Stages of mild cognitive impairment and Alzheimer’s disease can be differentiated by declines in timed up and go test: A systematic review and meta-analysis

Mobility, functionality and functional mobility: A review and application for canine veterinary patients

Mobility is an essential aspect of a dog's daily life. It is defined as the ability to move freely and easily and deviations from an animals' normal mobility capabilities are often an indicator of disease, injury or pain. When a dog's mobility is compromised, often functionality (ability to perform activities of daily living [ADL]), is also impeded, which can diminish an animal's quality of life. Given this, it is necessary to understand the extent to which conditions impact a dog's physiological ability to move around their environment to carry out ADL, a concept termed functional mobility. In contrast to human medicine, validated measures of canine functional mobility are currently limited. The aim of this review is to summarise the extent to which canine mobility and functionality are associated with various diseases and how mobility and functional mobility are currently assessed within veterinary medicine. Future work should focus on developing a standardised method of assessing functional mobility in dogs, which can contextualise how a wide range of conditions impact a dog's daily life. However, for a true functional mobility assessment to be developed, a greater understanding of what activities dogs do on a daily basis and movements underpinning these activities must first be established.

Digging into the intrinsic capacity concept: Can it be applied to Alzheimer's disease?

Historically, aging research has largely centered on disease pathology rather than promoting healthy aging. The World Health Organization's (WHO) policy framework (2015-2030) underscores the significance of fostering the contributions of older individuals to their families, communities, and economies. The WHO has introduced the concept of intrinsic capacity (IC) as a key metric for healthy aging, encompassing five primary domains: locomotion, vitality, sensory, cognitive, and psychological. Past AD research, constrained by methodological limitations, has focused on single outcome measures, sidelining the complexity of the disease. Our current scientific milieu, however, is primed to adopt the IC concept. This is due to three critical considerations: (I) the decline in IC is linked to neurocognitive disorders, including AD, (II) cognition, a key component of IC, is deeply affected in AD, and (III) the cognitive decline associated with AD involves multiple factors and pathophysiological pathways. Our study explores the application of the IC concept to AD patients, offering a comprehensive model that could revolutionize the disease's diagnosis and prognosis. There is a dearth of information on the biological characteristics of IC, which are a result of complex interactions within biological systems. Employing a systems biology approach, integrating omics technologies, could aid in unraveling these interactions and understanding IC from a holistic viewpoint. This comprehensive analysis of IC could be leveraged in clinical settings, equipping healthcare providers to assess AD patients' health status more effectively and devise personalized therapeutic interventions in accordance with the precision medicine paradigm. We aimed to determine whether the IC concept could be extended from older individuals to patients with AD, thereby presenting a model that could significantly enhance the diagnosis and prognosis of this disease.

Feasibility of Identifying Factors Related to Alzheimer's Disease and Related Dementia in Real-World Data

A comprehensive view of factors associated with AD/ADRD will significantly aid in studies to develop new treatments for AD/ADRD and identify high-risk populations and patients for prevention efforts. In our study, we summarized the risk factors for AD/ADRD by reviewing existing meta-analyses and review articles on risk and preventive factors for AD/ADRD. In total, we extracted 477 risk factors in 10 categories from 537 studies. We constructed an interactive knowledge map to disseminate our study results. Most of the risk factors are accessible from structured Electronic Health Records (EHRs), and clinical narratives show promise as information sources. However, evaluating genomic risk factors using RWD remains a challenge, as genetic testing for AD/ADRD is still not a common practice and is poorly documented in both structured and unstructured EHRs. Considering the constantly evolving research on AD/ADRD risk factors, literature mining via NLP methods offers a solution to automatically update our knowledge map.

The contribution of motor efficiency to drawing performance of older people with and without signs of cognitive decline

In clinical practice, different drawing tests are used for the assessment of cognitive efficiency in the geriatric population. However, so far, the contribution of motor skills to drawing performance has not been sufficiently examined in the late adult life span. This study was aimed at disentangling the role played by motor functioning in three well-known drawing tests that in the clinical field are commonly used to detect some signs of cognitive impairment of older individuals. One hundred and forty-nine community dwellers (M_age = 77.4 years, SD = 5.9 years) completed a battery of tests assessing global cognitive efficiency, drawing skills (i.e., Clock Drawing, Visuo-spatial Drawing ACE-R, Copy Figures Tests), handgrip muscular strength (HGS), and functional mobility (assessed through the Timed-Up-and-Go test). Significant relationships were found among those measures. Moreover, handgrip strength and functional mobility explained 12-19% of the variance in each drawing condition. Finally, participants exhibiting poorer HGS performed worse the drawing tasks and were successively recognized as cognitively deteriorated. In conclusion, these findings highlight that motor skills can significantly impact the assessment of cognitive efficiency in late adulthood. Therefore, in clinical practice, the concurrent assessment of basic motor functions (in terms of muscular strength and functional mobility) and cognitive efficiency of the geriatric population at risk for cognitive decline should be encouraged.

