Relationships between balance and cognition in patients with subjective cognitive impairment, mild cognitive impairment, and Alzheimer disease

Executive functions in patients with bilateral and unilateral peripheral vestibular dysfunction

Previous research suggests that patients with peripheral vestibular dysfunction (PVD) suffer from nonspatial cognitive problems, including executive impairments. However, previous studies that assessed executive functions are conflicting, limited to single executive components, and assessments are confounded by other cognitive functions. We compared performance in a comprehensive executive test battery in a large sample of 83 patients with several conditions of PVD (34 bilateral, 29 chronic unilateral, 20 acute unilateral) to healthy controls who were pairwise matched to patients regarding age, sex, and education. We assessed basic and complex executive functions with validated neuropsychological tests. Patients with bilateral PVD performed worse than controls in verbal initiation and working memory span, while other executive functions were preserved. Patients with chronic unilateral PVD had equal executive performance as controls. Patients with acute unilateral PVD performed worse than controls in the exact same tests as patients with bilateral PVD (verbal initiation, working memory span); however, this effect in patients with acute PVD diminished after correcting for multiple comparisons. Hearing loss and affective disorders did not influence our results. Vestibular related variables (disease duration, symptoms, dizziness handicap, deafferentation degree, and compensation) did not predict verbal initiation or working memory span in patients with bilateral PVD. The results suggest that bilateral PVD not only manifests in difficulties when solving spatial tasks but leads to more general neurocognitive deficits. This understanding is important for multidisciplinary workgroups (e.g., neurotologists, neurologists, audiologists) that are involved in diagnosing and treating patients with PVD. We recommend screening patients with PVD for executive impairments and if indicated providing them with cognitive training or psychoeducational support.

Perturbation-based dual task assessment in older adults with mild cognitive impairment

Background

Dual tasking (i.e., concurrent performance of motor and cognitive task) is significantly impaired in older adults with mild cognitive impairment (OAwMCI) compared to cognitively intact older adults (CIOA) and has been associated with increased fall risk. Dual task studies have primarily examined volitionally driven events, and the effects of mild cognitive impairment on reactive balance control (i.e., the ability to recover from unexpected balance threats) are unexplored. We examined the effect of cognitive tasks on reactive balance control in OAwMCI compared to CIOA.

Methods

Adults >55 years were included and completed the Montreal Cognitive Assessment (MoCA) to categorize them as OAwMCI (MoCA: 18-24, n = 15) or CIOA (MoCA: ≥25, n = 15). Both OAwMCI [MoCA: 22.4 (2.2), 65.4 (6.1) years, 3 females] and CIOA [MoCA: 28.4 (1.3), 68.2 (5.5) years, 10 females] responded to large magnitude stance slip-like perturbations alone (single task) and while performing perceptual cognitive tasks targeting the visuomotor domain (target and tracking game). In these tasks, participants rotated their head horizontally to control a motion mouse and catch a falling target (target game) or track a moving object (track). Margin of stability (MOS) and fall outcome (harness load cell >30% body weight) were used to quantify reactive balance control. Cognitive performance was determined using performance error (target) and sum of errors (tracking). A 3 × 2 repeated measures ANOVA examined the effect of group and task on MOS, and generalized estimating equations (GEE) model was used to determine changes in fall outcome between groups and tasks. 2 × 2 repeated measures ANOVAs examined the effect of group and task on cognitive performance.

Results

Compared to CIOA, OAwMCI exhibited significantly deteriorated MOS and greater number of falls during both single task and dual task (p < 0.05), and lower dual task tracking performance (p < 0.01). Compared to single task, both OAwMCI and CIOA exhibited significantly deteriorated perceptual cognitive performance during dual task (p < 0.05); however, no change in MOS or fall outcome between single task and dual task was observed.

Conclusion

Cognitive impairment may diminish the ability to compensate and provide attentional resources demanded by sensory systems to integrate perturbation specific information, resulting in deteriorated ability to recover balance control among OAwMCI.

Changes in postural stability after cerebrospinal fluid tap test in patients with idiopathic normal pressure hydrocephalus

Introduction

In patients with idiopathic normal pressure hydrocephalus (iNPH), the characteristics of balance disturbance are not as well understood as those related to gait. This study examined changes in postural stability in quiet standing after the cerebrospinal fluid tap test (CSFTT) in these patients. Furthermore, the study explored the relationship between the amount of spontaneous body sway and both gait and executive function.

Materials and methods

All patients diagnosed with iNPH underwent CSFTT. We evaluated their center of pressure (COP) measurements on a force plate during quiet standing, both pre- and post-CSFTT. Following the COP measurements, we calculated COP parameters using time and frequency domain analysis and assessed changes in these parameters after CSFTT. At pre-CSFTT, we assessed the Timed Up and Go (TUG) and the Frontal Assessment Battery (FAB). We investigated the relationship between COP parameters and the TUG and FAB scores at pre-CSFTT.

Results

A total of 72 patients with iNPH were initially enrolled, and 56 patients who responded positively to CSFTT were finally included. Post-CSFTT, significant improvements were observed in COP parameters through time domain analysis. These included the velocity of COP (vCOP), root-mean-square of COP (rmsCOP), turn index, torque, and base of support (BOS), compared to the pre-CSFTT values (p < 0.05). In the frequency domain analysis of COP parameters post-CSFTT, there was a decrease in both the peak and average of power spectral density (PSD) values in both the anteroposterior (AP) and mediolateral (ML) directions below 0.5 Hz (p < 0.05). In addition, the TUG scores showed a positive correlation with vCOP, rmsCOP, turn index, torque, BOS, and both the peak and average PSD values in the AP and ML directions below 0.5 Hz (p < 0.05). The FAB scores demonstrated a negative correlation with vCOP, rmsCOP, turns index, BOS, and both peak and average PSD values in the AP direction below 0.5 Hz (p < 0.05).

Conclusion

In patients with iNPH who responded to CSFTT, there was an improvement in spontaneous body sway during quiet standing after CSFTT. Increased spontaneous sway is associated with impaired gait and frontal lobe function. This may be linked to impaired cortico-cortical and cortico-subcortical circuits in patients with iNPH.

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.

Association Between Typologies of Sedentary Behavior and Muscle Strength, Gait Speed, and Balance in Community-Dwelling Older Adults

Knowledge of how the different types of sedentary behaviors (SB) are associated with functional limitations can guide professionals who work with older adults on better recommendations about the amount of daily time that should be encouraged in each type of SB. The objective was to estimate the associations between two SB typologies (SB television [TV] and SB computer/internet) and the presence of handgrip strength, lower limb strength, gait speed, and balance limitations in Brazilian community-dwelling older adults. This is a cross-sectional study with 1,298 community-dwelling older adults (≥60 years). SB was assessed by self-reporting daily time spent watching TV or using computer/internet (categorized into <2, 3-4, and ≥5 hr/day). Outcomes were handgrip strength, lower limb strength, gait speed, and balance limitations considering referenced cutoff points. Older adults in SB TV ≥5 hr/day had 1.75 (95% confidence interval [CI] [1.07, 2.86]) and 1.88 (95% CI [1.02, 3.46]) times more chances of handgrip strength and gait speed limitations, respectively. On the other hand, those who spent 3-4 and ≥5 hr/day in SB computer/internet had 0.45 (95% CI [0.20, 0.99]) and 0.37 (95% CI [0.15, 0.93]) had less chances of lower limb strength and balance limitations, respectively. In conclusion, functional limitations would be associated differently depending on the type of SB in the older adults sampled.

Quantitative analysis of balance function characteristics in older patients with mild to moderate cognitive impairment

BACKGROUND

Cognitive decline in older adults may affect balance function, but the relationship between the two is not fully understood, especially in the early stages of cognitive impairment. Mild to moderate cognitive impairment can be assessed with the Montreal Cognitive Assessment (MOCA).

AIM

This study quantitatively analyzed balance function in older adults with mild to moderate cognitive impairment using computerized dynamic posturography (CDP) testing.

METHODS

248 older patients were divided into a cognitive impaired group (MOCA <26, n = 126) and a normal group (MOCA ≥26, n = 122) based on the Montreal Cognitive Assessment (MOCA) Beijing Version. Patients underwent CDP testing, which included the sensory organization test (SOT) and the limits of stability test (LOS).

RESULTS

The cognitive impaired group had significantly lower SOT composite and visual scores, as well as reaction time (RT), movement velocity (MVL), endpoint excursion (EPE), maximum excursion (MXE), and directional control (DCL) of the LOS test. Binary logistic regression analysis revealed that RT and MXE were independent factors significantly associated with MOCA, even after adjustment for age and sex.

CONCLUSIONS

Older patients with mild to moderate cognitive impairment may have reduced sensory integration and balance stability limits, mainly manifested as prolonged motor reaction time and shortened maximum movement distance.

