijing, China
- Banner Alzheimer’s Institute, Phoenix, AZ, United States
| | - Junying Zhang
- BABRI Centre, Beijing Normal University, Beijing, China
- Institute of Basic Research in Clinical Medicine, China Academy of Traditional Chinese Medicine, Beijing, China
| | - He Li
- BABRI Centre, Beijing Normal University, Beijing, China
- Institute of Basic Research in Clinical Medicine, China Academy of Traditional Chinese Medicine, Beijing, China
| | - Zhanjun Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- BABRI Centre, Beijing Normal University, Beijing, China
- *Correspondence: Zhanjun Zhang
| |
Collapse
|
5
|
Min JY, Ha SW, Lee K, Min KB. Use of electroencephalogram, gait, and their combined signals for classifying cognitive impairment and normal cognition. Front Aging Neurosci 2022; 14:927295. [PMID: 36158559 PMCID: PMC9490417 DOI: 10.3389/fnagi.2022.927295] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Early identification of people at risk for cognitive decline is an important step in delaying the occurrence of cognitive impairment. This study investigated whether multimodal signals assessed using electroencephalogram (EEG) and gait kinematic parameters could be used to identify individuals at risk of cognitive impairment. Methods The survey was conducted at the Veterans Medical Research Institute in the Veterans Health Service Medical Center. A total of 220 individuals volunteered for this study and provided informed consent at enrollment. A cap-type wireless EEG device was used for EEG recording, with a linked-ear references based on a standard international 10/20 system. Three-dimensional motion capture equipment was used to collect kinematic gait parameters. Mild cognitive impairment (MCI) was evaluated by Seoul Neuropsychological Screening Battery-Core (SNSB-C). Results The mean age of the study participants was 73.5 years, and 54.7% were male. We found that specific EEG and gait parameters were significantly associated with cognitive status. Individuals with decreases in high-frequency EEG activity in high beta (25-30 Hz) and gamma (30-40 Hz) bands increased the odds ratio of MCI. There was an association between the pelvic obliquity angle and cognitive status, assessed by MCI or SNSB-C scores. Results from the ROC analysis revealed that multimodal signals combining high beta or gamma and pelvic obliquity improved the ability to discriminate MCI individuals from normal controls. Conclusion These findings support prior work on the association between cognitive status and EEG or gait, and offer new insights into the applicability of multimodal signals to distinguish cognitive impairment.
Collapse
Affiliation(s)
- Jin-Young Min
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, South Korea
| | - Sang-Won Ha
- Department of Neurology, Veterans Health Service Medical Center, Seoul, South Korea
| | - Kiwon Lee
- Ybrain Research Institute, Seongnam-si, South Korea
| | - Kyoung-Bok Min
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, South Korea
- Medical Research Center, Institute of Health Policy and Management, Seoul National University, Seoul, South Korea
| |
Collapse
|
6
|
Wang Z, Ren K, Li D, Lv Z, Li X, He X, Wang D, Jiang W. Assessment of Brain Function in Patients With Cognitive Impairment Based on fNIRS and Gait Analysis. Front Aging Neurosci 2022; 14:799732. [PMID: 35686022 PMCID: PMC9170988 DOI: 10.3389/fnagi.2022.799732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background Early detection of mild cognitive impairment is crucial in the prevention of Alzheimer’s disease (AD). This study aims to explore the changes in gait and brain co-functional connectivity between cognitively healthy and cognitively impaired groups under dual-task walking through the functional near-infrared spectroscopy (fNIRS) and gait analysis devices. Method This study used fNIRS device and gait analysis devices to collect the data of 54 older adults. According to the Mini-mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) scales, the older adults were cognitively healthy (control group) and cognitively impaired (experimental group), of which 38 were in the control group and 16 were in the experimental group. The experiment was divided into a total of three sets of task experiments: a walking-only experiment, a dual-task walking-easy (DTW-easy) experiment, and a dual-task walking-difficult (DTW-difficult) experiment. Main Result For the cognitively impaired and cognitively healthy populations, there were no significant differences in overall functional connectivity, region of interest (ROI) connection strength, and gait performance during single-task walking between the two groups.Whereas the performances of DTW differed significantly from the single-task walking in terms of between-group variability of functional connectivity strength change values, and ROI connection strength change values in relation to the dual-task cost of gait. Finally, the cognitively impaired group was significantly more affected by DTW-difficult tasks than the cognitively healthy group. Conclusion This study provides a new approach to assist in the diagnosis of people with cognitive impairment and provides a new research pathway for the identification of cognitive impairment.
Collapse
Affiliation(s)
- Zehua Wang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Ke Ren
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Deyu Li
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Zeping Lv
- National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Xiang Li
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS), Shenzhen, China
| | | | - Daifa Wang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- *Correspondence: Daifa Wang Wenyu Jiang
| | - Wenyu Jiang
- Jiangbin Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
- *Correspondence: Daifa Wang Wenyu Jiang
| |
Collapse
|
7
|
Gamwell HE, Wait SO, Royster JT, Ritch BL, Powell SC, Skinner JW. Aging and Gait Function: Examination of Multiple Factors that Influence Gait Variability. Gerontol Geriatr Med 2022; 8:23337214221080304. [PMID: 35237711 PMCID: PMC8882934 DOI: 10.1177/23337214221080304] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This investigation aimed to identify parameters of reduced functionality that are
responsible for variations in the normal gait cycle. Sixteen older adults (55–85 years;
nine males) and eighteen young adults (18–40 years; eight males) were enrolled.
Assessments included walking trials, questionnaires, and assessed maximal and submaximal
dorsiflexors (DF) and plantar flexors (PF) force. Multiple relationships were found
between the muscular capabilities of the ankle and gait variability in older adults. For
both the DF and PF muscles, the older adults produced significantly lower maximal force
production and higher levels of force variability than younger adults; physical activity
(PA) level was also significantly correlated. The reduction in muscular strength was
concurrent with increased force variability and deficits in spatiotemporal gait
parameters, suggesting an age-related worsening of the central motor control. Our results
found that PA engagement could preserve gait quality and independence. These are essential
considerations for further research on the cause and reduction of falls in older
adults.