Motor proficiency as a correlate of coping in late adult lifespan. An exploratory study

BACKGROUND AND OBJECTIVES

A body of studies suggests that coping resources may represent a protective factor against functional and cognitive losses associated with advanced ageing. This study intended to examine the contributions of global cognition, functional mobility, and muscular strength on self-reported coping strategies in late adulthood.

METHODS

One hundred and thirty-seven community-based older individuals (M_age = 77.2 years, SD = 5.8 years, age range: 63-92 years), 48 males and 89 females with and without signs of cognitive decline completed a battery of tools assessing global cognitive function, problem-focused coping, muscular strength (assessed by handgrip strength, HGS) and functional mobility (assessed using the instrumented Timed-Up-and-Go test).

RESULTS

Significant associations were found between problem-focused coping, global cognitive function, HGS, functional mobility parameters, age, and education. Moreover, when the effects of education and gender were controlled for, HGS, functional mobility, and global cognitive function scores accounted for 44% of the variance in coping.

CONCLUSIONS

In clinical practice, the use of functional mobility and muscular strength measures to screen the physical health of older individuals should be encouraged.

Functional mobility decline and incident mild cognitive impairment and early dementia in community-dwelling older adults: the Singapore Longitudinal Ageing Study

BACKGROUND

Motor and gait disturbances are evident in early Alzheimer and non-Alzheimer dementias and may predict the likelihood of mild cognitive impairment (MCI) or progression to dementia.

OBJECTIVE

We investigated the Timed-Up-and-Go (TUG) measure of functional mobility in predicting cognitive decline and incident MCI or early dementia (MCI-dementia).

DESIGN

Prospective cohort study with 4.5 years follow-up.

SETTING

Population based.

PARTICIPANTS

2,544 community-dwelling older adults aged 55+ years.

METHODS

Participants with baseline data on TUG, fast gait speed (GS), knee extension strength (KES) and performance-oriented mobility assessment (POMA) gait and balance were followed up for cognitive decline (Mini-Mental State Exam; MMSE drop of ≥2, among 1,336 dementia-free participants) and incident MCI-dementia (among 1,208 cognitively normal participants). Odds ratio (OR) and 95% confidence intervals (95% CI) were adjusted for age, sex, education, smoking, physical, social and productive activity, multi-morbidity, metabolic syndrome and MMSE.

RESULTS

Per standard deviation increase in TUG, POMA, GS and KES were significantly associated with incident MCI-dementia: TUG (OR = 2.84, 95% CI = 2.02-3.99), GS (OR = 2.17, 95% CI = 1.62-2.91), POMA (OR = 1.88, 95% CI = 1.22-2.92) and KES (OR = 1.52, 95% CI = 1.15-2.02). Adjusted OR remained significant only for TUG (OR = 1.52, 95% CI = 1.01-2.31) and GS (OR = 1.53, 95% CI = 1.08-2.16). Areas under the curve (AUC) for TUG (AUC = 0.729, 95% CI = 0.671-0.787) were significantly greater than GS (AUC = 0.683, 95% CI = 0.619-0.746), KES (AUC = 0.624, 95% CI = 0.558-0.689) and POMA (AUC = 0.561, 95% CI = 0.485-0.637). Similar associations with cognitive decline were significant though less pronounced, and adjusted ORs remained significant for TUG, GS and POMA.

CONCLUSION

Functional mobility decline precedes incident MCI and early dementia. The TUG appears to be especially accurate in predicting the future risks of adverse cognitive outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03405675. Registered 23 January 2018 (retrospectively registered).

Clasping, ledge-score coordination and early gait impairments as primary behavioural markers of functional impairment in Alzheimer's disease

Motor performance facilitates the understanding of the functional state related to the progression of Alzheimer's disease (AD). At the translational level, this brief report refines the characterization of the motor dysfunction of the 3xTg-AD mouse model in different motor tasks, focusing on the abnormal clasping reflex and coordination impairments measured through the Phenotype Scoring System four items screening originally developed for models of ataxia. We studied male 3xTg-AD mice at 6, 12, and 16 months of age (mimicking the early, advanced, and late stages of the disease, respectively) and their age-matched non-transgenic counterparts with normal aging. According to the score, incidence, or severity of the four items and the total score, the 3xTg-AD mice showed deficiencies in all score elements. Clasping was increased independently of age, and its severity worsened with repeated testing. In contrast, the impairment of coordination worsened with the progress of the disease. The gait score was sensitive to genotype since early stages, and the worse ledge score was evident at 16 months. Kyphosis and ledge scores were sensitive to age. The impairments and functional limitations of male 3xTg-AD mice related to the stages of AD provide a scenario that allows understanding the heterogeneity of non-cognitive symptoms.