Investigation of the relationship between trunk control and balance, gait, functional mobility, and fear of falling in people with Alzheimer's disease

INTRODUCTION

Optimal trunk control relies on adequate musculoskeletal, motor, and somatosensory systems that are often affected in people with Alzheimer's disease (AD). Therefore, the aim of this study was to compare trunk control between people with AD and healthy older adults, and investigate the relationship between trunk control and balance, gait, functional mobility, and fear of falling in people with AD.

METHODS

The study was completed with 35 people with AD and 33 healthy older adults with matching age and gender. Trunk control was evaluated with Trunk Impairment Scale (TIS); balance with Berg Balance Scale (BBS), Functional Reach Test (FRT), One-Leg Standing Test (OLST) and Five-Repeat Sit-and-Stand Test (5STS); gait with Dynamic Gait Index (DGI); functional mobility with Timed Up and Go (TUG) Test; fear of falling with Falls Efficacy Scale-International (FES-I).

RESULTS

BBS, FRT, OLST, and DGI scores were lower and 5STS and TUG Test scores were higher in people with AD compared to healthy older adults (p < 0.05). There was no difference in FES-I score between people with AD and healthy older adults (p > 0.05). TIS was associated with BBS, FRT, OLST, 5STS, DGI, TUG Test, and FES-I (r between - 0.341 and 0.738; p < 0.05 for all).

CONCLUSION

Trunk control is affected and related with balance, gait, functional mobility, and fear of falling in people with AD. For this reason, we think that trunk control should be evaluated in the early period, and applications for trunk control should be included in rehabilitation approaches in order to improve balance, gait, functional mobility, and reduce fear of falling.

Balance performance measured by posturography in mild-moderate Alzheimer's Disease: An undervalued assessment

PURPOSE

The aim of the study was to compare balance performance in mild-moderate stage Alzheimer's disease (AD) patients and healthy peers using clinical balance tests and computerized posturography.

METHODS

We recruited 95 patients and divided them into two groups; 51 patients (62 % (n=32) female) in AD group and 44 patients in healthy controls group (50 % (n=22) female). Berg Balance Scale (BBS) and Timed Up & Go (TUG) test were performed. Computerized posturography was performed.

RESULTS

The mean age was 77.2±5.5 years in the AD group and 73.8±4.4 years in the control group (p<0.001). Sensory organization test composite equilibrium score (60[30-81], p<0.001), step quick turn-sway velocity (69.2 [38.2-95.8], p<0.001) and step quick turn-time (3.8 [1.6-8.4], p<0.001) were significantly impaired in mild-moderate stage AD patients. Berg Balance Scale (50 [32-56], p<0.001) and TUG test (13.0 [7.0-25.7], p<0.001) results were worse in AD.

CONCLUSIONS

Computerized posturography measures were impaired in mild-moderate AD patients. The results highlight importance of early screening for balance and fall risk in AD patients. The study provides multi-dimensional and holistic assessment of balance performance in early-stage AD patients. Alzheimer's disease patients at earlier stages are prone to fall risk and should be evaluated accordingly.

Relationship of Neural Correlates of Gait Characteristics and Cognitive Dysfunction in Patients with Mild Cognitive Impairment

Background: Some patients with mild cognitive impairment (MCI) experience gait disturbances. However, there are few reports on the relationship between gait disturbance and cognitive function in patients with MCI. Therefore, we investigated the neural correlates of gait characteristics related to cognitive dysfunction. Methods: Eighty patients diagnosed with MCI from three dementia centers in Gangwon-do, Korea, were recruited for this study. We defined MCI as a Clinical Dementia Rating global score of 0.5 or higher, with a memory domain score of 0.5 or greater. The patients were classified as having either higher or lower MMSE and the groups were based on their Mini Mental Status Examination z-scores. Multiple logistic regression analysis was performed to examine the association between the gait characteristics and cognitive impairment. Analyses included variables such as age, sex, years of education, number of comorbidities, body mass index, and height. Results: Gait velocity, step count, step length, heel-to-heel base support, swing and stance phase duration, and support time were associated with cognitive function. A decrease in gray matter volume in the right pericalcarine area was associated with gait characteristics related to cognitive dysfunction. An increase in the curvature of gray matter in the right entorhinal, right lateral orbitofrontal, right cuneus, and right and left pars opercularis areas was also associated with gait characteristics related to cognitive dysfunction. Conclusion: Since gait impairment is an important factor in determining activities of daily living in patients with mild cognitive impairment, the evaluation of gait and cognitive functions in patients with mild cognitive impairment is important.

Explanatory Capacity of Postural Control and Physical Fitness in Cognitive Impairment and Support Needs among Individuals with Intellectual Disabilities-A Cross-Sectional Pilot Study

Postural control is a skill associated with most motor activities and is essential for the performance of activities of daily living. People with intellectual disabilities (ID) present postural control deficits that can be attributed to several causes. The aim of this study was to determine whether postural control and physical fitness could explain the cognitive impairment and support needs in this population. A cross-sectional pilot study was conducted with 18 people with ID. Data collection was based on assessments for postural control (Mini BESTest and Berg Balance Scale) and physical fitness (Senior Fitness Test). The data were analyzed using linear regression models. Anticipatory postural adjustments were associated with support needs, explaining up to 45% of these. Consecutive postural adjustments and upper limb strength were less significantly associated with support needs. However, none of the variables used explained cognitive impairment in ID. Knowledge of the relationships and behavior of the different measurement tools is essential for the development of appropriate interventions in this population.

Gait performance and prefrontal cortex activation during single and dual task walking in older adults with different cognitive levels

Background

Growing evidence shows the cognitive function influences the motor performance. The prefrontal cortex (PFC) as a part of the executive locomotor pathway is also important for cognitive function. This study investigated the differences in motor function and brain activity among older adults with different cognitive levels, and examined the significance of cognition on motor functions.

Methods

Normal control (NC), individuals with mild cognitive impairment (MCI) or mild dementia (MD) were enrolled in this study. All participants received a comprehensive assessment including cognitive function, motor function, PFC activity during walking, and fear of fall. The assessment of cognitive function included general cognition, attention, executive function, memory, and visuo-spatial. The assessment of motor function included timed up and go (TUG) test, single walking (SW), and cognitive dual task walking (CDW).

Results

Individuals with MD had worse SW, CDW and TUG performance as compared to individuals with MCI and NC. These gait and balance performance did not differ significantly between MCI and NC. Motor functions all correlated with general cognition, attention, executive function, memory, and visuo-spatial ability. Attention ability measured by trail making test A (TMT-A) was the best predictor for TUG and gait velocity. There were no significant differences in PFC activity among three groups. Nevertheless, the PFC activated more during CDW as compared with SW in individuals with MCI (p = 0.000), which was not demonstrated in the other two groups.

Conclusion

MD demonstrated worse motor function as compared to NC and MCI. The greater PFC activity during CDW in MCI may be considered as a compensatory strategy for maintaining the gait performance. Motor function was related to the cognitive function, and the TMT A was the best predictor for the gait related performance in present study among older adults.

Association between P300 parameters and cognitive function in people with diabetic neuropathy

Purpose

The purpose of this study was to investigate the association between event-related potential (ERP) P300 with cognitive function in people with diabetic peripheral neuropathy (DPN).

Methods

We performed a cross-sectional analysis of 19 type 2 diabetes mellitus (T2DM) patients, aged 18 and older with DPN. The participants were assessed for neuropathy, cognitive function, & dual-task performance. DPN was examined via the administration of diabetic neuropathy symptom score (DNSS) and vibration perception threshold (VPT). Cognitive dysfunction was evaluated using Mini-mental state examination (MMSE), trail making test-B (TMT-B), and ERP P300 wave latency & amplitude. For assessing dual-task performance, the dual-task cost (DTC) was calculated using the timed-up and go (TUG) test and TUG with dual task (TUG-DT).

Results

P300 latency was linearly related to TMT-B (R = 0.31, p = 0.01) and DTC (R = 0.22, p = 0.04). A similar trend was observed in TMT-B (R = 0.13, p = 0.04) & DTC (R =0 .67, p = 0.001) with respect to P300 amplitude. MMSE did not relate with P300 latency (R = 0.14, p = 0.58) & amplitude (R = 0.63, p = .44).

Conclusion

P300 latency and amplitude are associated with cognitive function and DTC of individuals with DPN.

Association between mild cognitive impairment and falls among Chinese older adults: the mediating roles of balance capacity and depressive symptoms

BACKGROUND

This study aimed to examine the association between mild cognitive impairment (MCI) and the follow-up risk of falls among Chinese older adults, exploring the mediating roles of balance capacity and depressive symptoms in the association between MCI and falls.

