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Gagliardo A, Grippo A, Di Stefano V, Carrai R, Scarpino M, Martini M, Falsini C, Rimmaudo G, Brighina F. Spatial and Temporal Gait Characteristics in Patients Admitted to a Neuro-Rehabilitation Department with Age-Related White Matter Changes: A Gait Analysis and Clinical Study. Neurol Int 2023; 15:708-724. [PMID: 37368328 DOI: 10.3390/neurolint15020044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/01/2023] [Accepted: 05/16/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Patients with age-related white matter changes (ARWMC) frequently present a gait disorder, depression and cognitive impairment. Our aims are to define which alterations in the gait parameters are associated with motor or neuro-psychological impairment and to assess the role of motor, mood or cognitive dysfunction in explaining the variance of the gait parameters. METHODS Patients with gait disorders admitted to a Neuro-rehabilitation Department, affected by vascular leukoencephalopathy who had ARWMC confirmed by a brain MRI, were consecutively enrolled, classified by a neuroradiological scale (Fazekas 1987) and compared to healthy controls. We excluded subjects unable to walk independently, subjects with hydrocephalus or severe aphasia, with orthopaedic and other neurological pathologies conditioning the walking pattern. Patients and controls were assessed by clinical and functional scales (Mini Mental State Examination, Geriatric Depression Scale, Nevitt Motor Performance Scale, Berg Balance Scale, Functional Independence Measure), and computerised gait analysis was performed to assess the spatial and temporal gait parameters in a cross-sectional study. RESULTS We recruited 76 patients (48 males, aged 78.3 ± 6.2 years) and 14 controls (6 males, aged 75.8 ± 5 years). In the multiple regression analysis, the gait parameter with overall best model summary values, associated with the ARWMC severity, was the stride length even after correction for age, sex, weight and height (R2 = 0.327). The motor performances justified at least in part of the gait disorder (R2 change = 0.220), but the mood state accounted independently for gait alterations (R2 change = 0.039). The increase in ARWMC severity, the reduction of motor performance and a depressed mood state were associated with a reduction of stride length (R = 0.766, R2 = 0.587), reduction of gait speed (R2 = 0.573) and an increase in double support time (R2 = 0.421). CONCLUSION The gait disorders in patients with ARWMC are related to motor impairment, but the presence of depression is an independent factor for determining gait alterations and functional status. These data pave the way for longitudinal studies, including gait parameters, to quantitatively assess gait changes after treatment or to monitor the natural progression of the gait disorders.
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Affiliation(s)
- Andrea Gagliardo
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- Clinical Neurophysiology Unit, "Clinical Course", 90143 Palermo, Italy
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
| | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscoloscheletrico e degli Organi di Senso, AOU Careggi, 50134 Firenze, Italy
| | - Vincenzo Di Stefano
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
| | - Riccardo Carrai
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscoloscheletrico e degli Organi di Senso, AOU Careggi, 50134 Firenze, Italy
| | - Maenia Scarpino
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscoloscheletrico e degli Organi di Senso, AOU Careggi, 50134 Firenze, Italy
| | - Monica Martini
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
| | | | - Giulia Rimmaudo
- Clinical Neurophysiology Unit, "Clinical Course", 90143 Palermo, Italy
| | - Filippo Brighina
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
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Hopkins J, Hill K, Jacques A, Burton E. Prevalence, risk factors and effectiveness of falls prevention interventions for adults living with Mild Cognitive Impairment in the community: A systematic review and meta-analysis. Clin Rehabil 2022; 37:215-243. [PMID: 36189497 DOI: 10.1177/02692155221129832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To identify falls prevalence, falls risk factors and evaluate the effectiveness of falls prevention interventions for community-dwelling people with Mild Cognitive Impairment. DATA SOURCES Peer-reviewed articles (inception to 4 August 2022) from PubMed, CINAHL, PsycInfo, EMBASE, Scopus, SportDiscus and the Cochrane library. REVIEW METHODS All types of methodological approaches were considered. Inclusion criteria were community-dwelling; diagnosis of Mild Cognitive Impairment; aged 50+ years. Interventions needed to include falls prevention programs aiming to reduce falls and/or risk of falls. Outcomes of interest included number and/or rate of falls, falls prevalence and falls risk factors. For controlled trials, any control group was included. Quality assessment was completed using Cochrane's Risk of Bias Tool for randomized controlled trials and the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields for all other studies. Where statistical data pooling was not possible, narrative synthesis was used to present data in tables and figures. RESULTS Forty-seven studies were included. Prevalence of falls was 43% when data were gathered prospectively for 12 months. Confirmed falls risk factors included slow gait, dual-tasking, postural control and non-amnesic Mild Cognitive Impairment. Few studies evaluated interventions to reduce falls. Six meta-analyses were conducted, no significant reduction in falls was found. CONCLUSIONS Until further high-quality, adequately powered studies are available to guide practice, best practice guidelines recommend balance training as a core component of falls prevention programs for older people generally, as well as people with Mild Cognitive Impairment.
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Affiliation(s)
- Jane Hopkins
- Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia
| | - Keith Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Angela Jacques
- Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia.,Institute for Health Research, 3431University of Notre Dame Australia, Fremantle, WA, Australia
| | - Elissa Burton
- Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia.,enAble Institute, 1649Curtin University, Perth, WA, Australia
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Hackett K, Giovannetti T. Capturing Cognitive Aging in Vivo: Application of a Neuropsychological Framework for Emerging Digital Tools. JMIR Aging 2022; 5:e38130. [PMID: 36069747 PMCID: PMC9494215 DOI: 10.2196/38130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/19/2022] [Accepted: 07/31/2022] [Indexed: 11/13/2022] Open
Abstract
As the global burden of dementia continues to plague our healthcare systems, efficient, objective, and sensitive tools to detect neurodegenerative disease and capture meaningful changes in everyday cognition are increasingly needed. Emerging digital tools present a promising option to address many drawbacks of current approaches, with contexts of use that include early detection, risk stratification, prognosis, and outcome measurement. However, conceptual models to guide hypotheses and interpretation of results from digital tools are lacking and are needed to sort and organize the large amount of continuous data from a variety of sensors. In this viewpoint, we propose a neuropsychological framework for use alongside a key emerging approach—digital phenotyping. The Variability in Everyday Behavior (VIBE) model is rooted in established trends from the neuropsychology, neurology, rehabilitation psychology, cognitive neuroscience, and computer science literature and links patterns of intraindividual variability, cognitive abilities, and everyday functioning across clinical stages from healthy to dementia. Based on the VIBE model, we present testable hypotheses to guide the design and interpretation of digital phenotyping studies that capture everyday cognition in vivo. We conclude with methodological considerations and future directions regarding the application of the digital phenotyping approach to improve the efficiency, accessibility, accuracy, and ecological validity of cognitive assessment in older adults.