Effect of Wearable Sensor-Based Exercise on Musculoskeletal Disorders in Individuals With Neurodegenerative Diseases: A Systematic Review and Meta-Analysis

Background

The application of wearable sensor technology in an exercise intervention provides a new method for the standardization and accuracy of intervention. Considering that the deterioration of musculoskeletal conditions is of serious concern in patients with neurodegenerative diseases, it is worthwhile to clarify the effect of wearable sensor-based exercise on musculoskeletal disorders in such patients compared with traditional exercise.

Methods

Five health science-related databases, including PubMed, Cochrane Library, Embase, Web of Science, and Ebsco Cumulative Index to Nursing and Allied Health, were systematically searched. The protocol number of the study is PROSPERO CRD42022319763. Randomized controlled trials (RCTs) that were published up to March 2022 and written in English were included. Balance was the primary outcome measure, comprising questionnaires on postural stability and computerized dynamic posturography. The secondary outcome measures are motor symptoms, mobility ability, functional gait abilities, fall-associated self-efficacy, and adverse events. Stata version 16.0 was used for statistical analysis, and the weighted mean difference (WMD) was selected as the effect size with a 95% confidence interval (CI).

Results

Fifteen RCTs involving 488 participants with mean ages ranging from 58.6 to 81.6 years were included in this review, with 14 of them being pooled in a quantitative meta-analysis. Only five included studies showed a low risk of bias. The Berg balance scale (BBS) was used in nine studies, and the pooled data showed a significant improvement in the wearable sensor-based exercise group compared with the traditional exercise group after 3–12-week intervention (WMD = 1.43; 95% CI, 0.50 to 2.36, P = 0.003). A significant change in visual score was found both post-assessment and at 1-month follow-up assessment (WMD = 4.38; 95% CI, 1.69 to 7.07, P = 0.001; I2 = 0.0%). However, no significant differences were found between the two groups in the secondary outcome measures (all p > 0.05). No major adverse events were reported.

Conclusion

The wearable sensor-based exercise had advantages in improving balance in patients with neurodegenerative diseases, while there was a lack of evidence in motor symptoms, mobility, and functional gait ability enhancement. Future studies are recommended to construct a comprehensive rehabilitation treatment system for the improvement in both postural control and quality of life.

Systematic Review Registration

http://www.crd.york.ac.uk/prospero/, identifier CRD42022319763.

Executive and Motor Functions in Older Individuals with Cognitive Impairment

Background: A current research trend is the examination of the interplay between cognitive functioning, higher-order processes, and motor efficiency in late adulthood. However, the association between motor and cognitive functions when cognitive decline occurs has not been extensively explored. This study investigated whether gait features, functional mobility, and handgrip strength were associated with executive functions in older people with mild cognitive impairment (MCI) or dementia. Methods: 127 older participants (M_age = 77.9 years, SD = 5.8 years) who had received a diagnosis of MCI and dementia voluntarily took part in the study. A battery of tests assessing global cognitive function, executive functions, muscular strength, functional mobility, and spatio-temporal parameters of gait was completed by the participants. Results: Statistically significant correlations were obtained between global cognitive function, executive functions, and motor efficiency measures. Moreover, a series of regression analyses showed that 8–13% of the variance of several motor parameters was predicted by several executive functions. Additionally, walking, functional mobility, and global cognitive function predicted 53–71% of the variance relative to the occurrence of dementia. In conclusion, motor functioning is closely related to cognitive functioning in late adulthood. Conclusions: The assessment of muscular strength and functional mobility should be promoted in clinical settings.

Neural Mechanisms of Motor Dysfunction in Mild Cognitive Impairment and Alzheimer’s Disease: A Systematic Review

Background:

Despite the prevalence of motor symptoms in mild cognitive impairment (MCI) and Alzheimer’s disease (AD), their underlying neural mechanisms have not been thoroughly studied.

Objective:

This review summarizes the neural underpinnings of motor deficits in MCI and AD.

Methods:

We searched PubMed up until August of 2021 and identified 37 articles on neuroimaging of motor function in MCI and AD. Study bias was evaluated based on sample size, availability of control samples, and definition of the study population in terms of diagnosis.