METHODS

A total of 5482 adults aged 60 years and above from waves 2015 and 2018 of the China Health and Retirement Longitudinal Study were included for analysis. Cognition was assessed by a global cognition score, which included three tests: episodic memory, figure drawing and Telephone Interview of Cognitive Status. Depressive symptoms were assessed with the Centre for Epidemiological Studies Depression Scale. Logistic regression models were used to estimate the association between MCI and falls. Mediation analysis was employed to explore the potential mediating roles of balance capacity and depressive symptoms in the association between MCI and falls.

RESULTS

MCI was significantly associated with the risk of falls (OR 1.259, 95% CI 1.080 to 1.467). Balance capacity and depressive symptoms played parallel mediating roles in the association between MCI and falls, and the mediating effects were 0.004 (95% CI 0.003 to 0.024) and 0.010 (95% CI 0.004 to 0.016), respectively.

CONCLUSIONS

It is necessary to screen for and recognise MCI in order to prevent falls among older adults. More efforts should be made to improve balance capacity and relieve depressive symptoms to reduce the risk of falls among older adults with MCI.

Striatal fibrinogen extravasation and vascular degeneration correlate with motor dysfunction in an aging mouse model of Alzheimer’s disease

Introduction: Alzheimer’s Disease (AD) patients exhibit signs of motor dysfunction, including gait, locomotion, and balance deficits. Changes in motor function often precede other symptoms of AD as well as correlate with increased severity and mortality. Despite the frequent occurrence of motor dysfunction in AD patients, little is known about the mechanisms by which this behavior is altered.

Methods and Results: In the present study, we investigated the relationship between cerebrovascular impairment and motor dysfunction in a mouse model of AD (Tg6799). We found an age-dependent increase of extravasated fibrinogen deposits in the cortex and striatum of AD mice. Interestingly, there was significantly decreased cerebrovascular density in the striatum of the 15-month-old as compared to 7-month-old AD mice. We also found significant demyelination and axonal damage in the striatum of aged AD mice. We analyzed striatum-related motor function and anxiety levels of AD mice at both ages and found that aged AD mice exhibited significant impairment of motor function but not in the younger AD mice.

Discussion: Our finding suggests an enticing correlation between extravasated fibrinogen, cerebrovascular damage of the striatum, and motor dysfunction in an AD mouse model, suggesting a possible mechanism underlying motor dysfunction in AD.

What do functional neuroimaging studies tell us about the association between falls and cognition in older adults? A systematic review

Impaired cognition is a known risk factor for falls in older adults. To enhance prevention strategies and treatment of falls among an aging global population, an understanding of the neural processes and networks involved is required. We present a systematic review investigating how functional neuroimaging techniques have been used to examine the association between falls and cognition in seniors. Peer-reviewed articles were identified through searching five electronic databases: 1) Medline, 2) PsycINFO, 3) CINAHL, 4) EMBASE, and 5) Pubmed. Key author, key paper, and reference searching was also conducted. Nine studies were included in this review. A questionnaire composed of seven questions was used to assess the quality of each study. EEG, fMRI, and PET were utilized across studies to examine brain function in older adults. Consistent evidence demonstrates that cognition is associated with measures of falls/falls risk, specifically visual attention and executive function. Our results show that falls/falls risk may be implicated with specific brain regions and networks. Future studies should be prospective and long-term in nature, with standardized outcome measures. Mobile neuroimaging techniques may also provide insight into brain activity as it pertains to cognition and falls in older adults in real-world settings.

Physical and cognitive function to explain the quality of life among older adults with cognitive impairment: exploring cognitive function as a mediator

BACKGROUND

Physical and cognitive function are both indicators of aging, characterized by a loss of adaptive response to life challenges and functional limitations, subsequently affecting their quality of life. This study aimed to identify the direct effect of physical function and the indirect effect of cognitive function on the quality of life in older adults with mild cognitive impairment.

METHODS

The study participants were 79 older adults recruited from community centers in four urban districts of Korea. All participants completed a self-reported questionnaire for demographic characteristics and outcome variables. Outcome measures included physical function (grip strength, balance, and mobility), cognitive function, and mental and physical components of quality of life (QOL). Statistical analyses were conducted using hierarchical multiple linear regression and the PROCESS macro for mediation analysis.

RESULTS

The mean age of participants was 77.46 years old with an elementary or lower education level (53.2%). The mean score of cognitive function was 16.39 (SD = 6.5). Physical function (grip strength, balance, mobility) and cognitive function explained 25% of the variance in physical (p = 0.004) and 29% in mental (p < 0.001) components of QOL after controlling for age, sex, and education level. Mobility was associated with both physical (β=-0.27, p = 0.024) and mental (β=-0.36, p = 0.002) components of QOL. The cognitive function partially mediated the relationship between balance and the physical component of QOL; the proportion of mediation was 55%.

CONCLUSION

In conclusion, physical and cognitive function were significant predictors of QOL in older adults with cognitive impairment. Specifically, balance has significant indirect effects on the physical component of QOL through cognitive function as a mediator. Health-promoting strategies could be more effective when focusing on the direct effect of physical function as well as the mediating effect of cognitive function to promote the quality of life in this population.

Mobility and associations with levels of cerebrospinal fluid amyloid β and tau in a memory clinic cohort

Background

Mobility impairments, in terms of gait and balance, are common in persons with dementia. To explore this relationship further, we examined the associations between mobility and cerebrospinal fluid (CSF) core biomarkers for Alzheimer's disease (AD).

Methods

In this cross-sectional study, we included 64 participants [two with subjective cognitive decline (SCD), 13 with mild cognitive impairment (MCI) and 49 with dementia] from a memory clinic. Mobility was examined using gait speed, Mini-Balance Evaluation Systems test (Mini-BESTest), Timed Up and Go (TUG), and TUG dual-task cost (TUG DTC). The CSF biomarkers included were amyloid-β 42 (Aβ₄₂), total-tau (t-tau), and phospho tau (p-tau₁₈₁). Associations between mobility and biomarkers were analyzed through correlations and multiple linear regression analyses adjusted for (1) age, sex, and comorbidity, and (2) SCD/MCI vs. dementia.

Results

Aβ₄₂ was significantly correlated with each of the mobility outcomes. In the adjusted multiple regression analyses, Aβ₄₂ was significantly associated with Mini-BESTest and TUG in the fully adjusted model and with TUG DTC in step 1 of the adjusted model (adjusting for age, sex, and comorbidity). T-tau was only associated with TUG DTC in step 1 of the adjusted model. P-tau₁₈₁ was not associated with any of the mobility outcomes in any of the analyses.

Conclusion

Better performance on mobility outcomes were associated with higher levels of CSF Aβ₄₂. The association was strongest between Aβ₄₂ and Mini-BESTest, suggesting that dynamic balance might be closely related with AD-specific pathology.

Cerebello-cortical functional connectivity may regulate reactive balance control in older adults with mild cognitive impairment

Background

Older adults with mild cognitive impairment (OAwMCI) experience a two-fold increased risk of falling compared to their cognitively intact counterparts. This increased risk could be attributed to impairments in balance control mechanisms (both volitional and reactive), however, the exact neural substrates contributing to the balance impairments remain unclear. While changes in functional connectivity (FC) networks in volitional balance control tasks have been well highlighted, the relationship between these changes and reactive balance control has not been examined. Therefore, this study aims to explore the relationship between FC networks of the brain obtained during resting state fMRI (no visualization or active task performed) and behavioral measures on a reactive balance task in OAwMCI.

Methods

Eleven OAwMCI (< 25/30 on MoCA, > 55 years) underwent fMRI and were exposed to slip-like perturbations on the Activestep treadmill. Postural stability, i.e., dynamic center of mass motion state (i.e., its position and velocity) was computed to determine reactive balance control performance. The relationship between reactive stability and FC networks was explored using the CONN software.

Results

OAwMCI with greater FC in default mode network-cerebellum (r² = 0.43, p < 0.05), and sensorimotor-cerebellum (r² = 0.41, p < 0.05) network exhibited lower reactive stability. Further, people with lower FC in middle frontal gyrus-cerebellum (r² = 0.37, p < 0.05), frontoparietal-cerebellum (r² = 0.79, p < 0.05) and cerebellar network-brainstem (r² = 0.49, p < 0.05) exhibited lower reactive stability.

Conclusion

Older adults with mild cognitive impairment demonstrate significant associations between reactive balance control and cortico-subcortical regions involved in cognitive-motor control. Results indicate that the cerebellum and its communications with higher cortical centers could be potential substrates contributing to impaired reactive responses in OAwMCI.

