Relationship Between Balance, Gait, and Activities of Daily Living in Older Adults With Dementia

Investigating balance-related gait patterns and their relationship with maximum torques generated by the hamstrings and quadriceps in older adults - Results from the Baltimore longitudinal study of aging

BACKGROUND

Balance-related gait patterns in older adults can be objectively discerned through the examination of gait parameters, maximum leg torques, and their interconnections.

OBJECTIVE

To investigate the correlation between leg muscle strength and balance during gait concerning functional performance in healthy older adults.

METHODS

Participants included 117 adults aged 60-95 years were recruited from the Baltimore Longitudinal Study of Aging (BLSA). They underwent evaluations of gait, balance, and maximum isometric leg torque (for both hamstrings and quadriceps). Analyses examined the association between leg torque and functional performance among those with higher and lower balances.

RESULTS

Individuals with lower balance (n = 43) were older, more prone to experiencing a fear of falling, and exhibited lower functional performance (gait speeds and Generalized Gait Stability Scores (GGSS), ps < 0.001) compared to their counterparts with higher balance (n = 74). At a usual walking pace, the GGSS showed a positive association with concentric Quadriceps Maximum Torque (QMT) in participants with lower balance (p = 0.013). Conversely, it displayed a positive association with eccentric QMT in those with higher balance (p = 0.014). At a fast walking pace, only individuals with higher balance demonstrated a positive muscle torque association with both gait speed and GGSS, encompassing concentric and eccentric actions in both the quadriceps and hamstrings (ps < 0.050).

CONCLUSION

Evaluating muscle strength capacity in both concentric and eccentric phases during dynamic high-effort events, along with investigating their associations with gait performance, can be beneficial for identifying subtle gait deficits. This comprehensive approach may assist in the early detection of gait deterioration among healthy older adults, given the intricate muscle activations involved in lower body functional performance.

Physical Fitness and Cognitive Function in Persons with Dementia and their Caregiver

A cross-sectional design investigated the physical attributes of 15 dyads of people with dementia and their caregivers. Physical and cognitive markers determined deviations from clinical thresholds for loss of functional independence, where 100% of participants performed below criterion-referenced threshold values for aerobic endurance. Walking distance for people with dementia was associated with bath/shower activity (p = .007), transfers (p < .001), and mobility (p = .013). Less distance walked was associated with more assistance with self-care tasks. Physical deficits associated with low aerobic endurance and lower body strength compromised independence, placing dyads at risk for falls and mobility-related health issues.

Prioritising restorative care programs in light of current age care reform

BACKGROUND

Short-term restorative care (STRC) aims to reduce the demand for long-term aged care services through 8 weeks of intensive, multidisciplinary services designed to enhance the independence of community-dwelling older Australians at risk of functional decline. Evidence surrounding the effectiveness and feasibility of STRC is limited.

OBJECTIVE

This study aimed to examine the effectiveness of an existing exercise-based STRC model and help inform successful service delivery to maximise participant outcomes nationally.

METHODS

An observational cohort study was conducted to evaluate the potential benefits accrued by community-dwelling older adults accessing Southern Cross Care's current exercise-based STRC model in Adelaide, South Australia. Program effectiveness was determined via improvements in outcome measures specific to functional decline risk factors from baseline (Week 0) to discharge (Week 8).

RESULTS

Results demonstrated significant improvements (p < 0.001) in participants' (n = 62) lower extremity function (44.9%), depressive symptoms (52.4%), anxiety (45.8%), frailty stage (57.9%), independence in activities of daily living (17.3%) and health-related quality of life (24.0%). No significant change was found for grip strength or BMI post-intervention. The most frequent services were exercise-based (54.3% of total services), with participants receiving an average of two to three exercise services per week.

CONCLUSIONS

An exercise-based STRC model is an effective mechanism to reverse functional decline and associated risk factors among community-dwelling older Australians. Adoption of multidisciplinary intervention as a standardised STRC service model could help improve client outcomes nationally and offset expected increases in community and long-term aged care demand.

Do physical fitness and cognitive function mediate the relationship between basic activities of daily living and quality of life in older adults with dementia?

PURPOSE

Independence in activities of daily living (ADLs) is associated with quality of life (QoL) in individuals with dementia. However, the contribution of physical and cognitive functions to this relationship needs further examination. This study aims to examine the mediating effect of physical fitness and cognitive function in the relationship between independence in basic ADLs and QoL among older adults with dementia.

METHODS

This cross-sectional study included 107 older adults with dementia (74.8% women; age 78.21 ± 7.70 years). Independence in basic ADL and QoL were evaluated using the Barthel Index (BI) and QoL- Alzheimer's Disease Scale, respectively. The Alzheimer's Disease Assessment Scale-Cognitive Subscale and the Mini-Mental State Examination were applied to assess cognitive function. Physical fitness was evaluated using the 30-s chair stand, 2-min step and the Timed-Up and Go tests. A structural equation modelling (SEM) with bootstrapping estimation was conducted to determine the relationship between all variables.

