1
|
Morrison L, Dyer AH, Dolphin H, Killane I, Bourke NM, Widdowson M, Woods CP, Gibney J, Reilly RB, Kennelly SP. Discrete Relationships between Spatiotemporal Gait Characteristics and Domain-Specific Neuropsychological Performance in Midlife. SENSORS (BASEL, SWITZERLAND) 2024; 24:3903. [PMID: 38931687 PMCID: PMC11207228 DOI: 10.3390/s24123903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/04/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
Midlife risk factors such as type 2 diabetes mellitus (T2DM) confer a significantly increased risk of cognitive impairment in later life with executive function, memory, and attention domains often affected first. Spatiotemporal gait characteristics are emerging as important integrative biomarkers of neurocognitive function and of later dementia risk. We examined 24 spatiotemporal gait parameters across five domains of gait previously linked to cognitive function on usual-pace, maximal-pace, and cognitive dual-task gait conditions in 102 middle-aged adults with (57.5 ± 8.0 years; 40% female) and without (57.0 ± 8.3 years; 62.1% female) T2DM. Neurocognitive function was measured using a neuropsychological assessment battery. T2DM was associated with significant changes in gait phases and rhythm domains at usual pace, and greater gait variability observed during maximal pace and dual tasks. In the overall cohort, both the gait pace and rhythm domains were associated with memory and executive function during usual pace. At maximal pace, gait pace parameters were associated with reaction time and delayed memory. During the cognitive dual task, associations between gait variability and both delayed memory/executive function were observed. Associations persisted following covariate adjustment and did not differ by T2DM status. Principal components analysis identified a consistent association of slower gait pace (step/stride length) and increased gait variability during maximal-pace walking with poorer memory and executive function performance. These data support the use of spatiotemporal gait as an integrative biomarker of neurocognitive function in otherwise healthy middle-aged individuals and reveal discrete associations between both differing gait tasks and gait domains with domain-specific neuropsychological performance. Employing both maximal-pace and dual-task paradigms may be important in cognitively unimpaired populations with risk factors for later cognitive decline-with the aim of identifying individuals who may benefit from potential preventative interventions.
Collapse
Affiliation(s)
- Laura Morrison
- Tallaght Institute of Memory and Cognition, Tallaght University Hospital, D24 NR0A Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Adam H. Dyer
- Tallaght Institute of Memory and Cognition, Tallaght University Hospital, D24 NR0A Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Helena Dolphin
- Tallaght Institute of Memory and Cognition, Tallaght University Hospital, D24 NR0A Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Isabelle Killane
- Department of Engineering, Technological University Dublin, D07 EWV4 Dublin, Ireland
| | - Nollaig M. Bourke
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Matthew Widdowson
- Department of Clinical Medicine, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland
- Robert Graves Institute of Endocrinology, Tallaght University Hospital, D24 NR0A Dublin, Ireland
| | - Conor P. Woods
- Department of Clinical Medicine, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland
- Robert Graves Institute of Endocrinology, Tallaght University Hospital, D24 NR0A Dublin, Ireland
| | - James Gibney
- Department of Clinical Medicine, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland
- Robert Graves Institute of Endocrinology, Tallaght University Hospital, D24 NR0A Dublin, Ireland
| | - Richard B. Reilly
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Sean P. Kennelly
- Tallaght Institute of Memory and Cognition, Tallaght University Hospital, D24 NR0A Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| |
Collapse
|
2
|
Kim B, Youm C, Park H, Choi H, Shin S. Machine learning approach to classifying declines of physical function and muscle strength associated with cognitive function in older women: gait characteristics based on three speeds. Front Public Health 2024; 12:1376736. [PMID: 38983250 PMCID: PMC11232496 DOI: 10.3389/fpubh.2024.1376736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/30/2024] [Indexed: 07/11/2024] Open
Abstract
Background The aging process is associated with a cognitive and physical declines that affects neuromotor control, memory, executive functions, and motor abilities. Previous studies have made efforts to find biomarkers, utilizing complex factors such as gait as indicators of cognitive and physical health in older adults. However, while gait involves various complex factors, such as attention and the integration of sensory input, cognitive-related motor planning and execution, and the musculoskeletal system, research on biomarkers that simultaneously considers multiple factors is scarce. This study aimed to extract gait features through stepwise regression, based on three speeds, and evaluate the accuracy of machine-learning (ML) models based on the selected features to solve classification problems caused by declines in cognitive function (Cog) and physical function (PF), and in Cog and muscle strength (MS). Methods Cognitive assessments, five times sit-to-stand, and handgrip strength were performed to evaluate the Cog, PF, and MS of 198 women aged 65 years or older. For gait assessment, all participants walked along a 19-meter straight path at three speeds [preferred walking speed (PWS), slower walking speed (SWS), and faster walking speed (FWS)]. The extracted gait features based on the three speeds were selected using stepwise regression. Results The ML model accuracies were revealed as follows: 91.2% for the random forest model when using all gait features and 91.9% when using the three features (walking speed and coefficient of variation of the left double support phase at FWS and the right double support phase at SWS) selected for the Cog+PF+ and Cog-PF- classification. In addition, support vector machine showed a Cog+MS+ and Cog-MS- classification problem with 93.6% accuracy when using all gait features and two selected features (left step time at PWS and gait asymmetry at SWS). Conclusion Our study provides insights into the gait characteristics of older women with decreased Cog, PF, and MS, based on the three walking speeds and ML analysis using selected gait features, and may help improve objective classification and evaluation according to declines in Cog, PF, and MS among older women.
Collapse
Affiliation(s)
- Bohyun Kim
- Department of Health Sciences, The Graduate School of Dong-A University, Busan, Republic of Korea
- Biomechanics Laboratory, Dong-A University, Busan, Republic of Korea
| | - Changhong Youm
- Department of Health Sciences, The Graduate School of Dong-A University, Busan, Republic of Korea
- Biomechanics Laboratory, Dong-A University, Busan, Republic of Korea
| | - Hwayoung Park
- Biomechanics Laboratory, Dong-A University, Busan, Republic of Korea
| | - Hyejin Choi
- Department of Health Sciences, The Graduate School of Dong-A University, Busan, Republic of Korea
- Biomechanics Laboratory, Dong-A University, Busan, Republic of Korea
| | - Sungtae Shin
- Department of Mechanical Engineering, College of Engineering, Dong-A University, Busan, Republic of Korea
| |
Collapse
|
3
|
Campbell K, Vetter J, Vilson FL, Ogawa S, Baas W, Klim A, Paradis A, Ksiazek D, Wolff D, Lai H, Murphy G. Manual Dexterity Predictors of Artificial Urinary Sphincter Success. Urology 2024; 188:144-149. [PMID: 38648949 DOI: 10.1016/j.urology.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/08/2024] [Accepted: 04/05/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To determine better in-office measures for artificial urinary sphincter outcomes, we investigated the ability of preoperative timed peg-transfer, pinch strength, grip strength, and Disabilities of the Arm Shoulder and Hand Outcome questionnaire in predicting postoperative satisfaction, confidence, and ease of use of artificial urinary sphincter placement for stress urinary incontinence. MATERIALS AND METHODS A timed 9-hole peg test, pinch and grip strength assessment, and upper extremity questionnaire were administered during the preoperative visit before sphincter placement. In addition to standard preoperative workup, short-form International Consultation of Incontinence Questionnaire and physician handshake were recorded. Activation occurred 6 weeks after surgery along with assessment of adequacy of pump placement. Three months from surgery a repeat incontinence questionnaire and a survey measuring satisfaction, difficulty of use, and confidence were given. Correlation between preoperative assessment variables and the postoperative questionnaire was assessed. RESULTS Thirty-nine patients were included. Average age and body mass index were 68.8 years and 28.8 kg/m2, respectively. Prior prostatectomy accounted for 92.3% of patients, and 46.2% had prior pelvic radiation. Postoperatively, 59.0% of patients were very satisfied; 64.1% of patients reported no difficulty of use; 53.8% felt confidence within 1 day; and 66.7% had much better bladder control. Average pad improvement count was 5.3. Pinch test was associated with satisfaction (P = .011) while peg test was associated with confidence (P = .049). Handshake and upper extremity questionnaire were not significant. CONCLUSION The pinch and 9-hole peg transfer tests are cost-effective and easily performed adjuncts that could be used during artificial urinary sphincter evaluation for patients with unclear manual functional status.
Collapse
Affiliation(s)
| | - Joel Vetter
- Washington University in St. Louis, St. Louis, MO
| | | | | | - Wesley Baas
- Washington University in St. Louis, St. Louis, MO
| | | | | | | | - Diana Wolff
- Washington University in St. Louis, St. Louis, MO
| | - Henry Lai
- Washington University in St. Louis, St. Louis, MO
| | | |
Collapse
|
4
|
Hamsanathan S, Anthonymuthu T, Prosser D, Lokshin A, Greenspan SL, Resnick NM, Perera S, Okawa S, Narasimhan G, Gurkar AU. A molecular index for biological age identified from the metabolome and senescence-associated secretome in humans. Aging Cell 2024; 23:e14104. [PMID: 38454639 PMCID: PMC11019119 DOI: 10.1111/acel.14104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 03/09/2024] Open
Abstract
Unlike chronological age, biological age is a strong indicator of health of an individual. However, the molecular fingerprint associated with biological age is ill-defined. To define a high-resolution signature of biological age, we analyzed metabolome, circulating senescence-associated secretome (SASP)/inflammation markers and the interaction between them, from a cohort of healthy and rapid agers. The balance between two fatty acid oxidation mechanisms, β-oxidation and ω-oxidation, associated with the extent of functional aging. Furthermore, a panel of 25 metabolites, Healthy Aging Metabolic (HAM) index, predicted healthy agers regardless of gender and race. HAM index was also validated in an independent cohort. Causal inference with machine learning implied three metabolites, β-cryptoxanthin, prolylhydroxyproline, and eicosenoylcarnitine as putative drivers of biological aging. Multiple SASP markers were also elevated in rapid agers. Together, our findings reveal that a network of metabolic pathways underlie biological aging, and the HAM index could serve as a predictor of phenotypic aging in humans.
Collapse
Affiliation(s)
- Shruthi Hamsanathan
- Aging Institute of UPMC and the University of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Tamil Anthonymuthu
- Department of Critical Care MedicineUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Denise Prosser
- Department of MedicineUniversity of Pittsburgh Medical Center and University of Pittsburgh Cancer InstitutePittsburghPennsylvaniaUSA
| | - Anna Lokshin
- Department of MedicineUniversity of Pittsburgh Medical Center and University of Pittsburgh Cancer InstitutePittsburghPennsylvaniaUSA
| | - Susan L. Greenspan
- Division of Geriatric Medicine, Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Neil M. Resnick
- Aging Institute of UPMC and the University of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
- Division of Geriatric Medicine, Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Subashan Perera
- Division of Geriatric Medicine, Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
- Department of BiostatisticsUniversity of Pittsburgh Graduate School of Public HealthPittsburghPennsylvaniaUSA
| | - Satoshi Okawa
- Pittsburgh Heart, Lung, and Blood Vascular Medicine InstituteUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
- Department of Computational and Systems BiologyUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
- McGowan Institute for Regenerative MedicineUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Giri Narasimhan
- Bioinformatics Research Group (BioRG), School of Computing and Information Sciences, Biomolecular Sciences InstituteFlorida International UniversityMiamiFloridaUSA
| | - Aditi U. Gurkar
- Aging Institute of UPMC and the University of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
- Division of Geriatric Medicine, Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| |
Collapse
|
5
|
Lee HS, Ko M, Kim HJ. Concurrent Validity of Dual-Task Walking Speed With CERAD-NP Assessment Battery in Community-Dwelling Older Adults. Arch Rehabil Res Clin Transl 2023; 5:100291. [PMID: 38163023 PMCID: PMC10757158 DOI: 10.1016/j.arrct.2023.100291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Objective To explore the concurrent validity of the dual-task walking speed assessments in older adults using the Consortium to Establish a Registry for Alzheimer's Disease Neuro-Psychological (CERAD-NP) Assessment Battery. Design Cross-sectional design. Setting Welfare care centers, Senior complex centers, and Dementia prevention care centers. Participants A total of 163 community-dwelling older adults (N=163) were recruited using consecutive sampling. Participants were composed of 65 older adults with cognitive decline and 98 without cognitive decline. Interventions Not applicable. Main Outcome Measures This study assessed the concurrent validity between dual-task walking speed assessments and the Total II score of CERAD-NP using Spearman's rank order correlations. The effect of the dual-task walking speed assessments on the Total II score was further investigated through multiple linear regression analysis. Results There was a moderate and statically significant association between the Total II score and all 8 dual-task walking speed assessments (P<.05). The Total II score was strongly associated with the dual tasks of walking on a straight path while counting backward and crossing over an obstacle (r=0.698, r=0.697, respectively; P<.05). According to multiple linear regression, only the dual task of walking while counting backward was significantly associated with the Total II score (P<.05). Conclusion The dual-task walking speed assessments, which involved walking and performing a secondary task such as counting backward or crossing an obstacle on a straight path, were highly indicative of cognitive decline. The combination of results from both tasks may provide a more comprehensive evaluation of cognitive decline compared with relying solely on a single-task assessment.
