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Seifallahi M, Galvin JE, Ghoraani B. Detection of mild cognitive impairment using various types of gait tests and machine learning. Front Neurol 2024; 15:1354092. [PMID: 39055321 PMCID: PMC11269186 DOI: 10.3389/fneur.2024.1354092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 06/27/2024] [Indexed: 07/27/2024] Open
Abstract
Introduction Alzheimer's disease and related disorders (ADRD) progressively impair cognitive function, prompting the need for early detection to mitigate its impact. Mild Cognitive Impairment (MCI) may signal an early cognitive decline due to ADRD. Thus, developing an accessible, non-invasive method for detecting MCI is vital for initiating early interventions to prevent severe cognitive deterioration. Methods This study explores the utility of analyzing gait patterns, a fundamental aspect of human motor behavior, on straight and oval paths for diagnosing MCI. Using a Kinect v.2 camera, we recorded the movements of 25 body joints from 25 individuals with MCI and 30 healthy older adults (HC). Signal processing, descriptive statistical analysis, and machine learning techniques were employed to analyze the skeletal gait data in both walking conditions. Results and discussion The study demonstrated that both straight and oval walking patterns provide valuable insights for MCI detection, with a notable increase in identifiable gait features in the more complex oval walking test. The Random Forest model excelled among various algorithms, achieving an 85.50% accuracy and an 83.9% F-score in detecting MCI during oval walking tests. This research introduces a cost-effective, Kinect-based method that integrates gait analysis-a key behavioral pattern-with machine learning, offering a practical tool for MCI screening in both clinical and home environments.
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Affiliation(s)
- Mahmoud Seifallahi
- Department of Computer and Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL, United States
| | - James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami, Boca Raton, FL, United States
| | - Behnaz Ghoraani
- Department of Computer and Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL, United States
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Bringas S, Duque R, Lage C, Montana JL. CLADSI: Deep Continual Learning for Alzheimer's Disease Stage Identification Using Accelerometer Data. IEEE J Biomed Health Inform 2024; 28:3401-3410. [PMID: 38648143 DOI: 10.1109/jbhi.2024.3392354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Alzheimer's disease (AD) is a neurodegenerative disorder that can cause a significant impairment in physical and cognitive functions. Gait disturbances are also reported as a symptom of AD. Previous works have used Convolutional Neural Networks (CNNs) to analyze data provided by motion sensors that monitor Alzheimer's patients. However, these works have not explored continual learning algorithms that allow the CNN to configure itself as it receives new data from these sensors. This work proposes a method aimed at enabling CNNs to learn from a continuous stream of data from motion sensors without having full access to previous data. The CNN identifies the stage of AD from the analysis of data provided by motion sensors. The work includes an experimentation with data captured by accelerometers that monitored the activity of 35 Alzheimer's patients for a week in a daycare center. The CNN achieves an accuracy of 86,94%, 86,48% and 84,37% for 2, 3 and 4 experiences respectively. The proposal provides advantages to working with a continuous stream of data so that the CNN are constantly self-configuring without the intervention of a human. The work can be considered as promising and helpful in finding deep learning solutions in medical cases in which patients are constantly monitored.
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Pawlaczyk NA, Milner R, Szmytke M, Kiljanek B, Bałaj B, Wypych A, Lewandowska M. Medial Temporal Lobe Atrophy in Older Adults With Subjective Cognitive Impairments Affects Gait Parameters in the Spatial Navigation Task. J Aging Phys Act 2024; 32:185-197. [PMID: 37989135 DOI: 10.1123/japa.2022-0335] [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: 11/12/2022] [Revised: 07/05/2023] [Accepted: 08/21/2023] [Indexed: 11/23/2023]
Abstract
Both navigation abilities and gait can be affected by the atrophy in the medial temporal cortex. This study aimed to determine whether navigation abilities could differentiate seniors with and without medial temporal lobe atrophy who complained about their cognitive status. The participants, classified to either the medial temporal atrophy group (n = 23) or the control group (n = 22) underwent neuropsychological assessment and performed a spatial navigation task while their gait parameters were recorded. The study showed no significant differences between the two groups in memory, fluency, and semantic knowledge or typical measures of navigating abilities. However, gait parameters, particularly the propulsion index during certain phases of the navigation task, distinguished between seniors with and without medial temporal lobe lesions. These findings suggest that the gait parameters in the navigation task may be a valuable tool for identifying seniors with cognitive complaints and subtle medial temporal atrophy.
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Affiliation(s)
- Natalia Anna Pawlaczyk
- Faculty of Philosophy and Social Sciences, Institute of Psychology, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Rafał Milner
- Faculty of Philosophy and Social Sciences, Institute of Psychology, Nicolaus Copernicus University in Torun, Torun, Poland
| | | | - Bartłomiej Kiljanek
- Faculty of Philosophy and Social Sciences, Institute of Psychology, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Bibianna Bałaj
- Faculty of Philosophy and Social Sciences, Institute of Psychology, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Aleksandra Wypych
- Center for Modern Interdisciplinary Technologies, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Monika Lewandowska
- Faculty of Philosophy and Social Sciences, Institute of Psychology, Nicolaus Copernicus University in Torun, Torun, Poland
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Kerminen H, Marzetti E, D’Angelo E. Biological and Physical Performance Markers for Early Detection of Cognitive Impairment in Older Adults. J Clin Med 2024; 13:806. [PMID: 38337499 PMCID: PMC10856537 DOI: 10.3390/jcm13030806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Dementia is a major cause of poor quality of life, disability, and mortality in old age. According to the geroscience paradigm, the mechanisms that drive the aging process are also involved in the pathogenesis of chronic degenerative diseases, including dementia. The dissection of such mechanisms is therefore instrumental in providing biological targets for interventions and new sources for biomarkers. Within the geroscience paradigm, several biomarkers have been discovered that can be measured in blood and that allow early identification of individuals at risk of cognitive impairment. Examples of such markers include inflammatory biomolecules, markers of neuroaxonal damage, extracellular vesicles, and DNA methylation. Furthermore, gait speed, measured at a usual and fast pace and as part of a dual task, has been shown to detect individuals at risk of future dementia. Here, we provide an overview of available biomarkers that may be used to gauge the risk of cognitive impairment in apparently healthy older adults. Further research should establish which combination of biomarkers possesses the highest predictive accuracy toward incident dementia. The implementation of currently available markers may allow the identification of a large share of at-risk individuals in whom preventive interventions should be implemented to maintain or increase cognitive reserves, thereby reducing the risk of progression to dementia.
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Affiliation(s)
- Hanna Kerminen
- Faculty of Medicine and Health Technology, Gerontology Research Center (GEREC), Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland;
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Emanuele Marzetti
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy;
| | - Emanuela D’Angelo
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy;
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Hamedani M, Caneva S, Mancardi GL, Alì PA, Fiaschi P, Massa F, Schenone A, Pardini M. Toward Quantitative Neurology: Sensors to Assess Motor Deficits in Dementia. J Alzheimers Dis 2024; 101:1083-1106. [PMID: 39269840 DOI: 10.3233/jad-240559] [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: 09/15/2024]
Abstract
Background Alzheimer's disease (AD) is the most common neurodegenerative disorder which primarily involves memory and cognitive functions. It is increasingly recognized that motor involvement is also a common and significant aspect of AD, contributing to functional decline and profoundly impacting quality of life. Motor impairment, either at early or later stages of cognitive disorders, can be considered as a proxy measure of cognitive impairment, and technological devices can provide objective measures for both diagnosis and prognosis purposes. However, compared to other neurodegenerative disorders, the use of technological tools in neurocognitive disorders, including AD, is still in its infancy. Objective This report aims to evaluate the role of technological devices in assessing motor involvement across the AD spectrum and in other dementing conditions, providing an overview of the existing devices that show promise in this area and exploring their clinical applications. Methods The evaluation involves a review of the existing literature in the PubMed, Web of Science, Scopus, and Cochrane databases on the effectiveness of these technologies. 21 studies were identified and categorized as: wearable inertial sensors/IMU, console/kinect, gait analysis, tapping device, tablet/mobile, and computer. Results We found several parameters, such as speed and stride length, that appear promising for detecting abnormal motor function in MCI or dementia. In addition, some studies have found correlations between these motor aspects and cognitive state. Conclusions Clinical application of technological tools to assess motor function in people with cognitive impairments of a neurodegenerative nature, such as AD, may improve early detection and stratification of patients.
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Affiliation(s)
- Mehrnaz Hamedani
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy
| | - Stefano Caneva
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy
| | - Gian Luigi Mancardi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy
| | - Paolo Alessandro Alì
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy
| | - Pietro Fiaschi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federico Massa
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Angelo Schenone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Pardini
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Byun S, Lee HJ, Kim JS, Choi E, Lee S, Kim TH, Kim JH, Han JW, Kim KW. Exploring shared neural substrates underlying cognition and gait variability in adults without dementia. Alzheimers Res Ther 2023; 15:206. [PMID: 38012628 PMCID: PMC10680297 DOI: 10.1186/s13195-023-01354-y] [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: 02/22/2023] [Accepted: 11/16/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND High gait variability is associated with neurodegeneration and cognitive impairments and is predictive of cognitive impairment and dementia. The objective of this study was to identify cortical or subcortical structures of the brain shared by gait variability measured using a body-worn tri-axial accelerometer (TAA) and cognitive function. METHODS This study is a part of a larger population-based cohort study on cognitive aging and dementia. The study included 207 participants without dementia, with a mean age of 72.6, and 45.4% of them are females. We conducted standardized diagnostic interview including a detailed medical history, physical and neurological examinations, and laboratory tests for cognitive impairment. We obtained gait variability during walking using a body-worn TAA along and measured cortical thickness and subcortical volume from brain magnetic resonance (MR) images. We cross-sectionally investigated the cortical and subcortical neural structures associated with gait variability and the shared neural substrates of gait variability and cognitive function. RESULTS Higher gait variability was associated with the lower cognitive function and thinner cortical gray matter but not smaller subcortical structures. Among the clusters exhibiting correlations with gait variability, one that included the inferior temporal, entorhinal, parahippocampal, fusiform, and lingual regions in the left hemisphere was also associated with global cognitive and verbal memory function. Mediation analysis results revealed that the cluster's cortical thickness played a mediating role in the association between gait variability and cognitive function. CONCLUSION Gait variability and cognitive function may share neural substrates, specifically in regions related to memory and visuospatial navigation.
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Affiliation(s)
- Seonjeong Byun
- Department of Neuropsychiatry, College of Medicine, Uijeongbu St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyang Jun Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, 82 Gumiro 173 Beongil, Bundanggu, Seongnamsi, Gyeonggido, 463-707, Republic of Korea
| | - Jun Sung Kim
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Euna Choi
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Subin Lee
- Laboratory for Imaging Science and Technology, Department of Electrical and Computer Engineering, Seoul National University, Seoul, Republic of Korea
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Jae Hyoung Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, 82 Gumiro 173 Beongil, Bundanggu, Seongnamsi, Gyeonggido, 463-707, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, 82 Gumiro 173 Beongil, Bundanggu, Seongnamsi, Gyeonggido, 463-707, Republic of Korea.
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea.