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Affiliation(s)
- Katherine Hackett
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, United States
| | - Tania Giovannetti
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, United States
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Koppelmans V, Silvester B, Duff K. Neural Mechanisms of Motor Dysfunction in Mild Cognitive Impairment and Alzheimer’s Disease: A Systematic Review. J Alzheimers Dis Rep 2022; 6:307-344. [PMID: 35891638 PMCID: PMC9277676 DOI: 10.3233/adr-210065] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 05/23/2022] [Indexed: 12/20/2022] Open
Abstract
Background: Despite the prevalence of motor symptoms in mild cognitive impairment (MCI) and Alzheimer’s disease (AD), their underlying neural mechanisms have not been thoroughly studied. Objective: This review summarizes the neural underpinnings of motor deficits in MCI and AD. Methods: We searched PubMed up until August of 2021 and identified 37 articles on neuroimaging of motor function in MCI and AD. Study bias was evaluated based on sample size, availability of control samples, and definition of the study population in terms of diagnosis. Results: The majority of studies investigated gait, showing that slower gait was associated with smaller hippocampal volume and prefrontal deactivation. Less prefrontal activation was also observed during cognitive-motor dual tasking, while more activation in cerebellar, cingulate, cuneal, somatosensory, and fusiform brain regions was observed when performing a hand squeezing task. Excessive subcortical white matter lesions in AD were associated with more signs of parkinsonism, poorer performance during a cognitive and motor dual task, and poorer functional mobility. Gait and cognitive dual-tasking was furthermore associated with cortical thickness of temporal lobe regions. Most non-gait motor measures were only reported in one study in relation to neural measures. Conclusion: Cross-sectional designs, lack of control groups, mixing amnestic- and non-amnestic MCI, disregard of sex differences, and small sample sizes limited the interpretation of several studies, which needs to be addressed in future research to progress the field.
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Affiliation(s)
- Vincent Koppelmans
- Department of Psychiatry, University of Utah, SaltLake City, UT, USA
- Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, USA
| | - Benjamin Silvester
- Department of Psychiatry, University of Utah, SaltLake City, UT, USA
- Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, USA
| | - Kevin Duff
- Department of Neurology, University of Utah, SaltLake City, UT, USA
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Chronic Kidney Disease and Cognitive Impairment. J Stroke Cerebrovasc Dis 2021; 30:105529. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105529] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/05/2020] [Accepted: 12/01/2020] [Indexed: 12/21/2022] Open
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Hairu R, Close JCT, Lord SR, Delbaere K, Wen W, Jiang J, Taylor ME. The association between white matter hyperintensity volume and gait performance under single and dual task conditions in older people with dementia: A cross-sectional study. Arch Gerontol Geriatr 2021; 95:104427. [PMID: 34015687 DOI: 10.1016/j.archger.2021.104427] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Understanding the relationship between white matter hyperintensities (WMHs) and gait may assist in understanding the central control of gait and determining treatment modalities. These relationships are yet to be realized in older people with dementia. OBJECTIVE To examine the association between WMH volume and gait under single-task and dual task (DT) conditions in people with dementia. METHODS Twenty-eight community-dwelling older people with dementia (median age=83 years; [IQR=77-86]; 36% female) had timed gait speed assessed at usual pace. Gait (speed, stride length, cadence) was assessed using the GAITRite® mat under three conditions (n = 18/28): a) single-task, b) functional DT: carrying a glass of water and c) cognitive DT: counting backwards from 30. WMH volumes were quantified using a fully automated segmentation toolbox. RESULTS Total, temporal and parietal WMH volumes were negatively correlated with timed and functional DT gait speed, and with stride length under single-task, functional DT and cognitive DT conditions. Frontal WMH volumes were negatively correlated with timed gait speed and stride length under single-task and functional DT conditions. Participants with higher total WMH burden had significantly slower timed and functional DT gait speed and reduced stride length under single-task, functional DT and cognitive DT conditions compared to participants with lower WMH burden. CONCLUSIONS WMH volume was associated with slower gait speed and reduced stride length, but not cadence, under single-task and DT conditions in people with dementia. Further research is needed to confirm these findings and determine whether vascular risk management can improve gait in older people with dementia.
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Affiliation(s)
- Rismah Hairu
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia; Prince of Wales Clinical School, Medicine, UNSW, Sydney, NSW, Australia
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia; Prince of Wales Clinical School, Medicine, UNSW, Sydney, NSW, Australia
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia; School of Public Health and Community Medicine, Medicine, UNSW, Sydney, NSW, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia; School of Public Health and Community Medicine, Medicine, UNSW, Sydney, NSW, Australia
| | - Wei Wen
- Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, Medicine, University of New South Wales, Sydney, Australia
| | - Jiyang Jiang
- Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, Medicine, University of New South Wales, Sydney, Australia
| | - Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia; Prince of Wales Clinical School, Medicine, UNSW, Sydney, NSW, Australia.
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Grazzi G, Mazzoni G, Myers J, Caruso L, Sassone B, Pasanisi G, Guerzoni F, Napoli N, Pizzolato M, Zerbini V, Franchi M, Masotti S, Mandini S, Raisi A, Chiaranda G. Impact of Improvement in Walking Speed on Hospitalization and Mortality in Females with Cardiovascular Disease. J Clin Med 2020; 9:jcm9061755. [PMID: 32517001 PMCID: PMC7357156 DOI: 10.3390/jcm9061755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 12/25/2022] Open
Abstract
Cardiovascular disease (CVD) is the principal cause of death in women. Walking speed (WS) is strongly related with mortality and CVD. The rate of all-cause hospitalization or death was assessed in 290 female outpatients with CVD after participation in a cardiac rehabilitation/secondary prevention program (CR/SP) and associated with the WS maintained during a moderate 1 km treadmill-walk. Three-year mortality rates were 57%, 44%, and 29% for the slow (2.1 ± 0.4 km/h), moderate (3.1 ± 0.3 km/h), and fast (4.3 ± 0.6 km/h) walkers, respectively, with adjusted hazard ratios (HRs) of 0.78 (p = 0.24) and 0.55 (p = 0.03) for moderate and fast walkers compared to the slow walkers. In addition, hospitalization or death was examined four to six years after enrollment as a function of the change in the WS of 176 patients re-assessed during the third year after baseline. The rates of hospitalization or death were higher across tertiles of reduced WS, with 35%, 50%, and 53% for the high (1.5 ± 0.3 km/h), intermediate (0.7 ± 0.2 km/h), and low tertiles (0.2 ± 0.2 km/h). Adjusted HRs were 0.79 (p = 0.38) for the intermediate and 0.47 (p = 0.02) for the high tertile compared to the low improvement tertile. Improved walking speed was associated with a graded decrease in hospitalization or death from any cause in women undergoing CR/SP.