Collapse
Affiliation(s)
- Han suk Lee
- Department of Physical Therapy, Eulji University, Seongnam-si, Gyeonggi-do, South Korea
| | - Mansoo Ko
- Department of Physical Therapy, University of Texas Medical Branch, Galveston, TX, USA
| | - Hyung-Ji Kim
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, South Korea
| |
Collapse
|
6
|
Feng W, Chen Q, Ma M, Xu J, Guo H, Yuan W, Li R, Gao H, Gu C, Ma Y, Sun Z, Tuo N, Zheng L. Sex-modified association between grip strength and mild cognitive impairment: a cross-sectional and follow-up study in rural China. BMC Geriatr 2023; 23:710. [PMID: 37919648 PMCID: PMC10623700 DOI: 10.1186/s12877-023-04376-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/03/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND The sex difference in the association between grip strength and mild cognitive impairment (MCI) remains controversial and unclear. METHODS This is a part of a chronic disease cohort study conducted in rural areas, Fuxin, Liaoning Province, China. At the baseline survey, a total of 2633 participants aged 35- 85 were included in the cross-sectional study. Handgrip strength (HGS, kg) was measured by a dynamometer (Jamar +). MCI were assessed using the Chinese version of the Montreal Cognitive Assessment-Basic (MOCA-BC). Then, a total of 1667 cognitively normal individuals (NCs) were planed to follow up and to assess the incident MCI after two years. We used logistic regression to examine the association between HGS (as a continuous variable and quintiles) and MCI and analyzed the interaction between sex and HGS on MCI. Models stratified by sex were adjusted for demographic information (age, ethnicity, education, marital status, income, physical labor level), modifiable risk factors (body mass index, smoking, drinking) and disease history (hypertension, diabetes, dyslipidemia and coronary heart disease). Baseline MOCA-BC scores were additionally adjusted in the longitudinal study. RESULTS In the cross-sectional study, participants were on average 56.6 ± 9.8 years, and 1713 (65.1%) were females. In the cohort study, 743 individuals were followed up with an average age of 55.9 ± 9.6 years, which included 530 (71.3%) females. The cumulative incidence of MCI over a two-year period was 17.1%. In the cross-sectional study, compared to the highest quintile of HGS, the lowest HGS was associated with higher risk of MCI in males (odds ratio [OR]: 2.66; 95% confidence interval [CI]: 1.54, 4.64) and females (OR: 1.70; 95% CI: 1.17, 2.49) with adjustment of potential confounding factors. In the cohort study, compared to the highest quintile of HGS, the lowest HGS was associated with an increased risk of incident MCI in females (OR: 3.93; 95% CI: 1.39, 13.01) but not in males (OR: 0.56; 95% CI: 0.11, 2.94, P for interaction = 0.015). CONCLUSIONS Lower grip strength is a risk factor for mild cognitive impairment and predicts a higher risk of MCI in females.
Collapse
Affiliation(s)
- Wenjing Feng
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | - Qian Chen
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Mingfeng Ma
- Department of Cardiology, Fenyang Hospital of Shanxi Province, Fenyang, Shanxi, China
| | - Jiahui Xu
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Guo
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | - Wei Yuan
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | - Ruixue Li
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | - Hanshu Gao
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | - Cuiying Gu
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | - Yanan Ma
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, China
- Institute of Health Sciences, China Medical University, Shenyang, China
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Nan Tuo
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Liqiang Zheng
- The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, China.
| |
Collapse
|
7
|
Wang Z, Wang J, Guo J, Dove A, Arfanakis K, Qi X, Bennett DA, Xu W. Association of Motor Function With Cognitive Trajectories and Structural Brain Differences: A Community-Based Cohort Study. Neurology 2023; 101:e1718-e1728. [PMID: 37657942 PMCID: PMC10624482 DOI: 10.1212/wnl.0000000000207745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/20/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The association of motor function with cognitive health remains controversial, and the mechanisms underlying this relationship are unclear. We aimed to examine the association between motor function and long-term cognitive trajectories and further explore the underlying mechanisms using brain MRI. METHODS In the Rush Memory and Aging Project, a prospective cohort study, a total of 2,192 volunteers were recruited from the communities in northeastern Illinois and followed up for up to 22 years (from 1997 to 2020). Individuals with dementia, disability, missing data on motor function at baseline, and missing follow-up data on cognitive function were excluded. At baseline, global motor function was evaluated using the averaged z scores of 10 motor tests covering dexterity, gait, and hand strength; the composite score was tertiled as low, moderate, or high. Global and domain-specific cognitive functions-including episodic memory, semantic memory, working memory, visuospatial ability, and perceptual speed-were measured annually through 19 cognitive tests. A subsample (n = 401) underwent brain MRI scans and regional brain volumes were measured. Data were analyzed using linear mixed-effects models and linear regression. RESULTS Among the 1,618 participants (mean age 79.45 ± 7.32 years) included in this study, baseline global motor function score ranged from 0.36 to 1.82 (mean 1.03 ± 0.22). Over the follow-up (median 6.03 years, interquartile range 3.00-10.01 years), low global motor function and its subcomponents were related to significantly faster declines in global cognitive function (β = -0.005, 95% CI -0.006 to -0.005) and each of the 5 cognitive domains. Of the 344 participants with available MRI data, low motor function was also associated with smaller total brain (β = -25.848, 95% CI -44.902 to -6.795), total white matter (β = -18.252, 95% CI -33.277 to -3.226), and cortical white matter (β = -17.503, 95% CI -32.215 to -2.792) volumes, but a larger volume of white matter hyperintensities (β = 0.257, 95% CI 0.118-0.397). DISCUSSION Low motor function is associated with an accelerated decline in global and domain-specific cognitive functions. Both neurodegenerative and cerebrovascular pathologies might contribute to this association.
Collapse
Affiliation(s)
- Zhangyu Wang
- From the Department of Epidemiology and Biostatistics (Z.W., J.W., X.Q., W.X.), School of Public Health, Tianjin Medical University, China; Aging Research Center, Department of Neurobiology (J.G., A.D., W.X.), Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Rush Alzheimer's Disease Center (K.A., D.A.B.), Rush University Medical Center, Chicago, IL; and Department of Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago
| | - Jiao Wang
- From the Department of Epidemiology and Biostatistics (Z.W., J.W., X.Q., W.X.), School of Public Health, Tianjin Medical University, China; Aging Research Center, Department of Neurobiology (J.G., A.D., W.X.), Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Rush Alzheimer's Disease Center (K.A., D.A.B.), Rush University Medical Center, Chicago, IL; and Department of Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago
| | - Jie Guo
- From the Department of Epidemiology and Biostatistics (Z.W., J.W., X.Q., W.X.), School of Public Health, Tianjin Medical University, China; Aging Research Center, Department of Neurobiology (J.G., A.D., W.X.), Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Rush Alzheimer's Disease Center (K.A., D.A.B.), Rush University Medical Center, Chicago, IL; and Department of Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago
| | - Abigail Dove
- From the Department of Epidemiology and Biostatistics (Z.W., J.W., X.Q., W.X.), School of Public Health, Tianjin Medical University, China; Aging Research Center, Department of Neurobiology (J.G., A.D., W.X.), Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Rush Alzheimer's Disease Center (K.A., D.A.B.), Rush University Medical Center, Chicago, IL; and Department of Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago
| | - Konstantinos Arfanakis
- From the Department of Epidemiology and Biostatistics (Z.W., J.W., X.Q., W.X.), School of Public Health, Tianjin Medical University, China; Aging Research Center, Department of Neurobiology (J.G., A.D., W.X.), Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Rush Alzheimer's Disease Center (K.A., D.A.B.), Rush University Medical Center, Chicago, IL; and Department of Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago
| | - Xiuying Qi
- From the Department of Epidemiology and Biostatistics (Z.W., J.W., X.Q., W.X.), School of Public Health, Tianjin Medical University, China; Aging Research Center, Department of Neurobiology (J.G., A.D., W.X.), Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Rush Alzheimer's Disease Center (K.A., D.A.B.), Rush University Medical Center, Chicago, IL; and Department of Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago
| | - David A Bennett
- From the Department of Epidemiology and Biostatistics (Z.W., J.W., X.Q., W.X.), School of Public Health, Tianjin Medical University, China; Aging Research Center, Department of Neurobiology (J.G., A.D., W.X.), Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Rush Alzheimer's Disease Center (K.A., D.A.B.), Rush University Medical Center, Chicago, IL; and Department of Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago
| | - Weili Xu
- From the Department of Epidemiology and Biostatistics (Z.W., J.W., X.Q., W.X.), School of Public Health, Tianjin Medical University, China; Aging Research Center, Department of Neurobiology (J.G., A.D., W.X.), Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Rush Alzheimer's Disease Center (K.A., D.A.B.), Rush University Medical Center, Chicago, IL; and Department of Biomedical Engineering (K.A.), Illinois Institute of Technology, Chicago.
| |
Collapse
|
8
|
Theobald P, Herold F, Gronwald T, Müller NG. [Motoric cognitive risk syndrome-Setting the course for dementia prevention?]. DER NERVENARZT 2023; 94:944-950. [PMID: 37140606 PMCID: PMC10575804 DOI: 10.1007/s00115-023-01487-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND The predicted increase in adults with dementia will pose a major challenge for the German healthcare system. To mitigate this challenge, the early detection of adults with an increased risk of dementia is crucial. In this context, the concept of motoric cognitive risk (MCR) syndrome has been introduced into the English literature but is currently relatively unknown in German-speaking countries. OBJECTIVE What are the characteristics and diagnostic criteria of MCR? What is the impact of MCR on health-related parameters? What is the current state of evidence regarding the risk factors and prevention of the MCR? MATERIAL AND METHODS We reviewed the English language literature concerning MCR, the associated risk factors, and protective factors, similarities or differences with the concept of mild cognitive impairment (MCI), and its influence on the central nervous system. RESULTS The MCR syndrome is characterized by subjective cognitive impairment and a slower gait speed. Compared to healthy adults, adults with the MCR have a higher risk of dementia, falls, and mortality. Modifiable risk factors provide a starting point for specific multimodal lifestyle-related preventive interventions. CONCLUSION As MCR can be easily diagnosed in practical settings, it could become an important concept for the early detection of adults with an increased risk of dementia in German-speaking countries, although further research is necessary to empirically confirm this assumption.
Collapse
Affiliation(s)
- Paula Theobald
- Professur für degenerative und chronische Erkrankungen, Bewegung, Fakultät für Gesundheitswissenschaften Brandenburg, Universität Potsdam, Am Mühlenberg 9, 14476, Potsdam, Deutschland.
| | - Fabian Herold
- Professur für degenerative und chronische Erkrankungen, Bewegung, Fakultät für Gesundheitswissenschaften Brandenburg, Universität Potsdam, Am Mühlenberg 9, 14476, Potsdam, Deutschland
| | - Thomas Gronwald
- Professur für Sportwissenschaften, Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Am Kaiserkai 1, 20457, Hamburg, Deutschland
| | - Notger G Müller
- Professur für degenerative und chronische Erkrankungen, Bewegung, Fakultät für Gesundheitswissenschaften Brandenburg, Universität Potsdam, Am Mühlenberg 9, 14476, Potsdam, Deutschland
| |
Collapse
|
9
|
Kwak K, Kostic E, Kim D. Gait variability-based classification of the stages of the cognitive decline using partial least squares-discriminant analysis. Sci Prog 2023; 106:368504231218604. [PMID: 38115812 PMCID: PMC10734339 DOI: 10.1177/00368504231218604] [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] [Indexed: 12/21/2023]
Abstract
The purpose of the present study was to examine the differences in gait variability in terms of spatiotemporal, sub-gait cycle, ground reaction force, and the joint profiles of kinematics and kinetics between older individuals with and without risk of potential cognitive impairment, and to derive the crucial features to discriminating the older adults with future risk cognitive decline by using partial least squares-discriminant analysis. A total of 90 community-dwelling older adults aged over 65 years underwent cognitive function assessment and were divided into three groups depending on cognitive assessment score. The participants' level-walking was analyzed by using three-dimensional instrumented gait analysis. The coefficient of variation was extracted and then comparatively analyzed depending on the stages of the cognitive decline. To identify the most important contributor when differentiating the older adults with a risk of future cognitive decline, partial least squares-discriminant analysis was applied, and the discriminative power of the coefficients confirmed as features of great importance were investigated via the receiver operating characteristic area under the curve. The differences in gait variability were found mainly between the suspected dementia groups and other groups, especially in joint dynamics variables. Through the partial least squares-discriminant analysis, the discriminative features were found as follows: the mid-stance, the moments, and the power in the hip, knee, and ankle joints. In addition, the discrimination model was found to differentiate well between the three groups. The classification accuracy of intact cognition, diminished cognition, and suspected dementia was 0.857, 0.710, and 0.857, respectively. These findings mean that gait variability changes according to continuous cognitive decline, especially in sub-gait cycles and joint biomechanics, and suggest that measures of variation can be used as predictors to identify older individuals with a risk of potential cognitive impairment.
Collapse
Affiliation(s)
- Kiyoung Kwak
- Division of Biomedical Engineering, College of Engineering, Jeonbuk National University, Jeonju-si, Jeollabuk-do, Republic of Korea
| | - Emilija Kostic
- Department of Healthcare Engineering, The Graduate School, Jeonbuk National University, Jeonju-si, Jeollabuk-do, Republic of Korea
| | - Dongwook Kim
- Division of Biomedical Engineering, College of Engineering, Jeonbuk National University, Jeonju-si, Jeollabuk-do, Republic of Korea
- Research Center for Healthcare & Welfare Instrument for the Aged, Jeonbuk National University, Jeonju-si, Jeollabuk-do, Republic of Korea
| |
Collapse
|
10
|
Guimarães V, Sousa I, de Bruin ED, Pais J, Correia MV. Minding your steps: a cross-sectional pilot study using foot-worn inertial sensors and dual-task gait analysis to assess the cognitive status of older adults with mobility limitations. BMC Geriatr 2023; 23:329. [PMID: 37237278 DOI: 10.1186/s12877-023-04042-6] [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: 10/10/2022] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Cognitive impairment is a critical aspect of our aging society. Yet, it receives inadequate intervention due to delayed or missed detection. Dual-task gait analysis is currently considered a solution to improve the early detection of cognitive impairment in clinical settings. Recently, our group proposed a new approach for the gait analysis resorting to inertial sensors placed on the shoes. This pilot study aimed to investigate the potential of this system to capture and differentiate gait performance in the presence of cognitive impairment based on single- and dual-task gait assessments. METHODS We analyzed demographic and medical data, cognitive tests scores, physical tests scores, and gait metrics acquired from 29 older adults with mobility limitations. Gait metrics were extracted using the newly developed gait analysis approach and recorded in single- and dual-task conditions. Participants were stratified into two groups based on their Montreal Cognitive Assessment (MoCA) global cognitive scores. Statistical analysis was performed to assess differences between groups, discrimination ability, and association of gait metrics with cognitive performance. RESULTS The addition of the cognitive task influenced gait performance of both groups, but the effect was higher in the group with cognitive impairment. Multiple dual-task costs, dual-task variability, and dual-task asymmetry metrics presented significant differences between groups. Also, several of these metrics provided acceptable discrimination ability and had a significant association with MoCA scores. The dual-task effect on gait speed explained the highest percentage of the variance in MoCA scores. None of the single-task gait metrics presented significant differences between groups. CONCLUSIONS Our preliminary results show that the newly developed gait analysis solution based on foot-worn inertial sensors is a pertinent tool to evaluate gait metrics affected by the cognitive status of older adults relying on single- and dual-task gait assessments. Further evaluation with a larger and more diverse group is required to establish system feasibility and reliability in clinical practice. TRIAL REGISTRATION ClinicalTrials.gov (identifier: NCT04587895).