Results:

The majority of studies investigated gait, showing that slower gait was associated with smaller hippocampal volume and prefrontal deactivation. Less prefrontal activation was also observed during cognitive-motor dual tasking, while more activation in cerebellar, cingulate, cuneal, somatosensory, and fusiform brain regions was observed when performing a hand squeezing task. Excessive subcortical white matter lesions in AD were associated with more signs of parkinsonism, poorer performance during a cognitive and motor dual task, and poorer functional mobility. Gait and cognitive dual-tasking was furthermore associated with cortical thickness of temporal lobe regions. Most non-gait motor measures were only reported in one study in relation to neural measures.

Conclusion:

Cross-sectional designs, lack of control groups, mixing amnestic- and non-amnestic MCI, disregard of sex differences, and small sample sizes limited the interpretation of several studies, which needs to be addressed in future research to progress the field.

Alzheimer's Disease Detection Using Comprehensive Analysis of Timed Up and Go Test via Kinect V.2 Camera and Machine Learning

Alzheimer's disease (AD) is a progressive neurodegenerative disease affecting cognitive and functional abilities. However, many patients presume lower cognitive or functional abilities because of aging and do not undergo clinical assessments until the symptoms become too advanced. Developing a low-cost and easy-to-use AD detection tool, which can be used in any clinical or non-clinical setting, can enable widespread AD assessments and diagnosis. This paper investigated the feasibility of developing such a tool to detect AD vs. healthy control (HC) from a simple balance and walking assessment called the Timed Up and Go (TUG) test. We collected joint position data of 47 HC and 38 AD subjects as they performed TUG in front of a Kinect V.2 camera. Our signal processing and statistical analyses provided a comprehensive analysis of balance and gait with 12 significant features for discriminating AD from HC after adjusting for age and the Geriatric Depression Scale. Using these features and a support vector machine classifier, our model classified the two groups with an average accuracy of 97.75% and an F-score of 97.67% for five-fold cross-validation and 98.68% and 98.67% for leave-one-subject out cross-validation. These results demonstrate the potential of our approach as a new quantitative complementary tool for detecting AD among older adults. Our work is novel as it presents the first application of Kinect V.2 camera and machine learning to provide a comprehensive and quantitative analysis of the TUG test to detect AD patients from HC. This study supports the feasibility of developing a low-cost and convenient AD assessment tool that can be used during routine checkups or even at home; however, future investigations could confirm its clinical diagnostic value in a larger cohort.

Characteristics of transitional locomotor tasks performed by patients with dementia

Elderly individuals may be at increased risk of falls than their peers. Early identification of balance disorders and their appropriate intervention are crucial for patients with dementia. The aim of this study was to identify postural instability in patients from mild to moderate dementia while performing transitional locomotor tasks under different conditions. Fifty-four patients with dementia and 30 healthy controls voluntarily participated in the study. The transitional locomotor task was performed on two force platforms under four conditions: unimpeded transition, obstacle clearance, step-up and step-down trials. The recording of center of foot pressure displacements was divided into three distinct phases: 1st phase-quiet standing before the transitional locomotor task, 2nd phase-forward stepping, 3rd phase-quiet standing after the transitional locomotor task. Patients with dementia were characterized by a longer transitional locomotor task time than the control group under all conditions (P < 0.03). Significant differences in quiet standing before the transitional locomotor task were observed between patients with dementia and the control group, but only in unimpeded transition and obstacle clearance trials (P < 0.02). No significant differences in quiet standing after step transition were observed between patients with dementia and the control group (P > 0.05). Postural control research in patients with dementia should focus on the functional motor task rather than on a simple motor task (quiet standing). Because even patients with mild dementia have impaired dynamic balance, the assessment of transitional locomotor tasks performed by patients with dementia might provide an indicator of an early diagnosis of dementia and might lead to better individualized physiotherapy.

Research progress on multicomponent physical exercise for patients with neurocognitive impairment

Neurocognitive impairment is a group of clinical syndromes characterized by impaired cognitive function and decreased motor ability. Non-pharmacological interventions such as physical exercise have advantages in the treatment of patients with neurocognitive impairment. Multicomponent exercise is a combination of various physical exercises, including strength training, endurance training, balance training and flexibility training, that can improve gait, balance and cardiopulmonary function by increasing muscle mass, strength and endurance in people with neurocognitive impairment, while also reducing the risk of falls in elders. This article reviews the benefits of multicomponent exercise for patients with neurocognitive impairment and its evaluation methods; also describes 4 intervention programs and their clinical application, to provide evidence for clinical practice and promote the application of multicomponent exercise in patients with neurocognitive impairment.