Collapse
Affiliation(s)
- Hope E. Gamwell
- Department of Health and Exercise Science, Appalachian State University, Boone, NC, USA
| | - Seaver O. Wait
- Department of Health and Exercise Science, Appalachian State University, Boone, NC, USA
| | - Jackson T. Royster
- Department of Health and Exercise Science, Appalachian State University, Boone, NC, USA
| | - Brody L. Ritch
- Department of Health and Exercise Science, Appalachian State University, Boone, NC, USA
| | - Sarah C. Powell
- Department of Health and Exercise Science, Appalachian State University, Boone, NC, USA
| | - Jared W. Skinner
- Department of Health and Exercise Science, Appalachian State University, Boone, NC, USA
| |
Collapse
|
8
|
Bareiss SK, Johnston T, Lu Q, Tran TD. The effect of exercise on early sensorimotor performance alterations in the 3xTg-AD model of Alzheimer's disease. Neurosci Res 2022; 178:60-68. [PMID: 35033583 DOI: 10.1016/j.neures.2022.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 12/29/2021] [Accepted: 01/12/2022] [Indexed: 01/13/2023]
Abstract
Alzheimer's disease (AD) is characterized by a progressive decline in cognitive function; however, recent evidence suggests that non-cognitive sensorimotor and psychomotor symptoms accompany early stages of the disease in humans and AD models. Although exercise is emerging as an important therapeutic to combat AD progression, little is known about the effect of exercise on sensorimotor domain functions. The purpose of this study was to determine if early sensorimotor symptoms accompany deficits in Morris water maze (MWM) performance in the 3xTg-AD model, and investigate if exercise could protect against early behavioral decline. 3xTg-AD and wild-type (WT) control mice were subjected to 12 weeks of moderate intensity wheel running or remained sedentary. At 6 months of age, animals underwent a series of sensorimotor and MWM testing. 3xTg-AD mice displayed deficits in sensorimotor function (beam traversal, spontaneous activity, and adhesive removal) and MWM performance. Interestingly, 3xTg-AD animals exhibited increased freezing and unusual shaking/tremoring behaviors not displayed by WT controls. Exercise improved beam traversal, adhesive removal, and reduced the unusual motor-related behaviors in 3xTg-AD mice. Our study shows that sensorimotor symptoms coincide with deficits in MWM performance, and suggest that exercise may mitigate deficits associated with early disease in 3xTg-AD mice.
Collapse
Affiliation(s)
- Sonja K Bareiss
- Department of Physical Therapy, School of Rehabilitation and Movement Sciences, Bellarmine University, Louisville, KY 40205, United States; Department of Neurological Surgery, University of Louisville, United States; The Harriet and John Wooten Laboratory for Alzheimer's and Neurodegenerative Diseases Research, East Carolina University, United States.
| | - Tyler Johnston
- Department of Physical Therapy, East Carolina University, Greenville, NC 27834, United States.
| | - Qun Lu
- Department of Anatomy and Cell Biology, Brody School of Medicine, United States; The Harriet and John Wooten Laboratory for Alzheimer's and Neurodegenerative Diseases Research, East Carolina University, United States.
| | - Tuan D Tran
- The Harriet and John Wooten Laboratory for Alzheimer's and Neurodegenerative Diseases Research, East Carolina University, United States; Department of Psychology East Carolina University, Greenville, NC 27834, United States.
| |
Collapse
|
9
|
Detection of mild cognitive Impairment from gait using Adaptive Neuro-Fuzzy Inference system. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2021.103195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
10
|
Ni L, Lv W, Sun D, Sun Y, Sun Y, Xu X, Chang M, Han X, Tao S, Hu X, Cai H. Pathological Gait Signatures of Post-stroke Dementia With Toe-Off and Heel-to-Ground Angles Discriminate From Alzheimer's Disease. Front Aging Neurosci 2021; 13:766884. [PMID: 34867293 PMCID: PMC8638706 DOI: 10.3389/fnagi.2021.766884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Given the limited power of neuropsychological tests, there is a need for a simple, reliable means, such as gait, to identify mild dementia and its subtypes. However, gait characteristics of patients with post-stroke dementia (PSD) and Alzheimer’s disease (AD) are unclear. We sought to describe their gait signatures and to explore gait parameters distinguishing PSD from post-stroke non-dementia (PSND) and patients with AD. We divided 3-month post-stroke patients into PSND and PSD groups based on the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the activity of daily living (ADL). Thirty-one patients with AD and thirty-two healthy controls (HCs) were also recruited. Ten gait parameters in one single and two dual-task gait tests (counting-backward or naming-animals while walking) were compared among the groups, with adjustment for baseline demographic covariates and the MMSE score. The area under the receiver operating characteristic curve (AUC) was used to identify parameters discriminating PSD from individuals with PSND and AD. Patients with PSD and patients with AD showed impaired stride length, velocity, stride time, and cadence while patients with PSD had altered stance and swing phase proportions (all p ≤ 0.01, post hoc). Patients with AD had smaller toe-off (ToA) and heel-to-ground angles (HtA) (p ≤ 0.01) than HCs in dual-task gait tests. Individuals with PSD had a shorter stride length, slower velocity, and altered stance and swing phase percentages in all tests (p ≤ 0.01), but a higher coefficient of variation of stride length (CoVSL) and time (CoVST) only in the naming animals-task gait test (p ≤ 0.001) than individuals with PSND. ToA and HtA in the naming animals-task gait test were smaller in individuals with AD than those with PSD (p ≤ 0.01). Statistical significance persisted after adjusting for demographic covariates, but not for MMSE. The pace and the percentage of stance or swing phase in all tests, CoVST in the dual-task paradigm, and CoVSL only in the naming animals-task gait test (moderate accuracy, AUC > 0.700, p ≤ 0.01) could distinguish PSD from PSND. Furthermore, the ToA and HtA in the naming animals-task gait paradigm discriminated AD from PSD (moderate accuracy, AUC > 0.700, p ≤ 0.01). Thus, specific gait characteristics could allow early identification of PSD and may allow non-invasive discrimination between PSD and AD, or even other subtypes of dementia.