Collapse
Affiliation(s)
- Vânia Guimarães
- Fraunhofer Portugal AICOS, Porto, Portugal.
- Faculty of Engineering, University of Porto, Porto, Portugal.
| | - Inês Sousa
- Fraunhofer Portugal AICOS, Porto, Portugal
| | - Eling D de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- OST - Eastern Swiss University of Applied Sciences, Department of Health, St. Gallen, Switzerland
| | - Joana Pais
- Neuroinova, Lda., Vila Nova de Gaia, Portugal
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
| | - Miguel Velhote Correia
- Faculty of Engineering, University of Porto, Porto, Portugal
- INESC TEC (Institute for Systems and Computer Engineering, Technology and Science), Porto, Portugal
| |
Collapse
|
11
|
DuBord AY, Paolillo EW, Staffaroni AM. Remote Digital Technologies for the Early Detection and Monitoring of Cognitive Decline in Patients With Type 2 Diabetes: Insights From Studies of Neurodegenerative Diseases. J Diabetes Sci Technol 2023:19322968231171399. [PMID: 37102472 DOI: 10.1177/19322968231171399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Type 2 diabetes (T2D) is a risk factor for cognitive decline. In neurodegenerative disease research, remote digital cognitive assessments and unobtrusive sensors are gaining traction for their potential to improve early detection and monitoring of cognitive impairment. Given the high prevalence of cognitive impairments in T2D, these digital tools are highly relevant. Further research incorporating remote digital biomarkers of cognition, behavior, and motor functioning may enable comprehensive characterizations of patients with T2D and may ultimately improve clinical care and equitable access to research participation. The aim of this commentary article is to review the feasibility, validity, and limitations of using remote digital cognitive tests and unobtrusive detection methods to identify and monitor cognitive decline in neurodegenerative conditions and apply these insights to patients with T2D.
Collapse
Affiliation(s)
- Ashley Y DuBord
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Diabetes Technology Society, Burlingame, CA, USA
| | - Emily W Paolillo
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Adam M Staffaroni
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
12
|
Wang Y, Yang Q, Tian C, Zeng J, Yang M, Li J, Mao J. A dual-task gait test detects mild cognitive impairment with a specificity of 91.2. Front Neurosci 2023; 16:1100642. [PMID: 36825213 PMCID: PMC9942944 DOI: 10.3389/fnins.2022.1100642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/30/2022] [Indexed: 02/10/2023] Open
Abstract
Background Mild cognitive impairment (MCI) is a valuable intervention window in the progress of senile dementia, but the question of how to easily and conveniently detect MCI in the community remains unanswered. Gait performance reflects cognitive function, but how to reliably detect MCI through gait testing is still being explored. Objective To develop a dual-task gait testing method that could reliably detect MCI in the community. Methods A cross-sectional diagnostic study was conducted in 111 older adults (mean age = 72.14 ± 6.90 years) from five communities in Wuhan, China. A novel dual-task gait testing method, walking while identifying animals in pictures (AniP-DT gait test), was developed. The participants were classified into MCI or cognitively intact based on their performance on the Montreal Cognitive Assessment Scale (MoCA). Gait performance was assessed using both single-task and the AniP-DT gait test. Multiple linear regression and binary logistic regression were used to model the association between gait speed and cognitive status, and receiver operating characteristic (ROC) curve analysis was used to assess the discrimination ability. Results Compared to the cognitively intact group, the gait speed of the MCI group was lower in both single-task and the AniP-DT gait tests. The gait speed of the AniP-DT gait test was significantly associated with MoCA scores after adjusting the covariates and exhibited good discrimination ability in MCI detection (AUC = 0.814), with a specificity of 91.2%. ROC analysis of the logistic models revealed better discrimination ability of dual-task gait velocity when adjusted with age and years of education (AUC = 0.862). Conclusion The evidence in this study suggested that the AniP-DT gait test could be an easy and reliable screening tool for MCI in community older adults.
Collapse
Affiliation(s)
- Yuxin Wang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qing Yang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chong Tian
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,*Correspondence: Chong Tian,
| | - Jing Zeng
- Centers for Disease Control and Prevention of Wuhan Economic and Technological Development Zone, Wuhan, Hubei, China
| | - Mengshu Yang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jie Li
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jing Mao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| |
Collapse
|
13
|
Bargiotas I, Wang D, Mantilla J, Quijoux F, Moreau A, Vidal C, Barrois R, Nicolai A, Audiffren J, Labourdette C, Bertin-Hugaul F, Oudre L, Buffat S, Yelnik A, Ricard D, Vayatis N, Vidal PP. Preventing falls: the use of machine learning for the prediction of future falls in individuals without history of fall. J Neurol 2023; 270:618-631. [PMID: 35817988 PMCID: PMC9886639 DOI: 10.1007/s00415-022-11251-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 06/03/2022] [Accepted: 06/20/2022] [Indexed: 02/03/2023]
Abstract
Nowadays, it becomes of paramount societal importance to support many frail-prone groups in our society (elderly, patients with neurodegenerative diseases, etc.) to remain socially and physically active, maintain their quality of life, and avoid their loss of autonomy. Once older people enter the prefrail stage, they are already likely to experience falls whose consequences may accelerate the deterioration of their quality of life (injuries, fear of falling, reduction of physical activity). In that context, detecting frailty and high risk of fall at an early stage is the first line of defense against the detrimental consequences of fall. The second line of defense would be to develop original protocols to detect future fallers before any fall occur. This paper briefly summarizes the current advancements and perspectives that may arise from the combination of affordable and easy-to-use non-wearable systems (force platforms, 3D tracking motion systems), wearable systems (accelerometers, gyroscopes, inertial measurement units-IMUs) with appropriate machine learning analytics, as well as the efforts to address these challenges.
Collapse
Affiliation(s)
- Ioannis Bargiotas
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France. .,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France.
| | - Danping Wang
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France
| | - Juan Mantilla
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France
| | - Flavien Quijoux
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France.,ORPEA Group, Puteaux, France
| | - Albane Moreau
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France
| | - Catherine Vidal
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France.,Service of Otorhinolaryngology (ENT), AP-HP, Hôpital Universitaire Pitié Salpêtrière, Paris, 75013, France
| | - Remi Barrois
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France
| | - Alice Nicolai
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France
| | - Julien Audiffren
- Department of Neuroscience, University of Fribourg, Fribourg, Switzerland
| | - Christophe Labourdette
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France
| | | | - Laurent Oudre
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France
| | - Stephane Buffat
- Laboratoire d'accidentologie de biomécanique et du comportement des conducteurs, GIE Psa Renault Groupes, Nanterre, France
| | - Alain Yelnik
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France.,Service of Physical and Rehabilitation Medicine (PRM), AP- HP, GH St Louis, Lariboisière, F. Widal, Paris, 75010, France
| | - Damien Ricard
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France.,Service of Neurology, AP-HP, Hôpital d'Instruction des Armées de Percy, Service de Santé des Armées, Clamart, 92140, France.,École d'application du Val-de-Grâce, Service de Santé des Armée, Paris, France
| | - Nicolas Vayatis
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France
| | - Pierre-Paul Vidal
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, 91190, France.,Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, 75006, France.,Institute of Information and Control, Hangzhou Dianzi University, Zhejiang, China
| |
Collapse
|
14
|
Dos Santos RCB, do Nascimento SB, de Sousa Rego Mendes T, Santos LS, de Lemos MCC, Pinho CPS. Wasting syndrome and associated factors in hospitalized older people. Exp Gerontol 2022; 170:111985. [PMID: 36280091 DOI: 10.1016/j.exger.2022.111985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/17/2022] [Accepted: 10/18/2022] [Indexed: 12/29/2022]
Abstract
Wasting syndrome (WS) is characterized by clinically important unintentional weight loss >5 % in six to 12 months. This syndrome is responsible for a significant portion of hospitalizations throughout the world and is an important indicator of serious diseases, especially in individuals with 60 years of age or older. The aim of the present study was to investigate WS and associated factors in hospitalized older people. An observational cross-sectional study was developed at a university hospital in Brazil with male and female patients ≥60 years of age. WS was considered in the occurrence of unintentional weight loss of 10 % in 12 months, 7.5 % in six months or >5 % in three months. Data were collected on sociodemographic, clinical, lifestyle, nutritional and biochemical characteristics. This study received approval from the local institutional review board and all participants signed a statement of informed consent. The sample was composed of 178 older people with a mean age of 70.0 ± 8.0 years. The prevalence of WS was 45.5 %. WS was associated with the following clinical variables: conservative CKD (p = 0.007), dysphagia (p = 0.035), dementia (p = 0.017), anorexia (p < 0.001), fatigue (p = 0.001), functional dependence (measured using the Barthel Index) (p = 0.001) and medications that cause malabsorption (p = 0.020); the following nutritional variables: body mass index (p < 0.001), low calf circumference (p < 0.001), low muscle strength (p = 0.001), low muscle mass (p < 0.001) and undernourishment or risk of malnutrition (evaluated using the Mini Nutritional Assessment); and the following biochemical variables: high CRP (p = 0.027), hypoalbuminemia (p = 0.005) and anemia (p < 0.001). The prevalence of WS was high among the hospitalized older people in the present sample and was associated with clinical and biochemical aspects as well as all nutritional variables analyzed. In contrast, lifestyle and sociodemographic characteristics were not associated with wasting syndrome.
Collapse
Affiliation(s)
| | | | | | - Letícia Sabino Santos
- Hospital das Clínicas - UFPE, Av. Prof. Moraes Rego, 1235 - Cidade Universitária, Recife, PE 50670-901, Brazil
| | | | - Cláudia Porto Sabino Pinho
- Hospital das Clínicas, UFPE. Av. Prof. Moraes Rego, 1235 - Cidade Universitária, Recife, PE 50670-901, Brazil
| |
Collapse
|
15
|
Liu J, Cui K, Chen Q, Li Z, Fu J, Gong X, Xu H. Association of walking speed with cognitive function in Chinese older adults: A nationally representative cohort study. Front Aging Neurosci 2022; 14:1003896. [PMID: 36438013 PMCID: PMC9685315 DOI: 10.3389/fnagi.2022.1003896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/25/2022] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Slow walking speed has been shown to predict cognitive decline in older individuals, but studies conducted among Chinese older adults are scarce. We examined the association of walking speed with cognitive function and the trajectory of cognitive decline among Chinese adults aged 60 years and older. METHODS Data was from the China Health and Retirement Longitudinal Study (CHARLS), an ongoing nationally representative prospective cohort study. Walking speed was evaluated over a straight 2.5-meter flat course at baseline and categorized into tertiles (the lowest, middle, and highest). Cognitive function was assessed at each wave in three domains: episodic memory, mental status, and global cognition. Data were analyzed using linear mixed-effects models. RESULTS A total of 3,954 older adults (48.6% female; mean age: 67.6 ± 5.55 years) were followed for up to 7 years. Participants with lowest walking speed have poorer episodic memory (β = -0.37; 95% CI: -0.46, -0.28), mental status (β = -0.45; 95% CI: -0.60, -0.29), and global cognition (β = -0.81; 95% CI: -1.03, -0.60) over the follow-up. Compared with the highest tertile of walking speed, the lowest walking speed was associated with a faster decline in episodic memory (β = -0.04; 95% CI: -0.07, -0.02), mental status (β = -0.04; 95% CI: -0.07, -0.01), and global cognition (β = -0.06; 95% CI: -0.11, -0.01). CONCLUSION Slower walking speed is associated with subsequent risk of poorer cognitive function and faster cognitive decline in older Chinese adults.