Does motor functioning mediate the relationship between executive functions and psychological well-being of atypically developing older adults?

The contribution of motor efficiency to the maintenance of psychological well-being in cognitively impaired older individuals is still insufficiently examined. This investigation primarily intended to evaluate whether muscular strength mediates the relationship between different facets of psychological well-being (i.e., personal satisfaction, emotional competence, coping), negative mood, and central executive efficiency through the Clock-Drawing, Trail-Making (Part A), and verbal fluency tests. Furthermore, the impact of cognitive decline on self-reported psychological well-being and depression was explored, using the handgrip strength (HGS) measure as a covariate. One hundred and nineteen older participants, 44 males and 75 females, aged 63 years and older (Mage = 77.7 years, SD = 5.6 years), completed a battery of tests assessing executive functions, HGS, depression, and psychological well-being. Significant low to moderate associations were found between distinct executive functions, HGS, psychological well-being, and depression. In addition, personal satisfaction did not correlate with any measure of executive functions, the clock-drawing score was associated only with coping index, and self-reported depression correlated only with the Trail-Making Test score. Moreover, a series of mediation analyses documented that executive functions (primarily assessing verbal fluency and motor speed) and HGS explained approximately 20–46% of the variance in perceived psychological well-being and depression. Finally, more cognitively impaired participants reported worse total psychological well-being, emotional competence, and coping. In conclusion, motor proficiency mediates the relationship between selective measures of executive functions and perceived psychological well-being and depression in cognitively impaired individuals.

Relationship Between Aerobic Capacity, Mobility, and Spatial Navigation in Healthy Individuals and Older Adults With Mild Cognitive Impairment: A Cross-Sectional Study

This study aimed to investigate the relationship between physical ability and spatial navigation in older adults with mild cognitive impairment and healthy controls, using the floor maze test. Study participants (n = 58) were subjected to the following tests: floor maze test, sit-to-stand, 8-foot up-and-go, and aerobic steps. Factorial analyses showed that performance of the physical tests combined explained approximately 87% of the sample variability. Mobility (R2 = .22, p ≤ .001) and aerobic capacity (R2 = .27, p ≤ .001) were both associated with delayed maze time in the floor maze test. Low levels of aerobic capacity were also associated with an increased odds to perform poorly in the delayed maze time after controlling for age, sex, and mild cognitive impairment diagnosis (odds ratio = 3.1; 95% confidence interval [1.0, 9.5]; p = .04). Aerobic capacity and mobility are associated with spatial navigation in patients with mild cognitive impairment and healthy older adults.

Clinical assessment of gait and functional mobility in Italian healthy and cognitively impaired older persons using wearable inertial sensors

AIM

The main purpose of the present study was to verify the feasibility of wearable inertial sensors (IMUs) in a clinical setting to screen gait and functional mobility in Italian older persons. In particular, we intended to verify the capability of IMUs to discriminate individuals with and without cognitive impairments and assess the existence of significant correlations between mobility parameters extracted by processing trunk accelerations and cognitive status.

METHODS

This is a cross-sectional study performed on 213 adults aged over 65 years (mean age 77.0 ± 5.4; 62% female) who underwent cognitive assessment (through Addenbrooke's Cognitive Examination Revised, ACE-R) instrumental gait analysis and the Timed Up and Go (TUG) test carried out using a wearable IMU located in the lower back.

RESULTS

Individuals with cognitive impairments exhibit a peculiar gait pattern, characterized by significant reduction of speed (- 34% vs. healthy individuals), stride length (- 28%), cadence (- 9%), and increase in double support duration (+ 11%). Slight, but significant changes in stance and swing phase duration were also detected. Poorer performances in presence of cognitive impairment were observed in terms of functional mobility as overall and sub-phase TUG times resulted significantly higher with respect to healthy individuals (overall time, + 38%, sub-phases times ranging from + 22 to + 34%), although with some difference associated with age. The severity of mobility alterations was found moderately to strongly correlated with the ACE-R score (Spearman's rho = 0.58 vs. gait speed, 0.54 vs. stride length, 0.66 vs. overall TUG time).

CONCLUSION

The findings obtained in the present study suggest that wearable IMUs appear to be an effective solution for the clinical assessment of mobility parameters of older persons screened for cognitive impairments within a clinical setting. They may represent a useful tool for the clinician in verifying the effectiveness of interventions to alleviate the impact of mobility limitations on daily life in cognitively impaired individuals.