RESULTS

Independence in basic ADL positively affected QoL and this association was mediated by physical fitness (β = 0.242, p = 0.011). No statistically significant results were observed when testing cognitive function as a mediator between BI and QoL (β = 0.009, p = 0.345).

CONCLUSIONS

Physical fitness (i.e., lower body strength, aerobic capacity, and mobility) plays a role in the relationship between basic ADL independence and QoL of older adults with dementia, reinforcing the need to improve and monitor these parameters throughout the disease progression. Future longitudinal studies should explore the temporal relationship between physical and cognitive function and its contribution to basic ADL independence and QoL.

Susceptibility to the sound-induced flash illusion is associated with gait speed in a large sample of middle-aged and older adults

BACKGROUND

Multisensory integration is the ability to appropriately merge information from different senses for the purpose of perceiving and acting in the environment. During walking, information from multiple senses must be integrated appropriately to coordinate effective movements. We tested the association between a well characterised multisensory task, the Sound-Induced Flash Illusion (SIFI), and gait speed in 3255 participants from The Irish Longitudinal Study on Ageing. High susceptibility to this illusion at longer stimulus onset asynchronies characterises older adults, and has been associated with cognitive and functional impairments, therefore it should be associated with slower gait speed.

METHOD

Gait was measured under three conditions; usual pace, cognitive dual tasking, and maximal walking speed. A separate logistic mixed effects regression model was run for 1) gait at usual pace, 2) change in gait speed for the cognitive dual tasking relative to usual pace and 3) change in maximal walking speed relative to usual pace. In all cases a binary response indicating a correct/incorrect response to each SIFI trial was the dependent variable. The model controlled for covariates including age, sex, education, vision and hearing abilities, Body Mass Index, and cognitive function.

RESULTS

Slower gait was associated with more illusions, particularly at longer temporal intervals between the flash-beep pair and the second beep, indicating that those who integrated incongruent sensory inputs over longer intervals, also walked slower. The relative changes in gait speed for cognitive dual tasking and maximal walking speed were also significantly associated with SIFI at longer SOAs.

CONCLUSIONS

These findings support growing evidence that mobility, susceptibility to falling and balance control are associated with multisensory processing in ageing.

Wearable sensors for assessing disease severity and progression in Progressive Supranuclear Palsy

INTRODUCTION

Progressive supranuclear palsy (PSP) is an atypical parkinsonism characterized by prominent gait and postural impairment. The PSP rating scale (PSPrs) is a clinician-administered tool to evaluate disease severity and progression. More recently, digital technologies have been used to investigate gait parameters. Therefore, object of this study was to implement a protocol using wearable sensors evaluating disease severity and progression in PSP.

METHODS

Patients were evaluated with the PSPrs as well as with three wearable sensors located on the feet and lumbar area. Spearman coefficient was used to assess the relationship between PSPrs and quantitative measurements. Furthermore, sensor parameters were included in a multiple linear regression model to assess their ability in predicting the PSPrs total score and sub-scores. Finally, differences between baseline and three-month follow-up were calculated for PSPrs and each quantitative variable. The significance level in all analyses was set at ≤ 0.05.

RESULTS

Fifty-eight evaluations from thirty-five patients were analyzed. Quantitative measurements showed multiple significant correlations with the PSPrs scores (r between 0.3 and 0.7; p < 0.05). Linear regression models confirmed the relationships. After three months visit, significant worsening from baseline was observed for cadence, cycle duration and PSPrs item 25, while PSPrs item 10 showed a significant improvement.

CONCLUSION

We propose wearable sensors can provide an objective, sensitive quantitative evaluation and immediate notification of gait changes in PSP. Our protocol can be easily introduced in outpatient and research settings as a complementary tool to clinical measures as well as an informative tool on disease severity and progression in PSP.

Gait monitoring for older adults during guided walking: An integrated assistive robot and wearable sensor approach

An active lifestyle can mitigate physical decline and cognitive impairment in older adults. Regular walking exercises for older individuals result in enhanced balance and reduced risk of falling. In this article, we present a study on gait monitoring for older adults during walking using an integrated system encompassing an assistive robot and wearable sensors. The system fuses data from the robot onboard Red Green Blue plus Depth (RGB-D) sensor with inertial and pressure sensors embedded in shoe insoles, and estimates spatiotemporal gait parameters and dynamic margin of stability in real-time. Data collected with 24 participants at a community center reveal associations between gait parameters, physical performance (evaluated with the Short Physical Performance Battery), and cognitive ability (measured with the Montreal Cognitive Assessment). The results validate the feasibility of using such a portable system in out-of-the-lab conditions and will be helpful for designing future technology-enhanced exercise interventions to improve balance, mobility, and strength and potentially reduce falls in older adults.