Collapse
Affiliation(s)
- Linhui Ni
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wen Lv
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Di Sun
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yi Sun
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Electroencephalogram Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yu Sun
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, Zhejiang University, Hangzhou, China.,Zhejiang Lab, Hangzhou, China
| | - Xinxin Xu
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Mengyue Chang
- Dalian Key Laboratory of Smart Medical and Health, Dalian University, Dalian, China
| | - Xing Han
- Dalian Key Laboratory of Smart Medical and Health, Dalian University, Dalian, China
| | - Shuai Tao
- Dalian Key Laboratory of Smart Medical and Health, Dalian University, Dalian, China
| | - Xingyue Hu
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Huaying Cai
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
11
|
Influence of Different Dual-Task Conditions During Straight or Curved Walking on Gait Performance of Physically Active Older Women With Cognitive Decline. J Aging Phys Act 2021; 30:411-420. [PMID: 34510022 DOI: 10.1123/japa.2021-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 11/18/2022]
Abstract
Real-world walking requires shifting attention from different cognitive demands to adapt gait. This study aims to evaluate the effect of dual tasking on spatiotemporal gait parameters of older adults. Participants were asked to perform a primary complex single-walking task, consisting of a fast-paced linear and a curved gait. Primary task was performed separately and simultaneously with different motor and cognitive secondary tasks. Spatiotemporal gait parameters, walk ratio, and walk stability ratio were measured. Apart from stride length, which stood relatively unchanged, gait speed and cadence were strongly affected by cognitive dual tasking. Cadence seems to be the most impacted by dual tasking during curved gait as it combines challenges of both primary and secondary tasks. Also, during curved phase, walking ratio was significantly lower and stability ratio was greater demonstrating that participants adopted a cautious gait where maintenance of stability took preference over efficiency.
Collapse
|
12
|
Bishnoi A, Hernandez ME. Dual task walking costs in older adults with mild cognitive impairment: a systematic review and meta-analysis. Aging Ment Health 2021; 25:1618-1629. [PMID: 32757759 DOI: 10.1080/13607863.2020.1802576] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this systematic review and meta-analysis (PROSPERO registration No CRD42020192121) is to review existing literature focusing on effects of different dual task paradigms on walking speed in older adults with and without Mild Cognitive Impairment. METHODS (1) Data Sources: PubMEd, Cumulative Index of Nursing and Allied Health, Cochrane library, and Web of Science. (2) Study Selection: The key terms searched included those associated with dual task, walking speed, executive function, older adults, and MCI. (3) Data Extraction: The search yielded 140 results with 20 studies meeting the inclusion criteria, which were rated by two independent reviewers using the Quality Assessment Tool. Descriptions of each study including the single and dual task protocol, outcome measure, and final outcomes were extracted. Meta-analysis was performed to evaluate the dual task effects on walking costs in older adults with and without MCI. RESULTS Meta-analysis revealed that there were significant differences in the dual task walking costs among older adults with or without MCI (p < .05). Pooled effect sizes of the serial subtraction (9.54; 95%CI, 3.93-15.15) and verbal fluency tasks (10.06; 95%CI, 6.26-15.65) showed that there are higher motor dual-task costs in older adults with MCI than age-matched controls. For quality assessment, all studies ranged from 12 to 16 in score, out of 18 (high quality). CONCLUSIONS In the studies included in this review, mental tracking tasks, consisting of serial subtraction and verbal fluency, were found to be the most sensitive in detecting MCI-related changes in older adults, and could serve an important role as a target measure for evaluating the efficacy of interventions aimed at improving cognitive and motor function in older adults.
Collapse
Affiliation(s)
- Alka Bishnoi
- Mobility and Fall Prevention Research Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Manuel E Hernandez
- Mobility and Fall Prevention Research Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| |
Collapse
|
13
|
Poirier G, Ohayon A, Juranville A, Mourey F, Gaveau J. Deterioration, Compensation and Motor Control Processes in Healthy Aging, Mild Cognitive Impairment and Alzheimer's Disease. Geriatrics (Basel) 2021; 6:33. [PMID: 33807008 PMCID: PMC8006018 DOI: 10.3390/geriatrics6010033] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 01/07/2023] Open
Abstract
Aging is associated with modifications of several brain structures and functions. These modifications then manifest as modified behaviors. It has been proposed that some brain function modifications may compensate for some other deteriorated ones, thus maintaining behavioral performance. Through the concept of compensation versus deterioration, this article reviews the literature on motor function in healthy and pathological aging. We first highlight mechanistic studies that used paradigms, allowing us to identify precise compensation mechanisms in healthy aging. Subsequently, we review studies investigating motor function in two often-associated neurological conditions, i.e., mild cognitive impairment and Alzheimer's disease. We point out the need to expand the knowledge gained from descriptive studies with studies targeting specific motor control processes. Teasing apart deteriorated versus compensating processes represents precious knowledge that could significantly improve the prevention and rehabilitation of age-related loss of mobility.
Collapse
Affiliation(s)
- Gabriel Poirier
- INSERM U1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, F-21000 Dijon, France; (A.O.); (A.J.); (F.M.); (J.G.)
- Espace d’Étude du Mouvement—Étienne Jules MAREY, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, F-21000 Dijon, France
| | - Alice Ohayon
- INSERM U1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, F-21000 Dijon, France; (A.O.); (A.J.); (F.M.); (J.G.)
| | - Adrien Juranville
- INSERM U1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, F-21000 Dijon, France; (A.O.); (A.J.); (F.M.); (J.G.)
| | - France Mourey
- INSERM U1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, F-21000 Dijon, France; (A.O.); (A.J.); (F.M.); (J.G.)
- Espace d’Étude du Mouvement—Étienne Jules MAREY, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, F-21000 Dijon, France
| | - Jeremie Gaveau
- INSERM U1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, F-21000 Dijon, France; (A.O.); (A.J.); (F.M.); (J.G.)