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Affiliation(s)
- Giovanni Grazzi
- Center of Sport and Exercise Science, University of Ferrara, 44121 Ferrara, Italy; (G.G.); (G.M.); (L.C.); (M.P.); (V.Z.); (M.F.); (S.M.); (S.M.)
- Public Health Department, AUSL Ferrara, 44121 Ferrara, Italy
| | - Gianni Mazzoni
- Center of Sport and Exercise Science, University of Ferrara, 44121 Ferrara, Italy; (G.G.); (G.M.); (L.C.); (M.P.); (V.Z.); (M.F.); (S.M.); (S.M.)
- Public Health Department, AUSL Ferrara, 44121 Ferrara, Italy
| | - Jonathan Myers
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA;
- Stanford Medical School, University of Stanford, Stanford, CA 94305, USA
| | - Lorenzo Caruso
- Center of Sport and Exercise Science, University of Ferrara, 44121 Ferrara, Italy; (G.G.); (G.M.); (L.C.); (M.P.); (V.Z.); (M.F.); (S.M.); (S.M.)
| | - Biagio Sassone
- Department of Morphology, Surgery & Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy;
- Department of Emergency, Division of Cardiology, Cento SS.ma Annunziata Hospital, 44121 AUSL Ferrara, Italy
| | - Giovanni Pasanisi
- Department of Emergency, Division of Cardiology, “Delta” Hospital, AUSL Ferrara, 44121 Ferrara, Italy;
| | - Franco Guerzoni
- Health Statistics Unit, University Hospital, 44121 Ferrara, Italy; (F.G.); (N.N.)
| | - Nicola Napoli
- Health Statistics Unit, University Hospital, 44121 Ferrara, Italy; (F.G.); (N.N.)
| | - Matteo Pizzolato
- Center of Sport and Exercise Science, University of Ferrara, 44121 Ferrara, Italy; (G.G.); (G.M.); (L.C.); (M.P.); (V.Z.); (M.F.); (S.M.); (S.M.)
| | - Valentina Zerbini
- Center of Sport and Exercise Science, University of Ferrara, 44121 Ferrara, Italy; (G.G.); (G.M.); (L.C.); (M.P.); (V.Z.); (M.F.); (S.M.); (S.M.)
| | - Michele Franchi
- Center of Sport and Exercise Science, University of Ferrara, 44121 Ferrara, Italy; (G.G.); (G.M.); (L.C.); (M.P.); (V.Z.); (M.F.); (S.M.); (S.M.)
| | - Sabrina Masotti
- Center of Sport and Exercise Science, University of Ferrara, 44121 Ferrara, Italy; (G.G.); (G.M.); (L.C.); (M.P.); (V.Z.); (M.F.); (S.M.); (S.M.)
| | - Simona Mandini
- Center of Sport and Exercise Science, University of Ferrara, 44121 Ferrara, Italy; (G.G.); (G.M.); (L.C.); (M.P.); (V.Z.); (M.F.); (S.M.); (S.M.)
| | - Andrea Raisi
- Center of Sport and Exercise Science, University of Ferrara, 44121 Ferrara, Italy; (G.G.); (G.M.); (L.C.); (M.P.); (V.Z.); (M.F.); (S.M.); (S.M.)
- Correspondence: ; Tel.: +39-532-455970; Fax: +39-532-705018
| | - Giorgio Chiaranda
- General Directorship for Public Health and Integration Policy, Emilia-Romagna Region, 40133 Bologna, Italy;
- Public Health Department, AUSL Piacenza, 29121 Piacenza, Italy
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Palac D, Bullard T, Cohen JD, Nguyen LT, Mudar RA, Mullen SP. Effects of Traditional vs. iPad-Enhanced Aerobic Exercise on Wayfinding Efficacy and Cognition: A Pilot Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183495. [PMID: 31546856 PMCID: PMC6766024 DOI: 10.3390/ijerph16183495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/09/2019] [Accepted: 09/14/2019] [Indexed: 12/19/2022]
Abstract
The purpose of this pilot study was to test the feasibility and efficacy of an iPad-enhanced aerobic exercise intervention designed to enhance wayfinding efficacy and performance and relevant cognitive functioning among middle-aged adults at risk for cognitive impairment. Twenty-seven low active adults (21 females) aged 45 to 62 years (51.22 ± 5.20) participated in a ten-week randomized controlled trial. Participants were randomized to an iPad-enhanced aerobic exercise group (experimental group) or an aerobic exercise-only group (control group) following baseline assessment. Both groups exercised at 50% to 75% of age-predicted heart rate maximum for 30 to 50 min/d, 2 d/wk for 10 weeks. During aerobic exercise, the experimental group engaged in virtual tours delivered via iPad. Baseline and post-intervention assessments of wayfinding self-efficacy, wayfinding task performance, cognitive functioning, electroencephalogram (EEG), and psychosocial questionnaires were administered. The results suggest that ten weeks of iPad-enhanced, moderately intense aerobic exercise had specific effects on wayfinding self-efficacy; however, no statistical differences were found between groups on the behavioral wayfinding task or spatial memory performance at follow-up. Performance scores on an inhibitory attentional-control cognitive assessment revealed significant differences between groups, favoring the experimental group (p < 0.05). Virtual reality-enhanced aerobic exercise may prove to be an effective method for improving cognitive function and increasing confidence to navigate real-world scenarios among individuals at risk of cognitive impairment.
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Affiliation(s)
- Daniel Palac
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
| | - Tiffany Bullard
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
| | - Jason D Cohen
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
| | - Lydia T Nguyen
- Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
| | - Raksha A Mudar
- Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign; Champaign, IL 61820, USA.
| | - Sean P Mullen
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign; Urbana, IL 61801, USA.
- Illinois Informatics Institute, University of Illinois at Urbana-Champaign; Urbana, IL 61801, USA.