Collapse
Affiliation(s)
- Jianping Liu
- Department of Respiratory and Critical Care Medicine, Ganzhou Institute of Respiratory Diseases, The Fifth People’s Hospital of Ganzhou, Ganzhou, Jiangxi, China
| | - Kaiwang Cui
- Department of Respiratory and Critical Care Medicine, Ganzhou Institute of Respiratory Diseases, The Fifth People’s Hospital of Ganzhou, Ganzhou, Jiangxi, China
| | - Qian Chen
- Department of Respiratory and Critical Care Medicine, Ganzhou Institute of Respiratory Diseases, The Fifth People’s Hospital of Ganzhou, Ganzhou, Jiangxi, China
| | - Zhiteng Li
- Department of Respiratory and Critical Care Medicine, Ganzhou Institute of Respiratory Diseases, The Fifth People’s Hospital of Ganzhou, Ganzhou, Jiangxi, China
| | - Jing Fu
- Department of Respiratory and Critical Care Medicine, Ganzhou Institute of Respiratory Diseases, The Fifth People’s Hospital of Ganzhou, Ganzhou, Jiangxi, China
| | - Xiangwen Gong
- Department of Respiratory and Critical Care Medicine, Ganzhou Institute of Respiratory Diseases, The Fifth People’s Hospital of Ganzhou, Ganzhou, Jiangxi, China
| | - Hui Xu
- Big Data Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| |
Collapse
|
16
|
The effects of aerobic exercise and transcranial direct current stimulation on cognitive function in older adults with and without cognitive impairment: A systematic review and meta-analysis. Ageing Res Rev 2022; 81:101738. [PMID: 36162707 DOI: 10.1016/j.arr.2022.101738] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Aerobic exercise (AE) may slow age-related cognitive decline. However, such cognition-sparing effects are not uniform across cognitive domains and studies. Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation and is also emerging as a potential alternative to pharmaceutical therapies. Like AE, the effectiveness of tDCS is also inconsistent for reducing cognitive impairment in ageing. The unexplored possibility exists that pairing AE and tDCS could produce synergistic effects and reciprocally augment cognition-improving effects in older individuals with and without cognitive impairments. Previous research found such synergistic effects on cognition when cognitive training is paired with tDCS in older individuals with and without mild cognitive impairment (MCI) or dementia. AIM The purpose of this systematic review with meta-analysis was to explore if pairing AE with tDCS could augment singular effects of AE and tDCS on global cognition (GC), working memory (WM) and executive function (EF) in older individuals with or without MCI and dementia. METHODS Using a PRISMA-based systematic review, we compiled studies that examined the effects of AE alone, tDCS alone, and AE and tDCS combined on cognitive function in older individuals with and without mild cognitive impairment (MCI) or dementia. Using a PICOS approach, we systematically searched PubMed, Scopus and Web of Science searches up to December 2021, we focused on 'MoCA', 'MMSE', 'Mini-Cog' (measures) and 'cognition', 'cognitive function', 'cognitive', 'cognitive performance', 'executive function', 'executive process', 'attention', 'memory', 'memory performance' (outcome terms). We included only randomized controlled trials (RTC) in humans if available in English full text over the past 20 years, with participants' age over 60. We assessed the methodological quality of the included studies (RTC) by the Physiotherapy Evidence Database (PEDro) scale. RESULTS Overall, 68 studies were included in the meta-analyses. AE (ES = 0.56 [95% CI: 0.28-0.83], p = 0.01) and tDCS (ES = 0.69 [95% CI: 0.12-1.26], p = 0.02) improved GC in all three groups of older adults combined (healthy, MCI, demented). In healthy population, AE improved GC (ES = 0.46 [95% CI: 0.22-0.69], p = 0.01) and EF (ES = 0.27 [95% CI: 0.05-0.49], p = 0.02). AE improved GC in older adults with MCI (ES = 0.76 [95% CI: 0.21-1.32], p = 0.01). tDCS improved GC (ES = 0.69 [90% CI: 0.12-1.26], p = 0.02), all three cognitive function (GC, WM and EF) combined in older adults with dementia (ES = 1.12 [95% CI: 0.04-2.19], p = 0.04) and improved cognitive function in older adults overall (ES = 0.69 [95% CI: 0.20-1,18], p = 0.01). CONCLUSION Our systematic review with meta-analysis provided evidence that beyond the cardiovascular and fitness benefits of AE, pairing AE with tDCS may have the potential to slow symptom progression of cognitive decline in MCI and dementia. Future studies will examine the hypothesis of this present review that a potentiating effect would incrementally improve cognition with increasing severity of cognitive impairment.
Collapse
|
17
|
Dougherty RJ, Liu F, An Y, Wanigatunga AA, Tian Q, Davatzikos C, Simonsick EM, Ferrucci L, Resnick SM, Schrack JA. Energetic Cost of Walking and Brain Atrophy in Mid-to-Late Life. J Gerontol A Biol Sci Med Sci 2022; 77:2068-2076. [PMID: 34628503 PMCID: PMC9536456 DOI: 10.1093/gerona/glab309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Higher energetic costs for mobility are associated with declining gait speed, and slow gait is linked to cognitive decline and Alzheimer's disease. However, the physiological underpinnings of gait and brain health have not been well explored. We examined the associations of the energetic cost of walking with brain volume in cognitively unimpaired adults from the Baltimore Longitudinal Study of Aging. METHODS We used brain magnetic resonance imaging (MRI) data from 850 participants (mean baseline age 66.3 ± 14.5 years), of whom 451 had longitudinal MRI data (2.8 ± 1.0 MRI scans over 4.0 ± 2.0 years). The energetic cost of walking was assessed as the average energy expended (V̇O2) during 2.5 minutes of customary-paced overground walking. Multivariable linear mixed-effects models examined the associations between baseline energetic cost of walking and regional brain volumes adjusting for covariates. RESULTS At baseline, higher energetic cost of walking was cross-sectionally associated with lower gray and white matter volumes within the frontal, parietal, and temporal lobes, as well as hippocampal, total brain, and larger ventricular volumes (all false-discovery rate [FDR] p < .05). A baseline energetic cost of walking × time interaction demonstrated that participants with higher energetic cost of walking had faster annual decline in hippocampal volume (FDR p = .02) and accelerated annual increase in ventricular volumes (FDR p = .02). CONCLUSIONS The energetic cost of walking is associated with gray and white matter volumes and subsequent hippocampal atrophy and ventricular enlargement. Collectively, these data suggest the energetic cost of walking may be an early marker of neurodegeneration that contributes to the gait brain connection.
Collapse
Affiliation(s)
- Ryan J Dougherty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Fangyu Liu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yang An
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Amal A Wanigatunga
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Qu Tian
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Christos Davatzikos
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eleanor M Simonsick
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Susan M Resnick
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
| | - Jennifer A Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland, USA
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
18
|
Sun Q, Jiang N, Lu N, Lou VWQ. Bidirectional relationship between cognitive function and loss hierarchy of activities of daily living among older adults with disabilities in urban China: a cross-lagged analysis. BMJ Open 2022; 12:e057211. [PMID: 36691162 PMCID: PMC9442490 DOI: 10.1136/bmjopen-2021-057211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 08/11/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES The present study aimed to determine the bidirectional relationship between cognitive function and the loss hierarchy of activities of daily living (ADL) among older adults in China. DESIGN Data were derived from the Longitudinal Study on Family Caregivers for Frail Older Adults Aged 75 or Above in Shanghai (2010-2013). SETTING Community-dwelling older adults and their primary caregivers were invited to participate in this research. PARTICIPANTS The inclusion criteria for the older adults were as follows: (a) have a Shanghai urban household registration status, (b) be 75 years old or older, (c) have no fewer than two limitations in ADLs or equivalent, and (d) have one primary caregiver aged 18 years or older. 469 older adults cared by their spouses or children were included in the final analytical sample of this research. PRIMARY AND SECONDARY OUTCOME MEASURES Cognitive function was assessed using the Chinese version of the Short Portable Mental Status Questionnaire and ADLs were measured by self-reports of having difficulty or needing help with basic daily activities. RESULTS Cognitive function in 2010 was a significant predictor of intermediate loss of ADLs in 2013 (β=-0.13, p<0.05) and late loss of ADLs in 2013 (β=-0.17, p<0.01). The loss hierarchy of ADLs among older adults was not shown to be significant as a risk factor of cognitive function in 2013. CONCLUSIONS Practitioners are encouraged to adopt the ADL loss hierarchy as a supplementary needs assessment tool to make the social service delivery process more effective, economical and tailored. Cognitive function change monitoring programmes and services providing education on nutrition and encouraging social participation of older individuals were also helpful in promoting the quality of life of the older adults.
Collapse
Affiliation(s)
- Qian Sun
- Department of Social Security, Hebei University of Economics and Business, Shijiazhuang, People's Republic of China
- Hebei Collaborative Innovation Center On Urban-rural Integration, Shijiazhuang, People's Republic of China
- Sau Po Centre on Ageing, the University of Hong Kong, Hong Kong, People's Republic of China
| | - Nan Jiang
- Institute of Hospital Management, School of Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Nan Lu
- Department of Social Work, Renmin University of China, Beijing, China
| | - Vivian W Q Lou
- Sau Po Centre on Ageing, the University of Hong Kong, Hong Kong, People's Republic of China
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, People's Republic of China
| |
Collapse
|
19
|
Hicks TH, Ballard HK, Sang H, Bernard JA. Age-volume associations in cerebellar lobules by sex and reproductive stage. Brain Struct Funct 2022; 227:2439-2455. [PMID: 35876952 PMCID: PMC10167909 DOI: 10.1007/s00429-022-02535-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/01/2022] [Indexed: 11/02/2022]
Abstract
The cerebellum has established associations with motor function and a well-recognized role in cognition. In advanced age, cognitive and motor impairments contribute to reduced quality of life and are more common. Regional cerebellar volume is associated with performance across these domains and sex hormones may influence this volume. Examining sex differences in regional cerebellar volume in conjunction with age, and in the context of reproductive stage stands to improve our understanding of cerebellar aging and pathology. Data from 508 healthy adults (ages 18-88; 47% female) from the Cambridge Centre for Ageing and Neuroscience database were used here. CERES was used to assess lobular volume in T1-weighted images. We examined sex differences in adjusted regional cerebellar volume while controlling for age. A subgroup of participants (n = 370, 50% female) was used to assess group differences in female reproductive stages as compared to age-matched males. Sex differences in adjusted volume were seen across most anterior and posterior cerebellar lobules. Most of these lobules had significant linear relationships with age in males and females. While there were no interactions between sex and reproductive stage groups, exploratory analyses in females alone revealed multiple regional differences by reproductive stage. We found sex differences in volume across much of the cerebellum, linear associations with age, and did not find an interaction for sex and reproductive stage on regional cerebellar volume. Longitudinal investigation into hormonal influences on cerebellar structure and function is warranted as hormonal changes with menopause may impact cerebellar volume over time.
Collapse
Affiliation(s)
- Tracey H Hicks
- Department of Psychological and Brain Sciences, Texas A&M University, 4235 TAMU, College Station, TX, 77840, USA.
| | - Hannah K Ballard
- Texas A&M University Institute for Neuroscience, 3474 TAMU, College Station, TX, 77843, USA
| | - Huiyan Sang
- Department of Statistics, Texas A&M University, 3143 TAMU, College Station, TX, 77843, USA
| | - Jessica A Bernard
- Department of Psychological and Brain Sciences, Texas A&M University, 4235 TAMU, College Station, TX, 77840, USA
- Texas A&M University Institute for Neuroscience, 3474 TAMU, College Station, TX, 77843, USA
| |
Collapse
|
20
|
Executive and Motor Functions in Older Individuals with Cognitive Impairment. Behav Sci (Basel) 2022; 12:bs12070214. [PMID: 35877284 PMCID: PMC9311572 DOI: 10.3390/bs12070214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 12/10/2022] Open
Abstract
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 (Mage = 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.
Collapse
|
21
|
Beam width and arm position but not cognitive task affect walking balance in older adults. Sci Rep 2022; 12:6854. [PMID: 35477729 PMCID: PMC9046185 DOI: 10.1038/s41598-022-10848-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 04/11/2022] [Indexed: 11/08/2022] Open
Abstract
Detection of changes in dynamic balance could help identify older adults at fall risk. Walking on a narrow beam with its width, cognitive load, and arm position manipulated could be an alternative to current tests. Therefore, we examined additive and interactive effects of beam width, cognitive task (CT), and arm position on dynamic balance during beam walking in older adults. Twenty older adults (69 ± 4y) walked on 6, 8, and 10-cm wide beams (2-cm high, 4-m-long), with and without CT, with three arm positions (free, crossed, akimbo). We determined cognitive errors, distance walked, step speed, root mean square (RMS) of center of mass (COM) displacement and trunk acceleration in the frontal plane. Beam width decrease progressively reduced distance walked and increased trunk acceleration RMS. Step speed decreased on the narrowest beam and with CT. Arm crossing decreased distance walked and step speed. COM displacement RMS and cognitive errors were not affected by any manipulation. In conclusion, distance walked indicated that beam width and arm position, but less so CT, affected dynamic balance, implying that beam walking has the potential to become a test of fall risk. Stability measurements suggested effective trunk adjustments to control COM position and keep dynamic balance during the task.
Collapse
|
22
|
Characteristics of transitional locomotor tasks performed by patients with dementia. Exp Brain Res 2022; 240:1605-1616. [PMID: 35362724 DOI: 10.1007/s00221-022-06355-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/21/2022] [Indexed: 11/04/2022]
Abstract
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.
Collapse
|
23
|
Braun Janzen T, Koshimori Y, Richard NM, Thaut MH. Rhythm and Music-Based Interventions in Motor Rehabilitation: Current Evidence and Future Perspectives. Front Hum Neurosci 2022; 15:789467. [PMID: 35111007 PMCID: PMC8801707 DOI: 10.3389/fnhum.2021.789467] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/27/2021] [Indexed: 12/17/2022] Open
Abstract
Research in basic and clinical neuroscience of music conducted over the past decades has begun to uncover music’s high potential as a tool for rehabilitation. Advances in our understanding of how music engages parallel brain networks underpinning sensory and motor processes, arousal, reward, and affective regulation, have laid a sound neuroscientific foundation for the development of theory-driven music interventions that have been systematically tested in clinical settings. Of particular significance in the context of motor rehabilitation is the notion that musical rhythms can entrain movement patterns in patients with movement-related disorders, serving as a continuous time reference that can help regulate movement timing and pace. To date, a significant number of clinical and experimental studies have tested the application of rhythm- and music-based interventions to improve motor functions following central nervous injury and/or degeneration. The goal of this review is to appraise the current state of knowledge on the effectiveness of music and rhythm to modulate movement spatiotemporal patterns and restore motor function. By organizing and providing a critical appraisal of a large body of research, we hope to provide a revised framework for future research on the effectiveness of rhythm- and music-based interventions to restore and (re)train motor function.