Associations Between Cognitive Function, Balance, and Gait Speed in Community-Dwelling Older Adults with COPD

BACKGROUND AND PURPOSE

Older adults with chronic obstructive pulmonary disease (COPD) are at risk for physical and cognitive impairment. Cognitive function is associated with falls in older adults. However, it is unknown whether a relationship exists between cognitive function and falls in patients with COPD. The aim of this study was to examine the relationships between cognitive function, balance, and gait speed in older adults with COPD.

PATIENTS AND METHODS

A secondary analysis was performed using data from the 2010 wave of the Health and Retirement Study (HRS). Cognitive (immediate and delayed recall, executive function) and physical (gait speed, tandem balance time) measure data were extracted for older adults with COPD (n = 382) and an age-matched control group without COPD (n = 382) who met inclusion/exclusion criteria. Multivariate linear regression modeling was performed to examine associations between cognitive function and mobility or balance while controlling for age, gender, body mass index, grip strength, and education.

RESULTS

In older adults with COPD, delayed recall was significantly associated with tandem balance performance (β= 1.42, P < .05). Other cognitive measures were not associated with gait speed or balance.

CONCLUSION

In older adults with COPD, one of four cognitive functions was associated with a static standing balance task. Screening of cognitive function, specifically delayed recall, should be a part of the management of falls in this population.

[Influence of the dementia stage on motor skills in senior citizens]

BACKGROUND

The progressive course of dementia is not only manifested in the increasing impairment of cognitive functions but also in the motor skills of those affected and also impairs their mobility and independence in coping with everyday tasks. The present study investigated whether and to what extent there is a difference in selected skills of motor performance depending on the stages of dementia.

MATERIAL AND METHODS

This study included 32 senior citizens with mild dementia (group A; 84.3 ± 6.1 years) and 27 senior citizens with moderate dementia (group B; 85.6 ± 5.5 years), whose classification was based on the mini-mental state examination (MMSE). The following motor tests were used: the hand dynamometer test (general strength), the drop bar test (motor reaction ability), frailty and injuries: cooperative studies of intervention techniques (FICSIT‑4; balance), the timed up-and-go test (TUG) and the modified chair rising test (CRT; both assess mobility and transfer performances in everyday life).

RESULTS

Group A, in contrast to group B, showed significantly better motor performance in all motor tests except the drop bar test. The largest differences were found in the CRT (p = 0.000) and TUG (p = 0.011).

CONCLUSION

In terms of overall strength, balance and mobility, people with more advanced dementia showed lower performance. Therefore, subsequent studies investigating the impact of dementia on motor skills should always include a classification of dementia levels. Intervention programs should contain physical activities that focus on increasing general strength as well as balance.

Neurometabolic correlates of posturography in normal aging and older adults with mild cognitive impairment: Evidence from a 1H-MRS study

Proton magnetic resonance spectroscopy (¹H-MRS) holds promise for revealing and understanding neurodegenerative processes associated with cognitive and functional impairments in aging. In the present study, we examined the neurometabolic correlates of balance performance in 42 cognitively intact older adults (healthy controls - HC) and 26 older individuals that were diagnosed with mild cognitive impairment (MCI). Neurometabolite ratios of total N-acetyl aspartate (tNAA), glutamate-glutamine complex (Glx), total choline (tCho) and myo-inositol (mIns) relative to total creatine (tCr) were assessed using single voxel ¹H-MRS in four different brain regions. Regions of interest were the left hippocampus (HPC), dorsal posterior cingulate cortex (dPCC), left sensorimotor cortex (SM1), and right dorsolateral prefrontal cortex (dlPFC). Center-of-pressure velocity (Vcop) and dual task effect (DTE) were used as measures of balance performance. Results indicated no significant group differences in neurometabolite ratios and balance performance measures. However, our observations revealed that higher tCho/tCr and mIns/tCr in hippocampus and dPCC were generic predictors of worse balance performance, suggesting that neuroinflammatory processes in these regions might be a driving factor for impaired balance performance in aging. Further, we found that higher tNAA/tCr and mIns/tCr and lower Glx/tCr in left SM1 were predictors of better balance performance in MCI but not in HC. The latter observation hints at the possibility that individuals with MCI may upregulate balance control through recruitment of sensorimotor pathways.

Effects of instability resistance training on static postural control of cognitively impaired older adults

BACKGROUND: Mounting evidence has demonstrated functional and cognitive-related benefits after Instability Resistance Training (IRT) in individuals, healthy as wellas patients presenting with neurological disorders. However, whether IRT may play a significant role in the postural control of older adults has not been established. OBJECTIVE: To evaluate the effects of 12- weeks of IRT on static postural control of older adults with subjective cognitive impairment. METHODS: In this randomized controlled trial, a total of 67 participants (aged 65 years and older) were randomly assigned to either 12 weeks of IRT (n= 22), traditional resistance training (RT) (n= 23), or a health education control group (CON) (n= 22). Static postural control was assessed using a force platform that recorded the displacement amplitude of the center of pressure (CoP) in the anteroposterior (AP) and mediolateral (ML) directions in bipedal support (30 seconds) with eyes open and closed. RESULTS: All groups increased AP displacement in the conditions of eyes open and closed. During the eyes-closed condition, only the IRT group increased the ML displacement. No between-group differences were detected in any postural control (p> 0.05). CONCLUSIONS: 12 weeks of IRT does not improve the static postural control in older adults with cognitive impairment.

Prospective association between standing balance and cognitive function in middle-aged and older Chinese adults

Objective

To investigate the association of standing balance with cognitive functions and the rate of cognitive decline among middle-aged and older Chinese adults.

Methods

Participants were selected from China’s Health and Retirement Longitudinal Study. A total of 8,499 subjects aged ≥45 years who participated in wave 1 to wave 3 surveys were included in the final analysis. Standing balance was measured using the tandem test, and participants were categorized into two groups according to their ability to maintain standing balance. Cognitive functions were assessed in three domains: episodic memory, mental status, and global cognition. The associations between standing balance scores, cognitive scores, and the rate of cognitive decline were evaluated using linear regression and linear mixed models.

Results

Compared with participants who successfully completed the standing balance test, those who were unable to complete the test had lower scores on episodic memory [β = −0.18; 95% confidence interval (CI): −0.24, −0.11], mental status (β = −0.28; 95% CI: −0.37, −0.19), and global cognition (β = −0.51; 95% CI: −0.65, −0.38) after 4 years of follow-up. In addition, the rate of decline in mental status and global cognition increased by 0.10 (β = 0.10; 95% CI: 0.07, 0.13) and 0.08 (β = 0.08; 95% CI: 0.04, 0.12) units, respectively, in participants who were unable to complete the test compared with their counterparts.

Conclusion

Good standing balance was significantly associated with higher cognitive function and a lower decline in mental status and global cognition in middle-aged and older Chinese adults.

Effect of the GERAS DANcing for Cognition and Exercise Program on Physical Function in Older Adults

GERAS DANcing for Cognition and Exercise is a therapeutic dance program for older adults with cognitive or mobility impairments. Using a pre-/posttest study design, we investigated the effect of 12 weeks of dance on the short performance physical battery (SPPB). In 107 participants aged 61-93 (mean 76.1, SD = 7.0; 20% men), over 90% had multifrailty and/or cognitive impairment. The mean attendance rate was 18/24 classes (75%). A substantial minimal clinically important difference (>0.4) occurred for SPPB total (+0.53, SD = 2.04, p = .002) and chair stands (+0.45, SD = 0.92, p < .001). Individuals with baseline SPPB ≤8 points (n = 38)-indicative of sarcopenia and physical frailty-had the most marked improvement (SPPB total: +1.45, SD = 1.97, p < .001; balance: +0.65, SD = 1.27, p = .006; chair stands: +0.68, SD = 0.97, p < .001). GERAS DANcing for Cognition and Exercise may be a promising rehabilitation intervention to improve daily physical function.

Fun and a meaningful routine: the experience of physical activity in people with dementia

Background

Physical activity is important to health and wellbeing. People with dementia are less physically active than their cognitively healthy counterparts. Reasons for this are multifaceted, and are thought to be social, psychological, and physiological. People with dementia often use services such as home care, day care centres and nursing home, and according to the stage of disease they are less or more dependent on other people to take part in activities. To develop appropriate services to this patient group, their needs and preferences regarding physical activity must be recognized. The aim of the study was therefore to provide insight into experiences with physical activity in people with dementia.

Methods

The current study is part of a larger research project on needs in people with dementia. The main project included qualitative semi-structured interviews with 35 persons with dementia. 27 of the participants talked about their experience with physical activity. In the current study, the relevant findings on this theme were analysed separately. A phenomenological hermeneutic research design was applied.