- Espace d’Étude du Mouvement—Étienne Jules MAREY, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, F-21000 Dijon, France
| |
Collapse
|
14
|
Postural Control Dysfunction and Balance Rehabilitation in Older Adults with Mild Cognitive Impairment. Brain Sci 2020; 10:brainsci10110873. [PMID: 33227910 PMCID: PMC7699138 DOI: 10.3390/brainsci10110873] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/03/2020] [Accepted: 11/18/2020] [Indexed: 12/04/2022] Open
Abstract
Older adults with mild cognitive impairment (MCI) are at an increased risk for falls and fall-related injuries. It is unclear whether current balance rehabilitation techniques largely developed in cognitively intact populations would be successful in older adults with MCI. This mapping review examined the available balance rehabilitation research conducted in older adults with MCI. Databases Medline, Cinahl, Cochrane, PubMed, Scopus, and PsycINFO were systematically searched from inception to August 2020. Twenty-one studies with 16 original randomized controlled trials (RCTs) involving 1201 older adults with MCI (>age 60) met the inclusion criteria, of which 17 studies showed significant treatment effects on balance functions. However, only six studies demonstrated adequate quality (at least single-blind, no significant dropouts, and intervention and control groups are equivalent at baseline) and evidence (medium or large effect size on at least one balance outcome) in improving balance in this population, and none of them are double- or triple-blind. Therefore, more high-quality RCTs are needed to inform future balance rehabilitation program development for older adults with MCI. Moreover, few studies examined the incidence of falls after the intervention, which limits clinical utility. Future RCTs should prospectively monitor falls or changes in risk of falls after the intervention.
Collapse
|
15
|
Mancioppi G, Fiorini L, Rovini E, Cavallo F. The use of Motor and Cognitive Dual-Task quantitative assessment on subjects with mild cognitive impairment: A systematic review. Mech Ageing Dev 2020; 193:111393. [PMID: 33188785 DOI: 10.1016/j.mad.2020.111393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 12/19/2022]
Abstract
Dementia and Alzheimer's Disease (AD) represent a health emergency. The identification of valid and noninvasive markers to identify people with Mild Cognitive Impairment (MCI) is profoundly advocated. This review outlines the use of quantitative Motor and Cognitive Dual-Task (MCDT) on MCI, by technologies aid. We describe the framework and the most valuable researches, displaying the adopted protocols, and the available technologies. PubMed Central, Web of Science, and Scopus were inspected between January 2010 and May 2020. 1939 articles were found in the initial quest. Exclusion criteria allowed the selection of the most relevant papers; 38 papers were included. The articles, regarding four technological solutions "wearable sensors", "personal devices", "optokinetic systems", and "electronic walkways", are organized into three categories: "Quantitative MCDT", "MCDT Inspired by Neuropsychological Test", and "MCDT for MCI Stimulation". MCDT might furnish clinical landmarks, supplying aid for disease stratication, risk prediction, and intervention optimization. Such protocols could foster the use of data mining and machine learning techniques. Notwithstanding, there is still a need to standardize and harmonize such protocols.
Collapse
Affiliation(s)
- Gianmaria Mancioppi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, Pontedera (PI), 56025 Pisa, Italy; Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy
| | - Laura Fiorini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, Pontedera (PI), 56025 Pisa, Italy; Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy
| | - Erika Rovini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, Pontedera (PI), 56025 Pisa, Italy; Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy
| | - Filippo Cavallo
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, Pontedera (PI), 56025 Pisa, Italy; Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy; Department of Industrial Engineering, University of Florence, Via Santa Marta 3, 50139 Florence, Italy.
| |
Collapse
|
16
|
Cheng Q, Wu M, Wu Y, Hu Y, Kwapong WR, Shi X, Fan Y, Yu X, He J, Wang Z. Weaker Braking Force, A New Marker of Worse Gait Stability in Alzheimer Disease. Front Aging Neurosci 2020; 12:554168. [PMID: 33024432 PMCID: PMC7516124 DOI: 10.3389/fnagi.2020.554168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/14/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Braking force is a gait marker associated with gait stability. This study aimed to determine the alteration of braking force and its correlation with gait stability in Alzheimer disease (AD). Methods: A total of 32 AD patients and 32 healthy controls (HCs) were enrolled in this study. Gait parameters (braking force, gait variability, and fall risk) in the walking tests of Free walk, Barrier, and Count backward were measured by JiBuEn® gait analysis system. Gait variability was calculated by the coefficient of variation (COV) of stride time, stance time, and swing time. Results: The braking force of AD was significantly weaker than HCs in three walking tests (P < 0.001, P < 0.001, P = 0.007). Gait variability of AD showed significant elevation than HCs in the walking of Count backward (COVstride: P = 0.013; COVswing: P = 0.006). Fall risk of AD was significantly higher than HCs in three walking tests (P = 0.001, P = 0.001, P = 0.001). Braking force was negatively associated with fall risks in three walking tests (P < 0.001, P < 0.001, P < 0.001). There were significant negative correlations between braking force and gait variability in the walking of Free walk (COVstride: P = 0.018; COVswing: P = 0.013) and Barrier (COVstride: P = 0.002; COVswing: P = 0.001), but not Count backward (COVstride: P = 0.888; COVswing: P = 0.555). Conclusion: Braking force was weaker in AD compared to HCs, reflecting the worse gait stability of AD. Our study suggests that weakening of braking force may be a new gait marker to indicate cognitive and motor impairment and predict fall risk in AD.