Collapse
Affiliation(s)
- Thenille Braun Janzen
- Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, São Bernardo do Campo, Brazil
| | - Yuko Koshimori
- Music and Health Science Research Collaboratory, Faculty of Music, University of Toronto, Toronto, ON, Canada
- Brain Health Imaging Centre, CAMH, Toronto, ON, Canada
| | - Nicole M. Richard
- Music and Health Science Research Collaboratory, Faculty of Music, University of Toronto, Toronto, ON, Canada
- Faculty of Music, Belmont University, Nashville, TN, United States
| | - Michael H. Thaut
- Music and Health Science Research Collaboratory, Faculty of Music, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- *Correspondence: Michael H. Thaut,
| |
Collapse
|
24
|
Flugon SJ, Jøranson N, Tangen GG. Mobility and Depressive Symptoms in Persons With Mild Cognitive Impairment and Alzheimer Dementia. J Neurol Phys Ther 2022; 46:11-17. [PMID: 34507341 DOI: 10.1097/npt.0000000000000378] [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: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Persons with mild cognitive impairment (MCI) and Alzheimer dementia (AD) often experience gait and balance disturbances and depressive symptoms alongside their cognitive impairment. The aim of this study was to explore the relationship between mobility and depressive symptoms in community-dwelling persons with MCI and mild to moderate AD. METHODS Ninety-nine participants with MCI and AD from the memory clinic at Oslo University Hospital, Ullevål, Norway, were included. The Balance Evaluation Systems Test (BESTest), 10-m walk test regular (gait speed), and dual task (naming animals, dual-task cost in percent) were used to assess mobility. The Cornell Scale for Depression in Dementia, with validated cut-off 5/6 points, was used to assess presence of depressive symptoms. Multiple regression analysis was used to explore the relationship between mobility (3 separate models) and depressive symptoms, controlled for demographic factors, comorbidity, and Mini-Mental State Examination. RESULTS One-third of the participants had depressive symptoms, mean (SD) gait speed was 1.09 (0.3) m/s, and median (interquartile range) BESTest percent score was 81.5 (17.6). No statistically significant associations were found between depression and BESTest, gait speed or dual-task cost, neither in the simple models (P = 0.15-0.85), nor in the 3 multivariate models (P = 0.57-0.69). DISCUSSION AND CONCLUSIONS In this study, we found no associations between mobility and depressive symptoms in persons with MCI and AD recruited at a memory clinic. Few participants had major symptoms of depression, which may have influenced the results. Longitudinal studies are needed to explore the long-time associations between mobility and depression.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A366).
Collapse
Affiliation(s)
- Susannah Julie Flugon
- Municipality of Oslo, Oslo, Norway (S.J.F.); Faculty of Health Studies, VID Specialized University, Oslo, Norway (N.J.), and Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, and Department of Geriatric Medicine, Oslo University Hospital, Ullevål, Norway (G.G.T.)
| | | | | |
Collapse
|
25
|
Taraldsen K, Helbostad JL, Follestad T, Bergh S, Selbæk G, Saltvedt I. Gait, physical function, and physical activity in three groups of home-dwelling older adults with different severity of cognitive impairment - a cross-sectional study. BMC Geriatr 2021; 21:670. [PMID: 34852786 PMCID: PMC8638089 DOI: 10.1186/s12877-021-02598-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background The research on associations between gait, physical function, physical activity (PA), and cognitive function is growing. Still, clinical assessments of cognitive function and motor function is often kept separate. In this study, we aimed to look at a broad range of measures of gait, physical function, and PA in three groups of home-dwelling older adults with no or questionable dementia, mild dementia, and moderate/severe dementia. Methods This cross-sectional study included 100 home-dwelling older adults, recruited from an outpatient geriatric memory clinic. Severity of dementia was categorised using the clinical dementia rating scale (CDR), with no or questionable dementia (CDR score 0 and 0.5), mild dementia (CDR score 1) and moderate/severe dementia (CDR score 2 and 3). We used thigh worn accelerometers to measure daily PA, the Short Physical Performance Battery (SPPB) to measure physical function, and an electronic gait mat to evaluate gait characteristics. Associations between severity of dementia and measures of PA, physical function, and gait characteristics were assessed by linear regression. Results Participants’ (mean age 78.9 (SD 6.7) years, 57% women) average gait speed was 0.93 m/sec, and average upright time was 301 min/day. Statistically significant associations were found for the severity of dementia and gait speed (p=0.002), step time (p=0.001), physical function (SPPB, p=0.007), and PA (upright time, p=0.031), after adjusting for age. Overall, having no or questionable dementia was associated with faster gait speed (mean difference 0.163 (95% CI: 0.053 to 0.273)), shorter step time (-0.043 (-0.082 to -0.005)), better SPPB score (1.7 (0.5 to 2.8)), and longer upright time (78.9 (18.9 to 139.0)), compared to those with mild dementia. Furthermore, having no or questionable dementia was also associated with faster gait speed and better SPPB scores, as compared to those with moderate to severe dementia. No evidence of any differences was found between the participants with the mild dementia versus the moderate to severe dementia. Conclusions After adjusting for age, we found that the no or questionable dementia group to be associated with better gait and physical function, and more PA, as compared with the two groups with mild or moderate/severe dementia. Evaluation of gait, physical function, and PA can add clinically important information of everyday functioning in memory clinics meeting geriatric patients, but investigations on how to use these results to guide interventions are still needed.
Collapse
Affiliation(s)
- Kristin Taraldsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), Oslo, Norway. .,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. .,Clinic of Clinical Service, St Olav University Hospital, Trondheim, Norway.
| | - Jorunn L Helbostad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Turid Follestad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sverre Bergh
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Geriatrics, St Olav University Hospital, Trondheim, Norway
| |
Collapse
|
26
|
Rincé G, Couturier C, Berrut G, Dylis A, Montero-Odasso M, Deschamps T. Impact of an individual personalised rehabilitation program on mobility performance in older-old people. Aging Clin Exp Res 2021; 33:2821-2830. [PMID: 33625687 DOI: 10.1007/s40520-021-01812-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/08/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Studies have shown benefits of exercise interventions on preferred and fast gait speed in healthy older adults, but the impact of a personalised rehabilitation program targeting a large cohort of non-disabled older-old adults has rarely been examined. AIMS The purpose was to determine whether personalised intervention-related improvements in gait and mobility performance in older-old adults were dependent on cognitive status and/or history of falls. METHODS Based on a pre-post design, 483 older-old persons (mean age: 83.3 ± 5.1 years) were followed during a personalised rehabilitation program over a period of 7 weeks, with twice-weekly sessions (45 min each). Gait speed in four conditions (preferred, fast, and under two dual-task conditions), static postural sway, Timed Up and Go test, Five Times Sit to Stand test, the ability to rise from the floor, and handgrip strength test were assessed. RESULTS Using a pre-post analysis of covariance, a significant increase in preferred gait speed (+ 20.1%), fast gait speed (+ 15.8%), and dual-task speed while counting (+ 13.4%) was observed after the rehabilitation, regardless of the baseline cognitive status and fall history. Similar improvements in TUG and maximal handgrip force were observed, with a significant reduction of performance time (-19.5%) or an increase of handgrip strength (+ 6.2%). DISCUSSION Results suggest the effectiveness of personalised intervention to improve a battery of physical performance measures in older-old adults, even for the frailest participants. CONCLUSION Implementing a personalised intervention for targeting the high-risk older-old adults in priority is critical regarding the clinically meaningful change in gait speed.
Collapse
Affiliation(s)
- Guy Rincé
- Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 44000, Nantes, France
| | - Catherine Couturier
- Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 44000, Nantes, France
| | - Gilles Berrut
- Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 44000, Nantes, France
- Nantes Université, CHU Nantes, Movement - Interactions - Performance, MIP, 4334, F-44000, Nantes, EA, France
| | - Anthony Dylis
- Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 44000, Nantes, France
| | - Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- Schulich School of Medicine & Dentistry, Department of Medicine and Division of Geriatric Medicine, The University of Western Ontario, London, ON, Canada
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada
| | - Thibault Deschamps
- Nantes Université, CHU Nantes, Movement - Interactions - Performance, MIP, 4334, F-44000, Nantes, EA, France.
| |
Collapse
|
27
|
Zhong Q, Ali N, Gao Y, Wu H, Wu X, Sun C, Ma J, Thabane L, Xiao M, Zhou Q, Shen Y, Wang T, Zhu Y. Gait Kinematic and Kinetic Characteristics of Older Adults With Mild Cognitive Impairment and Subjective Cognitive Decline: A Cross-Sectional Study. Front Aging Neurosci 2021; 13:664558. [PMID: 34413762 PMCID: PMC8368728 DOI: 10.3389/fnagi.2021.664558] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/09/2021] [Indexed: 01/14/2023] Open
Abstract
Background Older adults with mild cognitive impairment (MCI) have slower gait speed and poor gait performance under dual-task conditions. However, gait kinematic and kinetic characteristics in older adults with MCI or subjective cognitive decline (SCD) remain unknown. This study was designed to explore the difference in gait kinematics and kinetics during level walking among older people with MCI, SCD, and normal cognition (NC). Methods This cross-sectional study recruited 181 participants from July to December 2019; only 82 met the inclusion criteria and consented to participate and only 79 completed gait analysis. Kinematic and kinetic data were obtained using three-dimensional motion capture system during level walking, and joint movements of the lower limbs in the sagittal plane were analyzed by Visual 3D software. Differences in gait kinematics and kinetics among the groups were analyzed using multivariate analysis of covariance (MANCOVA) with Bonferroni post-hoc analysis. After adjusting for multiple comparisons, the significance level was p < 0.002 for MANCOVA and p < 0.0008 for post-hoc analysis. Results Twenty-two participants were MCI [mean ± standard deviation (SD) age, 71.23 ± 6.65 years], 33 were SCD (age, 72.73 ± 5.25 years), and 24 were NC (age, 71.96 ± 5.30 years). MANCOVA adjusted for age, gender, body mass index (BMI), gait speed, years of education, diabetes mellitus, and Geriatric Depression Scale (GDS) revealed a significant multivariate effect of group in knee peak extension angle (F = 8.77, p < 0.0001) and knee heel strike angle (F = 8.07, p = 0.001) on the right side. Post-hoc comparisons with Bonferroni correction showed a significant increase of 5.91° in knee peak extension angle (p < 0.0001) and a noticeable decrease of 6.21°in knee heel strike angle (p = 0.001) in MCI compared with NC on the right side. However, no significant intergroup difference was found in gait kinetics, including dorsiflexion, plantar flexion, knee flexion, knee extension, hip flexion, and hip extension(p > 0.002). Conclusion An increase of right knee peak extension angle and a decrease of right knee heel strike angle during level walking were found among older adults with MCI compared to those with NC.
Collapse
Affiliation(s)
- Qian Zhong
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,Department of Rehabilitation, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Nawab Ali
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,Swat Institute of Rehabilitation & Medical Sciences, Swat, Pakistan
| | - Yaxin Gao
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,Department of Rehabilitation, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Han Wu
- Department of Rehabilitation, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Xixi Wu
- Zhongshan Rehabilitation Branch, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Cuiyun Sun
- Department of Rehabilitation, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Biostatistics Unit, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Ming Xiao
- Jiangsu Key Laboratory of Neurodegeneration, Center for Global Health, Nanjing Medical University, Nanjing, China.,Brain Institute, The Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Qiumin Zhou
- Department of Rehabilitation, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Ying Shen
- Department of Rehabilitation, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Tong Wang
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yi Zhu
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
28
|
Dougherty RJ, Ramachandran J, Liu F, An Y, Wanigatunga AA, Tian Q, Bilgel M, Simonsick EM, Ferrucci L, Resnick SM, Schrack JA. Association of walking energetics with amyloid beta status: Findings from the Baltimore Longitudinal Study of Aging. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12228. [PMID: 34458552 PMCID: PMC8377776 DOI: 10.1002/dad2.12228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Higher energetic costs for mobility predict gait speed decline. Slow gait is linked to cognitive decline and Alzheimer's disease (AD). Whether the energetic cost of walking is linked to AD pathology is unknown. We investigated the cross-sectional association between the energetic cost of walking, gait speed, and amyloid beta (Aβ) status (+/-) in older adults. METHODS One hundred forty-nine cognitively normal adults (56% women, mean age 77.5 ± 8.4 years) completed customary-paced walking assessments with indirect calorimetry and 11C-Pittsburgh compound B positron emission tomography. Logistic regression models examined associations adjusted for demographics, body composition, comorbid conditions, and apolipoprotein E ε4. RESULTS Each 0.01 mL/kg/m greater energy cost was associated with 18% higher odds of being Aβ+ (odds ratio [OR] = 1.18; 95% confidence interval [CI]: 1.04 to 1.34; P = .011). These findings were not observed when investigating gait speed (OR = 0.99; 95% CI: 0.97 to 1.01; P = .321). DISCUSSION High energetic cost of walking is linked to AD pathology and may be a potential target for therapeutic intervention.