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Longhurst JK, Rider JV, Cummings JL, John SE, Poston B, Landers MR. Cognitive-motor dual-task interference in Alzheimer's disease, Parkinson's disease, and prodromal neurodegeneration: A scoping review. Gait Posture 2023; 105:58-74. [PMID: 37487365 PMCID: PMC10720398 DOI: 10.1016/j.gaitpost.2023.07.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/20/2022] [Accepted: 07/13/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Cognitive-motor interference (CMI) is a common deficit in Alzheimer's (AD) disease and Parkinson's disease (PD) and may have utility in identification of prodromal neurodegeneration. There is lack of consensus regarding measurement of CMI resulting from dual task paradigms. RESEARCH QUESTION How are individuals with AD, PD, and prodromal neurodegeneration impacted by CMI as measured by dual-task (DT) performance? METHODS A systematic literature search was performed in six datasets using the PRISMA guidelines. Studies were included if they had samples of participants with AD, PD, or prodromal neurodegeneration and reported at least one measure of cognitive-motor DT performance. RESULTS 4741 articles were screened and 95 included as part of this scoping review. Articles were divided into three non-mutually exclusive groups based on diagnoses, with 26 articles in AD, 56 articles in PD, and 29 articles in prodromal neurodegeneration, and results presented accordingly. SIGNIFICANCE Individuals with AD and PD are both impacted by CMI, though the impact is likely different for each disease. We found a robust body of evidence regarding the utility of measures of DT performance in the detection of subtle deficits in prodromal AD and some signals of utility in prodromal PD. There are several key methodological challenges related to DT paradigms for the measurement of CMI in neurodegeneration. Overall, DT paradigms show good potential as a clinical method to probe specific brain regions, networks, and function; however, task selection and effect measurement should be carefully considered.
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Affiliation(s)
- Jason K Longhurst
- Department of Physical Therapy and Athletic Training, Saint Louis University, 3437 Caroline St. Suite, 1011 St. Louis, MO, USA.
| | - John V Rider
- School of Occupational Therapy, Touro University Nevada, Henderson, NV, USA; Department of Physical Therapy, University of Nevada, Las Vegas, NV, USA.
| | | | - Samantha E John
- Department of Brain Health, University of Nevada, Las Vegas, NV, USA.
| | - Brach Poston
- Department of Kinesiology and Nutrition, University of Nevada, Las Vegas, NV, USA.
| | - Merrill R Landers
- Department of Physical Therapy, University of Nevada, Las Vegas, NV, USA.
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Tuena C, Maestri S, Serino S, Pedroli E, Stramba-Badiale M, Riva G. Prognostic relevance of gait-related cognitive functions for dementia conversion in amnestic mild cognitive impairment. BMC Geriatr 2023; 23:462. [PMID: 37525134 PMCID: PMC10388514 DOI: 10.1186/s12877-023-04175-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/15/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Increasing research suggests that gait abnormalities can be a risk factor for Alzheimer's Disease (AD). Notably, there is growing evidence highlighting this risk factor in individuals with amnestic Mild Cognitive Impairment (aMCI), however further studies are needed. The aim of this study is to analyze cognitive tests results and brain-related measures over time in aMCI and examine how the presence of gait abnormalities (neurological or orthopedic) or normal gait affects these trends. Additionally, we sought to assess the significance of gait and gait-related measures as prognostic indicators for the progression from aMCI to AD dementia, comparing those who converted to AD with those who remained with a stable aMCI diagnosis during the follow-up. METHODS Four hundred two individuals with aMCI from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database were included. Robust linear mixed-effects models were used to study the impact of gait abnormalities on a comprehensive neuropsychological battery over 36 months while controlling for relevant medical variables at baseline. The impact of gait on brain measures was also investigated. Lastly, the Cox proportional-hazards model was used to explore the prognostic relevance of abnormal gait and neuropsychological associated tests. RESULTS While controlling for relevant covariates, we found that gait abnormalities led to a greater decline over time in attention (DSST) and global cognition (MMSE). Intriguingly, psychomotor speed (TMT-A) and divided attention (TMT-B) declined uniquely in the abnormal gait group. Conversely, specific AD global cognition tests (ADAS-13) and auditory-verbal memory (RAVLT immediate recall) declined over time independently of gait profile. All the other cognitive tests were not significantly affected by time or by gait profile. In addition, we found that ventricles size increased faster in the abnormal gait group compared to the normal gait group. In terms of prognosis, abnormal gait (HR = 1.7), MMSE (HR = 1.09), and DSST (HR = 1.03) covariates showed a higher impact on AD dementia conversion. CONCLUSIONS The importance of the link between gait and related cognitive functions in terms of diagnosis, prognosis, and rehabilitation in aMCI is critical. We showed that in aMCI gait abnormalities lead to executive functions/attention deterioration and conversion to AD dementia.
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Affiliation(s)
- Cosimo Tuena
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy.
| | - Sara Maestri
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Silvia Serino
- Department of Psychology, Università degli Studi Milano-Bicocca, Milan, Italy
| | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Faculty of Psychology, Università eCampus, Novedrate, Italy
| | - Marco Stramba-Badiale
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Humane Technology Lab, Università Cattolica del Sacro Cuore, Milan, Italy
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Bachman SL, Blankenship JM, Busa M, Serviente C, Lyden K, Clay I. Capturing Measures That Matter: The Potential Value of Digital Measures of Physical Behavior for Alzheimer's Disease Drug Development. J Alzheimers Dis 2023; 95:379-389. [PMID: 37545234 PMCID: PMC10578291 DOI: 10.3233/jad-230152] [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] [Accepted: 06/30/2023] [Indexed: 08/08/2023]
Abstract
Alzheimer's disease (AD) is a devastating neurodegenerative disease and the primary cause of dementia worldwide. Despite the magnitude of AD's impact on patients, caregivers, and society, nearly all AD clinical trials fail. A potential contributor to this high rate of failure is that established clinical outcome assessments fail to capture subtle clinical changes, entail high burden for patients and their caregivers, and ineffectively address the aspects of health deemed important by patients and their caregivers. AD progression is associated with widespread changes in physical behavior that have impacts on the ability to function independently, which is a meaningful aspect of health for patients with AD and important for diagnosis. However, established assessments of functional independence remain underutilized in AD clinical trials and are limited by subjective biases and ceiling effects. Digital measures of real-world physical behavior assessed passively, continuously, and remotely using digital health technologies have the potential to address some of these limitations and to capture aspects of functional independence in patients with AD. In particular, measures of real-world gait, physical activity, and life-space mobility captured with wearable sensors may offer value. Additional research is needed to understand the validity, feasibility, and acceptability of these measures in AD clinical research.
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Affiliation(s)
| | | | - Michael Busa
- Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA, USA
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA
| | - Corinna Serviente
- Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA, USA
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Hackett K, Giovannetti T. Capturing Cognitive Aging in Vivo: Application of a Neuropsychological Framework for Emerging Digital Tools. JMIR Aging 2022; 5:e38130. [PMID: 36069747 PMCID: PMC9494215 DOI: 10.2196/38130] [Citation(s) in RCA: 6] [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: 03/21/2022] [Revised: 07/19/2022] [Accepted: 07/31/2022] [Indexed: 11/13/2022] Open
Abstract
As the global burden of dementia continues to plague our healthcare systems, efficient, objective, and sensitive tools to detect neurodegenerative disease and capture meaningful changes in everyday cognition are increasingly needed. Emerging digital tools present a promising option to address many drawbacks of current approaches, with contexts of use that include early detection, risk stratification, prognosis, and outcome measurement. However, conceptual models to guide hypotheses and interpretation of results from digital tools are lacking and are needed to sort and organize the large amount of continuous data from a variety of sensors. In this viewpoint, we propose a neuropsychological framework for use alongside a key emerging approach-digital phenotyping. The Variability in Everyday Behavior (VIBE) model is rooted in established trends from the neuropsychology, neurology, rehabilitation psychology, cognitive neuroscience, and computer science literature and links patterns of intraindividual variability, cognitive abilities, and everyday functioning across clinical stages from healthy to dementia. Based on the VIBE model, we present testable hypotheses to guide the design and interpretation of digital phenotyping studies that capture everyday cognition in vivo. We conclude with methodological considerations and future directions regarding the application of the digital phenotyping approach to improve the efficiency, accessibility, accuracy, and ecological validity of cognitive assessment in older adults.
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Affiliation(s)
- Katherine Hackett
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, United States
| | - Tania Giovannetti
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, United States
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Bernstein JPK, Dorociak K, Mattek N, Leese M, Trapp C, Beattie Z, Kaye J, Hughes A. Unobtrusive, in-home assessment of older adults' everyday activities and health events: associations with cognitive performance over a brief observation period. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2022; 29:781-798. [PMID: 33866939 PMCID: PMC8522171 DOI: 10.1080/13825585.2021.1917503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/11/2021] [Indexed: 12/22/2022]
Abstract
In-home assessment of everyday activities over many months to years may be useful in predicting cognitive decline in older adulthood. This study examined whether a comparatively brief data collection period (3 months) may yield similar diagnostic information. A total of 91 community-dwelling older adults without dementia underwent baseline neuropsychological testing and completed weekly computer-based surveys assessing health-related events/activities. A subset of participants wore fitness tracker watches assessing daily sleep and physical activity patterns, used a sensor-instrumented pillbox, and had their computer use frequency recorded on a daily basis. Similar patterns in computer use, sleep and medication use were noted in comparison to prior literature with more extensive data collection periods. Greater computer use and sleep, as well as self-reported pain and independence, were also linked to better cognition. These activities and symptoms may be useful correlates of cognitive function even when assessed over a relatively brief monitoring period.