Beyond the Mini-Mental State Examination: The Use of Physical and Spatial Navigation Tests to Help to Screen for Mild Cognitive Impairment and Alzheimer's Disease

BACKGROUND

Spatial navigation and dual-task (DT) performance may represent a low-cost approach to the identification of the cognitive decline in older adults and may support the clinical diagnosis of mild cognitive impairment (MCI) and Alzheimer's disease (AD).

OBJECTIVE

To assess the accuracy of different types of motor tasks in differentiating older persons with MCI and AD from healthy peers.

METHODS

Older adults aged 60 years or over (n = 105; healthy = 39; MCI = 23; AD = 43) were evaluated by the floor maze test (FMT), the senior fitness test, and DT performance. Receiver operating characteristic curve (ROC) analysis was used to evaluate the accuracy of the tests. We also performed principal component analysis (PCA) and logistic regression analysis to explore the variance and possible associations of the variables within the sample.

RESULTS

FMT (AUC = 0.84, sensitivity = 75.7%, specificity = 76.1%, p < 0.001) and DT (AUC = 0.87, sensitivity = 80.4%, specificity = 86.9%, p < 0.001) showed the highest performance for distinguishing MCI from AD individuals. Moreover, FMT presented better sensitivity in distinguishing AD patients from their healthy peers (AUC = 0.93, sensitivity = 94%, specificity = 85.6%, p < 0.001) when compared to the Mini-Mental State Examination. PCA revealed that the motor test performance explains a total of 73.9% of the variance of the sample. Additionally, the results of the motor tests were not influenced by age and education.

CONCLUSION

Spatial navigation tests showed better accuracy than usual cognitive screening tests in distinguishing patients with neurocognitive disorders.

Effects of yoga-related mind-body therapies on cognitive function in older adults: A systematic review with meta-analysis

OBJECTIVES

Considering dementia has no definite curative intervention available through modern medical management, alternative therapeutic symptomatic interventions are needed urgently. This systematic review with meta-analysis evaluated whether yoga-related practices, as a preventive mind-body therapy, is effective for the management of cognitive decline in older adults.

METHODS

Seven electronic databases (Abstracts in Social Gerontology, Age Line, CINAHL, PsycINFO, PubMed, Scopus, and Web of Science) were searched using specified inclusion criteria to identify original studies that investigated the effects of yoga-related mind-body therapies on cognitive function, in the context of aging. A meta-analysis was also carried out calculating the overall effect sizes, expressed as standardized mean differences (i.e., d).

RESULTS

Twelve studies, including 912 participants (73.9% female; 239 with and 673 without cognitive impairment) were selected for this review; eleven were randomized controlled trials. One study had a high risk of bias and was excluded from the meta-analysis. Studies involved a wide variety of yoga practices with a common focus on meditative postural exercises. Results revealed significant beneficial effects on memory (Cohen's d = 0.38), executive function (Cohen's d = 0.40), and attention and processing speed (Cohen's d = 0.33). No adverse effects were reported.

DISCUSSION

Yoga-related mind-body interventions for older adults appear to be safe, feasible, and effective alternative practice for maintenance of cognitive functions both in age- and disease-related cognitive decline. Practicing yoga can be a useful part of daily routine to maintain cognitive function in older adulthood. Suggestions for further research were discussed.

Loss of functional capacity in elderly individuals with Alzheimer disease

ABSTRACT. Background: The functional capacity of elderly individuals with Alzheimer disease (AD) progressively declines. Objective: To verify the influence of sociodemographic, clinical, staging, mobility, and postural and cognitive balance data on the impairment of the functional capacity of elderly individuals with AD. Methods: This observational, analytical, cross-sectional study was performed at the Physiotherapy Department of the Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. The study consisted of forty elderly individuals aged ≥60 years old with mild or moderate AD, who could ambulate independently. The instruments used included a questionnaire to assess sociodemographic and anthropometric data; the Mini-Mental Health State Examination (MMSE); the Clinical Dementia Rating (CDR); a clock drawing test (CDT); a verbal fluency test (VFT); the Timed Up and Go Test (TUG); and the Clinical Test of Sensory Organization and Balance (CTSIB). Simple descriptive analyses, Mann-Whitney test, Spearman's correlation test, linear regression modeling, and prediction equation (p<0.05, 95% confidence interval [95%CI]) were performed. Results: Fifteen linear regression models were generated, with the final model chosen for analysis. The variables assumed in that model were CDR, MMSE score, and condition 3 of the CTSIB, which explained 60.1% of the outcome. Conclusions: Impairment of functional capacity in elderly individuals with AD was influenced by disease progression, which was due to cognitive deficits and deficits in postural balance, which are related to the inaccuracy of the somatosensory system in performing sensory integration.