Collapse
Affiliation(s)
- Ryan J. Dougherty
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Janani Ramachandran
- Departments of Epidemiology and BiostatisticsBoston University School of Public HealthBostonMassachusettsUSA
| | - Fangyu Liu
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Yang An
- Intramural Research Program, National Institute on AgingBaltimoreMarylandUSA
| | - Amal A. Wanigatunga
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Center on Aging and HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Qu Tian
- Intramural Research Program, National Institute on AgingBaltimoreMarylandUSA
| | - Murat Bilgel
- Intramural Research Program, National Institute on AgingBaltimoreMarylandUSA
| | | | - Luigi Ferrucci
- Intramural Research Program, National Institute on AgingBaltimoreMarylandUSA
| | - Susan M. Resnick
- Intramural Research Program, National Institute on AgingBaltimoreMarylandUSA
| | - Jennifer A. Schrack
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Intramural Research Program, National Institute on AgingBaltimoreMarylandUSA
- Center on Aging and HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| |
Collapse
|
29
|
Association Between Gait, Cognition, and Gray Matter Volumes in Mild Cognitive Impairment and Healthy Controls. Alzheimer Dis Assoc Disord 2021; 34:231-237. [PMID: 31977569 DOI: 10.1097/wad.0000000000000371] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIMS To assess the correlation between cognitive functioning and 3 gait parameters (gait speed, cadence, and stride length) in persons with mild cognitive impairment (MCI) and cognitively healthy controls and investigate linear correlations between gait and gray matter volumes. MATERIALS AND METHODS Participants were recruited at IRCCS San Camillo Hospital, Venice, Italy (MCI=43; age-matched controls=43). Participants underwent comprehensive neuropsychological assessment. Gait speed, cadence, and stride length, were assessed with the BTS FREEMG 300 device. Three-dimensional (3D) T1-weighted MR images were acquired using a 1.5 T Philips Achieva MRI system with a Turbo Field Echo sequence. RESULTS In MCI there was a positive correlation between gait speed and memory tests (P<0.05). In controls all 3 gait parameters correlated with executive functioning (P<0.01). Temporal and limbic areas (ie, superior temporal gyrus, thalamus and parahippocampal gyrus) were associated with gait parameters in MCI whereas in controls the associations were with frontal areas (ie, middle, inferior, and superior frontal gyrus) and in the cerebellum (anterior and posterior lobe). CONCLUSIONS Our results highlight a distinct pattern of association between gray matter volume and gait parameters in MCI patients and controls (temporal areas in MCI and frontal areas in healthy elderly), suggesting a relationship between dementia-related pathology and gait dysfunction.
Collapse
|
30
|
Nohelova D, Bizovska L, Vuillerme N, Svoboda Z. Gait Variability and Complexity during Single and Dual-Task Walking on Different Surfaces in Outdoor Environment. SENSORS (BASEL, SWITZERLAND) 2021; 21:4792. [PMID: 34300532 PMCID: PMC8309897 DOI: 10.3390/s21144792] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/09/2021] [Accepted: 07/11/2021] [Indexed: 11/28/2022]
Abstract
Nowadays, gait assessment in the real life environment is gaining more attention. Therefore, it is desirable to know how some factors, such as surfaces (natural, artificial) or dual-tasking, influence real life gait pattern. The aim of this study was to assess gait variability and gait complexity during single and dual-task walking on different surfaces in an outdoor environment. Twenty-nine healthy young adults aged 23.31 ± 2.26 years (18 females, 11 males) walked at their preferred walking speed on three different surfaces (asphalt, cobbles, grass) in single-task and in two dual-task conditions (manual task-carrying a cup filled with water, cognitive task-subtracting the number 7). A triaxial inertial sensor attached to the lower trunk was used to record trunk acceleration during gait. From 15 strides, sample entropy (SampEn) as an indicator of gait complexity and root mean square (RMS) as an indicator of gait variability were computed. The findings demonstrate that in an outdoor environment, the surfaces significantly impacted only gait variability, not complexity, and that the tasks affected both gait variability and complexity in young healthy adults.
Collapse
Affiliation(s)
- Denisa Nohelova
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacký University Olomouc, 771 11 Olomouc, Czech Republic; (L.B.); (Z.S.)
- Laboratory AGEIS, Université Grenoble Alpes, AGEIS, 38000 Grenoble, France;
- LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000 Grenoble, France
| | - Lucia Bizovska
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacký University Olomouc, 771 11 Olomouc, Czech Republic; (L.B.); (Z.S.)
| | - Nicolas Vuillerme
- Laboratory AGEIS, Université Grenoble Alpes, AGEIS, 38000 Grenoble, France;
- LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000 Grenoble, France
- Institut Universitaire de France, 75231 Paris, France
| | - Zdenek Svoboda
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacký University Olomouc, 771 11 Olomouc, Czech Republic; (L.B.); (Z.S.)
| |
Collapse
|
31
|
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: 1.0] [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.
Collapse
|
32
|
Cicirelli G, Impedovo D, Dentamaro V, Marani R, Pirlo G, D'Orazio TR. Human Gait Analysis in Neurodegenerative Diseases: a Review. IEEE J Biomed Health Inform 2021; 26:229-242. [PMID: 34181559 DOI: 10.1109/jbhi.2021.3092875] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper reviews the recent literature on technologies and methodologies for quantitative human gait analysis in the context of neurodegnerative diseases. The use of technological instruments can be of great support in both clinical diagnosis and severity assessment of these pathologies. In this paper, sensors, features and processing methodologies have been reviewed in order to provide a highly consistent work that explores the issues related to gait analysis. First, the phases of the human gait cycle are briefly explained, along with some non-normal gait patterns (gait abnormalities) typical of some neurodegenerative diseases. The work continues with a survey on the publicly available datasets principally used for comparing results. Then the paper reports the most common processing techniques for both feature selection and extraction and for classification and clustering. Finally, a conclusive discussion on current open problems and future directions is outlined.
Collapse
|
33
|
Noh B, Youm C, Goh E, Lee M, Park H, Jeon H, Kim OY. XGBoost based machine learning approach to predict the risk of fall in older adults using gait outcomes. Sci Rep 2021; 11:12183. [PMID: 34108595 PMCID: PMC8190134 DOI: 10.1038/s41598-021-91797-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 04/21/2021] [Indexed: 11/09/2022] Open
Abstract
This study aimed to identify the optimal features of gait parameters to predict the fall risk level in older adults. The study included 746 older adults (age: 63–89 years). Gait tests (20 m walkway) included speed modification (slower, preferred, and faster-walking) while wearing the inertial measurement unit sensors embedded in the shoe-type data loggers on both outsoles. A metric was defined to classify the fall risks, determined based on a set of questions determining the history of falls and fear of falls. The extreme gradient boosting (XGBoost) model was built from gait features to predict the factor affecting the risk of falls. Moreover, the definition of the fall levels was classified into high- and low-risk groups. At all speeds, three gait features were identified with the XGBoost (stride length, walking speed, and stance phase) that accurately classified the fall risk levels. The model accuracy in classifying fall risk levels ranged between 67–70% with 43–53% sensitivity and 77–84% specificity. Thus, we identified the optimal gait features for accurate fall risk level classification in older adults. The XGBoost model could inspire future works on fall prevention and the fall-risk assessment potential through the gait analysis of older adults.
Collapse
Affiliation(s)
- Byungjoo Noh
- Department of Kinesiology, Jeju National University, Jeju, Republic of Korea
| | - Changhong Youm
- Department of Health Sciences, The Graduate School of Dong-A University, Busan, Republic of Korea.
| | - Eunkyoung Goh
- Human Life Research Center, Dong-A University, Busan, Republic of Korea
| | - Myeounggon Lee
- Department of Health Sciences, The Graduate School of Dong-A University, Busan, Republic of Korea
| | - Hwayoung Park
- Department of Health Sciences, The Graduate School of Dong-A University, Busan, Republic of Korea
| | - Hyojeong Jeon
- Department of Child Studies, Dong-A University, Busan, Republic of Korea
| | - Oh Yoen Kim
- Department of Food Science and Nutrition, Dong-A University, Busan, Republic of Korea
| |
Collapse
|
34
|
Chiaramonte R, Cioni M. Critical spatiotemporal gait parameters for individuals with dementia: A systematic review and meta-analysis. Hong Kong Physiother J 2021; 41:1-14. [PMID: 34054252 PMCID: PMC8158408 DOI: 10.1142/s101370252130001x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 08/24/2020] [Indexed: 11/30/2022] Open
Abstract
Instrumented gait analysis allows for the identification of walking parameters to predict cognitive decline and the worsening of dementia. The aim of this study was to perform a meta-analysis to better clarify which gait parameters are affected or modified with the progression of the dementia in a larger sample, as well as which gait assessment conditions (single-task or dual-task conditions) would be more sensitive to reflect the influence of dementia. Literature searches were conducted with the keywords "quantitative gait" OR "gait analysis" AND "dementia" AND "single-task" AND "dual-task," and for "quantitative gait" OR "gait analysis" AND "dementia" AND "fall risk" on PubMed, EMBASE, the Cochrane Library, Scopus, and Web of Science. The results were used to perform a systematic review focussing on instrumental quantitative assessment of the walking of patients with dementia, during both single and dual tasks. The search was performed independently by two authors (C. R. and C. M.) from January 2018 to April 2020 using the PICOS criteria. Nine publications met the inclusion criteria and were included in the systematic review. Our meta-analysis showed that during a single task, most of the spatiotemporal parameters of gait discriminated best between patients with dementia and healthy controls, including speed, cadence, stride length, stride time, stride time variability, and stance time. In dual tasks, only speed, stride length, and stride time variability discriminated between the two groups. In addition, compared with spatial parameters (e.g. stride length), some temporal gait parameters were more correlated to the risk of falls during the comfortable walking in a single task, such as cadence, stride time, stride time variability, and stance time. During a dual task, only the variability of stride time was associated with the risk of falls.
Collapse
Affiliation(s)
- Rita Chiaramonte
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
- Department of Physical Medicine and Rehabilitation, ASP 7, Scicli Hospital, Ragusa, Italy
| | - Matteo Cioni
- Laboratory of Neurobiomechanics, Department of Biomedical and Biotechnological Sciences, Catania, Italy
- Gait and Posture Analysis Laboratory, AOU Policlinico Vittorio Emanuele, 95123 Catania, Italy
| |
Collapse
|
35
|
Dupré C, Helmer C, Bongue B, Dartigues JF, Roche F, Berr C, Carrière I. Associations between physical activity types and multi-domain cognitive decline in older adults from the Three-city cohort. PLoS One 2021; 16:e0252500. [PMID: 34061901 PMCID: PMC8168837 DOI: 10.1371/journal.pone.0252500] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/18/2021] [Indexed: 11/18/2022] Open
Abstract
Several studies suggest that physical activity improves cognitive functions and reduces cognitive decline, whereas others did not find any evidence of a neuroprotective effect. Furthermore, few cohort studies have analyzed the different physical activity types and particularly household activities. Our objective was to assess the association of two physical activity types with the decline in different cognitive domains in a large prospective cohort of community-dwelling older adults from the Three-city study. Physical activity (domestic/transportation activities and leisure/sport activities) was assessed with the Voorrips questionnaire, specific for older adults. Baseline sociodemographic and health history variables as well as cognitive performance data at baseline and during the 8-year follow-up (Mini-Mental State Examination, Benton Visual Retention Test, Trail Making Tests A and B, Isaac's Set Test and Free and Cued Selective Reminding Test) were also available. Associations between physical activity scores and cognitive decline in different domains were tested using minimally- and multi-adjusted linear mixed models. The analysis included 1697 participants without dementia at baseline and with at least one follow-up visit. At baseline, participants with higher sub-scores for the two physical activity types had better cognitive performances. Interaction with time showed that decline in some cognitive scores (Trail Making Test B and Isaac's Set Test) was significantly less pronounced in participants with higher household/transportation activity sub-scores. No significant effect over time was found for leisure/sport activities. This study shows that during an 8-year follow-up, executive functions and verbal fluency were better preserved in older adults who performed household/transportation activities at moderate to high level. Participation in domestic activities and using adapted transport means could allow older adults to maintain specific cognitive abilities.
Collapse
Affiliation(s)
- Caroline Dupré
- CETAF, Saint-Etienne, France
- Laboratoire SNA-EPIS, University Jean Monnet, Saint-Etienne, France
| | - Catherine Helmer
- Inserm, Bordeaux Population Health Research Center, Univ. Bordeaux, Bordeaux, France
| | - Bienvenu Bongue
- CETAF, Saint-Etienne, France
- Laboratoire SNA-EPIS, University Jean Monnet, Saint-Etienne, France
| | | | - Frédéric Roche
- Laboratoire SNA-EPIS, University Jean Monnet, Saint-Etienne, France
| | - Claudine Berr
- Institute for Neurosciences of Montpellier, Inserm, Univ. Montpellier, Montpellier, France
| | - Isabelle Carrière
- Institute for Neurosciences of Montpellier, Inserm, Univ. Montpellier, Montpellier, France
- * E-mail:
| |
Collapse
|
36
|
Spatio-temporal gait parameters obtained from foot-worn inertial sensors are reliable in healthy adults in single- and dual-task conditions. Sci Rep 2021; 11:10229. [PMID: 33986307 PMCID: PMC8119721 DOI: 10.1038/s41598-021-88794-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 04/07/2021] [Indexed: 02/07/2023] Open
Abstract
Inertial measurement units (IMUs) are increasingly popular and may be usable in clinical routine to assess gait. However, assessing their intra-session reliability is crucial and has not been tested with foot-worn sensors in healthy participants. The aim of this study was to assess the intra-session reliability of foot-worn IMUs for measuring gait parameters in healthy adults. Twenty healthy participants were enrolled in the study and performed the 10-m walk test in single- and dual-task ('carrying a full cup of water') conditions, three trials per condition. IMUs were used to assess spatiotemporal gait parameters, gait symmetry parameters (symmetry index (SI) and symmetry ratio (SR)), and dual task effects parameters. The relative and the absolute reliability were calculated for each gait parameter. Results showed that spatiotemporal gait parameters measured with foot-worn inertial sensors were reliable; symmetry gait parameters relative reliability was low, and SR showed better absolute reliability than SI; dual task effects were poorly reliable, and taking the mean of the second and the third trials was the most reliable. Foot-worn IMUs are reliable to assess spatiotemporal and symmetry ratio gait parameters but symmetry index and DTE gait parameters reliabilities were low and need to be interpreted with cautious by clinicians and researchers.
Collapse
|
37
|
Abstract
Even for a stereotyped task, sensorimotor behavior is generally variable due to noise, redundancy, adaptability, learning or plasticity. The sources and significance of different kinds of behavioral variability have attracted considerable attention in recent years. However, the idea that part of this variability depends on unique individual strategies has been explored to a lesser extent. In particular, the notion of style recurs infrequently in the literature on sensorimotor behavior. In general use, style refers to a distinctive manner or custom of behaving oneself or of doing something, especially one that is typical of a person, group of people, place, context, or period. The application of the term to the domain of perceptual and motor phenomenology opens new perspectives on the nature of behavioral variability, perspectives that are complementary to those typically considered in the studies of sensorimotor variability. In particular, the concept of style may help toward the development of personalised physiology and medicine by providing markers of individual behaviour and response to different stimuli or treatments. Here, we cover some potential applications of the concept of perceptual-motor style to different areas of neuroscience, both in the healthy and the diseased. We prefer to be as general as possible in the types of applications we consider, even at the expense of running the risk of encompassing loosely related studies, given the relative novelty of the introduction of the term perceptual-motor style in neurosciences.