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Affiliation(s)
| | - Katherine Dorociak
- Department of Psychology, Palo Alto VA Health Care System, Palo Alto, CA, USA
| | - Nora Mattek
- Oregon Center for Aging & Technology, Portland, OR, USA
| | - Mira Leese
- Department of Psychology, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Chelsea Trapp
- Department of Psychology, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | | | - Jeffrey Kaye
- Oregon Center for Aging & Technology, Portland, OR, USA
| | - Adriana Hughes
- Oregon Center for Aging & Technology, Portland, OR, USA
- Department of Psychology, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
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Christova M, Strohmaier R, Fuchs-Neuhold B, Guggenberger B, Loder-Fink B, Draxler T, Palli C, Simi H, Schadenbauer S, Nischelwitzer A, Sprung G, Pilz R, Darkow R, Staubmann W. Mixed Reality Prototype of Multimodal Screening for Early Detection of Cognitive Impairments in Elderly Individuals: Protocol Development and Usability Study (Preprint). JMIR Res Protoc 2022; 11:e39513. [PMID: 36239994 PMCID: PMC9617182 DOI: 10.2196/39513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/28/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background The early diagnosis of cognitive impairments is an important step in the adequate management of dementia. The project “Smart Cognition & Behaviour Screening powered by Augmented Reality” (SCOBES-AR) aims to develop a multimodal screening tool (MST) for the early detection of cognitive impairments using augmented and virtual reality. The first project phase selected validated assessments for combination with the MST and tested it in 300 healthy older adults. Objective This study established a protocol for the implementation and usability of a mixed reality (MR)–enhanced multidisciplinary screening tool for the early detection of cognitive impairments in older adults. The developed MST will be partially enhanced by MR, which is a combination of augmented reality (AR) and virtual reality (VR). This MR-enhanced prototype of the screening tool (MR-MST) will be tested and compared to the previously developed MST. The usability of the prototype will also be examined. Methods This single-center observational crossover design study screens 100 healthy participants (aged 60-75 years) for cognitive decline using a specially developed MST (assessment of cognitive functions, olfactory sensitivity, nutritional preferences, gait parameters, reaction times, and activities of daily living) and an MR-enhanced MST in which the assessments of cognitive functions, reaction time, activities of daily living, and gait will be performed using tailor-made software and AR and VR hardware. The results of the MR-enhanced MST will be compared to those without MR. The usability of the developed MR-enhanced MST will be tested on 10 investigators and 10 test participants using observed summative evaluation and the codiscovery method, and on 2 usability experts using the codiscovery and cognitive walkthrough methods. Results This study was funded by the Austrian Research Promotion Agency (grant 866873) and received approval from the ethics committee of the Medical University of Graz. The MR-MST and the experimental protocol for this study were developed. All participants gave written informed consent. As of July 15, 2022, a total of 70 participants have been screened. Data analysis and dissemination are scheduled for completion by September 2023. Conclusions The development and testing of the MR-MST is an important step toward the establishment of the best practice procedure for the implementation of AR and VR in the screening of cognitive declines in older adults. It will help improve our knowledge of the usability and applicability of the developed prototype and promote further advancement in AR and VR technologies to be used in therapeutic settings. International Registered Report Identifier (IRRID) DERR1-10.2196/39513
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Affiliation(s)
- Monica Christova
- Institute of Physiotherapy, University of Applied Sciences FH JOANNEUM, Graz, Austria
- Section of Physiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Robert Strohmaier
- Institute of Business Informatics and Data Science, University of Applied Sciences FH JOANNEUM, Graz, Austria
| | - Bianca Fuchs-Neuhold
- Institute of Dietetics and Nutrition, University of Applied Sciences FH JOANNEUM, Graz, Austria
- Institute of Health and Tourism Management, University of Applied Sciences FH JOANNEUM, Bad Gleichenberg, Austria
| | - Bernhard Guggenberger
- Institute of Physiotherapy, University of Applied Sciences FH JOANNEUM, Graz, Austria
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Brigitte Loder-Fink
- Institute of Occupational Therapy, University of Applied Sciences FH JOANNEUM, Graz, Austria
| | - Theresa Draxler
- Institute of Dietetics and Nutrition, University of Applied Sciences FH JOANNEUM, Graz, Austria
| | - Christoph Palli
- Institute of Health Care and Nursing, University of Applied Sciences FH JOANNEUM, Graz, Austria
| | - Helmut Simi
- Institute of Health and Tourism Management, University of Applied Sciences FH JOANNEUM, Bad Gleichenberg, Austria
| | - Sandra Schadenbauer
- Institute of Business Informatics and Data Science, University of Applied Sciences FH JOANNEUM, Graz, Austria
| | - Alexander Nischelwitzer
- Institute of Business Informatics and Data Science, University of Applied Sciences FH JOANNEUM, Graz, Austria
| | - Gerhard Sprung
- Institute of Business Informatics and Data Science, University of Applied Sciences FH JOANNEUM, Graz, Austria
| | - René Pilz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Robert Darkow
- Institute of Logopedics, University of Applied Sciences FH JOANNEUM, Graz, Austria
| | - Wolfgang Staubmann
- Institute of Dietetics and Nutrition, University of Applied Sciences FH JOANNEUM, Graz, Austria
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Miller MJ, Cenzer I, Barnes DE, Covinsky KE. Physical inactivity in older adults with cognitive impairment without dementia: room for improvement. Aging Clin Exp Res 2022; 34:837-845. [PMID: 34674188 PMCID: PMC9021326 DOI: 10.1007/s40520-021-01999-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Persons with cognitive impairment without dementia are at high risk of adverse health outcomes. Tailored intervention targeting moderate-vigorous physical activity (MVPA) may reduce these risks. AIMS To identify the prevalence and predictors of physical inactivity among older adults with cognitive impairment, no dementia (CIND); and estimate the proportion of inactive people with CIND who are capable of greater MVPA. METHODS We studied 1875 community dwelling participants (over age 65) with CIND in the Health and Retirement Study. Physical inactivity was defined as MVPA ≤ 1x/week. Associations of physical inactivity with sociodemographic, health, and physical function were examined using chi-square and modified Poisson regression. We considered physically inactive participants capable of greater MVPA if they reported MVPA at least 1-3x/month, no difficulty walking several blocks, or no difficulty climbing several flights of stairs. RESULTS Fifty-six percent of participants with CIND were physically inactive. Variables with the highest age, sex, and race/ethnicity adjusted risk ratio (ARR) for physical inactivity were self-rated health (poor [76.9%]vs. excellent [34.2%]; ARR [95% CI] 2.27 [1.56-3.30]), difficulty walking (across the room [86.5%] vs. none [40.5%]; ARR [95% CI] 2.09 [1.87-2.35]), total assets (lowest quartile [62.6%] vs. highest quartile [43.1%]; ARR [95% CI] 1.54 [1.29-1.83]), and lower education attainment (less than high school [59.6%] vs college graduate [42.8%]; ARR [95% CI] 1.46 [1.17-1.83]). Among physically inactive older adults with CIND, 61% were estimated to be capable of greater MVPA. CONCLUSIONS Although physical inactivity is prevalent among older adults with CIND, many are capable of greater MVPA. Developing tailored physical activity interventions for this vulnerable population may improve cognitive, health, and quality of life outcomes.
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Affiliation(s)
- Matthew J Miller
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, CA, USA.
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA.
| | - Irena Cenzer
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Deborah E Barnes
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Kenneth E Covinsky
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
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Mobbs RJ, Perring J, Raj SM, Maharaj M, Yoong NKM, Sy LW, Fonseka RD, Natarajan P, Choy WJ. Gait metrics analysis utilizing single-point inertial measurement units: a systematic review. Mhealth 2022; 8:9. [PMID: 35178440 PMCID: PMC8800203 DOI: 10.21037/mhealth-21-17] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/27/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Wearable sensors, particularly accelerometers alone or combined with gyroscopes and magnetometers in an inertial measurement unit (IMU), are a logical alternative for gait analysis. While issues with intrusive and complex sensor placement limit practicality of multi-point IMU systems, single-point IMUs could potentially maximize patient compliance and allow inconspicuous monitoring in daily-living. Therefore, this review aimed to examine the validity of single-point IMUs for gait metrics analysis and identify studies employing them for clinical applications. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines (PRISMA) were followed utilizing the following databases: PubMed; MEDLINE; EMBASE and Cochrane. Four databases were systematically searched to obtain relevant journal articles focusing on the measurement of gait metrics using single-point IMU sensors. RESULTS A total of 90 articles were selected for inclusion. Critical analysis of studies was conducted, and data collected included: sensor type(s); sensor placement; study aim(s); study conclusion(s); gait metrics and methods; and clinical application. Validation research primarily focuses on lower trunk sensors in healthy cohorts. Clinical applications focus on diagnosis and severity assessment, rehabilitation and intervention efficacy and delineating pathological subjects from healthy controls. DISCUSSION This review has demonstrated the validity of single-point IMUs for gait metrics analysis and their ability to assist in clinical scenarios. Further validation for continuous monitoring in daily living scenarios and performance in pathological cohorts is required before commercial and clinical uptake can be expected.
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Affiliation(s)
- Ralph Jasper Mobbs
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
| | - Jordan Perring
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | | | - Monish Maharaj
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Nicole Kah Mun Yoong
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Luke Wicent Sy
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia
| | - Rannulu Dineth Fonseka
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Pragadesh Natarajan
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Wen Jie Choy
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
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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: 20] [Impact Index Per Article: 5.0] [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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16
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Miyazaki T, Kiyama R, Nakai Y, Kawada M, Takeshita Y, Araki S, Makizako H. Relationships between Gait Regularity and Cognitive Function, including Cognitive Domains and Mild Cognitive Impairment, in Community-Dwelling Older People. Healthcare (Basel) 2021; 9:1571. [PMID: 34828617 PMCID: PMC8620724 DOI: 10.3390/healthcare9111571] [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: 10/27/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this cross-sectional study was to examine the correlations between gait regularity, cognitive functions including cognitive domains, and the mild cognitive impairment (MCI) in community-dwelling older people. This study included 463 older adults (63.4% women, mean age: 74.1), and their step and stride regularity along the three-axis components was estimated from trunk acceleration, which was measured by inertial measurement units during a comfortable gait. Four aspects of cognitive function were assessed using a tablet computer: attention, executive function, processing speed, and memory, and participants were classified into those with or without MCI. The vertical component of stride and step regularity was associated with attention and executive function (r = -0.176--0.109, p ≤ 0.019), and processing speed (r = 0.152, p < 0.001), after it was adjusted for age and gait speed. The low vertical component of step regularity was related to the MCI after it was adjusted for covariates (OR 0.019; p = 0.016). The results revealed that cognitive function could affect gait regularity, and the vertical component of gait regularity, as measured by a wearable sensor, could play an important role in investigating cognitive decline in older people.
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Affiliation(s)
- Takasuke Miyazaki
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 891-0175, Japan; (T.M.); (Y.N.); (M.K.); (S.A.); (H.M.)
- Department of Rehabilitation, Tarumizu Municipal Medical Center, Tarumizu Central Hospital, Kagoshima 891-2124, Japan;
| | - Ryoji Kiyama
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 891-0175, Japan; (T.M.); (Y.N.); (M.K.); (S.A.); (H.M.)
| | - Yuki Nakai
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 891-0175, Japan; (T.M.); (Y.N.); (M.K.); (S.A.); (H.M.)
- Department of Mechanical Systems Engineering, Daiichi Institute of Technology, Kagoshima 899-4395, Japan
| | - Masayuki Kawada
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 891-0175, Japan; (T.M.); (Y.N.); (M.K.); (S.A.); (H.M.)
| | - Yasufumi Takeshita
- Department of Rehabilitation, Tarumizu Municipal Medical Center, Tarumizu Central Hospital, Kagoshima 891-2124, Japan;
- Graduate School of Health Sciences, Kagoshima University, Kagoshima 891-0175, Japan
| | - Sota Araki
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 891-0175, Japan; (T.M.); (Y.N.); (M.K.); (S.A.); (H.M.)
| | - Hyuma Makizako
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 891-0175, Japan; (T.M.); (Y.N.); (M.K.); (S.A.); (H.M.)