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Hsu CL, Best JR, Voss MW, Handy TC, Beauchet O, Lim C, Liu-Ambrose T. Functional Neural Correlates of Slower Gait Among Older Adults With Mild Cognitive Impairment. J Gerontol A Biol Sci Med Sci 2018; 74:513-518. [DOI: 10.1093/gerona/gly027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chun Liang Hsu
- Aging, Mobility, and Cognitive Neuroscience Lab, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Hip Health and Mobility, Vancouver, British Columbia, Canada
| | - John R Best
- Aging, Mobility, and Cognitive Neuroscience Lab, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Hip Health and Mobility, Vancouver, British Columbia, Canada
| | - Michelle W Voss
- Health, Brain, & Cognition Lab, University of Iowa, Iowa City
- Department of Psychology, University of Iowa, Iowa City
| | - Todd C Handy
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Chris Lim
- Aging, Mobility, and Cognitive Neuroscience Lab, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Hip Health and Mobility, Vancouver, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Neuroscience Lab, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Hip Health and Mobility, Vancouver, British Columbia, Canada
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Dasgupta I, Patel M, Mohammed N, Baharani J, Subramanian T, Thomas GN, Tadros G. Cognitive Function Declines Significantly during Haemodialysis in a Majority of Patients: A Call for Further Research. Blood Purif 2018; 45:347-355. [PMID: 29455207 DOI: 10.1159/000485961] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 12/01/2017] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Cognitive impairment (CI) is very common condition that occurs in haemodialysis patients and it is associated with reduced functional capacity and mortality. We assessed the change in cognitive function during haemodialysis and associated risk factors. METHODS All patients ≥50 years, on haemodialysis for ≥3 months, no dementia from 2 dialysis centres were selected. Cognition was assessed before and after a haemodialysis session using parallel versions of the Montreal Cognitive Assessment (MOCA) tool. Multiple regression was used to examine potential confounders. RESULTS Eight-two patients completed both tests - median age 73 (52-91) years, 59% male, dialysis vintage 41 (3-88) months. Sixty-two (76%) had CI at baseline. Cognition declined over dialysis (MOCA 21 ± 4.8 to 19.1 ± 4.1, p < 0.001) and domains affected were attention, language, abstraction and delayed recall. Age and dialysis vintage were independently associated with decline. CONCLUSION Cognitive function declines over a haemodialysis session and this has significant clinical implications over health literacy, self-management and tasks like driving. More research is needed to find the cause for this decline in cognition.
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Affiliation(s)
- Indranil Dasgupta
- Department of Nephrology, Heartlands Hospital, Birmingham, United Kingdom
| | - Mitesh Patel
- Department of Psychiatry, Heartlands Hospital, Birmingham, United Kingdom
| | - Nuredin Mohammed
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Jyoti Baharani
- Department of Nephrology, Heartlands Hospital, Birmingham, United Kingdom
| | | | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - George Tadros
- Department of Psychiatry, Heartlands Hospital, Birmingham, United Kingdom.,Aston Medical School, Aston University, Birmingham, United Kingdom
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Gait characteristics under different walking conditions: Association with the presence of cognitive impairment in community-dwelling older people. PLoS One 2017; 12:e0178566. [PMID: 28570662 PMCID: PMC5453541 DOI: 10.1371/journal.pone.0178566] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 05/15/2017] [Indexed: 01/24/2023] Open
Abstract
Background Gait characteristics measured at usual pace may allow profiling in patients with cognitive problems. The influence of age, gender, leg length, modified speed or dual tasking is unclear. Methods Cross-sectional analysis was performed on a data registry containing demographic, physical and spatial-temporal gait parameters recorded in five walking conditions with a GAITRite® electronic carpet in community-dwelling older persons with memory complaints. Four cognitive stages were studied: cognitively healthy individuals, mild cognitive impaired patients, mild dementia patients and advanced dementia patients. Results The association between spatial-temporal gait characteristics and cognitive stages was the most prominent: in the entire study population using gait speed, steps per meter (translation for mean step length), swing time variability, normalised gait speed (corrected for leg length) and normalised steps per meter at all five walking conditions; in the 50-to-70 years old participants applying step width at fast pace and steps per meter at usual pace; in the 70-to-80 years old persons using gait speed and normalised gait speed at usual pace, fast pace, animal walk and counting walk or steps per meter and normalised steps per meter at all five walking conditions; in over-80 years old participants using gait speed, normalised gait speed, steps per meter and normalised steps per meter at fast pace and animal dual-task walking. Multivariable logistic regression analysis adjusted for gender predicted in two compiled models the presence of dementia or cognitive impairment with acceptable accuracy in persons with memory complaints. Conclusion Gait parameters in multiple walking conditions adjusted for age, gender and leg length showed a significant association with cognitive impairment. This study suggested that multifactorial gait analysis could be more informative than using gait analysis with only one test or one variable. Using this type of gait analysis in clinical practice could facilitate screening for cognitive impairment.
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Fischer BL, Bacher R, Bendlin BB, Birdsill AC, Ly M, Hoscheidt SM, Chappell RJ, Mahoney JE, Gleason CE. An Examination of Brain Abnormalities and Mobility in Individuals with Mild Cognitive Impairment and Alzheimer's Disease. Front Aging Neurosci 2017; 9:86. [PMID: 28424612 PMCID: PMC5380746 DOI: 10.3389/fnagi.2017.00086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 03/20/2017] [Indexed: 11/13/2022] Open
Abstract
Background: Mobility changes are concerning for elderly patients with cognitive decline. Given frail older individuals' vulnerability to injury, it is critical to identify contributors to limited mobility. Objective: To examine whether structural brain abnormalities, including reduced gray matter volume and white matter hyperintensities, would be associated with limited mobility among individuals with cognitive impairment, and to determine whether cognitive impairment would mediate this relationship. Methods: Thirty-four elderly individuals with mild cognitive impairment (MCI) and Alzheimer's disease underwent neuropsychological evaluation, mobility assessment, and structural brain neuroimaging. Linear regression was conducted with predictors including gray matter volume in six regions of interest (ROI) and white matter hyperintensity (WMH) burden, with mobility measures as outcomes. Results: Lower gray matter volume in caudate nucleus was associated with slower speed on a functional mobility task. Higher cerebellar volume was also associated with slower functional mobility. White matter hyperintensity burden was not significantly associated with mobility. Conclusion: Our findings provide evidence for associations between subcortical gray matter volume and speed on a functional mobility task among cognitively impaired individuals.