Collapse
Affiliation(s)
- Qianqian Cheng
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Mengxuan Wu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Yuemin Wu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yaoyao Hu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | | | - Xiang Shi
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Yinying Fan
- Wenzhou Yining Geriatric Hospital, Wenzhou, China
| | - Xin Yu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhen Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
17
|
Gait Change in Dual Task as a Behavioral Marker to Detect Mild Cognitive Impairment in Elderly Persons: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2020; 101:1813-1821. [DOI: 10.1016/j.apmr.2020.05.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 05/19/2020] [Accepted: 05/23/2020] [Indexed: 12/21/2022]
|
18
|
Lee NG, Kang TW, Park HJ. Relationship Between Balance, Gait, and Activities of Daily Living in Older Adults With Dementia. Geriatr Orthop Surg Rehabil 2020; 11:2151459320929578. [PMID: 32528740 PMCID: PMC7262984 DOI: 10.1177/2151459320929578] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: Gait characteristics are closely associated with executive functions including basic and high-level cognitive processes such as attention, working memory, decision-making, and problem-solving. Impaired cognitive function resulting from dementia is associated with loss of balance and poor activities of daily living (ADLs). If associations between gait parameters, balance, and ADLs are observed, then quantitative gait analysis may be optimal for reinforcing balance and ADL assessments in people with dementia. This study aimed to determine the association between balance, gait, and ADLs in older adults with dementia. Materials and Methods: A cross-sectional study was conducted in 46 older adults who have been diagnosed with dementia. Measurements including the Mini-Mental Statement Examination-Korean version (MMSE-K), Berg Balance Scale (BBS), 10-meter walk test (10MWT), Modified Barthel index (MBI), and GAITRite were used to assess cognitive function, balance, walking speed, ADLs, and gait parameters, respectively. The Pearson product correlation coefficient (r) was used for correlation analysis. Results and Discussion: Among the gait parameters, velocity was positively associated with the BBS, 10MWT, and MBI (r = 0.341-0.516, P > .05). Step length (r = 0.301-0.586, P > .05), stride length (r = 0.329-0.580, P > .05), and walk ratio (r = 0.324-0.556, P > .05) were positively associated with the MMSE-K, BBS, 10MWT, and MBI. A moderate positive association between single support time and MBI was observed (r = 0.308, P = .039). Additionally, a moderate negative association between double support time and the MBI was observed (r = −0.349, P = .019). This study presents the first empirical evidence on the association between balance, gait, and ADLs in older adults with dementia. Conclusions: This study identified important associations between balance, gait, and ADL assessments in people with dementia. Further studies involving targeted interventions addressing gait parameters and improving balance and functional performance in people with dementia are required in the future.
Collapse
Affiliation(s)
- Nam Gi Lee
- Rehabilitation Center, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Tae Woo Kang
- Department of Physical Therapy, Woosuk University, Jeonbuk, Republic of Korea
| | - Hyun Ju Park
- Department of Physical Therapy, Good Daycare Center, Daejeon, Republic of Korea
| |
Collapse
|
19
|
Xie H, Wang Y, Tao S, Huang S, Zhang C, Lv Z. Wearable Sensor-Based Daily Life Walking Assessment of Gait for Distinguishing Individuals With Amnestic Mild Cognitive Impairment. Front Aging Neurosci 2019; 11:285. [PMID: 31695605 PMCID: PMC6817674 DOI: 10.3389/fnagi.2019.00285] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/03/2019] [Indexed: 11/15/2022] Open
Abstract
Objectives: To characterize gait disorders in patients with amnestic mild cognitive impairment (aMCIs) and determine the association between the performance of the gait function and cognition. Methodology: In this study, we enrolled 38 patients with aMCI and 30 cognitively normal individuals normal controls (NC). Neuropsychological assessments included tests of memory, executive function, language, and attention. Using an inertial-sensor-based wearable instrument, we collected the gait data dynamically for at least 1 h/day for 2 weeks. The gait parameters included walking velocity, stride length, stride time, cadence, and stride time variability. Results: The aMCI patients had reduced walking velocity and stride length and increased stride time variability compared with the NCs. The total number of steps, stride time, and cadence did not differ between the two groups. For all the subjects, walking velocity and stride length was positively associated with memory and executive function. Stride time variability was negatively correlated with the cognitive domains including memory, executive function and attention. Conclusion: This study suggested that cognitive impairment-related gait disorders occur (reduced gait speed, gait length, and gait stability) in daily life walking among the aMCI patients. A sensor-based wearable device for gait measurement may be an alternative and convenient tool for screening cognitive impairment.
Collapse
Affiliation(s)
- Haiqun Xie
- Department of Neurology, First People's Hospital of Foshan, Foshan, China
| | - Yukai Wang
- Department of Neurology, First People's Hospital of Foshan, Foshan, China
| | - Shuai Tao
- Dalian Key Laboratory of Smart Medical and Health, Dalian University, Dalian, China
| | - Shuyun Huang
- Department of Neurology, First People's Hospital of Foshan, Foshan, China
| | - Chengguo Zhang
- Department of Neurology, First People's Hospital of Foshan, Foshan, China
| | - Zeping Lv
- National Research Center for Rehabilitation Technical Aids, Rehabilitation Hospital, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Intelligent Control and Rehabilitation Technology of the Ministry of Civil Affairs, Beijing, China
| |
Collapse
|
20
|
Ansai JH, Andrade LPD, Masse FAA, Gonçalves J, Takahashi ACDM, Vale FAC, Rebelatto JR. Risk Factors for Falls in Older Adults With Mild Cognitive Impairment and Mild Alzheimer Disease. J Geriatr Phys Ther 2019; 42:E116-E121. [DOI: 10.1519/jpt.0000000000000135] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
21
|
Sarcopenia Is Associated with Cognitive Impairment Mainly Due to Slow Gait Speed: Results from the Korean Frailty and Aging Cohort Study (KFACS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091491. [PMID: 31035553 PMCID: PMC6539557 DOI: 10.3390/ijerph16091491] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/19/2019] [Accepted: 04/23/2019] [Indexed: 12/19/2022]
Abstract
Sarcopenia and cognitive impairment may share common risk factors and pathophysiological pathways. We examined the association between impairments in specific cognitive domains and sarcopenia (and its defining components) in community-dwelling older adults. We analyzed 1887 patients who underwent cognitive function tests and dual-energy X-ray absorptiometry from the baseline data of adults aged 70-84 years obtained from the Korean Frailty and Aging Cohort Study. Those with disability in activities of daily living, dementia, severe cognitive impairment, Parkinson's disease, musculoskeletal complaints, neurological disorders, or who were illiterate were excluded. Cognitive function was assessed using the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet, the Frontal Assessment Battery. For sarcopenia, we used the diagnostic criteria of the Asian Working Group for Sarcopenia. The prevalence of sarcopenia was 9.6% for men and 7.6% for women. Sarcopenia (odds ratio [OR] 1.76, 95% confidence interval [CI] 1.04-2.99) and slow gait speed (OR 2.58, 95% CI 1.34-4.99) were associated with cognitive impairment in men. Only slow gait speed (OR 1.88, 95% CI 1.05-3.36) was associated with cognitive impairment in women. Sarcopenia is associated with cognitive impairment mainly due to slow gait speed. Our results suggested that cognitive impairment domains, such as processing speed and executive function, are associated with sarcopenia-related slow gait speed.