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Tian Q, Studenski SA, An Y, Kuo PL, Schrack JA, Wanigatunga AA, Simonsick EM, Resnick SM, Ferrucci L. Association of Combined Slow Gait and Low Activity Fragmentation With Later Onset of Cognitive Impairment. JAMA Netw Open 2021; 4:e2135168. [PMID: 34792590 PMCID: PMC8603083 DOI: 10.1001/jamanetworkopen.2021.35168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Among older people, slow walking is an early indicator of risk for Alzheimer disease (AD). However, studies that have assessed this association have not considered that slow walking may have different causes, some of which are not necessarily associated with higher AD risk. OBJECTIVE To evaluate whether low activity fragmentation among older adults with slow gait speed indicates neurological causes of slow walking that put these individuals at higher risk of AD. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study performed survival analyses using data from the Baltimore Longitudinal Study of Aging. Participants included 520 initially cognitively normal persons aged 60 years or older. New diagnoses of mild cognitive impairment (MCI) or AD were adjudicated during a mean (SD) follow-up of 7.3 (2.7) years. Initial assessment of gait speed and activity fragmentation occurred from January 3, 2007, to May 11, 2015, with follow-up completed on December 31, 2020. Data were analyzed from February 1 to May 15, 2021. EXPOSURES Gait speed for 6 m and activity fragmentation assessed by accelerometry. MAIN OUTCOMES AND MEASURES Associations of gait speed, activity fragmentation, and their interaction with incident MCI/AD were evaluated using Cox proportional hazards models, adjusted for covariates. RESULTS Among the 520 participants (265 women [51.0%]; 125 Black participants [24.0%]; 367 White participants [70.6%]; mean [SD] age, 73 [8] years), MCI/AD developed in 64 participants. Each 0.05-m/s slower gait was associated with a 7% increase in risk of developing MCI/AD (hazard ratio [HR], 1.07 [95% CI, 1.00-1.15]; P = .04). Activity fragmentation alone was not associated with MCI/AD risk (HR, 0.83 [95% CI, 0.56-1.23]; P = .35), but there was a significant interaction between gait speed and activity fragmentation (HR, 0.92 [95% CI, 0.87-0.98]; P = .01). At low activity fragmentation (-1 SD), each 0.05-m/s slower gait speed was associated with a 19% increase in hazard of developing MCI/AD (HR, 1.19 [95% CI, 1.07-1.32]), whereas at higher activity fragmentation (+1 SD), gait speed was not associated with MCI/AD (HR, 1.01 [95% CI, 0.93-1.10]). Among participants with slow gait, higher activity fragmentation was associated with higher odds of having lower extremity osteoarthritis (odds ratio, 1.31 [95% CI, 1.01-1.69]) and less decline in pegboard dominant hand performance (β = 0.026 [SE, 0.009]; P > .05). CONCLUSIONS AND RELEVANCE These findings suggest that frequent rests among older adults with slow gait speed are associated with lower risk of future MCI/AD and that this behavioral strategy is associated with a lower likelihood of subclinical neurological impairment.
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Affiliation(s)
- Qu Tian
- Translational Gerontology Branch Longitudinal Studies Section, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Stephanie A. Studenski
- Translational Gerontology Branch Longitudinal Studies Section, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
- Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Yang An
- Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Pei-Lun Kuo
- Translational Gerontology Branch Longitudinal Studies Section, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Jennifer A. Schrack
- Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Eleanor M. Simonsick
- Translational Gerontology Branch Longitudinal Studies Section, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Susan M. Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Luigi Ferrucci
- Translational Gerontology Branch Longitudinal Studies Section, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
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18
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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: 7.8] [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.
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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
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Nyul-Toth A, DelFavero J, Mukli P, Tarantini A, Ungvari A, Yabluchanskiy A, Csiszar A, Ungvari Z, Tarantini S. Early manifestation of gait alterations in the Tg2576 mouse model of Alzheimer's disease. GeroScience 2021; 43:1947-1957. [PMID: 34160781 PMCID: PMC8492885 DOI: 10.1007/s11357-021-00401-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/07/2021] [Indexed: 01/04/2023] Open
Abstract
There is strong clinical evidence that multifaceted gait abnormalities may be manifested at early stages of Alzheimer's disease (AD), are related to cognitive decline, and can be used as an early biomarker to identify patients at risk of progressing to full-blown dementia. Despite their importance, gait abnormalities have not been investigated in mouse models of AD, which replicate important aspects of the human disease. The Tg2576 is frequently used in AD research to test therapeutic interventions targeting cellular mechanisms contributing to the genesis of AD. This transgenic mouse strain overexpresses a mutant form of the 695 amino acid isoform of human amyloid precursor protein with K670N and M671L mutations (APPK670/671L) linked to early-onset familial AD. Tg2576 mice exhibit impaired cognitive functions and increased cortical and hippocampal soluble β-amyloid levels starting from 5 months of age and increased insoluble β-amyloid levels and amyloid plaques that resemble senile plaques associated with human AD by 13 months of age. To demonstrate early manifestations of gait dysfunction in this relevant preclinical model, we characterized gait and motor performance in 10-month-old Tg2576 mice and age-matched littermate controls using the semi-automated, highly sensitive, Catwalk XT system. We found that Tg2576 mice at the pre-plaque stage exhibited significantly altered duty cycle and step patterns and decreased stride length and stride time. Base-of-support, stride time variability, stride length variability, cadence, phase dispersions and gait symmetry indices were unaltered. The presence of measurable early gait abnormalities during the pre-plaque stages of AD in this relevant preclinical mouse model has direct translational relevance and supports the view that longitudinal monitoring of gait performance could be used in addition to behavioral testing to evaluate progression of the disease and to assess treatment efficacy.
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Affiliation(s)
- Adam Nyul-Toth
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Institute of Biophysics, Biological Research Centre, Eötvös Loránd Research Network (ELKH), Szeged, Hungary
| | - Jordan DelFavero
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA
| | - Peter Mukli
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Physiology, Semmelweis University, Budapest, Hungary
| | - Amber Tarantini
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA
| | - Anna Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA
| | - Andriy Yabluchanskiy
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA
| | - Anna Csiszar
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Zoltan Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA.
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary.
| | - Stefano Tarantini
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 N. E. 10th Street - BRC 1303, Oklahoma City, OK, 73104, USA.
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary.
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A combined stepping and visual tracking task predicts cognitive decline in older adults better than gait or visual tracking tasks alone: a prospective study. Aging Clin Exp Res 2021; 33:1865-1873. [PMID: 32965610 DOI: 10.1007/s40520-020-01714-w] [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: 04/24/2020] [Accepted: 09/09/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND It is unclear whether motor-cognitive dual tasks predict cognitive decline better than either motor or cognitive tasks alone. AIMS To examine the utility of the novel motor-cognitive dual-task test [Stepping Trail Making Test (S-TMT)], as a predictor of cognitive decline, and compare its predictive performance with single motor or cognitive tests. METHODS This 2-year population-based prospective study included 626 adults aged ≥ 70 years from Takashimadaira, Itabashi, Tokyo. The S-TMT measured the time taken to step on 16 numbers in order. Gait speed and TMT-A were assessed with standardized methods as single motor and cognitive tasks, respectively. A decline in the Mini-Mental State Examination score by ≥ 3 points over 2 years was defined as a significant cognitive decline. RESULTS Over 2 years, 97 (15.5%) experienced cognitive decline. After adjusting for confounders, binary logistic regression models showed no significant associations between gait speed, TMT-A time tertiles, and risk of cognitive decline, but participants in the longest tertile of S-TMT time were more likely to develop cognitive decline than those of the shortest tertile (odds ratio 2.14; 95% confidence interval 1.17-3.90). Only the addition of the S-TMT time to the covariates model significantly improved the reclassification indices for predicting cognitive decline (net reclassification improvement: 0.31, P < 0.01; integrated discrimination improvement: 0.01, P = 0.02). DISCUSSION AND CONCLUSION Only the S-TMT was significantly associated with cognitive decline and improved reclassification indices, indicating that it is more useful for predicting cognitive decline than individual gait speed or visual tracking tests alone.
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Párraga-Montilla JA, Pozuelo-Carrascosa DP, Carmona-Torres JM, Laredo-Aguilera JA, Cobo-Cuenca AI, Latorre-Román PÁ. Gait Performance as an Indicator of Cognitive Deficit in Older People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073428. [PMID: 33806244 PMCID: PMC8037000 DOI: 10.3390/ijerph18073428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/04/2021] [Accepted: 03/23/2021] [Indexed: 11/16/2022]
Abstract
Background: The purpose of this study was to analyze which gait variables are the best for detecting cognitive impairment and to determine if age and gender can influence gait variations in older people. Methods: 65 participants took part in this study (22 men and 43 women; age: 73.88 ± 9.56 years). We use the Montreal Cognitive Assessment (MoCA) to assess mild cognitive impairment (MCI). Gait speed (GS) and the complex gait test (CGT) were analyzed with photocells Witty (Microgate, Italia). The OptoGait system (Microgate, Italia) was used to analyze step length (SL) and step coefficient of variation (CV sl). Results: There was a significant association between MoCA and SL (r = 0.420; p = 0.002), CV sl (r = −0.591; p < 0.001), and CGT (r = −0.406; p = 0.001). Instrumental activities of daily living showed significant association with SL (r = 0.563; p < 0.001); CV sl (r = −0.762; p < 0.001), CGT (r = −0.622; p < 0.001), and GS (r = 0.418; p < 0.001). CV sl showed the best results with MoCA when linear regression analysis was applied (R2 = 0.560; p = 0.007; Y = 23.669 − 0.320x). Participants older than 79 years showed lower MoCA scores and poorer gait parameters than people younger than 79 years. Conclusions: CV sl, SL, CGT, and GS make it possible to detect MCI in older people, especially when these variables are evaluated as a whole.
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Affiliation(s)
- Juan Antonio Párraga-Montilla
- Department of Didactics of Music, Plastic and Corporal Expression, University of Jaén, 23071 Jaén, Spain; (J.A.P.-M.); (P.Á.L.-R.)
| | - Diana Patricia Pozuelo-Carrascosa
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy and Nursing of Toledo, University of Castilla-La Mancha, 45005 Toledo, Spain; (D.P.P.-C.); (J.M.C.-T.); (A.I.C.-C.)
- Multidisciplinary Research Group in Care (IMCU), University of Castilla-La Mancha, 45005 Toledo, Spain
- Social and Health Care Research Center (CESS), University of Castilla-La Mancha, 16071 Cuenca, Spain
| | - Juan Manuel Carmona-Torres
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy and Nursing of Toledo, University of Castilla-La Mancha, 45005 Toledo, Spain; (D.P.P.-C.); (J.M.C.-T.); (A.I.C.-C.)
- Multidisciplinary Research Group in Care (IMCU), University of Castilla-La Mancha, 45005 Toledo, Spain
| | - José Alberto Laredo-Aguilera
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy and Nursing of Toledo, University of Castilla-La Mancha, 45005 Toledo, Spain; (D.P.P.-C.); (J.M.C.-T.); (A.I.C.-C.)
- Multidisciplinary Research Group in Care (IMCU), University of Castilla-La Mancha, 45005 Toledo, Spain
- Correspondence:
| | - Ana Isabel Cobo-Cuenca
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy and Nursing of Toledo, University of Castilla-La Mancha, 45005 Toledo, Spain; (D.P.P.-C.); (J.M.C.-T.); (A.I.C.-C.)
- Multidisciplinary Research Group in Care (IMCU), University of Castilla-La Mancha, 45005 Toledo, Spain
| | - Pedro Ángel Latorre-Román
- Department of Didactics of Music, Plastic and Corporal Expression, University of Jaén, 23071 Jaén, Spain; (J.A.P.-M.); (P.Á.L.-R.)
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22
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Sakai Y, Wakao N, Matsui H, Tomita K, Watanabe T, Iida H. Surgical results in older patients with lumbar spinal stenosis according to gait speed in relation to the diagnosis for sarcopenia. J Orthop Surg (Hong Kong) 2021; 28:2309499020918422. [PMID: 32329390 DOI: 10.1177/2309499020918422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the implication of gait speed, which is a prerequisite for the diagnosis of sarcopenia in older patients with lumbar spinal stenosis (LSS). METHODS This study was conducted in a total of 235 patients with LSS who underwent surgical treatment. The state of sarcopenia and pre-sarcopenia, including gait speed, were evaluated before and after the operation. RESULTS The proportion of patients with lower than at baseline levels of skeletal muscle mass index (SMI) and gait speed was 27.2% and 17.9%, respectively. Significant changes were observed in gait speed, whereas SMI showed no significant differences between the preoperative and postoperative periods. Sarcopenic patients presented lower levels of activities of daily living preoperatively than pre-sarcopenic patients. However, favorable surgical results were obtained postoperatively. Significant changes were observed in gait speed, whereas grip strength and SMI showed no significant differences between the preoperative and postoperative periods. The postoperative decrease in SMI was not significant. CONCLUSION Postoperative gait speed was significantly improved, whereas muscle mass did not increase in the patients in this study. Therefore, low gait speed in patients with LSS seems to be derived from a neurologic disorder. The surgical results in low muscle mass patients without low gait speed were similar to those with low gait speed. Sarcopenia in elderly patients with locomotor disease should be evaluated using muscle mass alone without assessing physical performance.