Spatial navigation and dual-task performance in patients with Dementia that present partial dependence in instrumental activity of daily living

BACKGROUND

Instrumental activities of daily living (IADLs) ability impairments are clearly related to cognitive and motor decline, as well as to the progression of Dementia. However, more low-cost assessments are necessary to better understand the process of IADL in patients with Dementia.

OBJECTIVE

To compare cognitive, motor and cognitive-motor performance at different stages of dependence on IADL in patients with Dementia.

METHODS

Dementia patients (n = 53, age range: 63-94) and healthy older adults (n = 39, age range: 62-97) were included, and those with Dementia were separated into IADL 1 (n = 18), IADL 2 (n = 17), IADL 3 (n = 18). All groups performed cognitive (Trail making test A, semantic verbal fluency, and Stroop test), motor (sit to stand, aerobic steps, and 8-foot up-and-go), and cognitive-motor tests (dual-task, and spatial navigation). One-way ANOVA, Kruskal-Wallis, and Bonferroni post-hoc tests were used to compare groups. Also, an effect size (ES) has been applied to evaluate differences among the dementia groups while the healthy older adults were used as a reference group.

RESULTS

Only cognitive-motor and cognitive tests showed significant differences among groups (IADL 1 x IADL 2 x IADL 3). Compared with the healthy group, the ES analysis exposed that patients in different stages of IADL showed the worst performance on tests combining motor and cognitive demand, but not for motor and cognitive function separately.

CONCLUSION

Poor dual-task and spatial navigation abilities are present in partial dependence in IADL, and these tasks should be considered as a functionality screening tool in patients with Dementia.

Hearing impairment is associated with cognitive function in community-dwelling older adults: A cross-sectional study

BACKGROUND

Hearing impairment (HI) is associated with dementia. However, the cognitive screening tasks effective in older community dwellers presenting with HI are unclear.

METHODS

We retrospectively and cross-sectionally investigated the associations between HI and cognitive function assessed with screening tasks using data from two healthcare check-up programs for community dwellers ≥65 years old in 2018. We examined demographics, risk factors, cognitive function, hearing condition, lifestyles, and self-care levels. Cognitive function was assessed using the clock drawing task and the delayed three words recall task. Hearing condition was assessed using questionnaires on the use of hearing aids and HI during conversation situations. Multivariate analysis was used to identify independent associations between HI and cognitive assessment tasks.

RESULTS

We analyzed 1602 eligible participants (61.9% women; 74.3 ± 6.5 years old). Hearing aid users (n = 90) were older (80 vs. 73 years, respectively; p < 0.001) and less likely to draw the clock correctly (71.1% vs. 80.1% years, respectively; p = 0.044) than non-hearing aid users. Multivariate logistic regression analysis showed that HI was associated with inability to draw the clock correctly (odds ratio 1.60, 95% confidence interval 1.12-2.26; p = 0.011), independent of age, living alone, memory impairment, and impaired self-care levels.

CONCLUSION

Hearing impairment is independently associated with cognitive decline assessed by the clock drawing task. The clock drawing task may be useful for identifying an increased risk of dementia in older subjects presenting with HI.

Common and unique multimodal covarying patterns in autism spectrum disorder subtypes

BACKGROUND

The heterogeneity inherent in autism spectrum disorder (ASD) presents a substantial challenge to diagnosis and precision treatment. Heterogeneity across biological etiologies, genetics, neural systems, neurocognitive attributes and clinical subtypes or phenotypes has been observed across individuals with ASD.

METHODS

In this study, we aim to investigate the heterogeneity in ASD from a multimodal brain imaging perspective. The Autism Diagnostic Observation Schedule (ADOS) was used as a reference to guide functional and structural MRI fusion. DSM-IV-TR diagnosed Asperger's disorder (n = 79), pervasive developmental disorder-not otherwise specified [PDD-NOS] (n = 58) and Autistic disorder (n = 92) from ABIDE II were used as discovery cohort, and ABIDE I (n = 400) was used for replication.

RESULTS

Dorsolateral prefrontal cortex and superior/middle temporal cortex are the primary common functional-structural covarying cortical brain areas shared among Asperger's, PDD-NOS and Autistic subgroups. Key differences among the three subtypes are negative functional features within subcortical brain areas, including negative putamen-parahippocampus fractional amplitude of low-frequency fluctuations (fALFF) unique to the Asperger's subtype; negative fALFF in anterior cingulate cortex unique to PDD-NOS subtype; and negative thalamus-amygdala-caudate fALFF unique to the Autistic subtype. Furthermore, each subtype-specific brain pattern is correlated with different ADOS subdomains, with social interaction as the common subdomain. The identified subtype-specific patterns are only predictive for ASD symptoms manifested in the corresponding subtypes, but not the other subtypes.