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Affiliation(s)
- Barbara L Fischer
- Geriatric Research, Education, and Clinical Center, William S. Middleton Memorial Veterans HospitalMadison, WI, USA
| | - Rhonda Bacher
- Department of Statistics, University of Wisconsin-MadisonMadison, WI, USA
| | - Barbara B Bendlin
- School of Medicine and Public Health, University of Wisconsin-MadisonMadison, WI, USA.,Wisconsin Alzheimer's Disease Research CenterMadison, WI, USA
| | - Alex C Birdsill
- School of Medicine and Public Health, University of Wisconsin-MadisonMadison, WI, USA
| | - Martina Ly
- School of Medicine and Public Health, University of Wisconsin-MadisonMadison, WI, USA
| | - Siobhan M Hoscheidt
- School of Medicine and Public Health, University of Wisconsin-MadisonMadison, WI, USA.,Wisconsin Alzheimer's Disease Research CenterMadison, WI, USA
| | - Richard J Chappell
- Department of Statistics, University of Wisconsin-MadisonMadison, WI, USA.,Wisconsin Alzheimer's Disease Research CenterMadison, WI, USA.,Departments of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-MadisonMadison, WI, USA
| | - Jane E Mahoney
- Division of Geriatrics, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-MadisonMadison, WI, USA
| | - Carey E Gleason
- Geriatric Research, Education, and Clinical Center, William S. Middleton Memorial Veterans HospitalMadison, WI, USA.,School of Medicine and Public Health, University of Wisconsin-MadisonMadison, WI, USA.,Wisconsin Alzheimer's Disease Research CenterMadison, WI, USA
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13
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Grazzi G, Mazzoni G, Myers J, Codecà L, Pasanisi G, Napoli N, Guerzoni F, Volpato S, Conconi F, Chiaranda G. Improved walking speed is associated with lower hospitalisation rates in patients in an exercise-based secondary prevention programme. Heart 2016; 102:1902-1908. [PMID: 27390367 DOI: 10.1136/heartjnl-2015-309126] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 06/10/2016] [Accepted: 06/10/2016] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To determine the relationship between walking speed (WS) maintained during a 1 km test and its improvement on hospitalisation in cardiac outpatients who were referred to an exercise-based secondary prevention programme. METHODS Hospitalisation was assessed in 1791 patients 3 years after enrolment and related to the WS achieved during a 1 km walk at moderate intensity on a treadmill. Hospitalisation was also assessed during the fourth-to-sixth years as function of improvement in WS in 1111 participants who were re-evaluated 3 years after baseline. RESULTS Three-year hospitalisation rate across tertiles of baseline WS was 50% for the slow walkers (2.7±0.6 km/hour), 41% for the moderate (4.1±0.3 km/hour) and 25% for the fast walkers (5.2±0.5 km/hour) (p for trend <0.0001), with adjusted HRs (95% CI) of 0.93 (0.74 to 1.17, p=0.53) for intermediate and 0.58 (0.43 to 0.78, p=0.0003) for fast. Every 1 km/hour increase in WS was associated with a 21% reduction in hospitalisation (p<0.0001). Hospitalisation from the fourth-to-sixth years was lower across tertiles of improved WS, with 44% for the low (0.2±0.4 km/hour), 34% for the intermediate (0.8±0.2 km/hour) and 30% for the high tertile (1.6±0.4 km/hour) (p for trend <0.0001). Adjusted HRs were 0.68 (p=0.002) for the intermediate and 0.58 (p<0.0001) for the high tertile. Every 1 km/hour increase in WS was associated with a 35% reduction in hospitalisation (p<0.0001). CONCLUSION Improvement in WS is associated with a significant, dose-dependent lower rate of all-cause hospitalisation in cardiac outpatients. WS is a simple, easily applied and clinically useful tool for cardiac patients undergoing secondary prevention.
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Affiliation(s)
- Giovanni Grazzi
- Public Health Department, AUSL Ferrara, Ferrara, Italy.,Center of Biomedical Studies Applied to Sport, University of Ferrara, Ferrara, Italy
| | - Gianni Mazzoni
- Public Health Department, AUSL Ferrara, Ferrara, Italy.,Center of Biomedical Studies Applied to Sport, University of Ferrara, Ferrara, Italy
| | - Jonathan Myers
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Stanford University School of Medicine, Stanford, California, USA
| | - Luciano Codecà
- Center of Biomedical Studies Applied to Sport, University of Ferrara, Ferrara, Italy.,Cardiovascular Secondary Prevention Program, Public Health Department, AUSL Ferrara, Ferrara, Italy
| | - Giovanni Pasanisi
- Division of Cardiology, Department of Medicine, 'Delta' Hospital, AUSL Ferrara, Ferrara, Italy
| | - Nicola Napoli
- Health Statistics Unit, University Hospital, Ferrara, Italy
| | | | - Stefano Volpato
- Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Francesco Conconi
- Center of Biomedical Studies Applied to Sport, University of Ferrara, Ferrara, Italy
| | - Giorgio Chiaranda
- General Directorship for Public Health and Integration Policy, Emilia-Romagna Region, Bologna, Italy
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14
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McIntyre C, Crowley L. Dying to Feel Better: The Central Role of Dialysis-Induced Tissue Hypoxia. Clin J Am Soc Nephrol 2016; 11:549-51. [PMID: 26936947 DOI: 10.2215/cjn.01380216] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Christopher McIntyre
- Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Lisa Crowley
- Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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15
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Lemos R, Afonso A, Martins C, Waters JH, Blanco FS, Simões MR, Santana I. Selective Reminding and Free and Cued Selective Reminding in Mild Cognitive Impairment and Alzheimer Disease. APPLIED NEUROPSYCHOLOGY-ADULT 2015; 23:85-93. [PMID: 26375308 DOI: 10.1080/23279095.2015.1012761] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The Selective Reminding Test (SRT) and the Free and Cued Selective Reminding Test (FCSRT) are multitrial memory tests that use a common "selective reminding" paradigm that aims to facilitate learning by presenting only the missing words from the previous recall trial. While in the FCSRT semantic cues are provided to elicit recall, in the SRT, participants are merely reminded of the missing items by repeating them. These tests have been used to assess age-related memory changes and to predict dementia. The performance of healthy elders on these tests has been compared before, and results have shown that twice as many words were retrieved from long-term memory in the FCSRT compared with the SRT. In this study, we compared the tests' properties and their accuracy in discriminating amnestic mild cognitive impairment (aMCI; n = 20) from Alzheimer disease (AD; n = 18). Patients with AD performed significantly worse than patients with aMCI on both tests. The percentage of items recalled during the learning trials was significantly higher for the FCSRT in both groups, and a higher number of items were later retrieved, showing the benefit of category cueing. Our key finding was that the FCSRT showed higher accuracy in discriminating patients with aMCI from those with AD.