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Affiliation(s)
- Yoshihito Sakai
- Department of Orthopaedic Surgery, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Norimitsu Wakao
- Department of Orthopaedic Surgery, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Hiroki Matsui
- Department of Orthopaedic Surgery, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Keisuke Tomita
- Department of Orthopaedic Surgery, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Tsuyoshi Watanabe
- Department of Orthopaedic Surgery, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Hiroki Iida
- Department of Orthopaedic Surgery, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
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Cezar NODC, Ansai JH, de Oliveira MPB, da Silva DCP, Vale FAC, Takahashi ACDM, de Andrade LP. Changes in executive function and gait in people with mild cognitive impairment and Alzheimer disease. Dement Neuropsychol 2021; 15:60-68. [PMID: 33907598 PMCID: PMC8049569 DOI: 10.1590/1980-57642021dn15-010006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Changes in executive function and motor aspects can compromise the prognosis of older adults with mild cognitive impairment (MCI) and favor the evolution to dementia. Objectives The aim of this study was to investigate the changes in executive function and gait and to determine the association between changes in these variables. Methods A 32-month longitudinal study was conducted with 40 volunteers: 19 with preserved cognition (PrC), 15 with MCI and 6 with Alzheimer disease (AD). Executive function and gait speed were assessed using the Frontal Assessment Battery, the Clock-Drawing test and the 10-meter walk test. For data analysis, the Pearson product-moment correlation, two-way repeated-measures ANOVA, and chi-square were conducted. Results After 32 months, an improvement in the executive function was found in all groups (p=0.003). At baseline, gait speed was slower in individuals with MCI and AD compared to those with PrC (p=0.044), that was maintained after the follow-up (p=0.001). There was significant increase in number of steps in all groups (p=0.001). No significant association was found between changes in gait speed and executive function. Conclusions It should be taken into account that gait deteriorates prior to executive function to plan interventions and health strategies for this population.
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Affiliation(s)
| | - Juliana Hotta Ansai
- Graduate Program in Movement Sciences, Universidade Federal de Mato Grosso do Sul - Campo Grande, MS, Brazil
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Varma VR, Ghosal R, Hillel I, Volfson D, Weiss J, Urbanek J, Hausdorff JM, Zipunnikov V, Watts A. Continuous gait monitoring discriminates community-dwelling mild Alzheimer's disease from cognitively normal controls. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12131. [PMID: 33598530 PMCID: PMC7864220 DOI: 10.1002/trc2.12131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/25/2020] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Few studies have explored whether gait measured continuously within a community setting can identify individuals with Alzheimer's disease (AD). This study tests the feasibility of this method to identify individuals at the earliest stage of AD. METHODS Mild AD (n = 38) and cognitively normal control (CNC; n = 48) participants from the University of Kansas Alzheimer's Disease Center Registry wore a GT3x+ accelerometer continuously for 7 days to assess gait. Penalized logistic regression with repeated five-fold cross-validation followed by adjusted logistic regression was used to identify gait metrics with the highest predictive performance in discriminating mild AD from CNC. RESULTS Variability in step velocity and cadence had the highest predictive utility in identifying individuals with mild AD. Metrics were also associated with cognitive domains impacted in early AD. DISCUSSION Continuous gait monitoring may be a scalable method to identify individuals at-risk for developing dementia within large, population-based studies.
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Affiliation(s)
- Vijay R. Varma
- Clinical and Translational Neuroscience SectionLaboratory of Behavioral NeuroscienceNational Institute on Aging (NIA)National Institutes of Health (NIH)BaltimoreMarylandUSA
| | - Rahul Ghosal
- Department of BiostatisticsJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Inbar Hillel
- Center for the Study of Movement, Cognition and MobilityTel Aviv Sourasky Medical Center, Neurological InstituteTel AvivIsrael
| | - Dmitri Volfson
- Neuroscience AnalyticsComputational Biology, TakedaCambridgeMassachusettsUSA
| | - Jordan Weiss
- Department of DemographyUniversity of California, BerkeleyBerkeleyCaliforniaUSA
| | - Jacek Urbanek
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Jeffrey M. Hausdorff
- Center for the Study of Movement, Cognition and MobilityTel Aviv Sourasky Medical Center, Neurological InstituteTel AvivIsrael
- Sagol School of NeuroscienceTel Aviv UniversityTel AvivIsrael
- Rush Alzheimer's Disease Center and Department of Orthopaedic SurgeryRush University Medical CenterChicagoUSA
- Department of Physical Therapy, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Vadim Zipunnikov
- Department of BiostatisticsJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Amber Watts
- Department of PsychologyUniversity of KansasLawrenceKansasUSA
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Liu Y, Ma W, Li M, Han P, Cai M, Wang F, Wang J, Chen X, Shi J, Zhang X, Zheng Y, Chen M, Guo Q, Yu Y. Relationship Between Physical Performance and Mild Cognitive Impairment in Chinese Community-Dwelling Older Adults. Clin Interv Aging 2021; 16:119-127. [PMID: 33469279 PMCID: PMC7811437 DOI: 10.2147/cia.s288164] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/26/2020] [Indexed: 01/28/2023] Open
Abstract
Objective This study aimed to examine the relationship between physical performance and mild cognitive impairment (MCI) in Chinese older adults. Methods The sample comprised 956 relatively healthy and aged ≥65 years old Chinese community-dwelling participants (mean age, 72.56 ± 5.43 years; 56.8% female), which did not include those with dementia, severe cognitive impairment, mental illness etc. The Mini-Mental State Examination (MMSE) and the Instrumental Activities of Daily Living (IADL) scale were used for the initial classification of patients with MCI. Physical performance was measured via hand grip, Timed Up and Go Test (TUGT), and 4-m walking speed. Results The physical performance (grip strength, TUGT, and 4-m walking speed) correlated with MCI. The grip strength [odds ratio (OR) = 0.96, 95% confidence interval (CI) = 0.93–0.99] and 4-m walking speed (OR = 0.25, 95% CI = 0.10–0.64) correlated negatively with MCI, while TUGT (OR = 1.08, 95% CI = 1.03–1.13) and MCI correlated positively. Conclusion The physical performance (grip strength, TUGT, and 4-m walking speed) correlated with MCI. Further analysis showed that the grip strength was associated with overall cognition, time orientation, recall, and language, while TUGT and 4-m walking speed were associated with overall cognition and various cognitive domains, except recall.
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Affiliation(s)
- Yuewen Liu
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, People's Republic of China
| | - Weibo Ma
- Department of Nursing and Health Management, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Ming Li
- Office of the President, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, People's Republic of China
| | - Peipei Han
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, People's Republic of China
| | - Ming Cai
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, People's Republic of China
| | - Feng Wang
- Department of Nursing and Health Management, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Jingru Wang
- Department of Nursing and Health Management, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Xiaoyu Chen
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, People's Republic of China
| | - Jianrong Shi
- Department of Team, Buzhen Community Health Service Center, Chongming District, Shanghai, People's Republic of China
| | - Xiaoyan Zhang
- Department of Team, Buzhen Community Health Service Center, Chongming District, Shanghai, People's Republic of China
| | - Yiyi Zheng
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, People's Republic of China
| | - Mengqiu Chen
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, People's Republic of China
| | - Qi Guo
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, People's Republic of China
| | - Ying Yu
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, People's Republic of China
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Kawasaki T, Tozawa R. Motor Function Relating to the Accuracy of Self-Overestimation Error in Community-Dwelling Older Adults. Front Neurol 2020; 11:599787. [PMID: 33329358 PMCID: PMC7734288 DOI: 10.3389/fneur.2020.599787] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Older adults often overestimate their motor performance, which represents a serious safety hazard. The cause of this self-overestimation is to date, not yet fully established. Thus, the present study aimed to reveal the factors associated with self-overestimation by focusing on motor function. Methods: This study included 105 community-dwelling older adults [20 males, median (25, 75 percentile) age: 73.00 (69.50, 77.50)]. Participants were assessed for errors in their self-estimation using a two-step test. They estimated the two-step distance that could be reached with maximum effort. Thereafter, they performed the actual two-step action. Participants were comprehensively assessed for motor function by various tests (i.e., 10-meter Walking Test, Timed Up and Go Test, postural stability, and muscle strength). They were then divided into two groups (the self-underestimation or self-overestimation group) and their motor performances were compared. Multiple linear regression analysis was then utilized to investigate the relationship between self-estimation error and motor function. Results: Significant differences were found between the two groups regarding age, weight, actual two-step distance, and the time required for the Timed Up and Go Test and 10-meter Walking Test (p < 0.05). The regression analysis showed that self-estimation error was significantly related to the result of the 10-meter Walking Test (beta = 0.24, p = 0.011). Conclusions: The self-overestimation of motor performance, which is likely to lead to several dangers (i.e., falling or obstacle collision), was related to walking ability. Consequently, the results showed that the 10-meter Walking Test would assist in detecting the self-overestimation of motor performance.
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Affiliation(s)
- Tsubasa Kawasaki
- Institute of Sports Medicine and Science, Tokyo International University, Kawagoe, Japan
| | - Ryosuke Tozawa
- Department of Physical Therapy, Faculty of Health Science, Ryotokuji University, Urayasu, Japan
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Celik Y, Stuart S, Woo WL, Godfrey A. Gait analysis in neurological populations: Progression in the use of wearables. Med Eng Phys 2020; 87:9-29. [PMID: 33461679 DOI: 10.1016/j.medengphy.2020.11.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 12/19/2022]
Abstract
Gait assessment is an essential tool for clinical applications not only to diagnose different neurological conditions but also to monitor disease progression as it contributes to the understanding of underlying deficits. There are established methods and models for data collection and interpretation of gait assessment within different pathologies. This narrative review aims to depict the evolution of gait assessment from observation and rating scales to wearable sensors and laboratory technologies and provide limitations and possible future directions in the field of gait assessment. In this context, we first present an extensive review of current clinical outcomes and gait models. Then, we demonstrate commercially available wearable technologies with their technical capabilities along with their use in gait assessment studies for various neurological conditions. In the next sections, a descriptive knowledge for existing inertial and EMG based algorithms and a sign based guide that shows the outcomes of previous neurological gait assessment studies are presented. Finally, we state a discussion for the use of wearables in gait assessment and speculate the possible research directions by revealing the limitations and knowledge gaps in the literature.
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Affiliation(s)
- Y Celik
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - S Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - W L Woo
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - A Godfrey
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK.
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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: 16] [Impact Index Per Article: 3.2] [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.
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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.