Quantitative gait analysis in mild cognitive impairment, dementia, and cognitively intact individuals: a cross-sectional case-control study

Background

Cognitive age-related decline is linked to dementia development and gait has been proposed to measure the change in brain function. This study aimed to investigate if spatiotemporal gait variables could be used to differentiate between the three cognitive status groups.

Methods

Ninety-three older adults were screened and classified into three groups; mild cognitive impairment (MCI) (n = 32), dementia (n = 31), and a cognitively intact (n = 30). Spatiotemporal gait variables were assessed under single- and dual-tasks using an objective platform system. Effects of cognitive status and walking task were analyzed using a two-way ANCOVA. Sub-comparisons for between- and within-group were performed by one-way ANCOVA and Paired t-tests. Area Under the Curve (AUC) of Receiver Operating Characteristics (ROC) was used to discriminate between three groups on gait variables.

Results

There were significant effects (P < 0.05) of cognitive status during both single and dual-task walking in several variables between the MCI and dementia and between dementia and cognitively intact groups, while no difference was seen between the MCI and cognitively intact groups. A large differentiation effect between the groups was found for step length, stride length, and gait speed during both conditions of walking.

Conclusions

Spatiotemporal gait variables showed discriminative ability between dementia and cognitively intact groups in both single and dual-tasks. This suggests that gait could potentially be used as a clinical differentiation marker for individuals with cognitive problems.

Comparison of Montreal Cognitive Assessment in Korean Version for Predicting Mild Cognitive Assessment in 65-Year and Over Individuals

Objectives

The purpose of this study was to compare the validity and reliability of the two Korean versions of the MoCA for individuals aged ≥65 years.

Methods

A total of 185 participants aged ≥65 years were included in this cross-sectional study. This study investigated the reliability of the two Korean versions of the MoCA (the MoCA-K and MoCA-K2) by having each participant complete both assessments twice and comparing them to their Korean version of the Mini-Mental State Exam (MMSE-K) scores. The participants either completed the tests in order A (MoCA-K2 before MoCA-K) then B (MoCA-K before MoCA-K2) or vice versa. The tests were then completed in the opposite order. This study conducted all experiments at 3-day intervals.

Results

Of the 185 total participants analyzed, 95 indicated cognitive impairment, while 90 had normal in MoCA-K scores; 50 demonstrated cognitive impairment, while 135 had normal in MMSE-K scores; and 101 and 84 participants showed cognitive impairment and normal in MoCA-K2 scores, respectively. Cronbach's α values were 0.929 for the MoCA-K, 0.774 for the MMSE-K, and 0.919 for the MoCA-K2. The mean scores were 22.37, 25.29, and 21.96 points for the MoCA-K, MMSE-K, and MoCA-K2, respectively. The sensitivity and the specificity of the MoCA-K were 77.0% and 78.0%, respectively, while those of the MoCA-K2 were 68.9% and 80.0%, respectively.

Conclusions

These results suggest that both the MoCA-K and MoCA-K2 are suitable and reliable evaluation tools for MCI screening; however, the MoCA-K had better overall sensitivity and specificity.

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.

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Cognitive Domain Associations with Balance Performance in Community-Dwelling Older People with Cognitive Impairment

BACKGROUND

In older people with cognitive impairment (CI), executive function (EF) has been associated with motor performance including balance and gait. The literature examining and supporting a relationship between balance performance and other cognitive domains is limited.

OBJECTIVE

To investigate the relationship between global cognition and cognitive domain function and balance performance in older people with CI.

METHODS

The iFOCIS randomized controlled trial recruited 309 community-dwelling older people with CI. Baseline assessments completed before randomization were used for analyses including the Addenbrooke's Cognitive Examination-III (ACE-III; global cognition) and its individual cognitive domains (attention; memory; verbal fluency; language; visuospatial ability) and the Frontal Assessment Battery (FAB), a measure of EF. A composite balance score was derived from postural sway and leaning balance tests.

RESULTS

In linear regression analyses adjusted for covariates, global cognition and each cognitive domain were significantly associated with balance performance. EF (verbal fluency; β= -0.254, p < 0.001, adjusted R2 = 0.387) and visuospatial ability (β= -0.258, p < 0.001, adjusted R2 = 0.391) had the strongest associations with balance performance. In a comprehensively adjusted multivariable model including all of the ACE-III cognitive domains, visuospatial ability and EF (verbal fluency) were independently and significantly associated with balance performance.

CONCLUSION

Poorer global cognition and cognitive domain function were associated with poorer balance performance in this sample of people with CI. Visuospatial ability and EF were independently associated with balance, highlighting potential shared neural networks and the role higher-level cognitive processes and spatial perception/processing play in postural control.