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Affiliation(s)
- Raquel Lemos
- a Visual Neuroscience Laboratory, Institute of Biomedical Research in Light and Image, Faculty of Medicine , University of Coimbra , Coimbra , Portugal.,b Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal
| | - Ana Afonso
- b Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal
| | - Cristina Martins
- c Faculty of Humanities , University of Coimbra , Coimbra , Portugal
| | - James H Waters
- d Private Practice (Clinical and Forensic Psychology and Neuropsychology) , Boulder , Colorado
| | - Filipe Sobral Blanco
- e Neurology Department , Centro Hospitalar e Universitário de Coimbra , Coimbra , Portugal
| | - Mário R Simões
- b Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal
| | - Isabel Santana
- e Neurology Department , Centro Hospitalar e Universitário de Coimbra , Coimbra , Portugal.,f Faculty of Medicine , University of Coimbra , Coimbra , Portugal
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16
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Effects of a long-term aerobic exercise intervention on institutionalized patients with dementia. J Sci Med Sport 2015; 19:293-8. [PMID: 26087884 DOI: 10.1016/j.jsams.2015.05.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 05/13/2015] [Accepted: 05/28/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Long-term interventions aimed at analyzing the impact of physical exercise on important health markers in institutionalized individuals with dementia are relatively scarce. This longitudinal study intends to identify the effects of a physical exercise program on cognitive decline, memory, depression, functional dependence and neuropsychiatric disturbances in institutionalized individuals with dementia. DESIGN Randomized controlled trial. METHODS Homecare residents with dementia were assigned to an exercise (EG) or to a control group (CG). Participants in the EG cycled for at least 15min daily during 15 months, while those in the CG performed alternative sedentary recreational activities. The Mini-Mental State Examination (MEC), the Timed "Up & Go" Test, the Neuropsychiatric Inventory, the Katz Index, the Cornell Scale for Depression in Dementia and the Fuld Object Memory Evaluation were administered before and after the intervention. RESULTS Sixty-three individuals in the CG and 51 individuals in the EG completed the intervention. A statistically significant decline in cognitive function was observed in individuals included in the CG (p=0.015), while a slight improvement was observed in those included in the EG. Significant improvement was observed in the neuropsychiatric symptoms (p=0.020), memory function (p=0.028) and functional mobility (p=0.043) among those who exercised. Exercise seemed to have a greater effect in those suffering from severe cognitive impairment. CONCLUSIONS This study provides evidence that aerobic physical exercise has a significant impact on improving cognitive functioning, behavior, and functional mobility in institutionalized individuals with dementia.
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17
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McIntyre CW, Goldsmith DJ. Ischemic brain injury in hemodialysis patients: which is more dangerous, hypertension or intradialytic hypotension? Kidney Int 2015; 87:1109-15. [PMID: 25853331 DOI: 10.1038/ki.2015.62] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 11/05/2014] [Accepted: 12/11/2014] [Indexed: 12/15/2022]
Abstract
Abnormalities of cognitive function and high levels of depression incidence are characteristic of hemodialysis patients. Although previously attributed to the humoral effects of uremia, it is becoming increasingly appreciated that many elements of the overall disease state in CKD patients contribute to functional disturbances and physical brain injury. These factors range from those associated with the underlying primary diseases (cardiovascular, diabetes etc.) to those specifically associated with the requirement for dialysis (including consequences of the hemodialysis process itself). They are, however, predominantly ischemic threats to the integrity of brain tissue. These evolving insights are starting to allow nephrologists to appreciate the potential biological basis of dependency and depression in our patients, as well as develop and test new therapeutic approaches to this increasingly prevalent and important issue. This review aims to summarize the current understanding of brain injury in this setting, as well as examine recent advances being made in the modification of dialysis-associated brain injury.
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Affiliation(s)
- Christopher W McIntyre
- Division of Nephrology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - David J Goldsmith
- Guy's and St. Thomas' NHS Foundation Trust, King's College Academic Health Partners, London, UK
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18
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Stijntjes M, Pasma JH, van Vuuren M, Blauw GJ, Meskers CG, Maier AB. Low Cognitive Status Is Associated with a Lower Ability to Maintain Standing Balance in Elderly Outpatients. Gerontology 2014; 61:124-30. [DOI: 10.1159/000364916] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 05/31/2014] [Indexed: 11/19/2022] Open
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19
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Koskas P, Henry-Feugeas MC, Feugeas JP, Poissonnet A, Pons-Peyneau C, Wolmark Y, Drunat O. The Lawton Instrumental Activities Daily Living/Activities Daily Living Scales: A Sensitive Test to Alzheimer Disease in Community-Dwelling Elderly People? J Geriatr Psychiatry Neurol 2014; 27:85-93. [PMID: 24578460 DOI: 10.1177/0891988714522694] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 10/09/2013] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To examine the diagnostic ability of the Lawton Instrumental Activities Daily Living (IADLs) scale and the Activities Daily Living (ADLs) scale as a sensitive tool to Alzheimer's disease (AD) in community-dwelling elderly people. DESIGN In an old age memory outpatient center, among patients with a clinical diagnosis of AD dementia or no dementia supported by at least 6 months of follow-up, we looked back at the baseline Lawton IADL scale (short version IADL-4 item), ADL scale, Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MOCA) values. RESULTS There were 109 patients with AD and 53 nondemented individuals (81.4 ± 4.6 years). The sensitivity of ADL scale or IADL-4 item or the MMSE was low (52%-57%). The most efficient AD classification used both the IADLs-4 item and the MOCA with a threshold score of 20. Besides age and memory scores, the main correlates of IADLs scale or ADLs scale were executive, neuropsychiatric, vascular, and extrapyramidal scores. CONCLUSION Our results suggest that the Lawton IADLs-4 item scale and ADLs scale lack sensitivity to AD dementia in elderly people and support a better sensitivity of MOCA rather than MMSE and IADLs-4 item/ADLs at the expense of specificity.