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B Åhman H, Berglund L, Cedervall Y, Kilander L, Giedraitis V, McKee KJ, Ingelsson M, Rosendahl E, Åberg AC. Dual-Task Tests Predict Conversion to Dementia-A Prospective Memory-Clinic-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218129. [PMID: 33153203 PMCID: PMC7662628 DOI: 10.3390/ijerph17218129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/20/2020] [Accepted: 10/31/2020] [Indexed: 12/29/2022]
Abstract
The aim of this study was to investigate whether Timed Up-and-Go (TUG) dual-task (TUGdt) tests predict dementia incidence among patients with subjective or mild cognitive impairment (SCI; MCI). Other study objectives were to determine whether TUGdt improves dementia prediction compared to a) demographic characteristics and standard cognitive tests alone; and b) TUG and Verbal Fluency performed separately. Patients (n = 172, age range 39–91 years, 78 women) with SCI or MCI performed TUGdt tests, including 1) naming animals and 2) reciting months backwards, and clinical cognitive tests at baseline. Diagnoses were identified at follow-up after 2.5 years. Logistic regression was used to predict dementia incidence, receiver operating characteristic (ROC) curves and c-statistics for predictive capacity. Analyses were stratified by age and gender. At follow-up, 51 patients had developed dementia. The TUGdt result “animals/10 s” was associated with dementia incidence (standardized odds ratio (OR) = 4.06, 95% confidence interval (CI) 2.28–7.23, p < 0.001), more so among patients under the median age of 72 years (standardized OR = 19.4, 95% CI 3.53–106.17, p < 0.001). TUGdt “animals/10 s” improved dementia prediction compared to demographic characteristics and standard tests alone (c-statistics 0.88 to 0.94) and single-task tests (c-statistics 0.86 to 0.89), but only in the younger patient group. TUGdt has the potential to become a useful tool for dementia prediction.
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Affiliation(s)
- Hanna B Åhman
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, SE-751 22 Uppsala, Sweden; (L.B.); (Y.C.); (L.K.); (V.G.); (M.I.); (A.C.Å.)
- Correspondence:
| | - Lars Berglund
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, SE-751 22 Uppsala, Sweden; (L.B.); (Y.C.); (L.K.); (V.G.); (M.I.); (A.C.Å.)
- School of Education, Health and Social Studies, Dalarna University, SE-791 88 Falun, Sweden;
| | - Ylva Cedervall
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, SE-751 22 Uppsala, Sweden; (L.B.); (Y.C.); (L.K.); (V.G.); (M.I.); (A.C.Å.)
| | - Lena Kilander
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, SE-751 22 Uppsala, Sweden; (L.B.); (Y.C.); (L.K.); (V.G.); (M.I.); (A.C.Å.)
| | - Vilmantas Giedraitis
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, SE-751 22 Uppsala, Sweden; (L.B.); (Y.C.); (L.K.); (V.G.); (M.I.); (A.C.Å.)
| | - Kevin J. McKee
- School of Education, Health and Social Studies, Dalarna University, SE-791 88 Falun, Sweden;
| | - Martin Ingelsson
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, SE-751 22 Uppsala, Sweden; (L.B.); (Y.C.); (L.K.); (V.G.); (M.I.); (A.C.Å.)
| | - Erik Rosendahl
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE-901 87 Umeå, Sweden;
| | - Anna Cristina Åberg
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, SE-751 22 Uppsala, Sweden; (L.B.); (Y.C.); (L.K.); (V.G.); (M.I.); (A.C.Å.)
- School of Education, Health and Social Studies, Dalarna University, SE-791 88 Falun, Sweden;
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Nocera JR, Arsik I, Keskinocak P, Lepley-Flood A, Lah JJ, Levey AI, Esper GJ. The Feasibility of Measuring Gait in an Outpatient Cognitive Neurology Clinical Setting. J Alzheimers Dis 2020; 71:S51-S55. [PMID: 31322564 DOI: 10.3233/jad-190106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is increasing interest in gait evaluations in clinical settings given the associations between gait and health outcomes. However, efforts examining implementation of gait evaluation in neurological clinics are lacking. Herein, gait implementation within a cognitive neurology clinic is presented. Over a 21-month period, a gait evaluation was collected on 81% of eligible patients (n = 2,622; mean age 73.2±9.5; age range 49-94 years; 47% female). Patients and staff reported being satisfied with the gait assessment. These finding have implications for gait evaluations in clinical settings and for clinical research aimed at understanding the impact of cognitive symptomatology on gait.
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Affiliation(s)
- Joe R Nocera
- Emory University, Department of Neurology, Atlanta, GA, USA.,Emory University, Department of Rehabilitation Medicine, Atlanta, GA, USA.,Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Atlanta, GA, USA
| | - Idil Arsik
- Georgia Institute of Technology, School of Industrial and Systems Engineering, Atlanta, GA, USA
| | - Pinar Keskinocak
- Georgia Institute of Technology, School of Industrial and Systems Engineering, Atlanta, GA, USA
| | | | - James J Lah
- Emory University, Department of Neurology, Atlanta, GA, USA
| | - Allan I Levey
- Emory University, Department of Neurology, Atlanta, GA, USA
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Fuentes-Abolafio IJ, Stubbs B, Pérez-Belmonte LM, Bernal-López MR, Gómez-Huelgas R, Cuesta-Vargas A. Functional parameters indicative of mild cognitive impairment: a systematic review using instrumented kinematic assessment. BMC Geriatr 2020; 20:282. [PMID: 32778071 PMCID: PMC7418187 DOI: 10.1186/s12877-020-01678-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/27/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Patients with mild cognitive impairment (MCI) experience alterations of functional parameters, such as an impaired balance or gait. The current systematic review set out to investigate whether functional objective performance may predict a future risk of MCI; to compare functional objective parameters in patients with MCI and a control group; and to assess changes in these parameters after different physical activity interventions. METHODS Electronic databases, including PubMed, AMED, CINAHL, EMBASE, PEDro and Web of Science as well as grey literature databases, were searched from inception to February 2020. Cohort studies and Randomized Controlled Trials (RCTs) were included. The risk of bias of the included studies was assessed independently by reviewers using quality assessment checklists. The level of evidence per outcome was assessed using the GRADE criteria. RESULTS Seventeen studies met inclusion criteria including patients with MCI. Results from RCTs suggested that gait speed, gait variability and balance may be improved by different physical activity interventions. Cohort studies showed that slower gait speed, above all, under Dual Task (DT) conditions, was the main impaired parameter in patients with MCI in comparison with a Control Gorup. Furthermore, cohort studies suggested that gait variability could predict an incident MCI. Although most of included cohort studies reported low risk of bias, RCTs showed an unclear risk of bias. CONCLUSIONS Studies suggest that gait variability may predict an incident MCI. Moreover, different gait parameters, above all under DT conditions, could be impaired in patients with MCI. These parameters could be improved by some physical activity interventions. Although cohort studies reported low risk of bias, RCTs showed an unclear risk of bias and GRADE criteria showed a low level of evidence per outcome, so further studies are required to refute our findings. PROSPERO CRD42019119180.
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Affiliation(s)
- Iván José Fuentes-Abolafio
- Department of Physiotherapy, Faculty of Health Science, University ofMálaga. Biomedical Research Institute of Malaga (IBIMA), Clinimetric Group FE-14, Málaga, Spain. Av/ Arquitecto Peñalosa s/n (Teatinos Campus Expansion), 29071, Malaga, Spain
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Positive Ageing Research Intitute (PARI), Faculty of Health Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Luis Miguel Pérez-Belmonte
- Internal Medicine Department, Instituto de Investigación Biomédica de Malaga (IBIMA), Regional University Hospital of Málaga, Málaga, Spain.,Unidad de Neurofisiología Cognitiva, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Campus de Excelencia Internacional (CEI) Andalucía Tech, Málaga, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - María Rosa Bernal-López
- Internal Medicine Department, Instituto de Investigación Biomédica de Malaga (IBIMA), Regional University Hospital of Málaga, Málaga, Spain.,CIBER Fisio-patología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Instituto de Investigación Biomédica de Malaga (IBIMA), Regional University Hospital of Málaga, Málaga, Spain.,CIBER Fisio-patología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Cuesta-Vargas
- Department of Physiotherapy, Faculty of Health Science, University ofMálaga. Biomedical Research Institute of Malaga (IBIMA), Clinimetric Group FE-14, Málaga, Spain. Av/ Arquitecto Peñalosa s/n (Teatinos Campus Expansion), 29071, Malaga, Spain. .,School of Clinical Sciences, Faculty of Health at the Queensland University of Technology, Brisbane, Queensland, Australia.
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Bringas S, Salomón S, Duque R, Lage C, Montaña JL. Alzheimer's Disease stage identification using deep learning models. J Biomed Inform 2020; 109:103514. [PMID: 32711124 DOI: 10.1016/j.jbi.2020.103514] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this research is to identify the stage of Alzheimer's Disease (AD) patients through the use of mobility data and deep learning models. This process facilitates the monitoring of the disease and allows actions to be taken in order to provide the optimal treatment and the prevention of complications. MATERIALS AND METHODS We employed data from 35 patients with AD collected by smartphones for a week in a daycare center. The data sequences of each patient recorded the accelerometer changes while daily activities were performed and they were labeled with the stage of the disease (early, middle or late). Our methodology processes these time series and uses a Convolutional Neural Network (CNN) model to recognize the patterns that identify each stage. RESULTS The CNN-based method achieved a 90.91% accuracy and an F1-score of 0.897, greatly improving the results obtained by the traditional feature-based classifiers. DISCUSSION AND CONCLUSION In our research, we show that mobility data can be a valuable resource for the treatment of patients with AD as well as to study the progress of the disease. The use of our CNN-based method improves the accuracy of the identification of AD stages in comparison to common supervised learning models.
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Affiliation(s)
- Santos Bringas
- Fundación Centro Tecnológico de Componentes CTC, 39011 Santander, Spain.
| | | | - Rafael Duque
- Department of Mathematics, Statistics and Computer Science, Universidad de Cantabria, 39005 Santander, Spain.
| | - Carmen Lage
- Cognitive Disorders Unit, Department of Neurology, Marqués de Valdecilla University Hospital (HUMV), Valdecilla Biomedical Research Institute (IDIVAL), 39008 Santander, Spain.
| | - José Luis Montaña
- Department of Mathematics, Statistics and Computer Science, Universidad de Cantabria, 39005 Santander, Spain.
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McKeown A, Turner A, Angehrn Z, Gove D, Ly A, Nordon C, Nelson M, Tochel C, Mittelstadt B, Keenan A, Smith M, Singh I. Health Outcome Prioritization in Alzheimer's Disease: Understanding the Ethical Landscape. J Alzheimers Dis 2020; 77:339-353. [PMID: 32716354 PMCID: PMC7592677 DOI: 10.3233/jad-191300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dementia has been described as the greatest global health challenge in the 21st Century on account of longevity gains increasing its incidence, escalating health and social care pressures. These pressures highlight ethical, social, and political challenges about healthcare resource allocation, what health improvements matter to patients, and how they are measured. This study highlights the complexity of the ethical landscape, relating particularly to the balances that need to be struck when allocating resources; when measuring and prioritizing outcomes; and when individual preferences are sought. OBJECTIVE Health outcome prioritization is the ranking in order of desirability or importance of a set of disease-related objectives and their associated cost or risk. We analyze the complex ethical landscape in which this takes place in the most common dementia, Alzheimer's disease. METHODS Narrative review of literature published since 2007, incorporating snowball sampling where necessary. We identified, thematized, and discussed key issues of ethical salience. RESULTS Eight areas of ethical salience for outcome prioritization emerged: 1) Public health and distributive justice, 2) Scarcity of resources, 3) Heterogeneity and changing circumstances, 4) Knowledge of treatment, 5) Values and circumstances, 6) Conflicting priorities, 7) Communication, autonomy and caregiver issues, and 8) Disclosure of risk. CONCLUSION These areas highlight the difficult balance to be struck when allocating resources, when measuring and prioritizing outcomes, and when individual preferences are sought. We conclude by reflecting on how tools in social sciences and ethics can help address challenges posed by resource allocation, measuring and prioritizing outcomes, and eliciting stakeholder preferences.