Collapse
|
22
|
Morlino P, Balbi B, Guglielmetti S, Giardini M, Grasso M, Giordano C, Schieppati M, Nardone A. Gait abnormalities of COPD are not directly related to respiratory function. Gait Posture 2017; 58:352-357. [PMID: 28866454 DOI: 10.1016/j.gaitpost.2017.08.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 06/14/2017] [Accepted: 08/13/2017] [Indexed: 02/02/2023]
Abstract
STUDY OBJECTIVE To assess whether gait abnormalities in COPD depend on mere impairment of respiratory function. METHODS In 40 patients with COPD at different GOLD stages and 28 controls, we evaluated: forced expiratory volume in 1s (FEV1); partial pressure of oxygen; Mini-Mental State Examination (MMSE); dynamic balance through the Mini-BESTest (MBT); Timed Up and Go (TUG) test without and with dual task counting aloud back by three; 6-min walk test (6MWT); body sway during quiet stance (stabilometry); spatial-temporal variables of gait by a 4-m long sensorized walkway (baropodometry). Lower-limb muscle strength, tendon reflexes, and sensation were also clinically evaluated. RESULTS Muscle strength of proximal but not distal muscles was slightly reduced in patients, whereas reflexes and sensation were unaffected. FEV1, partial pressure of oxygen, MMSE, MBT, stabilometry, as well as baropodometry, were abnormal and unrelated to muscle weakness. The time taken to perform the TUG test was increased, and to a larger extent with than without dual task. At baropodometry, variability of step length was increased; abnormalities of gait variables were associated with larger body sway but not with FEV1 or hypoxemia. Gait speed at 6MWT was correlated with MBT score and with FEV1 as well as hypoxemia. CONCLUSIONS 6MWT findings give a measure of gait disability linked to endurance-related respiratory failure. Gait at baropodometry is associated with impairment of balance, cognitive status and abnormal dual task performance. We suggest that central nervous lesions, presumably of vascular origin, are detrimental to balance and gait in COPD.
Collapse
Affiliation(s)
- Paola Morlino
- Posture and Movement Laboratory, Division of Physical Medicine and Rehabilitation, ICS MAUGERI SPA SB, Institute of Veruno, IRCCS, Veruno (NO), Italy
| | - Bruno Balbi
- Division of Pulmonary Rehabilitation, ICS MAUGERI SPA SB, Institute of Veruno, IRCCS, Veruno (NO), Italy
| | - Simone Guglielmetti
- Posture and Movement Laboratory, Division of Physical Medicine and Rehabilitation, ICS MAUGERI SPA SB, Institute of Veruno, IRCCS, Veruno (NO), Italy
| | - Marica Giardini
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Margherita Grasso
- Posture and Movement Laboratory, Division of Physical Medicine and Rehabilitation, ICS MAUGERI SPA SB, Institute of Veruno, IRCCS, Veruno (NO), Italy
| | - Chiara Giordano
- Division of Pulmonary Rehabilitation, ICS MAUGERI SPA SB, Institute of Veruno, IRCCS, Veruno (NO), Italy
| | - Marco Schieppati
- Department of Exercise and Sport Science, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
| | - Antonio Nardone
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Centro Studi Attività Motorie, ICS MAUGERI SPA SB, Institute of Pavia, IRCCS, Pavia, Italy; Neurorehabilitation and Spinal Units, ICS MAUGERI SPA SB, Institute of Pavia, IRCCS, Pavia, Italy.
| |
Collapse
|
23
|
Belghali M, Chastan N, Cignetti F, Davenne D, Decker LM. Loss of gait control assessed by cognitive-motor dual-tasks: pros and cons in detecting people at risk of developing Alzheimer's and Parkinson's diseases. GeroScience 2017; 39:305-329. [PMID: 28551877 DOI: 10.1007/s11357-017-9977-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 05/02/2017] [Indexed: 12/26/2022] Open
Abstract
Alzheimer's and Parkinson's diseases are age-related progressive neurodegenerative diseases of increasing prevalence worldwide. In the absence of curative therapy, current research is interested in prevention, by identifying subtle signs of early-stage neurodegeneration. Today, the field of behavioral neuroscience has emerged as one of the most promising areas of research on this topic. Recently, it has been shown that the exacerbation of gait disorders under dual-task conditions (i.e., simultaneous performance of cognitive and motor tasks) could be a characteristic feature of Alzheimer's and Parkinson's diseases. The cognitive-motor dual-task paradigm during walking allows to assess whether (i) executive attention is abnormally impaired in prodromal Alzheimer's disease or (ii) compensation strategies are used in order to preserve gait function when the basal ganglia system is altered in prodromal Parkinson's disease. This review aims at (i) identifying patterns of dual-task-related gait changes that are specific to Alzheimer's and Parkinson's diseases, respectively, (ii) demonstrating that these changes could potentially be used as prediagnostic markers for disease onset, (iii) reviewing pros and cons of existing dual-task studies, and (iv) proposing future directions for clinical research.
Collapse
Affiliation(s)
- Maroua Belghali
- Normandie Univ, UNICAEN, INSERM, COMETE, 14000, Caen, France
| | - Nathalie Chastan
- Normandie Univ, UNICAEN, INSERM, COMETE, 14000, Caen, France.,Department of Neurophysiology, UNIROUEN, Rouen University Hospital-Charles Nicolle, Normandie Univ, 76000, Rouen, France
| | - Fabien Cignetti
- CNRS, LNC UMR 7291, Aix-Marseille Univ, 13331, Marseille, France
| | - Damien Davenne
- Normandie Univ, UNICAEN, INSERM, COMETE, 14000, Caen, France
| | - Leslie M Decker
- Normandie Univ, UNICAEN, INSERM, COMETE, 14000, Caen, France.
| |
Collapse
|
24
|
What can gait tell us about dementia? Review of epidemiological and neuropsychological evidence. Gait Posture 2017; 53:215-223. [PMID: 28222369 DOI: 10.1016/j.gaitpost.2017.01.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 01/22/2017] [Accepted: 01/29/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cognitive impairment and gait disorders in people over the age of 65 represent major public health issues because of their high frequency, their link to poor outcomes and high costs. Research has demonstrated that these two geriatric syndromes are closely related. METHODS AND RESULTS We aim to review the evidence supporting the relationship between gait and cognitive impairment, particularly focusing on epidemiological and neuropsychological studies in patients with Mild cognitive impairment, Alzheimer's disease and Vascular dementia. The review demonstrates that gait and cognition are closely related, but our knowledge of their interrelationship is limited. Emerging evidence shows that gait analysis has the potential to contribute to diagnosis and prognosis of cognitive impairment. CONCLUSIONS An integrated approach for evaluating these major geriatric syndromes, based on their close relationship, will not only increase our understanding of cognitive-motor interactions, but most importantly may be used to aid early diagnosis, prognosis and the development of new interventions.