Collapse
Affiliation(s)
- Pierre-Paul Vidal
- CNRS, SSA, ENS Paris Saclay, Université de Paris, Centre Borelli, 75005 Paris, France
- Institute of Information and Control, Hangzhou Dianzi University, Hangzhou, China
| | - Francesco Lacquaniti
- Department of Systems Medicine, Center of Space Biomedicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Laboratory of Neuromotor Physiology, Santa Lucia Foundation IRCCS, 00179 Rome, Italy
| |
Collapse
|
38
|
The Associations Between Grey Matter Volume Covariance Patterns and Gait Variability-The Tasmanian Study of Cognition and Gait. Brain Topogr 2021; 34:478-488. [PMID: 33914190 DOI: 10.1007/s10548-021-00841-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
Greater gait variability predicts dementia. However, little is known about the neural correlates of gait variability. The aims of this study were to determine (1) grey matter volume covariance patterns associated with gait variability and (2) whether these patterns were associated with specific cognitive domains. Participants (n = 351; mean age 71.9 ± 7.1) were randomly selected from the Southern Tasmanian electoral roll. Step time, step length, step width and double support time were measured using an electronic walkway. Gait variability was calculated as the standard deviation of all steps for each gait measure. Voxel-based morphometry and multivariate covariance-based analyses were used to identify grey matter patterns associated with each gait variability measure. The individual expressions of grey matter patterns were correlated with processing speed, memory, executive and visuospatial functions. The grey matter covariance pattern of double support time variability included frontal, medial temporal, anterior cingulate, insula, cerebellar and striatal regions. Greater expression of this pattern was correlated with poorer performance in all cognitive functions (p < 0.001). The covariance pattern of step length variability included frontal, temporal, insula, occipital and cerebellar regions and was correlated with all cognitive functions (p < 0.05), except memory (p = 0.76). The covariance pattern of step width variability was limited to the cerebellum and correlated only with memory (p = 0.047). No significant pattern was identified for step time variability. In conclusion, different grey matter covariance patterns were associated with individual gait variability measures. These patterns were also correlated with specific cognitive functions, suggesting common neural networks may underlie both gait and cognition.
Collapse
|
39
|
Yang SY, Lee HC, Huang CM, Chen JJ. Efficacy of Tai Chi-Style Multi-Component Exercise on Frontal-Related Cognition and Physical Health in Elderly With Amnestic Mild Cognitive Impairment. FRONTIERS IN AGING 2021; 2:636390. [PMID: 35822039 PMCID: PMC9261301 DOI: 10.3389/fragi.2021.636390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/17/2021] [Indexed: 02/06/2023]
Abstract
Early prevention from accelerated neurocognitive declines with advanced aging and the delay of the onset of dementia have became paramount for the achievement of active aging. The present study examined whether the proposed non-pharmaceutical, multi-component exercise training which combined Tai-Chi exercise, Aerobic fitness, and thera-band therapy protects against age-related neurocognitive and physical deterioration in the older participants with amnestic mild cognitive impairment (aMCI). Participants with aMCI in the quasi-experimental design were assigned to the multi-component exercise group or care control group. Evaluations of neuropsychological function and functional fitness were performed before and after 12-weeks intervention, and after 24-weeks follow-up. Our results showed that the multi-component intervention significantly improved various domains of neurocognitive function, particularly in memory- and frontal-related cognition, and better performance on functional fitness, including muscle strength, cardiopulmonary endurance, and agility. Furthermore, such beneficial effects were preserved after 24 weeks. The findings provide supportive evidence that non-pharmaceutically multi-component intervention with Tai-Chi style practice as a core exercise may protect against age-related neurocognitive and physical deficits and lay the path on developing age-friendly intervention programs to delay, or even reverse, the progression of MCI to dementia.
Collapse
Affiliation(s)
- Shao-Yun Yang
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Sports and Health Science Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsuei-Chen Lee
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Sports and Health Science Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Mao Huang
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-devices (IDSB), National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- *Correspondence: Chih-Mao Huang, ; Jin-Jong Chen,
| | - Jin-Jong Chen
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Sports and Health Science Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Innovation Center of Artificial Intelligence for Precision Exercise and Health Promotion, Yuanpei University of Medical Technology, Hsinchu, Taiwan
- *Correspondence: Chih-Mao Huang, ; Jin-Jong Chen,
| |
Collapse
|
40
|
Bortone I, Sardone R, Lampignano L, Castellana F, Zupo R, Lozupone M, Moretti B, Giannelli G, Panza F. How gait influences frailty models and health-related outcomes in clinical-based and population-based studies: a systematic review. J Cachexia Sarcopenia Muscle 2021; 12:274-297. [PMID: 33590975 PMCID: PMC8061366 DOI: 10.1002/jcsm.12667] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/30/2020] [Accepted: 12/16/2020] [Indexed: 12/20/2022] Open
Abstract
Aging is often associated with a decline in physical function that eventually leads to loss of autonomy in activities of daily living (ADL). Walking is a very common ADL, important for main determinants of quality of life in older age, and it requires the integration of many physiological systems. Gait speed has been described as the 'sixth vital sign' because it is a core indicator of health and function in aging and disease. We reviewed original studies up to June 2020 that assessed frailty in both longitudinal and cross-sectional observational studies, paying particular attention to how gait is measured in older population and how the gait parameter adopted may influence the estimated frailty models and the health-related outcomes of the various studies (i.e. clinical, cognitive, physical, and nutritional outcomes). Eighty-five studies met the search strategy and were included in the present systematic review. According to the frailty tools, more than 60% of the studies used the physical phenotype model proposed by Fried and colleagues, while one-third referred to multi-domain indexes or models and only 5% referred to other single-domain frailty models (social or cognitive). The great heterogeneity observed in gait measurements and protocols limited the possibility to directly compare the results of the studies and it could represent an important issue causing variability in the different outcome measures in both clinical-and population-based settings. Gait appeared to be an indicator of health and function also in frail older adults, and different gait parameters appeared to predict adverse health-related outcomes in clinical, cognitive, and physical domains and, to a lesser extent, in nutritional domain. Gait has the potential to elucidate the common basic mechanisms of cognitive and motor decline. Advances in technology may extend the validity of gait in different clinical settings also in frail older adults, and technology-based assessment should be encouraged. Combining various gait parameters may enhance frailty prediction and classification of different frailty phenotypes.
Collapse
Affiliation(s)
- Ilaria Bortone
- Population Health Unit – “Salus In Apulia Study”National Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
| | - Rodolfo Sardone
- Population Health Unit – “Salus In Apulia Study”National Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
| | - Luisa Lampignano
- Population Health Unit – “Salus In Apulia Study”National Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
| | - Fabio Castellana
- Population Health Unit – “Salus In Apulia Study”National Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
| | - Roberta Zupo
- Population Health Unit – “Salus In Apulia Study”National Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
| | - Madia Lozupone
- Population Health Unit – “Salus In Apulia Study”National Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense OrgansUniversity of Bari Aldo MoroBariItaly
| | - Biagio Moretti
- Orthopaedics and Trauma Unit, Department of Basic Medicine, Neuroscience, and Sense OrgansUniversity of Bari Aldo MoroBariItaly
| | - Gianluigi Giannelli
- Scientific DirectionNational Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
| | - Francesco Panza
- Population Health Unit – “Salus In Apulia Study”National Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense OrgansUniversity of Bari Aldo MoroBariItaly
| |
Collapse
|
41
|
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: 0.7] [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.
Collapse
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.)
| |
Collapse
|
42
|
Pimentel RE, Pieper NL, Clark WH, Franz JR. Muscle metabolic energy costs while modifying propulsive force generation during walking. Comput Methods Biomech Biomed Engin 2021; 24:1552-1565. [PMID: 33749464 DOI: 10.1080/10255842.2021.1900134] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We pose that an age-related increase in the metabolic cost of walking arises in part from a redistribution of joint power where muscles spanning the hip compensate for insufficient ankle push-off and smaller peak propulsive forces (FP). Young adults elicit a similar redistribution when walking with smaller FP via biofeedback. We used targeted FP biofeedback and musculoskeletal models to estimate the metabolic costs of operating lower limb muscles in young adults walking across a range of FP. Our simulations support the theory of distal-to-proximal redistribution of joint power as a determinant of increased metabolic cost in older adults during walking.
Collapse
Affiliation(s)
- Richard E Pimentel
- Joint Department of Biomedical Engineering, UNC Chapel Hill and NC State University, Chapel Hill, NC, USA
| | - Noah L Pieper
- Joint Department of Biomedical Engineering, UNC Chapel Hill and NC State University, Chapel Hill, NC, USA
| | - William H Clark
- Joint Department of Biomedical Engineering, UNC Chapel Hill and NC State University, Chapel Hill, NC, USA
| | - Jason R Franz
- Joint Department of Biomedical Engineering, UNC Chapel Hill and NC State University, Chapel Hill, NC, USA
| |
Collapse
|
43
|
Hortobágyi T, Deák D, Farkas D, Blényesi E, Török K, Granacher U, Tollár J. Effects of Exercise Dose and Detraining Duration on Mobility at Late Midlife: A Randomized Clinical Trial. Gerontology 2021; 67:403-414. [PMID: 33657562 DOI: 10.1159/000513505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/28/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Office workers near retirement tend to be sedentary and can be prone to mobility limitations and diseases. We examined the dose effects of exergaming volume and duration of detraining on motor and cognitive function in office workers at late midlife to reduce sedentariness and mobility limitations. METHODS In an assessor-blinded randomized trial, 160 workers aged 55-65 years performed physically active video games in a nonimmersive form of virtual reality (exergaming) in small, supervised groups for 1 h, 1×, 2×, or 3×/week for 8 weeks followed by detraining for 8 and 16 weeks. Exergaming comprises high-intensity, full-body sensorimotor coordination, balance, endurance, and strengthening exercises. The primary outcome was the 6-minute walk test (6MWT), and secondary outcomes were body mass, self-reported physical activity, sleep quality, Berg Balance Scale, Short Physical Performance Battery, fast gait speed, dynamic balance, heart rate recovery after step test, and 6 cognitive tests. RESULTS The 3 groups were not different in any of the outcomes at baseline (all p > 0.05). The outcomes were stable and had acceptable reliability (intraclass correlation coefficients ≥0.334) over an 8-week control period. Training produced an inverted U-shaped dose response of no (1×), most (2×), and medium (3×/week) effects of exergaming volume in most motor and selected cognitive outcomes. The distance walked in the 6MWT (primary outcome) increased most (94 m, 19%, p < 0.05), medium (57 m, 12%, p < 0.05), and least (4 m, 1%) after exergaming 2×, 3×, or 0× (control) (all different p < 0.05). The highest responders tended to retain the exercise effects over 8 weeks of detraining, independent of training volume. This maintenance effect was less consistent after 16 weeks of detraining. CONCLUSION Less was more during training and lasted longer after detraining. A medium dose volume of exergaming produced the largest clinically meaningful improvements in mobility and selected cognitive tests in 60-year-old office workers with mild mobility limitations and intact cognition.
Collapse
Affiliation(s)
- Tibor Hortobágyi
- Center for Human Movement Sciences, University Medical Center Groningen, Groningen, The Netherlands,
| | - Dorina Deák
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Dóra Farkas
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Eszter Blényesi
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary.,Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Katalin Török
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Urs Granacher
- Division of Training and Movement Sciences, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
| | - József Tollár
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary.,Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| |
Collapse
|
44
|
Michel A, Verin E, Hansen K, Chassagne P, Roca F. Buccofacial Apraxia, Oropharyngeal Dysphagia, and Dementia Severity in Community-Dwelling Elderly Patients. J Geriatr Psychiatry Neurol 2021; 34:150-155. [PMID: 32292086 DOI: 10.1177/0891988720915519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Apraxia occurs frequently in patients with dementia. Buccofacial apraxia (BFA) characteristics have been less investigated than limb or speech apraxia. An association between BFA and oropharyngeal dysphagia (OD) in old patients with dementia has not yet been explored. We aimed to assess the prevalence of BFA in patients with dementia and evaluate the relationship between BFA, OD, and dementia. We have prospectively included 117 outpatients with dementia referred to a geriatric consultation. Oropharyngeal dysphagia was diagnosed using the volume viscosity swallowing test (V-VST). Buccofacial apraxia was evaluated by miming 7 meaningless gestures. A complementary geriatric assessment of 6-domains completed the evaluation. Buccofacial apraxia was present in 54 (48.6%) patients. Proxies reported OD more frequently in the group of patients with BFA compared to the group without (P = .04). Prevalence of OD assessed with the V-VST was similar between patients with and without apraxia (P = .9). Patients with BFA had a significant lower Mini-Mental State Examination suggesting a more severe cognitive decline (18.1 ± 4.5 vs 15.8 ± 5, P = .01), a lower activities of daily living relative to disabilities (5 ± 0.8 vs 4.3 ± 1.3, P = .001), and had a lower gait speed that indicated frailty (P = .03).In conclusion, our results indicate a relationship between BFA and severity of dementia, disability, and frailty with no significant association between BFA and OD.