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Affiliation(s)
- Alex McKeown
- Department of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Andrew Turner
- The National Institute for Health Research Applied Research Collaboration West [NIHR ARC West] at University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | | | | | - Amanda Ly
- MRC Integrative Epidemiology Unit & Centre for Academic Mental Health, University of Bristol, Bristol, UK
| | | | - Mia Nelson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Claire Tochel
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Alex Keenan
- Janssen Pharmaceutica NV, Titusville, NJ, USA
| | - Michael Smith
- Alzheimer Scotland Centre for Policy and Practice, University of the West of Scotland, Paisley, Scotland, UK
| | - Ilina Singh
- Department of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
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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: 2.7] [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.
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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
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Grande G, Triolo F, Nuara A, Welmer AK, Fratiglioni L, Vetrano DL. Measuring gait speed to better identify prodromal dementia. Exp Gerontol 2019; 124:110625. [PMID: 31173841 DOI: 10.1016/j.exger.2019.05.014] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/25/2019] [Accepted: 05/29/2019] [Indexed: 10/26/2022]
Abstract
Slow gait speed has been shown to predict incident dementia and cognitive decline in older individuals. We aimed to summarize the evidence concerning the association of slow gait speed with cognitive decline and dementia, and discuss the possible shared pathways leading to cognitive and motor impairments, under the unifying hypothesis that body and mind are intimately connected. This is a scoping review supported by a systematic search of the literature, performed on PubMed and Web of Science. Longitudinal studies providing information on the role of gait speed in the prediction of cognitive decline and dementia in cognitively intact people and in those with initial cognitive impairment were eligible. Of 39 studies selected, including overall 57,456 participants, 33 reported a significant association between gait speed and cognitive outcomes, including dementia. Neurodegenerative pathology and cerebrovascular burden may damage cerebral areas involved in both cognitive functions and motor control. At the same time, systemic conditions, characterized by higher cardiorespiratory, and metabolic and inflammatory burden, can affect a number of organs and systems involved in motor functions, including the brain, having ultimately an impact on cognition. The interplay of body and mind seems relevant during the development of cognitive decline and dementia. The measurement of gait speed may improve the detection of prodromal dementia and cognitive impairment in individuals with and without initial cognitive deficits. The potential applicability of such a measure in both clinical and research settings points at the importance of expanding our knowledge about the common underlying mechanisms of cognitive and motor decline.
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Affiliation(s)
- Giulia Grande
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Federico Triolo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy
| | - Arturo Nuara
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy; Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Parma, Italy
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Allied Health Professionals, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Centro Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy.
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36
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López-López D, Grela-Fariña M, Losa-Iglesias ME, Calvo-Lobo C, Rodríguez-Sanz D, Palomo-López P, Becerro-de-Bengoa-Vallejo R. Clinical Aspects of Foot Health in Individuals with Alzheimer's Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E286. [PMID: 29414905 PMCID: PMC5858355 DOI: 10.3390/ijerph15020286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 02/01/2018] [Accepted: 02/04/2018] [Indexed: 11/16/2022]
Abstract
Alzheimer's disease (AD) shows a marked presence of physiologic changes and the start or aggravation of underlying diseases such as physical frailty in diverse anatomical regions. It is believed to have a particularly harmful effect on the health of the foot. We examined the foot health status in older persons with AD, with a specific focus on the extent to which people with AD may be using inadequate footwear in old age. Seventy-three community-dwelling people with probable, mild to moderate AD aged 65-95 years were recruited from a center of excellence for AD. A single trained physician evaluated health status and foot conditions. Current shoe and foot length and width measurements were taken using a calibrated Brannock device. The results indicate that sixty-five participants (89.04%) suffered from feet problems. Also, only twenty-two subjects (30.14%) used the correct shoes in width and size related with the morphology of their feet. Fifty-one participants (69.86%) were using incorrect shoes in length or width. The present study revealed that peoples with AD had a high presence of foot health problems. Also, the use of inappropriate shoes revealed measurable differences of association between shoe size and the morphology of the foot.
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Affiliation(s)
- Daniel López-López
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403 Ferrol, Spain.
| | - Marta Grela-Fariña
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403 Ferrol, Spain.
| | | | - César Calvo-Lobo
- Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Universidad de León, 24401 Ponferrada, Spain.
| | - David Rodríguez-Sanz
- Research Group, Faculty of Health, Exercise and Sport, European University of Madrid, 28670 Villaviciosa de Odón, Spain.
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Gillain S, Boutaayamou M, Dardenne N, Schwartz C, Demonceau M, Gerontitis C, Depierreux F, Salmon E, Garraux G, Bruyère O, Brüls O, Croisier JL, Petermans J. Data set of healthy old people assessed for three walking conditions using accelerometric and opto-electronic methods. Aging Clin Exp Res 2017; 29:1201-1209. [PMID: 28247211 DOI: 10.1007/s40520-017-0730-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/20/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gait patterns of healthy aging are needed to allow a comparison with pathological situations. However, little data is available. OBJECTIVE To present gait pattern of healthy older specially selected to be "healthy walkers". METHOD Fifty-seven older people benefited from a geriatric assessment including clinical and functional evaluations to include only those without gait disorders. Gait data were simultaneously recorded using a tri-axial accelerometer placed on the waist and four 3D position markers placed on the feet at the level of the heel and the toe. Volunteers walked at comfortable self-selected speed (CW), fast self-selected speed (FW), and finally in dual task walking condition (DTW). The extracted gait parameters were: gait speed, stride length, stride frequency, regularity and symmetry, swing, stance and double support time and ratio and minimum toe clearance. Gait speed and stride length were normalized to the right leg length. RESULTS Fifty-seven older people with a mean age of 69.7 ± 4.2 years old (range from 65 to 82 years) were included. Data were analyzed according to the gender and according to the age (<70 or ≥70 years old). After normalization to leg length, the main significant differences were shown for stride length and minimum toe clearance in CW, FW and in DTW that were shorter in women. The regularity in FW was significantly lower among older volunteers. CONCLUSIONS This work provides a data set considering 14 gait parameters obtained from 57 healthy old people strictly selected and assessed for three walking conditions and shows that GS, SL and MTC have to be related to the gender. The age-related impact on gait performances appears reduced in this cohort.
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Affiliation(s)
- S Gillain
- Geriatric Department, University Hospital of Liège, C.H.U. site NDB, Route de Gaillarmont, 600, 4032, Chênée, Belgium.
| | - M Boutaayamou
- INTELSIG Laboratory, Department of Electrical Engineering and Computer Science, University of Liège, Liege, Belgium
| | - N Dardenne
- Public Health Department, University of Liège, Liege, Belgium
| | - C Schwartz
- Laboratory of Human Motion Analysis, LAMH, University of Liège, Liege, Belgium
| | - M Demonceau
- Science of Motricity Department, University of Liège, Liege, Belgium
| | - C Gerontitis
- Geriatric Department, University Hospital of Liège, C.H.U. site NDB, Route de Gaillarmont, 600, 4032, Chênée, Belgium
| | - F Depierreux
- Neurology Department, University Hospital of Liège, Chênée, Belgium
| | - E Salmon
- Neurology Department, University Hospital of Liège, Chênée, Belgium
| | - G Garraux
- Neurology Department, University Hospital of Liège, Chênée, Belgium
| | - O Bruyère
- Research Unit in Public Health, Epidemiology and Health Economics, University of Liège, Liege, Belgium
| | - O Brüls
- Laboratory of Human Motion Analysis, LAMH, University of Liège, Liege, Belgium
| | - J-L Croisier
- Laboratory of Human Motion Analysis, LAMH, University of Liège, Liege, Belgium
| | - J Petermans
- Geriatric Department, University Hospital of Liège, C.H.U. site NDB, Route de Gaillarmont, 600, 4032, Chênée, Belgium
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Tarantini S, Yabluchanksiy A, Fülöp GA, Hertelendy P, Valcarcel-Ares MN, Kiss T, Bagwell JM, O'Connor D, Farkas E, Sorond F, Csiszar A, Ungvari Z. Pharmacologically induced impairment of neurovascular coupling responses alters gait coordination in mice. GeroScience 2017; 39:601-614. [PMID: 29243191 PMCID: PMC5745218 DOI: 10.1007/s11357-017-0003-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/01/2017] [Indexed: 12/20/2022] Open
Abstract
There is correlative evidence that impaired cerebral blood flow (CBF) regulation, in addition to promoting cognitive impairment, is also associated with alterations in gait and development of falls in elderly people. CBF is adjusted to neuronal activity via neurovascular coupling (NVC) and this mechanism becomes progressively impaired with age. To establish a direct cause-and-effect relationship between impaired NVC and gait abnormalities, we induced neurovascular uncoupling pharmacologically in young C57BL/6 mice by inhibiting the synthesis of vasodilator mediators involved in NVC. Treatment of mice with the epoxygenase inhibitor MSPPOH, the NO synthase inhibitor L-NAME, and the COX inhibitor indomethacin significantly decreased NVC mimicking the aging phenotype. Pharmacologically induced neurovascular uncoupling significantly decreased the dynamic gait parameter duty cycle, altered footfall patterns, and significantly increased phase dispersion, indicating impaired interlimb coordination. Impaired NVC also tended to increase gait variability. Thus, selective experimental disruption of NVC causes subclinical gait abnormalities, supporting the importance of CBF in both cognitive function and gait regulation.
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Affiliation(s)
- Stefano Tarantini
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andriy Yabluchanksiy
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Gábor A Fülöp
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Peter Hertelendy
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - M Noa Valcarcel-Ares
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Tamas Kiss
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jonathan M Bagwell
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Veterinary Pathobiology, Oklahoma State University, Stillwater, OK, USA
| | - Daniel O'Connor
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Eszter Farkas
- Department of Medical Physics and Informatics, Faculty of Medicine and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Farzaneh Sorond
- Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Anna Csiszar
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Medical Physics and Informatics, Faculty of Medicine and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Zoltan Ungvari
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- Department of Medical Physics and Informatics, Faculty of Medicine and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary.