Results

The analysis revealed three main categories regarding experiences with physical activity. To be physically active provided positive experiences such as feelings of mastering and post-exercise euphoria. To be physically active was meaningful. The daily walk was an important routine to many, and it gave meaningful content to the day. Keeping up with activities confirmed identity. Lastly, to be active was perceived as challenging. Participants described different barriers to being physically active such as a decline of physical function, lack of motivation and being dependent on others to go out.

Conclusions

Many of the participants expressed that being physically active was important to them. It is essential that informal and formal carers are aware of the role physical activity plays in the lives of many people with dementia, so that appropriate measures can be taken to assure continued active living in order to preserve health and quality of life.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03149-6.

Multitask Versus Multicomponent Training on Cognitive and Motor Functions in Persons With Mild Cognitive Impairment: A Randomized Trial

This study aims to compare the effects of multitask (MTT; multiple tasks performed simultaneously) and multicomponent training (MCT; various types of exercise performed sequentially) on processing speed, cognitive functions, gait speed, and balance functions in persons with mild cognitive impairment. Forty-two persons with mild cognitive impairment were randomly allocated to MTT (n = 21) or MCT (n = 21). Outcome measures included processing speed, cognitive functions (attention and executive functions), single-task gait speed, dual-task gait speed (DTGS-Arithmetic and DTGS-Verbal), and balance functions. Processing speed (except inhibition), cognitive functions, gait speed, and balance functions improved in the MTT and MCT groups following training, with no significant differences between the groups in processing speed or cognitive functions. The MCT group improved more on single-task gait speed (F = 15.097; p = .000; r = .270) and DTGS (DTGS-Arithmetic; F = 10.594; p = .002; r = .214), while the MTT group improved more on balance functions (F = 4.366; p = .043; r = .101). MTT and MCT strategies can be used to improve cognitive and physical outcomes in persons with mild cognitive impairment.

The Effects of High-Intensity Functional Training on Cognition in Older Adults with Cognitive Impairment: A Systematic Review

(1) Background: High-Intensity Functional Training (HIFT) is a new exercise modality that emphasizes multi-joint functional movements adaptable to any fitness level and promotes greater muscle recruitment. Previous studies have evaluated the positive effects of HIFT on mental and cognitive health but have not evaluated it in older people. This study aims to conduct a systematic review of randomized controlled trials assessing the effects of HIFT on general cognition in older adults with cognitive impairment. (2) Methods: Following the PRISMA 2020 guideline, articles that did a high-intensity functional physical exercise intervention on cognitive performance in older adults with mild to moderate cognitive impairment (MMSE > 10) or dementia, aged 55 years or older, published between 2011 and 2021 in five different electronic databases: PubMed, Web of Science, Scopus, CINAHL, and Cochrane plus were included. (3) Results: 7 articles were included, all having general cognition as their primary outcome. All assessed general cognition using the Mini-Mental State Examination, the ADAS-Cog, or both. All studies had at least one HIFT experimental group with a frequency of 2 sessions per week and a variable duration between protocols of 12, 13, 16, and 26 weeks. Two articles showed that a progressive HIFT program improves general cognition, four articles showed no significant changes within or between groups and one article concluded that a HIFT intervention does not slow cognitive decline. (4) Conclusions: Evidence exists of the benefits of HIFT on general cognition in older adults with cognitive impairment, assessed using the MMSE, the ADAS-cog, or both. Two articles that showed improvement in cognitive function used progressive HIFT with 80% RM at 6, 12, and 1 weeks; however, in the other articles, due to the heterogeneity of intervention protocols, measurement time points, and control group activities, mixed results were evidenced

Associations of Word Memory, Verbal Fluency, Processing Speed, and Crystallized Cognitive Ability With One-Legged Balance Performance in Mid- and Later Life

BACKGROUND

Cognitive integration of sensory input and motor output plays an important role in balance. Despite this, it is not clear if specific cognitive processes are associated with balance and how these associations change with age. We examined longitudinal associations of word memory, verbal fluency, search speed, and reading ability with repeated measures of one-legged balance performance.

METHOD

Up to 2 934 participants in the MRC National Survey of Health and Development, a British birth cohort study, were included. At age 53, word memory, verbal fluency, search speed, and reading ability were assessed. One-legged balance times (eyes closed) were measured at ages 53, 60-64, and 69 years. Associations between each cognitive measure and balance time were assessed using random-effects models. Adjustments were made for sex, death, attrition, height, body mass index, health conditions, health behaviors, education, and occupational class.

RESULTS

In sex-adjusted models, 1 SD higher scores in word memory, search speed, and verbal fluency were associated with 14.1% (95% CI: 11.3, 16.8), 7.2% (4.4, 9.9), and 10.3% (7.5, 13.0) better balance times at age 53, respectively. Higher reading scores were associated with better balance, although this association plateaued. Associations were partially attenuated in mutually adjusted models and effect sizes were smaller at ages 60-64 and 69. In fully adjusted models, associations were largely explained by education, although remained for word memory and search speed.

CONCLUSIONS

Higher cognitive performance across all measures was independently associated with better balance performance in midlife. Identification of individual cognitive mechanisms involved in balance could lead to opportunities for targeted interventions in midlife.

Association Between Turning Mobility and Cognitive Function in Chronic Poststroke

Turning difficulties are common in patients with stroke. The detrimental effects of dual tasks on turning indicate a correlation between turning and cognition. Cognitive impairment is prevalent after stroke, and stroke patients with mild cognitive impairment had a poorer turning performance than did stroke patients with intact cognitive abilities. Therefore, we investigated the association between turning mobility and cognitive function in patients with chronic poststroke. Ninety patients with chronic stroke (>6 months post-stroke) were recruited. Angular velocity was assessed using wearable sensors during 180° walking turns and 360° turning on the spot from both sides. Global cognition and distinct cognitive domains were assessed using the Mini-Mental State Examination. In patients with stroke, turning mobility was significantly associated with global cognitive function and distinct cognitive domains, such as visuospatial ability and language. The balance function and lower limbs strength were mediators of the association between cognition and turning. The association highlights the complexity of the turning movement and dynamic motor and cognitive coordination necessary to safely complete a turn. However, our findings should be regarded as preliminary, and a thorough neuropsychological assessment to provide a valid description of distinct cognitive domains is required.

Mobile Health App for Adolescents: Motion Sensor Data and Deep Learning Technique to Examine the Relationship between Obesity and Walking Patterns

With the prevalence of obesity in adolescents, and its long-term influence on their overall health, there is a large body of research exploring better ways to reduce the rate of obesity. A traditional way of maintaining an adequate body mass index (BMI), calculated by measuring the weight and height of an individual, is no longer enough, and we are in need of a better health care tool. Therefore, the current research proposes an easier method that offers instant and real-time feedback to the users from the data collected from the motion sensors of a smartphone. The study utilized the mHealth application to identify participants presenting the walking movements of the high BMI group. Using the feedforward deep learning models and convolutional neural network models, the study was able to distinguish the walking movements between nonobese and obese groups, at a rate of 90.5%. The research highlights the potential use of smartphones and suggests the mHealth application as a way to monitor individual health.

Mobility and Depressive Symptoms in Persons With Mild Cognitive Impairment and Alzheimer Dementia

BACKGROUND AND PURPOSE

Persons with mild cognitive impairment (MCI) and Alzheimer dementia (AD) often experience gait and balance disturbances and depressive symptoms alongside their cognitive impairment. The aim of this study was to explore the relationship between mobility and depressive symptoms in community-dwelling persons with MCI and mild to moderate AD.

METHODS

Ninety-nine participants with MCI and AD from the memory clinic at Oslo University Hospital, Ullevål, Norway, were included. The Balance Evaluation Systems Test (BESTest), 10-m walk test regular (gait speed), and dual task (naming animals, dual-task cost in percent) were used to assess mobility. The Cornell Scale for Depression in Dementia, with validated cut-off 5/6 points, was used to assess presence of depressive symptoms. Multiple regression analysis was used to explore the relationship between mobility (3 separate models) and depressive symptoms, controlled for demographic factors, comorbidity, and Mini-Mental State Examination.

RESULTS

One-third of the participants had depressive symptoms, mean (SD) gait speed was 1.09 (0.3) m/s, and median (interquartile range) BESTest percent score was 81.5 (17.6). No statistically significant associations were found between depression and BESTest, gait speed or dual-task cost, neither in the simple models (P = 0.15-0.85), nor in the 3 multivariate models (P = 0.57-0.69).

DISCUSSION AND CONCLUSIONS

In this study, we found no associations between mobility and depressive symptoms in persons with MCI and AD recruited at a memory clinic. Few participants had major symptoms of depression, which may have influenced the results. Longitudinal studies are needed to explore the long-time associations between mobility and depression.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A366).

