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Kerminen H, Marzetti E, D’Angelo E. Biological and Physical Performance Markers for Early Detection of Cognitive Impairment in Older Adults. J Clin Med 2024; 13:806. [PMID: 38337499 PMCID: PMC10856537 DOI: 10.3390/jcm13030806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Dementia is a major cause of poor quality of life, disability, and mortality in old age. According to the geroscience paradigm, the mechanisms that drive the aging process are also involved in the pathogenesis of chronic degenerative diseases, including dementia. The dissection of such mechanisms is therefore instrumental in providing biological targets for interventions and new sources for biomarkers. Within the geroscience paradigm, several biomarkers have been discovered that can be measured in blood and that allow early identification of individuals at risk of cognitive impairment. Examples of such markers include inflammatory biomolecules, markers of neuroaxonal damage, extracellular vesicles, and DNA methylation. Furthermore, gait speed, measured at a usual and fast pace and as part of a dual task, has been shown to detect individuals at risk of future dementia. Here, we provide an overview of available biomarkers that may be used to gauge the risk of cognitive impairment in apparently healthy older adults. Further research should establish which combination of biomarkers possesses the highest predictive accuracy toward incident dementia. The implementation of currently available markers may allow the identification of a large share of at-risk individuals in whom preventive interventions should be implemented to maintain or increase cognitive reserves, thereby reducing the risk of progression to dementia.
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Affiliation(s)
- Hanna Kerminen
- Faculty of Medicine and Health Technology, Gerontology Research Center (GEREC), Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland;
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Emanuele Marzetti
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy;
| | - Emanuela D’Angelo
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy;
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Al-Hammadi M, Fleyeh H, Åberg AC, Halvorsen K, Thomas I. Machine Learning Approaches for Dementia Detection Through Speech and Gait Analysis: A Systematic Literature Review. J Alzheimers Dis 2024; 100:1-27. [PMID: 38848181 DOI: 10.3233/jad-231459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Background Dementia is a general term for several progressive neurodegenerative disorders including Alzheimer's disease. Timely and accurate detection is crucial for early intervention. Advancements in artificial intelligence present significant potential for using machine learning to aid in early detection. Objective Summarize the state-of-the-art machine learning-based approaches for dementia prediction, focusing on non-invasive methods, as the burden on the patients is lower. Specifically, the analysis of gait and speech performance can offer insights into cognitive health through clinically cost-effective screening methods. Methods A systematic literature review was conducted following the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The search was performed on three electronic databases (Scopus, Web of Science, and PubMed) to identify the relevant studies published between 2017 to 2022. A total of 40 papers were selected for review. Results The most common machine learning methods employed were support vector machine followed by deep learning. Studies suggested the use of multimodal approaches as they can provide comprehensive and better prediction performance. Deep learning application in gait studies is still in the early stages as few studies have applied it. Moreover, including features of whole body movement contribute to better classification accuracy. Regarding speech studies, the combination of different parameters (acoustic, linguistic, cognitive testing) produced better results. Conclusions The review highlights the potential of machine learning, particularly non-invasive approaches, in the early prediction of dementia. The comparable prediction accuracies of manual and automatic speech analysis indicate an imminent fully automated approach for dementia detection.
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Affiliation(s)
- Mustafa Al-Hammadi
- School of Information and Engineering, Dalarna University, Falun, Sweden
| | - Hasan Fleyeh
- School of Information and Engineering, Dalarna University, Falun, Sweden
| | - Anna Cristina Åberg
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
| | | | - Ilias Thomas
- School of Information and Engineering, Dalarna University, Falun, Sweden
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Åberg AC, Petersson JR, Giedraitis V, McKee KJ, Rosendahl E, Halvorsen K, Berglund L. Prediction of conversion to dementia disorders based on timed up and go dual-task test verbal and motor outcomes: a five-year prospective memory-clinic-based study. BMC Geriatr 2023; 23:535. [PMID: 37660032 PMCID: PMC10475186 DOI: 10.1186/s12877-023-04262-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/28/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND While assessment tools can increase the detection of cognitive impairment, there is currently insufficient evidence regarding clinical outcomes based on screening for cognitive impairment in older adults. METHODS The study purpose was to investigate whether Timed Up and Go dual-task test (TUGdt) results, based on TUG combined with two different verbal tasks (name different animals, TUGdt-NA, and recite months in reverse order, TUGdt-MB), predicted dementia incidence over a period of five years among patients (N = 186, mean = 70.7 years; 45.7% female) diagnosed with Subjective Cognitive Impairment (SCI) and Mild Cognitive Impairment (MCI) following assessment at two memory clinics. Associations between TUG parameters and dementia incidence were examined in Cox regression models. RESULTS During follow-up time (median (range) 3.7 (0.1-6.1) years) 98 participants converted to dementia. Novel findings indicated that the TUGdt parameter words/time, after adjustment for age, gender, and education, can be used for the prediction of conversion to dementia in participants with SCI or MCI over a period of five years. Among the TUG-related parameters investigated, words/time showed the best predictive capacity, while time scores of TUG and TUGdt as well as TUGdt cost did not produce significant predictive results. Results further showed that the step parameter step length during TUGdt predicts conversion to dementia before adjustment for age, gender, and education. Optimal TUGdt cutoffs for predicting dementia at 2- and 4-year follow-up based on words/time were calculated. The sensitivity of the TUGdt cutoffs was high at 2-year follow-up: TUGdt-NA words/time, 0.79; TUGdt-MB words/time, 0.71; reducing respectively to 0.64 and 0.65 at 4-year follow-up. CONCLUSIONS TUGdt words/time parameters have potential as cost-efficient tools for conversion-to-dementia risk assessment, useful for research and clinical purposes. These parameters may be able to bridge the gap of insufficient evidence for such clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05893524: https://www. CLINICALTRIALS gov/study/NCT05893524?id=NCT05893524&rank=1 .