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Kuate-Tegueu C, Avila-Funes JA, Simo N, Le Goff M, Amiéva H, Dartigues JF, Tabue-Teguo M. Association of Gait Speed, Psychomotor Speed, and Dementia. J Alzheimers Dis 2017; 60:585-592. [DOI: 10.3233/jad-170267] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | - José-Alberto Avila-Funes
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- University Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
| | - Nadine Simo
- Centre Hospitalier de Villeneuve/lot, France
| | - Mélanie Le Goff
- University Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
- Bordeaux University, ISPED, Bordeaux, France
| | - Hélène Amiéva
- University Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
- Bordeaux University, ISPED, Bordeaux, France
| | - Jean-François Dartigues
- University Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
- Bordeaux University, ISPED, Bordeaux, France
| | - Maturin Tabue-Teguo
- Centre Hospitalier de Villeneuve/lot, France
- University Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
- Bordeaux University, ISPED, Bordeaux, France
- CHU of Pointe-à-Pitre, French West Indies University (Guadeloupe)
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40
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Hooghiemstra AM, Ramakers IHGB, Sistermans N, Pijnenburg YAL, Aalten P, Hamel REG, Melis RJF, Verhey FRJ, Olde Rikkert MGM, Scheltens P, van der Flier WM. Gait Speed and Grip Strength Reflect Cognitive Impairment and Are Modestly Related to Incident Cognitive Decline in Memory Clinic Patients With Subjective Cognitive Decline and Mild Cognitive Impairment: Findings From the 4C Study. J Gerontol A Biol Sci Med Sci 2017; 72:846-854. [PMID: 28177065 DOI: 10.1093/gerona/glx003] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 01/03/2017] [Indexed: 11/14/2022] Open
Abstract
Background Prospective studies in the general population show that slow gait speed is associated with cognitive decline and clinical progression to dementia. However, longitudinal studies in memory clinic populations are mostly lacking. We aimed to study the association between gait speed and grip strength and cognitive functioning at baseline and cognitive decline over time in memory clinic patients with subjective cognitive decline and mild cognitive impairment. Methods We included 309 patients (age 70 ± 9 years, 108 [35%] women, Mini-Mental State Examination 27 ± 3 points). Baseline gait speed was assessed over 15 feet, grip strength with a hydraulic hand dynamometer. Cognitive functioning was assessed annually with a comprehensive test battery during 3 years. Results Age- and gender-adjusted linear mixed models showed that slower gait speed was related to worse baseline attention, memory, information processing speed, and verbal fluency. Longitudinally, gait speed was related to decline in information processing speed and executive functioning. Weaker grip strength was related to worse baseline information processing speed and executive functioning but there were no longitudinal associations. Cox proportional hazards models revealed no significant associations with clinical progression. Conclusions Our findings suggest that markers of physical performance are related to current cognitive status and modestly related to cognitive decline but are seemingly not useful as an early marker of incident clinical progression.
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Affiliation(s)
- Astrid M Hooghiemstra
- Alzheimer Center, Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, The Netherlands.,Department of Clinical Neuropsychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Inez H G B Ramakers
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University Medical Center, The Netherlands
| | - Nicole Sistermans
- Alzheimer Center, Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, The Netherlands
| | - Yolande A L Pijnenburg
- Alzheimer Center, Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, The Netherlands
| | - Pauline Aalten
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University Medical Center, The Netherlands
| | - Renske E G Hamel
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University Medical Center, The Netherlands
| | - René J F Melis
- Department of Geriatrics and Radboudumc Alzheimer Center, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Frans R J Verhey
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University Medical Center, The Netherlands
| | - Marcel G M Olde Rikkert
- Department of Geriatrics and Radboudumc Alzheimer Center, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Philip Scheltens
- Alzheimer Center, Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center, Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, The Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, VU University Medical Center, The Netherlands
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41
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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: 6.6] [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.
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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.
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42
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Belghali M, Chastan N, Davenne D, Decker LM. Improving Dual-Task Walking Paradigms to Detect Prodromal Parkinson's and Alzheimer's Diseases. Front Neurol 2017; 8:207. [PMID: 28588547 PMCID: PMC5438971 DOI: 10.3389/fneur.2017.00207] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/27/2017] [Indexed: 12/22/2022] Open
Abstract
Gait control is a complex movement, relying on spinal, subcortical, and cortical structures. The presence of deficits in one or more of these structures will result in changes in gait automaticity and control, as is the case in several neurodegenerative diseases, such as Alzheimer's disease (AD) and Parkinson's disease (PD). By reviewing recent findings in this field of research, current studies have shown that gait performance assessment under dual-task conditions could contribute to predict both of these diseases. Such suggestions are relevant mainly for people at putatively high risk of developing AD (i.e., older adults with mild cognitive impairment subtypes) or PD (i.e., older adults with either Mild Parkinsonian signs or LRRK2 G2019S mutation). Despite the major importance of these results, the type of cognitive task that should be used as a concurrent secondary task has to be selected among the plurality of tasks proposed in the literature. Furthermore, the key aspects of gait control that represent sensitive and specific "gait signatures" for prodromal AD or PD need to be determined. In the present perspective article, we suggest the use of a Stroop interference task requiring inhibitory attentional control and a set-shifting task requiring reactive flexibility as being particularly relevant secondary tasks for challenging gait in prodromal AD and PD, respectively. Investigating how inhibition and cognitive flexibility interfere with gait control is a promising avenue for future research aimed at enhancing early detection of AD and PD, respectively.
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Affiliation(s)
| | - Nathalie Chastan
- Normandie Université, UNICAEN, INSERM, COMETE, Caen, France.,Department of Neurophysiology, Normandie Université, UNIROUEN, Rouen University Hospital-Charles Nicolle, Rouen, France
| | - Damien Davenne
- Normandie Université, UNICAEN, INSERM, COMETE, Caen, France
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Vienne A, Barrois RP, Buffat S, Ricard D, Vidal PP. Inertial Sensors to Assess Gait Quality in Patients with Neurological Disorders: A Systematic Review of Technical and Analytical Challenges. Front Psychol 2017; 8:817. [PMID: 28572784 PMCID: PMC5435996 DOI: 10.3389/fpsyg.2017.00817] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/04/2017] [Indexed: 11/13/2022] Open
Abstract
Gait disorders are major causes of falls in patients with neurological diseases. Understanding these disorders allows prevention and better insights into underlying diseases. InertiaLocoGraphy (ILG) -the quantification of gait by using inertial measurement units (IMUs) -shows great potential to address this public health challenge, but protocols vary widely and normative values of gait parameters are still unavailable. This systematic review critically compares ILG protocols, questions features extracted from inertial signals and proposes a semeiological analysis of clinimetric characteristics for use in neurological clinical routine. For this systematic review, PubMed, Cochrane and EMBASE were searched for articles assessing gait quality by using IMUs that were published from January 1, 2014 to August 31, 2016. ILG was used to assess gait in a wide range of neurological disorders - including Parkinson disease, mild cognitive impairment, Alzheimer disease, cerebral palsy, and cerebellar atrophy - as well as in the faller or frail older population and in people presenting rheumatological pathologies. However, results have not yet been driving changes in clinical practice. One reason could be that studies mainly aimed at comparing pathological gait to healthy gait, but there is stronger need for semiological descriptions of gait perturbation, severity or prognostic assessment. Furthermore, protocols used to assess gait using IMUs are too many. Likely, outcomes are highly heterogeneous and difficult to compare across large panels of studies. Therefore, homogenization is needed to foster the use of ILG to assess gait quality in neurological routine practice. The pros and cons of each protocol are emphasized so that a compromise can be reached. As well, analysis of seven complementary clinical criteria (springiness, sturdiness, smoothness, steadiness, stability, symmetry, synchronization) is advocated.
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Affiliation(s)
- Aliénor Vienne
- CNRS UMR 8257, Cognition and Action Group, Cognac-G, Université Paris Descartes, Service de Santé des ArméesParis, France
| | - Rémi P Barrois
- CNRS UMR 8257, Cognition and Action Group, Cognac-G, Université Paris Descartes, Service de Santé des ArméesParis, France
| | - Stéphane Buffat
- CNRS UMR 8257, Cognition and Action Group, Cognac-G, Université Paris Descartes, Service de Santé des ArméesParis, France.,Institut de Recherche Biomédicale des Armées, Service de Santé des ArméesBrétigny-sur-Orge, France.,Ecole du Val-de-Grâce, Service de Santé des ArméesParis, France
| | - Damien Ricard
- CNRS UMR 8257, Cognition and Action Group, Cognac-G, Université Paris Descartes, Service de Santé des ArméesParis, France.,Ecole du Val-de-Grâce, Service de Santé des ArméesParis, France.,Service de Neurologie de l'Hôpital d'Instruction des Armées de Percy, Service de Santé des ArméesClamart, France
| | - Pierre-Paul Vidal
- CNRS UMR 8257, Cognition and Action Group, Cognac-G, Université Paris Descartes, Service de Santé des ArméesParis, France
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Veronese N, Stubbs B, Trevisan C, Bolzetta F, De Rui M, Solmi M, Sartori L, Musacchio E, Zambon S, Perissinotto E, Crepaldi G, Manzato E, Sergi G. What physical performance measures predict incident cognitive decline among intact older adults? A 4.4year follow up study. Exp Gerontol 2016; 81:110-8. [DOI: 10.1016/j.exger.2016.05.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/10/2016] [Accepted: 05/21/2016] [Indexed: 01/07/2023]
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Hagner-Derengowska M, Kałużny K, Hagner W, Kałużna A, Kochański B, Borkowska A, Budzyński J. The Effect of Two Different Cognitive Tests on Gait Parameters during Dual Tasks in Healthy Postmenopausal Women. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1205469. [PMID: 27022602 PMCID: PMC4789027 DOI: 10.1155/2016/1205469] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 01/19/2016] [Accepted: 02/02/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The paper aims to evaluate the influence of two different demanding cognitive tasks on gait parameters using BTS SMART system analysis. PATIENTS AND METHODS The study comprised 53 postmenopausal women aged 64.5 ± 6.7 years (range: 47-79). For every subject, gait analysis using a BTS SMART system was performed in a dual-task study design under three conditions: (I) while walking only (single task), (II) walking while performing a simultaneous simple cognitive task (SCT) (dual task), and (III) walking while performing a simultaneous complex cognitive task (CCT) (dual task). Time-space parameters of gait pertaining to the length of a single support phase, double support phase, gait speed, step length, step width, and leg swing speed were analyzed. RESULTS Performance of cognitive tests during gait resulted in a statistically significant prolongation of the left (by 7%) and right (by 7%) foot gait cycle, shortening of the length of steps made with the right extremity (by 4%), reduction of speed of swings made with the left (by 11%) and right (by 8%) extremity, and reduction in gait speed (by 6%). CONCLUSIONS Performance of cognitive tests during gait changes its individual pattern in relation to the level of the difficulty of the task.
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Affiliation(s)
- Magdalena Hagner-Derengowska
- Chair of Clinical Neuropsychology, Faculty of Health Sciences, Nicolaus Copernicus University in Toruń, M. Skłodowskiej-Curie 9 Street, 85-094 Bydgoszcz, Poland
| | - Krystian Kałużny
- Chair and Clinic of Rehabilitation, Faculty of Health Sciences, Nicolaus Copernicus University in Toruń, M. Skłodowskiej-Curie 9 Street, 85-094 Bydgoszcz, Poland
| | - Wojciech Hagner
- Chair and Clinic of Rehabilitation, Faculty of Health Sciences, Nicolaus Copernicus University in Toruń, M. Skłodowskiej-Curie 9 Street, 85-094 Bydgoszcz, Poland
| | - Anna Kałużna
- Chair and Clinic of Rehabilitation, Faculty of Health Sciences, Nicolaus Copernicus University in Toruń, M. Skłodowskiej-Curie 9 Street, 85-094 Bydgoszcz, Poland
| | - Bartosz Kochański
- Chair and Clinic of Rehabilitation, Faculty of Health Sciences, Nicolaus Copernicus University in Toruń, M. Skłodowskiej-Curie 9 Street, 85-094 Bydgoszcz, Poland
| | - Alina Borkowska
- Chair of Clinical Neuropsychology, Faculty of Health Sciences, Nicolaus Copernicus University in Toruń, M. Skłodowskiej-Curie 9 Street, 85-094 Bydgoszcz, Poland
| | - Jacek Budzyński
- Chair of Vascular and Internal Diseases, Faculty of Health Sciences, Nicolaus Copernicus University in Toruń, Ujejskiego 75 Street, 85-168 Bydgoszcz, Poland
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