CONCLUSIONS

Although ASD has a common neural basis with core deficits linked to social interaction, each ASD subtype is strongly linked to unique brain systems and subdomain symptoms, which may help to better understand the underlying mechanisms of ASD heterogeneity from a multimodal neuroimaging perspective.

LIMITATIONS

This study is male based, which cannot be generalized to the female or the general ASD population.

Hand fine motor skill disability correlates with dementia severity

BACKGROUND

The progression of dementia, which impairs motor skills and cognitive function, is a warning of greater disability. The present study investigated the association between hand fine motor skills, assessed according to the Functioning Disability Evaluation Scale - Adult Version (FUNDES-Adult), and dementia severity.

METHODS

People with mild and moderate to severe dementia were identified from the Taiwan Data Bank of Persons with Disability. The FUNDES-Adult was assessed for all enrollees, and the following hand fine motor skills were evaluated: pen-holding, buttoning, and knotting. Statistical analysis was performed using SAS, and P values < 0.05 were considered significant.

RESULTS

Disability in all the 3 fin. motor skills was significantly greater in patients with moderate to severe dementia than in those with mild dementia. Disability in any of the skills was sensitive to distinguish mild from moderate to severe dementia (sensitivity: 78.1 %, specificity: 55.2 %, area under the curve: 0.739, 95 % confidence interval [CI]: 0.734-0.745). Those with fine motor skill disability were at a significantly higher risk of moderate to severe dementia (odds ratio: 3.71, 95 % CI: 3.53-3.90, P <  .001).

CONCLUSION

Hand fine motor skill disability was more prevalent in patients with moderate to severe dementia than in patients with mild dementia. A straightforward motor skill assessment can serve as a screening tool in the community to detect the progression of dementia.

Floor Maze Test as a predictor of cognitive decline in older adults living in nursing homes

ABSTRACT Objective Long-term care facilities (LTCF) are associated with an increased risk of cognitive decline and impairment in spatial navigation abilities. Recent studies have demonstrated that spatial navigation as a complex skill, involving cognitive and motor functions, emerging as a new marker for the progression of dementia. The present study aims to compare spatial navigation in healthy, institutionalized, and AD elderly subjects. Methods In a cross-sectional study, we evaluated 78 elderly individuals (healthy = 37, AD = 22, institutionalized = 19) using the Mini-Mental State Examination (MMSE), Floor Maze Test (FMT) and 8-foot-up-and-gotest (8UG) to assess global cognitive function, spatial navigation and motor function, respectively. Results In the FMT, the immediate maze time (IMT) and delay maze time (DMT) were significantly shorter in the healthy group than those of the institutionalized and AD groups ( X 2 = 31.23; p < 0.01) and ( X 2 = 41.21; p < 0.01), while there were no significant differences between the AD and institutionalized groups in terms of the DMT and MMSE results. However, the institutionalized group showed worse results in terms of IMT (p < 0.01) and 8UG (p < 0.01) than those in the dementia group. Conclusion Our results indicate that both institutionalized older people and patients with Dementia have a deficit in the spatial navigation ability, cognitive functions and motor skills. We should consider that there might be a possibility of underdiagnosis in institutionalized older people.

Gait analysis with videogrammetry can differentiate healthy elderly, mild cognitive impairment, and Alzheimer's disease: A cross-sectional study

Gait parameters have been investigated as an additional tool for differential diagnosis in neurocognitive disorders, especially among healthy elderly (HE), those with mild cognitive impairment (MCI), and Alzheimer's disease (AD) patients. A videogrammetry system could be used as a low-cost and clinically practical equipment to capture and analyze gait in older adults. The aim of this study was to select the better gait parameter to differentiate these groups among different motor test conditions with videogrammetry analyses. Different motor conditions were used in three specific assessments: 10-meter walk test (10mWT), timed up and go test (TUGT), and treadmill walk test (TWT). These tasks were compared among HE (n=17), MCI (n=23), and AD (n=23) groups. One-way ANOVA, Kruskal-Wallis, and Bonferroni post-hoc tests were used to compare variables among groups. Then, an effect size (ES) and a linear regression analysis were calculated. The gait parameters showed significant differences among groups in all conditions, but not in TWT. Controlled by confounding variables, the gait velocity in 10mWT at usual speed, and TUGT in dual-task condition, predicts 39% and 53% of the difference among diagnoses, respectively. Finally, these results suggest that a low-cost and practical video analysis could be able to differentiate HE, those with MCI, and AD patients in clinical assessments.