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

The Impact of Dual-Tasks and Disease Severity on Posture, Gait, and Functional Mobility among People Living with Dementia in Residential Care Facilities: A Pilot Study

Gait speed and timed-up-and-go (TUG) predict cognitive decline, falls, and mortality. Dual-tasks may be useful in cognitive screening among people living with dementia (PWD), but more evidence is needed. This cross-sectional study aimed to compare single- and dual-task performance and determine the influence of dementia severity on dual-task performance and interference. Thirty PWD in two residential care facilities (Age: 81.3 ± 7.1 years; Montreal Cognitive Assessment: 10.4 ± 6.0 points) completed two trials of single- (feet apart) and dual-task posture (feet apart while counting backward), single- (walk 4 m) and dual-task gait (walk 4m while naming words), and single- (timed-up-and-go (TUG)), and dual-task functional mobility (TUG while completing a category task) with APDM inertial sensors. Dual-tasks resulted in greater sway frequency, jerk, and sway area; slower gait speed; greater double limb support; shorter stride length; reduced mid-swing elevation; longer TUG duration; reduced turn angle; and slower turn velocity than single-tasks (ps < 0.05). Dual-task performance was impacted (reduced double limb support, greater mid-swing elevation), and dual-task interference (greater jerk, faster gait speed) was related to moderate-to-severe compared to mild PWD. Moderate-to-severe PWD had poorer dynamic stability and a reduced ability to appropriately select a cautious gait during dual-tasks than those with mild PWD, indicating the usefulness of dual-tasks for cognitive screening.

Do the dual-task "8-foot up and go" tests provide additional predictive value for early detection of cognitive decline in community-dwelling older women?

BACKGROUND

The 8-Foot Up and Go (8UG) test is a widely used mobility assessment. Some dual-task mobility assessments have been developed to help detect cognitive decline.

AIMS

This study developed a dual-task version of 8UG test to investigate the dual-task 8UG performance and to evaluate the ability of dual-task 8UG test in detecting cognitive decline.

METHODS

A total of 101 eligible community-dwelling women aged 60-74 years were grouped into the mild cognitive impairment group (MCI, n = 49) and the non-cognitive impairment group (NCI, n = 52). The 8UG tests under single-task (ST), manual dual-task (MT), and cognitive dual-task (CT) conditions were performed respectively. The dual-task cost (DTC) and the correct response rate (CRR) were calculated to quantify the dual-task interference.

RESULTS

Participants spent more time in performing the 8UG test under dual-task conditions. No differences were observed between NCI and MCI groups for 8UG parameters under ST and MT conditions (p > 0.05). When executing CT, significant differences were found in the number of correct answers and CRR (p < 0.05). CRR showed the strongest ability to predict MCI with a cut-off point of 0.50 (71.2% sensitivity and 61.2% specificity).

DISCUSSION

Both manual and cognitive dual-task were found to interfere with the 8UG performance. CRR with cutoff point of 0.50 could be a potential predictor of MCI in community-dwelling older women.

CONCLUSIONS

The CRR of the cognitive dual-task 8UG test could be recommended as a potential predictor for the early detection of MCI in community-dwelling older women.

Comparison of Azure Kinect overground gait spatiotemporal parameters to marker based optical motion capture

BACKGROUND

Instrumented measurement of spatiotemporal parameters during walking can provide valuable information on an individual's overall function and health. Efficient, inexpensive, and accurate measurement of overground walking spatiotemporal parameters would be a critical component of providing point-of-care assessments of gait function, concussion recovery, fall-risk, and cognitive decline. Depth cameras combined with skeleton pose tracking algorithms, such as the Microsoft Kinect with body tracking software, have been used to measure walking spatiotemporal parameters. However, the ability of the latest generation Microsoft Kinect sensor, the Azure Kinect, to accurately measure overground walking spatiotemporal parameters has not been evaluated in the literature.

RESEARCH QUESTION

The purpose of this work was to compare overground walking spatiotemporal parameters measurements from a 12 camera Vicon optical motion capture system to measurements of a single Azure Kinect with body tracking SDK (software development kit).

METHODS

Spatiotemporal parameters of overground walking were simultaneously collected on twenty young healthy participants. Stride length, stride time, step length and step width were derived from ankle joint center locations and measurements from the two instruments were compared using descriptive statistics, scatter plots, Pearson correlation analyses, and Bland-Altman analyses.