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Affiliation(s)
- Pierre Koskas
- Memory Center, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marie Cécile Henry-Feugeas
- Department of Radiology, Bichat Claude Bernard University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean Paul Feugeas
- UMR U722 INSERM Faculté de Médecine Xavier Bichat, Paris Diderot University, Paris, France
| | - Aurore Poissonnet
- Department of Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cécile Pons-Peyneau
- Department of Psycho-Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yves Wolmark
- Department of Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Drunat
- Department of Psycho-Geriatrics, Bretonneau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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20
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Amboni M, Barone P, Hausdorff JM. Cognitive contributions to gait and falls: evidence and implications. Mov Disord 2014; 28:1520-33. [PMID: 24132840 DOI: 10.1002/mds.25674] [Citation(s) in RCA: 324] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 08/15/2013] [Accepted: 08/19/2013] [Indexed: 12/18/2022] Open
Abstract
Dementia and gait impairments often coexist in older adults and patients with neurodegenerative disease. Both conditions represent independent risk factors for falls. The relationship between cognitive function and gait has recently received increasing attention. Gait is no longer considered merely automated motor activity but rather an activity that requires executive function and attention as well as judgment of external and internal cues. In this review, we intend to: (1) summarize and synthesize the experimental, neuropsychological, and neuroimaging evidence that supports the role played by cognition in the control of gait; and (2) briefly discuss the implications deriving from the interplay between cognition and gait. In recent years, the dual task paradigm has been widely used as an experimental method to explore the interplay between gait and cognition. Several neuropsychological investigations have also demonstrated that walking relies on the use of several cognitive domains, including executive-attentional function, visuospatial abilities, and even memory resources. A number of morphological and functional neuroimaging studies have offered additional evidence supporting the relationship between gait and cognitive resources. Based on the findings from 3 lines of studies, it appears that a growing body of evidence indicates a pivotal role of cognition in gait control and fall prevention. The interplay between higher-order neural function and gait has a number of clinical implications, ranging from integrated assessment tools to possible innovative lines of interventions, including cognitive therapy for falls prevention on one hand and walking program for reducing dementia risk on the other.
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Affiliation(s)
- Marianna Amboni
- Isituto di Diagnosi e Cura Hermitage-Capodimonte, Naples, Italy; Neurodegenerative Diseases Center, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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21
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Jolly TAD, Bateman GA, Levi CR, Parsons MW, Michie PT, Karayanidis F. Early detection of microstructural white matter changes associated with arterial pulsatility. Front Hum Neurosci 2013; 7:782. [PMID: 24302906 PMCID: PMC3831342 DOI: 10.3389/fnhum.2013.00782] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 10/29/2013] [Indexed: 11/13/2022] Open
Abstract
Increased cerebral blood flow pulsatility is common in vascular dementia and is associated with macrostructural damage to cerebral white matter or leukoaraiosis (LA). In this study, we examine whether cerebral blood flow pulsatility is associated with macrostructural and microstructural changes in cerebral white matter in older adults with no or mild LA and no evidence of dementia. Diffusion Tensor Imaging was used to measure fractional anisotropy (FA), an index of the microstructural integrity of white matter, and radial diffusivity (RaD), a measure sensitive to the integrity of myelin. When controlling for age, increased arterial pulsation was associated with deterioration in both measures of white matter microstructure but not LA severity. A stepwise multiple linear regression model revealed that arterial pulsatility index was the strongest predictor of FA (R = 0.483, adjusted R (2) = 0.220), followed by LA severity, but not age. These findings suggest that arterial pulsatility may provide insight into age-related reduction in white matter FA. Specifically, increased arterial pulsatility may increase perivascular shear stress and lead to accumulation of damage to perivascular oligodendrocytes, resulting in microstructural changes in white matter and contributing to proliferation of LA over time. Changes in cerebral blood flow pulsatility may therefore provide a sensitive index of white matter health that could facilitate the early detection of risk for perivascular white matter damage and the assessment of the effectiveness of preventative treatment targeted at reducing pulsatility.
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Affiliation(s)
- Todd A D Jolly
- Functional Neuroimaging Laboratory, Faculty of Science and IT, School of Psychology, University of Newcastle Newcastle, NSW, Australia ; Centre for Translational Neuroscience and Mental Health Research, University of Newcastle Newcastle, NSW, Australia ; Hunter Medical Research Institute Newcastle, NSW, Australia
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Contribution of new techniques to study the gait in old populations. Ann Phys Rehabil Med 2013; 56:384-95. [DOI: 10.1016/j.rehab.2013.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 05/24/2013] [Accepted: 05/25/2013] [Indexed: 11/24/2022]
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23
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Association Between Gait Speed as a Measure of Frailty and Risk of Cardiovascular Events After Myocardial Infarction. J Am Coll Cardiol 2013; 61:1964-72. [DOI: 10.1016/j.jacc.2013.02.020] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 01/24/2013] [Accepted: 02/05/2013] [Indexed: 11/24/2022]
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Annweiler C, Beauchet O, Bartha R, Wells JL, Borrie MJ, Hachinski V, Montero-Odasso M. Motor cortex and gait in mild cognitive impairment: a magnetic resonance spectroscopy and volumetric imaging study. Brain 2013; 136:859-71. [PMID: 23436505 DOI: 10.1093/brain/aws373] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Cédric Annweiler
- FRCPC, Gait and Brain Laboratory, Parkwood Hospital, Division of Geriatric Medicine, Room A-280, 801 Commissioners Rd E., London, Ontario, Canada N6A 5A5
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Uemura K, Shimada H, Makizako H, Doi T, Yoshida D, Tsutsumimoto K, Anan Y, Suzuki T. Cognitive function affects trainability for physical performance in exercise intervention among older adults with mild cognitive impairment. Clin Interv Aging 2013; 8:97-102. [PMID: 23390362 PMCID: PMC3564456 DOI: 10.2147/cia.s39434] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although much evidence supports the hypothesis that cognitive function and physical function are interrelated, it is unclear whether cognitive decline with mild cognitive impairment influences trainability of physical performance in exercise intervention. The purpose of this study was to examine the association between cognitive function at baseline and change in physical performance after exercise intervention in older adults with mild cognitive impairment. METHODS Forty-four older adults diagnosed with mild cognitive impairment based on the Peterson criteria (mean age 74.8 years) consented to and completed a 6-month twice weekly exercise intervention. The Timed Up and Go (TUG) test was used as a measure of physical performance. The Mini-Mental State Examination (MMSE), Trail Making Test Part B, Geriatric Depression Scale, baseline muscle strength of knee extension, and attendance rate of intervention, were measured as factors for predicting trainability. RESULTS In the correlation analysis, the change in TUG showed modest correlations with attendance rate in the exercise program (r = -0.354, P = 0.027) and MMSE at baseline (r = -0.321, P = 0.034). A multiple regression analysis revealed that change in TUG was independently associated with attendance rate (β = -0.322, P = 0.026) and MMSE score (β = -0.295, P = 0.041), controlling for age and gender. CONCLUSION General cognitive function was associated with improvements in physical performance after exercise intervention in subjects with mild cognitive impairment. Further research is needed to examine the effects of exercise programs designed to address cognitive obstacles in older adults with mild cognitive impairment.