Lower Cognitive Set Shifting Ability Is Associated With Stiffer Balance Recovery Behavior and Larger Perturbation-Evoked Cortical Responses in Older Adults

The mechanisms underlying associations between cognitive set shifting impairments and balance dysfunction are unclear. Cognitive set shifting refers to the ability to flexibly adjust behavior to changes in task rules or contexts, which could be involved in flexibly adjusting balance recovery behavior to different contexts, such as the direction the body is falling. Prior studies found associations between cognitive set shifting impairments and severe balance dysfunction in populations experiencing frequent falls. The objective of this study was to test whether cognitive set shifting ability is expressed in successful balance recovery behavior in older adults with high clinical balance ability (N = 19, 71 ± 7 years, 6 female). We measured cognitive set shifting ability using the Trail Making Test and clinical balance ability using the miniBESTest. For most participants, cognitive set shifting performance (Trail Making Test B-A = 37 ± 20 s) was faster than normative averages (46 s for comparable age and education levels), and balance ability scores (miniBESTest = 25 ± 2/28) were above the threshold for fall risk (23 for people between 70 and 80 years). Reactive balance recovery in response to support-surface translations in anterior and posterior directions was assessed in terms of body motion, muscle activity, and brain activity. Across participants, lower cognitive set shifting ability was associated with smaller peak center of mass displacement during balance recovery, lower directional specificity of late phase balance-correcting muscle activity (i.e., greater antagonist muscle activity 200-300 ms after perturbation onset), and larger cortical N1 responses (100-200 ms). None of these measures were associated with clinical balance ability. Our results suggest that cognitive set shifting ability is expressed in balance recovery behavior even in the absence of profound clinical balance disability. Specifically, our results suggest that lower flexibility in cognitive task performance is associated with lower ability to incorporate the directional context into the cortically mediated later phase of the motor response. The resulting antagonist activity and stiffer balance behavior may help explain associations between cognitive set shifting impairments and frequent falls.

Screening recall in older cancer survivors detects differences in balance and mobility

PURPOSE

Cognitive impairments have been reported by up to two-thirds of cancer survivors whose primary cancer did not occur in the central nervous system. Physical impairments as sequelae of cancer-related cognitive impairment (CRCI) have not been well described in previous studies. Furthermore, there is scarcity of literature describing differences among physical performance in those with and without CRCI. The purpose of this study is to examine the differences in physical function of older cancer survivors based on cognitive ability to determine if physical performance differs when different cognitive screening measures are employed.

METHODS

Adults age 65 + with a history of cancer from the 2010 Health and Retirement Study (n = 1,953) were assigned to groups according to their cognitive ability. Between-group demographic, mobility, and cognitive differences were analyzed using chi-squared and t tests. Recall and orientation were used as cognitive variables, and physical performance outcomes included gait speed, balance, and grip strength.

RESULTS

Respondents with Low Recall had more impaired balance (semi-tandem, tandem) (p < .05) and slower gait speeds (p < .05). Respondents that were Not-Oriented had slower gait speed (p < .05). Between-group differences in demographics were found by recall and orientation groups.

CONCLUSIONS

Impairments in balance and gait speed are able to be detected when recall is screened in a population of older cancer survivors. When assessing how physical mobility is related to fall risk, a screen of cognition should go beyond just orientation.

Neuroticism and Extraversion Are Related to Changes in Postural Stability During Anatomically-Related Cognitive Tasks

The relationship between personality and postural stability has received little attention. This study addressed whether neuroticism and extraversion correlate with changes in postural stability while performing cognitive tasks related to brain regions selectively associated with neuroticism and extraversion. Thirty-two adults stood on a foam mat in tandem stance and completed a 2-back task and a weather prediction task (WPT). As predicted, higher neuroticism was related to increased dual task sway during the 2-back task, r = 0.40, p = 0.023, and lower extraversion was related to increased dual task sway during the WPT, r = -0.43, p = 0.013, suggesting that personality is related to postural stability in healthy young adults and that personality could be considered in the prediction and treatment of individuals with balance difficulties.

Taurine and Camel Milk Modulate Neurobehavioral and Biochemical Changes in Aluminum Chloride-Induced Alzheimer's Disease in Rats

BACKGROUND

Alzheimer's disease (AD) is a neurodegenerative disease associated with deficiency in motor coordination, cognitive impairment, and excessive reactive oxygen species production in the brain.

OBJECTIVE

The study evaluated effects of taurine and camel milk (CM) on neurobehavior, amyloid-beta peptide 1-42 (Aβ) expression, acetylcholinesterase, and superoxide dismutase activities in aluminum chloride (AlCl3) model of Alzheimer's disease in rats.

METHODS

Thirty-five female Wistar rats were divided into seven groups (n = 5): Normal saline (0.2 mL/kg body weight); AlCl3 (100 mg/kg) (AD); CM (33 mL/kg); Taurine (50 mg/kg); AlCl3 (100 mg/kg) + CM (33 mL/kg); AlCl3 (100 mg/kg) + Taurine (50 mg/kg); and AlCl3 (100 mg/kg) + CM (33 mL/kg) + Taurine (50 mg/kg). The administration lasted for eight weeks via oral gavage. After the eighth week, neurobehavior assessments were performed. Rats were sacrificed, and brain and blood samples collected for analysis.

RESULTS

There was a significant (p < 0.0001) increase in the duration of motor endurance in AD + CM rats, compared to AD rats. Duration of forced swimming time was lowest (p < 0.0001) in AlCl3 + Taurine rats, compared to that of AD rats. Concentration of Aβ peptide decreased (p < 0.05) in AD rats, treated with CM and/or combination. In taurine-treated rats, superoxide dismutase activity was significantly (p < 0.05) higher than in AD rats. Treatment with taurine + CM increased (p < 0.05) acetylcholinesterase activity compared to controls.

CONCLUSION

Taurine and CM enhanced cognition and sensorimotor activity by decreasing Aβ peptide concentration and increasing superoxide dismutase and acetylcholinesterase activities in AD rats.

Perturbation-based balance assessment: Examining reactive balance control in older adults with mild cognitive impairments

Background

Older adults with mild cognitive impairment (OAwMCI) present subtle balance and gait deficits along with subjective memory decline. Although these presentations might not affect activities of daily living (ADLs), they attribute to a two-folded increase in falls. While changes occurring in volitional balance control during ADLs have been extensively examined among OAwMCI, reactive balance control, required to recover from external perturbations, has received little attention. Therefore, this study examined reactive balance control in OAwMCI compared to their healthy counterparts.

Methods

Fifteen older adults with mild cognitive impairment (OAwMCI), fifteen cognitively intact older adults (CIOA) (>55 years), and fifteen young adults (18-30 years) were exposed to stance perturbations at three different intensities. Behavioral outcomes postural COM state stability, step length, step initiation, and step execution were computed.

Results

Postural COM state stability was the lowest in OAwMCI compared to CIOA and young adults, and it deteriorated at higher perturbation intensities (P < 0.001). Step length was the lowest among OAwMCI and was significantly different from young adults (P < 0.001) but not from CIOA. Unlike OAwMCI, CIOA and young adults increased their step length at higher perturbation intensities (P < 0.001). OAwMCI showed longer recovery step initiation times and shorter execution times compared to CIOA and young adults at higher perturbation intensities (P < 0.001).

Conclusion

OAwMCI exhibit exacerbated reactive instability and are unable to modulate their responses as the threat to balance control altered. Thus, they are at a significantly higher risk of falls than their healthy counterparts.

Effects of the nursing intervention Fall prevention in older adults with arterial hypertension using NANDA-I, NIC, and NOC

PURPOSE

To measure the effects of the NIC intervention fall prevention on the magnitude of the NANDA-I Risk for falls' risk factors and of NOC indicators related to falls in older adults with arterial hypertension.

BACKGROUND

Nurses can use nursing taxonomies to provide effective care in preventing falls in specific populations.

METHODS

Clinical, randomized, open, parallel, and multicenter trial following the CONSORT recommendations for nonpharmacological trials. The clinical trial was registered. The research was conducted with 118 older adults allocated to intervention and control groups and matched by sex and age. The intervention was conducted in the participants' homes in three different moments and consisted of nursing activities belonging to the NIC Fall prevention and implemented with the aid of a protocol with operational definitions.

FINDINGS

Three months after the intervention, there was a significant intergroup difference in the frequency of Risk for falls and of the following factors/conditions: cluttered environment, unfamiliar setting, exposure to unsafe weather-related condition, insufficient anti-slip material in the bathroom, history of falls, acute illness, orthostatic hypotension, hearing impairment, and impaired vision. There was also a positive change in the magnitude of the following NOC indicators: risk control, cognitive orientation, knowledge: fall prevention, safe home environment, comfort level, vision compensation behavior, and leisure participation.

CONCLUSIONS

The NIC intervention Fall prevention was effective in modifying risk factors belonging to Risk for falls and NOC indicators related to falls in older adults.