RESULTS

Pearson correlation coefficients were greater than 0.87 for all spatiotemporal parameters with most parameters demonstrating very strong (> 0.9) agreement. The mean of the differences for stride length between measurements was 35.6 mm for the left limb and 39.1 mm for the right limb, both of which are less than 3% of average stride length. Mean of the differences for step width and stride time were less than 2% and 1% of their averages respectively.

SIGNIFICANCE

A single Microsoft Azure Kinect with body tracking SDK can provide clinically relevant measurement of walking spatiotemporal parameters, providing accessible and objective measurements that can improve clinical decision making across a variety of patient populations.

Effects of Cycling Dual-Task on Cognitive and Physical Function in Parkinson’s Disease: A Randomized Double-Blind Pilot Study

(1) Background: Those with Parkinson’s disease (PD) may present difficulties in performing dual tasks (DT). The use of DT during training can improve different abilities. Therefore, the objective of this study is to verify the influence of a cycling exercise program combined with a cognitive task on cognitive and physical PD aspects; (2) Methods: A double-blind, randomized pilot study was undertaken. Participants performed a DT intervention composed of cycling and a cognitive task. The cycling parameters, MDS-UPDRS, PDQ-39, TUG Test, 30 s Chair Sit to Stand test and Stroop were used to measure outcomes; (3) Results: DT generated impairment in performing the cycling task, with significant differences in cycling parameters, active and passive distance (m), total work (W) and active speed (rpm). At the cognitive level, there was a trend of improvement in the group that performed the training with DT, which improved by 211%; (4) Conclusions: Combining cycling with a cognitive task caused impairment in the performance of the physical task and an improvement at the cognitive level. Therefore, combining cycling with a cognitive task in a presumably safer environment for patients with PD can be a good way to train these patients for the dual-task challenges with practical applications.

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

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

The Performance of Dual-Task Tests Can Be a Combined Neuro-Psychological and Motor Marker of Mild Cognitive Impairment, Depression and Dementia in Geriatric Patients-A Cross-Sectional Study

The study aims to assess the performance of dual-task tests in the geriatric population and their association with the cognitive status of the patients.

METHODS

Patients admitted to the Department of Geriatrics, Hospital of the Ministry of Interior and Administration on Bialystok, Poland, in 2019 and 2020 were enrolled in the study. Data on the patients' clinical, functional, and cognitive status were collected based on the comprehensive geriatric assessment. Dual-task tests included Timed Up and Go (TUG) test while counting backward (CB7), enumerating animals (EA), and holding a cup (TUG M).

RESULTS

250 patients were included in the study, with a median age of 81.5 years (IQR 76-86) and most above 75 years of age (80.8%). Only 29 (11.6%) of study participants had no cognitive or mood disorders. Depression was diagnosed in 30.4%, MCI in 12%, and dementia in 38.4% of cases with median Mini-Mental Score Evaluation (MMSE) 17 (12-20) points. Dual-task TUG CB7 results did not differ between cognitive conditions of patients. TUG EA differed between healthy controls and other cognitive groups and TUG between healthy controls and depression and dementia, but not mild cognitive impairment (MCI). The performance of all dual-task tests differed in patients with and without dementia. Ability to finish TUG CB7 was low even in the group without dementia. There were statistically significant differences in median scores of MMSE and Clock Drawing Test (CDT) between patients who were able or not to finish single and dual-task gait tests.

CONCLUSION

Dual-task test results and the performance of these tasks can differentiate patients with depression, MCI and dementia compared to healthy controls in the geriatric population.

Single-Task or Dual-Task? Gait Assessment as a Potential Diagnostic Tool for Alzheimer's Dementia

Background:

A person’s gait performance requires the integration of sensorimotor and cognitive systems. Therefore, a person’s gait may be influenced by concurrent cognitive load such as simultaneous talking. Although it has been known that gait performance of people with Alzheimer’s dementia (AD) is compromised when they attempt a dual-task walking task, it is unclear if using a dual-task gait performance during an AD assessment yields higher diagnostic accuracy.

Objective:

This study was designed to compare the predictive power for AD of dual-task gait performance in an AD assessment to that of single-task gait performance.

Methods:

Participants (14 with AD and 15 healthy controls) walked across the GAITRite© Portable Walkway mat under three different cognitive load conditions: no simultaneous cognitive load, walking while counting numbers by ones, and walking while completing category naming.

Results:

Multiple logistic regression revealed that the gait performance under a dual-task condition (i.e., concurrent counting or category naming) increased the proportion of variance explained by the FAP, SL, and DST, of the incidence of AD.

Conclusion:

Dual-task walking and talking may be a more effective diagnostic feature than single-task walking in a comprehensive AD diagnostic assessment.