Collapse
Affiliation(s)
- Anne Michel
- Department of Geriatrics, 55052Rouen University Hospital, Rouen, France.,Department of Geriatrics, Evangelisches Krankenhaus Kalk, Cologne, Germany
| | - Eric Verin
- Department of Physiology, 55052Rouen University Hospital, Rouen, France
| | - Kevin Hansen
- Department of Otorhinolaryngology-Head and Neck Surgery, 61059Faculty of Medicine, University of Cologne, Cologne, Germany
| | | | - Frederic Roca
- Department of Geriatrics, 55052Rouen University Hospital, Rouen, France
| |
Collapse
|
45
|
Figgins E, Pieruccini-Faria F, Speechley M, Montero-Odasso M. Potentially modifiable risk factors for slow gait in community-dwelling older adults: A systematic review. Ageing Res Rev 2021; 66:101253. [PMID: 33429086 DOI: 10.1016/j.arr.2020.101253] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE Slow gait speed in older adults is associated with increased risk for falls and fractures, functional dependence, multimorbidity, and even mortality. The risk of these adverse outcomes can be reduced by intervening on potentially modifiable risk factors. The purpose of this systematic review was to identify potentially modifiable risk factors associated with slow gait speed and clinically meaningful gait speed decline in older community-dwelling adults. METHODS Literature searches were conducted in MEDLINE, EMBASE, and CINAHL, Google Scholar, and in the bibliographies of retrieved articles. RESULTS Forty studies met the inclusion criteria for qualitative review. Study designs were cross-sectional and longitudinal. Operational definitions of 'slow gait' and 'meaningful gait speed decline' were variable and based on sample distributions (e.g. quartiles), external criteria (e.g. < 0.8 m/s), and dynamic changes over time (e.g. ≥ 0.05 m/s decline per year). Twenty-six potentially modifiable risk factors were assessed in at least two studies. The risk factors most commonly investigated and that showed significant associations with slow gait and/or meaningful gait speed decline include physical activity, education, body mass index-obesity, pain, and depression/depressive symptoms. CONCLUSION Our results suggest that there are modifiable targets to maintain gait speed that are amenable to potential treatment.
Collapse
Affiliation(s)
- Erica Figgins
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, Kresge Building, Room K201, London, ON, N6A 5C1, Canada; Gait and Brain Laboratory, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada.
| | - Frederico Pieruccini-Faria
- Gait and Brain Laboratory, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada; Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, N6C 0A7, Canada.
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, Kresge Building, Room K201, London, ON, N6A 5C1, Canada; Gait and Brain Laboratory, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada; Schulich Interfaculty Program in Public Health, The University of Western Ontario, London, ON, N6G 2M1, Canada.
| | - Manuel Montero-Odasso
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, Kresge Building, Room K201, London, ON, N6A 5C1, Canada; Gait and Brain Laboratory, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada; Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, N6C 0A7, Canada.
| |
Collapse
|
46
|
Baricich A, Borg MB, Cuneo D, Cadario E, Azzolina D, Balbo PE, Bellan M, Zeppegno P, Pirisi M, Cisari C. Midterm functional sequelae and implications in rehabilitation after COVID-19: a cross-sectional study. Eur J Phys Rehabil Med 2021; 57:199-207. [PMID: 33565741 DOI: 10.23736/s1973-9087.21.06699-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND COVID-19 has been mainly investigated concerning the acute and subacute phase implications and management. Meanwhile, few studies focused on the midterm sequelae, which still remain largely unknown. AIM To assess the physical performance of COVID-19 survivors at 3 to 6 months from Hospital discharge. DESIGN A cross-sectional study focused on mid-term functional outcomes evaluation in COVID-19 survivors. SETTING Outpatients who had been previously hospitalized due to COVID-19 from March to May 2020 at the University Hospital of Novara, Italy. POPULATION We enrolled 204 patients, of which 60% were men, with the mean age of 57.9 years. METHODS Patients firstly underwent the short physical performance battery test (SPPB), which is composed of a series of physical tests assessing the lower limb function and the functional status of the subjects. Subsequently, based on SPPB results, patients' cardiorespiratory fitness performance was further investigated. Patients with normal SPPB score (SPPB>10) underwent the 2-minute walking test (2MWT) whereas, in order to safely test the cardiorespiratory function, in patients with abnormal SPPB score (SPPB≤10) the 1-minute sit-to-stand test (1MSTST) was performed. It should be noted that the 1MSTST can be safely performed even by subjects with compromised walking ability. RESULTS Overall, 66 patients (32% of our sample) showed an impaired physical performance at 3 to 6 months after hospital discharge. In particular, 29 patients presented an SPPB score ≤10, and the 1MSTST confirmed this status in the whole group (100%) compared to the reference values for age and sex. Besides, among patients with a normal SPPB score, 37 showed a lower sex- and age-matched 2MWT score. Finally, a significant association between Intensive Care Unit hospitalization or mechanical ventilation and physical impairment was observed together with a significant association between the walking ability (measured with SPPB and 2MWT) and the number of comorbidities. CONCLUSIONS A residual physical and functional impairment was observed in COVID-19 survivors at mid-term evaluation after hospitalization. CLINICAL REHABILITATION IMPACT Considering the current COVID-19 epidemiology, we might expect a tremendous burden of disability in the next future. Thus, an appropriate clinical rehabilitation pathway must be implemented.
Collapse
Affiliation(s)
- Alessio Baricich
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy - .,Department of Physical Medicine and Rehabilitation, Maggiore della Carità University Hospital, Novara, Italy -
| | - Margherita B Borg
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy.,Department of Physical Medicine and Rehabilitation, Maggiore della Carità University Hospital, Novara, Italy
| | - Daria Cuneo
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy.,Department of Physical Medicine and Rehabilitation, Maggiore della Carità University Hospital, Novara, Italy
| | - Emanuela Cadario
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Danila Azzolina
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Piero E Balbo
- Department of Pneumology, Maggiore della Carità University Hospital, Novara, Italy
| | - Mattia Bellan
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,Department of Internal Medicine, Maggiore della Carità University Hospital, Novara, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,Department of Psychiatry, Maggiore della Carità University Hospital, Novara, Italy
| | - Mario Pirisi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,Department of Internal Medicine, Maggiore della Carità University Hospital, Novara, Italy
| | - Carlo Cisari
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy.,Department of Physical Medicine and Rehabilitation, Maggiore della Carità University Hospital, Novara, Italy
| | | |
Collapse
|
47
|
Domergue H, Regueme SC, Zafra OL, Manaz-Rodriguez L, Sinclair A, Bourdel-Marchasson I. Gait Speed and Evolution of Verbal Fluencies in Frail or Prefrail Older People with Type 2 Diabetes. A Pilot Study. J Nutr Health Aging 2021; 25:802-807. [PMID: 34179937 DOI: 10.1007/s12603-021-1636-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Type 2 diabetes (T2D) is a risk factor of frailty and cognitive impairment. Impaired gait in older people is associated with incident vascular dementia. We aimed to assess whether in frail or prefrail older subjects with T2D, lower gait speed can be associated with faster cognitive decline. DESIGN Case-control study nested in a large randomized control trial (RCT, MID-frail); post hoc analysis. SETTING AND PARTICIPANTS Older frail and prefrail subjects (>70y) with T2D and with no history of cognitive problems were enrolled in a single recruiting center. Participants were divided into two groups depending on their walking speed - above (fast walkers) or below (slow walkers) using a cut off of 1 m/sec. MEASURE Cognitive function was assessed at baseline and during follow-up with the MMSE, category and letter fluencies at 15 sec (initiation) and 15-60 sec (late). RESULTS 48 subjects were included, 22 were fast walkers, 26 were slow walkers. The mean follow-up was 60.9 (SD 17.5) weeks. The baseline 0-15 sec letter fluency was higher in fast walkers (p=0.008). There was no difference at baseline with MMSE scores and category fluency. The MID-Frail intervention did not change the evolution of any cognitive changes. Comparisons were adjusted for age, sex and baseline performance, and showed a steeper decline of category fluency score in slow walkers (fast walkers +0.04 (-1.49 to1.56) compared with -0.89 (-2.15 to 0.38), p=0.049) with a moderate effect size. CONCLUSION In frail or prefrail older adults with diabetes, we observed a decline in category fluency in those with low gait speed.
Collapse
Affiliation(s)
- H Domergue
- Professor Isabelle Bourdel-Marchasson, Centre Henri Choussat, Hôpital Xavier Arnozan, 33604 Pessac cedex, France, tel: 33 (0)5 57 65 65 71, fax 33 (0)5 57 65 62 26,
| | | | | | | | | | | |
Collapse
|
48
|
Salvadori E, Galmozzi F, Uda F, Barbato C, Camilleri E, Cesari F, Chiti S, Diciotti S, Donnini S, Formelli B, Galora S, Giusti B, Gori AM, Marzi C, Melone A, Mistri D, Pescini F, Pracucci G, Rinnoci V, Sarti C, Fainardi E, Marcucci R, Poggesi A. Association Between Motor and Cognitive Performances in Elderly With Atrial Fibrillation: Strat-AF Study. Front Neurol 2020; 11:571978. [PMID: 33281708 PMCID: PMC7691488 DOI: 10.3389/fneur.2020.571978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/30/2020] [Indexed: 01/22/2023] Open
Abstract
Background/Objective: Growing evidence suggests a close relationship between motor and cognitive abilities, but possible common underlying mechanisms are not well-established. Atrial fibrillation (AF) is associated with reduced physical performance and increased risk of cognitive decline. The study aimed to assess in a cohort of elderly AF patients: (1) the association between motor and cognitive performances, and (2) the influence and potential mediating role of cerebral lesions burden. Design: Strat-AF is a prospective, observational study investigating biological markers for cerebral bleeding risk stratification in AF patients on oral anticoagulants. Baseline cross-sectional data are presented here. Setting: Thrombosis outpatient clinic (Careggi University Hospital). Participants: One-hundred and seventy patients (mean age 77.7 ± 6.8; females 35%). Measurements: Baseline protocol included: neuropsychological battery, motor assessment [Short Physical Performance Battery (SPPB), and walking speed], and brain magnetic resonance imaging (MRI) used for the visual assessment of white matter hyperintensities, lacunar and non-lacunar infarcts, cerebral microbleeds, and global cortical and medial temporal atrophies. Results: Mean Montreal Cognitive Assessment (MoCA) total score was 21.9 ± 3.9, SPPB total score 9.5 ± 2.2, and walking speed 0.9 ± 0.2. In univariate analyses, both SPPB and walking speed were significantly associated with MoCA (r = 0.359, r = 0.372, respectively), visual search (r = 0.361, r = 0.322), Stroop (r = −0.272, r = −0.263), short story (r = 0.263, r = 0.310), and semantic fluency (r = 0.311, r = 0.360). In multivariate models adjusted for demographics, heart failure, physical activity, and either stroke history (Model 1) or neuroimaging markers (Model 2), both SPPB and walking speed were confirmed significantly associated with MoCA (Model 1: β = 0.256, β = 0.236; Model 2: β = 0.276, β = 0.272, respectively), visual search (Model 1: β = 0.350, β = 0.313; Model 2: β = 0.344, β = 0.307), semantic fluency (Model 1: β = 0.223, β = 0.261), and short story (Model 2: β = 0.245, β = 0.273). Conclusions: In our cohort of elderly AF patients, a direct association between motor and cognitive functions consistently recurred using different evaluation of the performances, without an evident mediating role of cerebral lesions burden.
Collapse
Affiliation(s)
| | - Francesco Galmozzi
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Francesca Uda
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Carmen Barbato
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Eleonora Camilleri
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Atherothrombotic Diseases Center, Careggi University Hospital, Florence, Italy
| | - Francesca Cesari
- Central Laboratory, Careggi University Hospital, Florence, Italy
| | - Stefano Chiti
- Department Health Professions, U.O. Research and Development, Careggi University Hospital, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering 'Guglielmo Marconi', University of Bologna, Bologna, Italy
| | - Samira Donnini
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Benedetta Formelli
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Silvia Galora
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Atherothrombotic Diseases Center, Careggi University Hospital, Florence, Italy
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Atherothrombotic Diseases Center, Careggi University Hospital, Florence, Italy
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Atherothrombotic Diseases Center, Careggi University Hospital, Florence, Italy
| | - Chiara Marzi
- Department of Electrical, Electronic, and Information Engineering 'Guglielmo Marconi', University of Bologna, Bologna, Italy
| | - Anna Melone
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Damiano Mistri
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | | | - Giovanni Pracucci
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | | | - Cristina Sarti
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy.,Stroke Unit, Careggi University Hospital, Florence, Italy
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Atherothrombotic Diseases Center, Careggi University Hospital, Florence, Italy
| | - Anna Poggesi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy.,Stroke Unit, Careggi University Hospital, Florence, Italy
| |
Collapse
|
49
|
Gait Change in Dual Task as a Behavioral Marker to Detect Mild Cognitive Impairment in Elderly Persons: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2020; 101:1813-1821. [DOI: 10.1016/j.apmr.2020.05.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 05/19/2020] [Accepted: 05/23/2020] [Indexed: 12/21/2022]
|
50
|
Freiberger E, Sieber CC, Kob R. Mobility in Older Community-Dwelling Persons: A Narrative Review. Front Physiol 2020; 11:881. [PMID: 33041836 PMCID: PMC7522521 DOI: 10.3389/fphys.2020.00881] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 06/29/2020] [Indexed: 12/21/2022] Open
Abstract
Due to the demographic changes and the increasing awareness of the role of physical function, mobility in older age is becoming an important topic. Mobility limitations have been reported as increasingly prevalent in older persons affecting about 35% of persons aged 70 and the majority of persons over 85 years. Mobility limitations have been associated with increased fall risk, hospitalization, a decreased quality of life, and even mortality. As concepts of mobility are multifactorial and complex, in this narrative review, definitions, physical factors, and their age-related changes associated with mobility will be presented. Also, areas of cognitive decline and their impact on mobility, as well as neuromuscular factors related to mobility will be addressed. Another section will relate psychological factors such as Fall-related psychological concerns and sedentary behavior to mobility. Assessment of mobility as well as effective exercise interventions are only shortly addressed. In the last part, gaps and future work on mobility in older persons are discussed.
Collapse
Affiliation(s)
- Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Cornel Christian Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Robert Kob
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| |
Collapse
|