Collapse
|
25
|
Brodie MA, Coppens MJ, Ejupi A, Gschwind YJ, Annegarn J, Schoene D, Wieching R, Lord SR, Delbaere K. Comparison between clinical gait and daily-life gait assessments of fall risk in older people. Geriatr Gerontol Int 2017; 17:2274-2282. [DOI: 10.1111/ggi.12979] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 10/19/2016] [Accepted: 11/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - Milou J. Coppens
- Center for Human Movement Sciences, University Medical Center Groningen; University of Groningen; the Netherlands
| | - Andreas Ejupi
- Assistive Healthcare Information Technology Group; Austrian Institute of Technology; Vienna Austria
| | - Yves J. Gschwind
- Neuroscience Research Australia; UNSW; Randwick, Sydney Australia
| | - Janneke Annegarn
- Department of Personal Health, Philips Research; High Tech Campus 34, 5656AE Eindhoven the Netherlands
| | - Daniel Schoene
- Neuroscience Research Australia; UNSW; Randwick, Sydney Australia
- Institute for Biomedicine of Aging; Friedrich-Alexander University; Nuremberg Germany
| | - Rainer Wieching
- Institute for Information Systems; University Siegen; Siegen Germany
| | - Stephen R. Lord
- Neuroscience Research Australia; UNSW; Randwick, Sydney Australia
| | - Kim Delbaere
- Neuroscience Research Australia; UNSW; Randwick, Sydney Australia
| |
Collapse
|
26
|
Lach HW, Harrison BE, Phongphanngam S. Falls and Fall Prevention in Older Adults With Early-Stage Dementia: An Integrative Review. Res Gerontol Nurs 2016; 10:139-148. [PMID: 27665756 DOI: 10.3928/19404921-20160908-01] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/12/2016] [Indexed: 11/20/2022]
Abstract
Older adults with mild cognitive impairment (MCI) and early-stage dementia have an increased risk of falling, with risks to their health and quality of life. The purpose of the current integrative review was to evaluate evidence on fall risk and fall prevention in this population. Studies were included if they examined falls or fall risk factors in older adults with MCI or early-stage dementia, or reported interventions in this population; 40 studies met criteria. Evidence supports the increased risk of falls in individuals even in the early stages of dementia or MCI, and changes in gait, balance, and fear of falling that may be related to this increased fall risk. Interventions included exercise and multifactorial interventions that demonstrated some potential to reduce falls in this population. Few studies had strong designs to provide evidence for recommendations. Further study in this area is warranted. [Res Gerontol Nurs. 2017; 10(03):139-148.].
Collapse
|
27
|
Bahureksa L, Najafi B, Saleh A, Sabbagh M, Coon D, Mohler MJ, Schwenk M. The Impact of Mild Cognitive Impairment on Gait and Balance: A Systematic Review and Meta-Analysis of Studies Using Instrumented Assessment. Gerontology 2016; 63:67-83. [PMID: 27172932 DOI: 10.1159/000445831] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/30/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In addition to cognitive deficits, people with mild cognitive impairment (MCI) can experience motor dysfunction, including deficits in gait and balance. Objective, instrumented motor performance assessment may allow the detection of subtle MCI-related motor deficits, allowing early diagnosis and intervention. Motor assessment under dual-task conditions may increase diagnostic accuracy; however, the sensitivity of different cognitive tasks is unclear. OBJECTIVE To systematically review the extant literature focusing on instrumented assessment of gait and balance parameters for discriminating MCI patients from cognitively intact peers. METHODS Database searches were conducted in PubMed, EMBASE, Cochrane Library, PsycINFO and Web of Science. Inclusion criteria were: (1) clinically confirmed MCI; (2) instrumented measurement of gait and/or balance; (3) English language, and (4) reporting gait or balance parameters which could be included in a meta-analysis for discriminating between MCI patients and cognitively intact individuals based on weighted effect size (d). RESULTS Fourteen studies met the inclusion criteria and reported quantitative gait (n = 11) or postural balance (n = 4) parameters to be included in the meta-analysis. The meta-analysis revealed that several gait parameters including velocity (d = -0.74, p < 0.01), stride length (d = -0.65, p < 0.01), and stride time (mean: d = 0.56, p = 0.02; coefficient of variation: d = 0.50, p < 0.01) discriminated best between MCI and healthy controls under single-task conditions. Importantly, dual-task assessment increased the discriminative power of gait variables wherein gait variables with counting tasks appeared to be more sensitive (range d = 0.84-1.35) compared to verbal fluency tasks such as animal naming (range d = 0.65-0.94). Balance parameters identified as significant discriminators were anterior-posterior (d = 0.49, p < 0.01) and mediolateral (d = -0.34, p = 0.04) sway position in the eyes-open condition but not eyes-closed condition. CONCLUSION Existing studies provide evidence that MCI affects specific gait parameters. MCI-related gait changes were most pronounced when subjects are challenged cognitively (i.e., dual task), suggesting that gait assessment with an additional cognitive task is useful for diagnosis and outcome analysis in the target population. Static balance seems to also be affected by MCI, although limited evidence exists. Instrumented motor assessment could provide a critical opportunity for MCI diagnosis and tailored intervention targeting specific deficits and potentially slowing progression to dementia. Further studies are required to confirm our findings.