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Affiliation(s)
- Kazuki Uemura
- Section for Health Promotion, Department for Research and Development to Support Independent Life of Elderly, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
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26
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Annweiler C, Beauchet O, Celle S, Roche F, Annweiler T, Allali G, Bartha R, Montero-Odasso M. Contribution of brain imaging to the understanding of gait disorders in Alzheimer's disease: a systematic review. Am J Alzheimers Dis Other Demen 2012; 27:371-80. [PMID: 22930697 PMCID: PMC11008139 DOI: 10.1177/1533317512454710] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Although gait disorders are common in Alzheimer's disease (AD), determining which brain structures and related lesions are specifically involved is a goal yet to be reached. Our objective was to systematically review all published data that examined associations between gait disorders and brain imaging in AD. Of 486 selected studies, 4 observational studies met the selection criteria. The number of participants ranged from 2 to 61 community dwellers (29%-100% female) with prodromal or dementia-stage AD. Quantitative gait disorders (ie, slower gait velocity explained by shorter stride length) were associated with white matter lesions, mainly in the medial frontal lobes and basal ganglia. The nigrostriatal dopamine system was unaffected. Qualitative gait disorders (ie, higher stride length variability) correlated with lower hippocampal volume and function. Gait disorders in AD could be explained by a high burden of age-related subcortical hyperintensities on the frontal-subcortical circuits (nonspecific) together with hippocampal atrophy and hypometabolism (specific).
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Affiliation(s)
- Cédric Annweiler
- Division of Geriatric Medicine, Department of Medicine, Parkwood Hospital, St. Joseph's Health Care, London, Ontario, Canada.
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Dodge HH, Mattek NC, Austin D, Hayes TL, Kaye JA. In-home walking speeds and variability trajectories associated with mild cognitive impairment. Neurology 2012; 78:1946-52. [PMID: 22689734 DOI: 10.1212/wnl.0b013e318259e1de] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether unobtrusive long-term in-home assessment of walking speed and its variability can distinguish those with mild cognitive impairment (MCI) from those with intact cognition. METHODS Walking speed was assessed using passive infrared sensors fixed in series on the ceiling of the homes of elderly individuals participating in the Intelligent Systems for Assessing Aging Change (ISAAC) cohort study. Latent trajectory models were used to analyze weekly mean speed and walking speed variability (coefficient of variation [COV]). RESULTS ISAAC participants living alone included 54 participants with intact cognition, 31 participants with nonamnestic MCI (naMCI), and 8 participants with amnestic MCI at baseline, with a mean follow-up of 2.6 ± 1.0 years. Trajectory models identified 3 distinct trajectories (fast, moderate, and slow) of mean weekly walking speed. Participants with naMCI were more likely to be in the slow speed group than in the fast (p = 0.01) or moderate (p = 0.04) speed groups. For COV, 4 distinct trajectories were identified: group 1, the highest baseline and increasing COV followed by a sharply declining COV; groups 2 and 3, relatively stable COV; and group 4, the lowest baseline and decreasing COV. Participants with naMCI were more likely to be members of either highest or lowest baseline COV groups (groups 1 or 4), possibly representing the trajectory of walking speed variability for early- and late-stage MCI, respectively. CONCLUSION Walking speed and its daily variability may be an early marker of the development of MCI. These and other real-time measures of function may offer novel ways of detecting transition phases leading to dementia.
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Affiliation(s)
- H H Dodge
- Oregon Center for Aging and Technology, Department of Neurology, Oregon Health & Science University, Portland, OR, USA.
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Stubbs B. Falls in older adult psychiatric patients: equipping nurses with knowledge to make a difference. J Psychiatr Ment Health Nurs 2011; 18:457-62. [PMID: 21539692 DOI: 10.1111/j.1365-2850.2010.01686.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Falls are the most common cause of accidental death among older adults and are associated with increased morbidity and mortality. A particularly serious sequela of falls is osteoporotic fractures. Older adults with mental illness are at increased risk of both falls and subsequent fractures, because of a range of complex risk factors. Many falls are preventable and an awareness of the risk factors for falls among nurses will empower them to promptly refer a patient at risk to the multidisciplinary team. A multidisciplinary approach is required to be successful in any efforts to reduce an individual's risk of falls and nurses have a central role in achieving this. This article reviews the relevant literature on the causes and consequences of falls in older adults with mental illness in order to enable nurses to reduce falls and subsequent fractures.
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Abstract
Current conventional hemodialysis (HD) is largely an industrialized process, with inadequate attention to the role that the dialysis treatment itself may play in the development and promulgation of uremic related disease states. HD is capable of exerting significant recurrent systemic circulatory stress. There is already an appreciation that this may be important in the development of cardiac disease, but it appears that this systemic insult is capable of resulting in perfusion-dependent injury of a wide range of vulnerable vascular beds. These include gut, brain, and potentially the kidney. This predominantly hemodynamic injury can therefore result a mixed picture of direct perfusion-related injury, local/systemic inflammation, and potentiation of further cycles of injury. This article aims to put forward a pathophysiological paradigm that places dialysis-induced acute injury at the center of much of the observed disease burden in HD patients.
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Falls and gait disorders in geriatric neurology. Clin Neurol Neurosurg 2010; 112:265-74. [DOI: 10.1016/j.clineuro.2009.12.015] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 08/17/2009] [Accepted: 12/27/2009] [Indexed: 11/23/2022]
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Henry-Feugeas MC. Assessing cerebrovascular contribution to late dementia of the Alzheimer's type: the role of combined hemodynamic and structural MR analysis. J Neurol Sci 2009; 283:44-8. [PMID: 19268312 DOI: 10.1016/j.jns.2009.02.325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The critical question as to the respective role of Alzheimer's disease (AD) and cerebrovascular disease in dementia of the Alzheimer's type (DAT), the most common form of dementia, is still debated. But there has been considerable progress in understanding cerebral hemodynamics and the relationship between structural brain damage and cognitive decline, in routine neuro imaging techniques. These advances now allow the proposition of a novel MR classification of DAT including indicators of both cerebrovascular function and regional brain atrophy. MR indicators of windkessel function include the arterial pulsatility index, the intracranial blood stroke volume, the cerebral relative venous outflow rates and a relative index of craniospinal compliance. MR indicators of vascular conduct function include total arterial and superficial venous flow rates that are closely related to brain metabolism. Structural MR sequences allow the detection of structural markers of windkessel dysfunction and, beyond the non specific hippocampal atrophy, a more extensive AD-like MR pattern of atrophy. The first illustration of this MR classification in elderly patients that later progressed to dementia converges with recent neuropathological observations to suggest that the major enemy to combat in late-life dementia is not AD but cerebrovascular dysfunction.
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Affiliation(s)
- Marie Cécile Henry-Feugeas
- Department of Radiology, Bichat-Claude Bernard University Hospital, AP-HP, 46 rue Henri Huchard, 75877 Paris cedex 18, France.
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