IMPLICATIONS FOR NURSING PRACTICE

The tested intervention is important and should be instituted, mainly by nurses from primary care services who make home visits to older adults.

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.

Physical performance across the cognitive spectrum and between dementia subtypes in a population-based sample of older adults: The HUNT study

BACKGROUND

Literature on physical performance in older adults across the cognitive spectrum remains inconclusive, and knowledge on differences between dementia subtypes is lacking. We aim to identify distinct physical-performance deficits across the cognitive spectrum and between dementia subtypes.

METHODS

11,466 persons were included from the 70-year-and-older cohort in the fourth wave of the Trøndelag Health Study (HUNT4 70+). Physical performance was assessed with the Short Physical Performance Battery (SPPB), 4-meter gait speed, five-times-sit-to-stand (FTSS), grip strength and one-leg-standing (OLS). Clinical experts diagnosed dementia per DSM-5 criteria. Multiple linear and logistic regression were performed to analyze differences between groups. Age, sex, education, somatic comorbidity, physical activity and smoking status were used as covariates.

RESULTS

Gait speed declined across the cognitive spectrum, beginning in people with subjective cognitive decline (SCD). Participants with mild cognitive impairment (MCI) additionally showed reduced lower-limb muscle strength, balance and grip strength. Those with dementia scored lowest on all physical-performance measures. Participants with Alzheimer's disease (AD) had a higher SPPB sum score and faster gait speed than participants with vascular dementia (VaD) and Lewy body dementia (LBD); participants with VaD and LBD had lower odds of being able to perform FTSS and OLS than participants with AD.

CONCLUSIONS

Physical performance declined across the spectrum from cognitively healthy to SCD to MCI and to dementia. Participants with AD performed better on all assessments except grip strength than participants with VaD and LBD. Stage of cognitive impairment and dementia subtype should guide exercise interventions to prevent mobility decline and dependency.

Deterioration, Compensation and Motor Control Processes in Healthy Aging, Mild Cognitive Impairment and Alzheimer's Disease

Aging is associated with modifications of several brain structures and functions. These modifications then manifest as modified behaviors. It has been proposed that some brain function modifications may compensate for some other deteriorated ones, thus maintaining behavioral performance. Through the concept of compensation versus deterioration, this article reviews the literature on motor function in healthy and pathological aging. We first highlight mechanistic studies that used paradigms, allowing us to identify precise compensation mechanisms in healthy aging. Subsequently, we review studies investigating motor function in two often-associated neurological conditions, i.e., mild cognitive impairment and Alzheimer's disease. We point out the need to expand the knowledge gained from descriptive studies with studies targeting specific motor control processes. Teasing apart deteriorated versus compensating processes represents precious knowledge that could significantly improve the prevention and rehabilitation of age-related loss of mobility.

Translational Modeling of Psychomotor Function in Normal and AD-Pathological Aging With Special Concerns on the Effects of Social Isolation

One year after the start of the COVID-19 pandemic, its secondary impacts can be globally observed. Some of them result from physical distancing and severe social contact restrictions by policies still imposed to stop the fast spread of new variants of this infectious disease. People with Alzheimer's disease (AD) and other dementias can also be significantly affected by the reduction of their activity programs, the loss of partners, and social isolation. Searching for the closest translational scenario, the increased mortality rates in male 3xTg-AD mice modeling advanced stages of the disease can provide a scenario of “naturalistic isolation.” Our most recent work has shown its impact worsening AD-cognitive and emotional profiles, AD-brain asymmetry, and eliciting hyperactivity and bizarre behaviors. Here, we further investigated the psychomotor function through six different psychomotor analysis in a set of 13-month-old 3xTg-AD mice and their non-transgenic counterparts with normal aging. The subgroup of male 3xTg-AD mice that lost their partners lived alone for the last 2–3 months after 10 months of social life. AD's functional limitations were shown as increased physical frailty phenotype, poor or deficient psychomotor performance, including bizarre behavior, in variables involving information processing and decision-making (exploratory activity and spontaneous gait), that worsened with isolation. Paradoxical muscular strength and better motor performance (endurance and learning) was shown in variables related to physical work and found enhanced by isolation, in agreement with the hyperactivity and the appearance of bizarre behaviors previously reported. Despite the isolation, a delayed appearance of motor deficits related to physical resistance and tolerance to exercise was found in the 3xTg-AD mice, probably because of the interplay of hyperactivity and mortality/survivor bias. The translation of these results to the clinical setting offers a guide to generate flexible and personalized rehabilitation strategies adaptable to the restrictions of the COVID-19 pandemic.

Measurement of Human Walking Movements by Using a Mobile Health App: Motion Sensor Data Analysis

Background

This study presents a new approach to measure and analyze the walking balance of humans by collecting motion sensor data in a smartphone.

Objective

We aimed to develop a mobile health (mHealth) app that can measure the walking movements of human individuals and analyze the differences in the walking movements of different individuals based on their health conditions. A smartphone’s motion sensors were used to measure the walking movements and analyze the rotation matrix data by calculating the variation of each xyz rotation, which shows the variables in walking-related movement data over time.

Methods

Data were collected from 3 participants, that is, 2 healthy individuals (1 female and 1 male) and 1 male with back pain. The participant with back pain injured his back during strenuous exercise but he did not have any issues in walking. The participants wore the smartphone in the middle of their waistline (as the center of gravity) while walking. They were instructed to walk straight at their own pace in an indoor hallway of a building. The walked a distance of approximately 400 feet. They walked for 2-3 minutes in a straight line and then returned to the starting location. A rotation vector in the smartphone, calculated by the rotation matrix, was used to measure the pitch, roll, and yaw angles of the human body while walking. Each xyz-rotation vector datum was recalculated to find the variation in each participant’s walking movement.

Results

The male participant with back pain showed a diminished level of walking balance with a wider range of xyz-axis variations in the rotations compared to those of the healthy participants. The standard deviation in the xyz-axis of the male participant with back pain was larger than that of the healthy male participant. Moreover, the participant with back pain had the widest combined range of right-to-left and forward-to-backward motions. The healthy male participant showed smaller standard deviation while walking than the male participant with back pain and the female healthy participant, indicating that the healthy male participant had a well-balanced walking movement. The walking movement of the female healthy participant showed symmetry in the left-to-right (x-axis) and up-to-down (y-axis) motions in the x-y variations of rotation vectors, indicating that she had lesser bias in gait than the others.

Conclusions

This study shows that our mHealth app based on smartphone sensors and rotation vectors can measure the variations in the walking movements of different individuals. Further studies are needed to measure and compare walking movements by age, gender, as well as types of health problems or disease. This app can help in finding differences in gait in people with diseases that affect gait.

Associations between Cognition and Hand Function in Older People Diagnosed with Mild Cognitive Impairment or Dementia

Background/Aims

The aim of this study was to examine the associations between different cognitive domains and hand function in older people diagnosed with mild cognitive impairment (MCI) or dementia.

Methods

This study is cross-sectional, including 98 community-living older people aged ≥65 years with MCI or dementia. Assessments of hand function included grip strength, the Finger Tapping Test, and the Grooved Pegboard. Cognitive assessments were the Mini-Mental State Examination, the Clock Drawing Test, and Trail Making Tests A and B, as well as a 10-word List Learning Test. Statistical analyses were based on descriptive statistics and univariable and multivariable analyses.

Results

Sixty participants were diagnosed with MCI and 38 were diagnosed with dementia. The mean age was 78.8 years (SD 7.4). Analyses of hand function, cognitive tests, and demographic factors showed an association between cognitive tests, in particular executive function (EF), and hand function.

Conclusions

The findings indicated an association between physical and cognitive function. Among the cognitive domains, declines in EF were most related to a reduced physical function.

Associations between post-stroke motor and cognitive function: a cross-sectional study

BACKGROUND

Motor and cognitive impairments are frequently observed following stroke, but are often managed as distinct entities, and there is little evidence regarding how they are related. The aim of this study was to describe the prevalence of concurrent motor and cognitive impairments 3 months after stroke and to examine how motor performance was associated with memory, executive function and global cognition.

METHODS

The Norwegian Cognitive Impairment After Stroke (Nor-COAST) study is a prospective multicentre cohort study including patients hospitalized with acute stroke between May 2015 and March 2017. The National Institutes of Health Stroke Scale (NIHSS) was used to measure stroke severity at admission. Level of disability was assessed by the Modified Rankin Scale (mRS). Motor and cognitive functions were assessed 3 months post-stroke using the Montreal Cognitive Assessment (MoCA), Trail Making Test Part B (TMT-B), 10-Word List Recall (10WLR), Short Physical Performance Battery (SPPB), dual-task cost (DTC) and grip strength (Jamar®). Cut-offs were set according to current recommendations. Associations were examined using linear regression with cognitive tests as dependent variables and motor domains as covariates, adjusted for age, sex, education and stroke severity.