Collapse
Affiliation(s)
- Lindsay Bahureksa
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, College of Medicine, Arizona Center on Aging, Tucson, Ariz., USA
| | | | | | | | | | | | | |
Collapse
|
28
|
Kikkert LHJ, Vuillerme N, van Campen JP, Hortobágyi T, Lamoth CJ. Walking ability to predict future cognitive decline in old adults: A scoping review. Ageing Res Rev 2016; 27:1-14. [PMID: 26861693 DOI: 10.1016/j.arr.2016.02.001] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/02/2016] [Accepted: 02/05/2016] [Indexed: 01/02/2023]
Abstract
Early identification of individuals at risk for cognitive decline may facilitate the selection of those who benefit most from interventions. Current models predicting cognitive decline include neuropsychological and/or biological markers. Additional markers based on walking ability might improve accuracy and specificity of these models because motor and cognitive functions share neuroanatomical structures and psychological processes. We reviewed the relationship between walking ability at one point of (mid) life and cognitive decline at follow-up. A systematic literature search identified 20 longitudinal studies. The average follow-up time was 4.5 years. Gait speed quantified walking ability in most studies (n=18). Additional gait measures (n=4) were step frequency, variability and step-length. Despite methodological weaknesses, results revealed that gait slowing (0.68-1.1 m/sec) preceded cognitive decline and the presence of dementia syndromes (maximal odds and hazard ratios of 10.4 and 11.1, respectively). The results indicate that measures of walking ability could serve as additional markers to predict cognitive decline. However, gait speed alone might lack specificity. We recommend gait analysis, including dynamic gait parameters, in clinical evaluations of patients with suspected cognitive decline. Future studies should focus on examining the specificity and accuracy of various gait characteristics to predict future cognitive decline.
Collapse
Affiliation(s)
- Lisette H J Kikkert
- University of Groningen, University Medical Centre Groningen, Center for Human Movement Sciences, A. Deusinglaan 1, 9700 AD Groningen, The Netherlands; Univ. Grenoble Alpes, EA AGEIS, La Tronche, France.
| | - Nicolas Vuillerme
- Univ. Grenoble Alpes, EA AGEIS, La Tronche, France; Institut Universitaire de France, Paris, France.
| | - Jos P van Campen
- MC Slotervaart Hospital, Department of Geriatric Medicine, Amsterdam, The Netherlands.
| | - Tibor Hortobágyi
- University of Groningen, University Medical Centre Groningen, Center for Human Movement Sciences, A. Deusinglaan 1, 9700 AD Groningen, The Netherlands; Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK.
| | - Claudine J Lamoth
- University of Groningen, University Medical Centre Groningen, Center for Human Movement Sciences, A. Deusinglaan 1, 9700 AD Groningen, The Netherlands.
| |
Collapse
|
29
|
Brodie MA, Lord SR, Coppens MJ, Annegarn J, Delbaere K. Eight-Week Remote Monitoring Using a Freely Worn Device Reveals Unstable Gait Patterns in Older Fallers. IEEE Trans Biomed Eng 2015; 62:2588-94. [PMID: 25993701 DOI: 10.1109/tbme.2015.2433935] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Develop algorithms to detect gait impairments remotely using data from freely worn devices during long-term monitoring. Identify statistical models that describe how gait performances are distributed over several weeks. Determine the data window required to reliably assess an increased propensity for falling. METHODS 1085 days of walking data were collected from eighteen independent-living older people (mean age 83 years) using a freely worn pendant sensor (housing a triaxial accelerometer and pressure sensor). Statistical distributions from several accelerometer-derived gait features (encompassing quantity, exposure, intensity, and quality) were compared for those with and without a history of falling. RESULTS Participants completed more short walks relative to long walks, as approximated by a power law. Walks less than 13.1 s comprised 50% of exposure to walking-related falls. Daily-life cadence was bimodal and step-time variability followed a log-normal distribution. Fallers took significantly fewer steps per walk and had relatively more exposure from short walks and greater mode of step-time variability. CONCLUSIONS Using a freely worn device and wavelet-based analysis tools allowed long-term monitoring of walks greater than or equal to three steps. In older people, short walks constitute a large proportion of exposure to falls. To identify fallers, mode of variability may be a better measure of central tendency than mean of variability. A week's monitoring is sufficient to reliably assess the long-term propensity for falling. SIGNIFICANCE Statistical distributions of gait performances provide a reference for future wearable device development and research into the complex relationships between daily-life walking patterns, morbidity, and falls.
Collapse
|
30
|
Zhao X, Yuan L, Feng L, Xi Y, Yu H, Ma W, Zhang D, Xiao R. Association of dietary intake and lifestyle pattern with mild cognitive impairment in the elderly. J Nutr Health Aging 2015; 19:164-8. [PMID: 25651441 DOI: 10.1007/s12603-014-0524-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION OBJECTIVES Specific diets or lifestyles have an impact on cognitive function in previous studies. However, the association of the complex action of Chinese daily diets and lifestyle patterns with mild cognitive impairment (MCI) among elderly people had not been studied exactly. The aim of this study was to explore the association of dietary and lifestyle patterns with MCI among elderly people in Beijing. DESIGN Population-based and case-control design. SETTING The physical examination center in Xuanwu Hospital, Capital Medical University in Beijing. PARTICIPANTS A total of 404 subjects, aged 60 years old or above, with or without MCI. MEASUREMENTS The Montreal cognitive assessment (MoCA) was used to screen the subjects with MCI. All subjects were required to complete a questionnaire which was comprised of their demographic information, health status, lifestyles, and food frequency questionnaire (FFQ). Binary multivariable logistic regression was used to evaluate the potential association between MCI and these factors. RESULTS With adjustment for some factors, higher daily intake of eggs (OR, 0.975, 95% CI, 0.959-0.992, P=.003) and marine products (OR, 0.96, 95% CI, 0.943-0.979, P=.000), longer time of watching TV (OR, 0.763, 95% CI, 0.628-0.928, P=.007), reading (OR, 0.540, 95% CI, 0.379-0.769, P=.001) and physical exercise (OR, 0.382, 95% CI, 0.185-0.789) had significantly decreased odds of suffering from MCI compared with the control group. CONCLUSIONS Our findings suggested that daily higher intake of eggs and marine products, watching TV, reading and physical exercise were associated with preventing the development of MCI in this population-based samples.
Collapse
Affiliation(s)
- X Zhao
- Rong Xiao, No.10 Xitoutiao, You An Men, Beijing 100069, PR China, , Tel: 86-010-83911512, Fax: 86-010-83911512
| | | | | | | | | | | | | | | |
Collapse
|