RESULTS

Of 567 participants included, 242 (43%) were women, mean (SD) age was 72.2 (11.7) years, 416 (75%) had an NIHSS score ≤ 4 and 475 (84%) had an mRS score of ≤2. Prevalence of concurrent motor and cognitive impairment ranged from 9.5% for DTC and 10WLR to 22.9% for grip strength and TMT-B. SPPB was associated with MoCA (regression coefficient B = 0.465, 95%CI [0.352, 0.578]), TMT-B (B = -9.494, 95%CI [- 11.726, - 7.925]) and 10WLR (B = 0.132, 95%CI [0.054, 0.211]). Grip strength was associated with MoCA (B = 0.075, 95%CI [0.039, 0.112]), TMT-B (B = -1.972, 95%CI [- 2.672, - 1.272]) and 10WLR (B = 0.041, 95%CI [0.016, 0.066]). Higher DTC was associated with more time needed to complete TMT-B (B = 0.475, 95%CI [0.075, 0.875]) but not with MoCA or 10WLR.

CONCLUSION

Three months after suffering mainly minor strokes, 30-40% of participants had motor or cognitive impairments, while 20% had concurrent impairments. Motor performance was associated with memory, executive function and global cognition. The identification of concurrent impairments could be relevant for preventing functional decline.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02650531 .

2D Virtual Reality-Based Exercise Improves Spatial Navigation in Institutionalized Non-robust Older Persons: A Preliminary Data Report of a Single-Blind, Randomized, and Controlled Study

Background: Spatial navigation is a prodromal dementia marker. Exercise used alongside virtual reality improves many cognitive functions, but effects on spatial navigation are still unclear.

Objective: To investigate the effect of virtual reality-based physical exercise with 2D exergames on spatial navigation in institutionalized non-robust older persons.

Method: A total of 14 older persons (aged ≧ 60) were randomly allocated to the exergame (EG) and active control (ACG) groups. EG performed exercises with 2D exergames, while the ACG used the same movements as the EG, but without the use of virtual reality. Spatial navigation was assessed through the Floor Maze Test, where the immediate maze time (IMT) and delayed maze time (DMT) were recorded.

Results: Spatial navigation was enhanced in EG participants compared to ACG individuals. A significant (p = 0.01) IMT reduction between groups was observed, while DMT time without prior planning was significantly different at the significance threshold (p = 0.07).

Conclusions: Virtual reality-based exercise improves the spatial navigation of institutionalized non-robust older persons. This study should be replicated to confirm the findings reported herein.

Clinical Trial Registration: This study was registered in the Brazilian Registry of Clinical Trials (Protocol RBR-8dv3kg - https://ensaiosclinicos.gov.br/rg/RBR-8dv3kg).

The Effect of Cognitive Rehabilitation on Balance Skills of Individuals with Multiple Sclerosis

Balance skills can be affected by slow information processing speed in people with multiple sclerosis. This study explored the effect of cognitive-based rehabilitation on balance skills of individuals with multiple sclerosis. Seventy-one participants with multiple sclerosis were randomly assigned to the usual occupational therapy exercises as a control group (n = 36, male = 10) or the cognitive rehabilitation group (n = 35, male = 10). Using several assessments pre-intervention, post-intervention and two months after completion, participants in the cognitive rehabilitation group showed significant improvement in their balance skills in post-test and as well as follow-up measurements compared to the control group. Results also showed a large effect of cognitive rehabilitation for balance (eta-squared= 0.59) and for information processing speed measured. Inclusion of tasks related to information processing speed to the usual occupational therapy exercises seemed to be able to improve the balance skills of people with multiple sclerosis.

Effects of 6-Month Multimodal Physical Exercise Program on Bone Mineral Density, Fall Risk, Balance, and Gait in Patients with Alzheimer's Disease: A Controlled Clinical Trial

We aimed to determine the short- and medium-term effects of a multimodal physical exercise program (MPEP) on bone health status, fall risk, balance, and gait in patients with Alzheimer’s disease. A single-blinded, controlled clinical trial was performed where 72 subjects were allocated in a 3:1 ratio to an intervention group (IG; n = 53) and control group (CG; n = 19), where the IG’s subjects were admitted to live in a State Reference Center of Alzheimer’s disease, which offers the targeted exercise program, while the CG’s subjects resided in independent living. A multidisciplinary health team assessed all patients before allocation, and dependent outcomes were again assessed at one, three, and six months. During the study, falls were recorded, and in all evaluations, bone mineral density was measured using a calcaneal quantitative ultrasound densitometer; balance and gait were measured using the performance-oriented mobility assessment (POMA), the timed up and go test (TUG), the one-leg balance test (OLB), and the functional reach test (FR). There were no differences between groups at baseline for all outcome measures. The prevalence of falls was significantly lower in the IG (15.09%) than in the CG (42.11%) (χ² = 5.904; p = 0.015). We also found that there was a significant time*group interaction, with a post hoc Šidák test finding significant differences of improved physical function, especially in gait, for the IG, as assessed by POMA-Total, POMA-Gait, and TUG with a large effect size (ƞ²p = 0.185–0.201). In balance, we found significant differences between groups, regardless of time, and a medium effect size as assessed by POMA-Balance and the OLB (ƞ²p = 0.091–0.104). Clinically relevant effects were observed, although without significant differences in bone health, with a slowing of bone loss. These results show that a multimodal physical exercise program reduces fall risk and produces an improvement in gait, balance, and bone mineral density in the short and medium term in institutionalized patients with Alzheimer’s disease.

Relationships between Cognitive Function and Odor Identification, Balance Capability, and Muscle Strength in Middle-Aged Persons with and without Type 2 Diabetes

AIM

We investigated the relationship between cognitive function and olfactory and physical functions in middle-aged persons with and without type 2 diabetes (T2D) to examine the potential of olfactory and physical functions as biomarkers for early cognitive impairment.

METHODS

Enrolled were 70 T2D patients (age 40 to <65 y) and 81 age-matched control participants without diabetes. Cognitive function was assessed by the Montreal Cognitive Assessment (MoCA), Trail Making Test parts A and B (TMT-A/-B), Wisconsin Card Sorting Test (WCST), Quick Inventory of Depressive Symptomatology Self-Report (QIDS), and Starkstein Apathy Scale (SAS). Multiple linear regression analyses were performed.

RESULTS

Odor identification was an independent determinant shown in the results of the TMT-A in the entire participant group and was independently associated with the MoCA and TMT-B in the T2D group. Balance capability assessed with a stabilometer was independently associated with all cognitive function tests except for QISD and SAS in the entire participant group and the T2D group and was independently associated with TMT-A in the control group. Knee extension strength was independently associated with the SAS in the entire participant group and the T2D group.

CONCLUSIONS

Odor identification, balance capability, and knee extension strength were potential markers for cognitive decline in middle-aged persons with T2D.

Effects of Multicomponent Exercise on Cognitive Performance and Fall Risk in Older Women with Mild Cognitive Impairment

BACKGROUND

Emerging evidence suggests that multicomponent exercise provides greater benefits for physical and cognitive function than single component exercise. However, few studies have been conducted to determine these effects in older adults with mild cognitive impairment (MCI) and findings have been less conclusive. It has been reported that older women have a greater risk of falls and a higher incidence of dementia than men.

OBJECTIVES

To examine the effects of multicomponent exercise on cognitive performance and fall risk in older women with MCI.

DESIGN

An experimental design comparing the exercise and control groups.

SETTING AND PARTICIPANTS

Forty community-dwelling older women with MCI were allocated to the exercise (n = 20) and control (n = 20) groups.

INTERVENTION

Twelve weeks of multicomponent exercise program (aerobic, resistance, and balance exercise) 60 mins/day, 3 days/week.

MEASUREMENT

Cognitive performance including the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) and Trail Making Test (TMT) and fall risk including the Timed Up and Go (TUG) single-, dual-task, and Physiological Profile Assessment (PPA) were administered before and after the 12-week exercise program.

RESULTS

At the end of the 12-week training, participants in the exercise group had a significantly greater improvement in TMT part A (p < 0.05), TUG dual-task (p < 0.05), and PPA composite score (p < 0.05) when compared to the control group. The exercise group also demonstrated significant improvement in TUG dual-task, PPA composite score, PPA subcomponents including postural sway and reaction time when compared to baseline (p < 0.05). In contrast, at 12-week, the control group showed a decline in TUG dual-task performance as compared to baseline (p < 0.05).

CONCLUSION

The 12-week multicomponent exercise improved attention, dual-task ability, and reduced risk of falling in older women with mild cognitive impairment.