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Affiliation(s)
- Anna Cristina Åberg
- School of Health and Welfare, Dalarna University, 791 88, Falun, Sweden.
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala Universit, y, Box 564, 52 37, UPPSALA, Sweden.
| | - Johanna R Petersson
- School of Health and Welfare, Dalarna University, 791 88, Falun, Sweden
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala Universit, y, Box 564, 52 37, UPPSALA, Sweden
| | - Vilmantas Giedraitis
- School of Health and Welfare, Dalarna University, 791 88, Falun, Sweden
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala Universit, y, Box 564, 52 37, UPPSALA, Sweden
| | - Kevin J McKee
- School of Health and Welfare, Dalarna University, 791 88, Falun, Sweden
| | - Erik Rosendahl
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, 90187, Umeå, Sweden
| | - Kjartan Halvorsen
- School of Health and Welfare, Dalarna University, 791 88, Falun, Sweden
- Department of Mechatronics, School of Engineering and Sciences, Campus Estado de Mexico, Tecnologico de Monterrey, Atizapan, Mexico, Carretera Lago de Guadalupe Km 3.5, 52926, Atizapan, Estado de Mexico, Mexico
| | - Lars Berglund
- School of Health and Welfare, Dalarna University, 791 88, Falun, Sweden
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala Universit, y, Box 564, 52 37, UPPSALA, Sweden
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Wang J, Hong JT, Xiang Y, Zhang C. Do the dual-task "8-foot up and go" tests provide additional predictive value for early detection of cognitive decline in community-dwelling older women? Aging Clin Exp Res 2022; 34:2431-2439. [PMID: 35838984 DOI: 10.1007/s40520-022-02193-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/28/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The 8-Foot Up and Go (8UG) test is a widely used mobility assessment. Some dual-task mobility assessments have been developed to help detect cognitive decline. AIMS This study developed a dual-task version of 8UG test to investigate the dual-task 8UG performance and to evaluate the ability of dual-task 8UG test in detecting cognitive decline. METHODS A total of 101 eligible community-dwelling women aged 60-74 years were grouped into the mild cognitive impairment group (MCI, n = 49) and the non-cognitive impairment group (NCI, n = 52). The 8UG tests under single-task (ST), manual dual-task (MT), and cognitive dual-task (CT) conditions were performed respectively. The dual-task cost (DTC) and the correct response rate (CRR) were calculated to quantify the dual-task interference. RESULTS Participants spent more time in performing the 8UG test under dual-task conditions. No differences were observed between NCI and MCI groups for 8UG parameters under ST and MT conditions (p > 0.05). When executing CT, significant differences were found in the number of correct answers and CRR (p < 0.05). CRR showed the strongest ability to predict MCI with a cut-off point of 0.50 (71.2% sensitivity and 61.2% specificity). DISCUSSION Both manual and cognitive dual-task were found to interfere with the 8UG performance. CRR with cutoff point of 0.50 could be a potential predictor of MCI in community-dwelling older women. CONCLUSIONS The CRR of the cognitive dual-task 8UG test could be recommended as a potential predictor for the early detection of MCI in community-dwelling older women.
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Affiliation(s)
- Jingjing Wang
- School of Exercise and Health, Shanghai University of Sport, Yangpu District, 650 Qing Yuan Huan Rd, Shanghai, 200438, China.,Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, 200030, China
| | - Jin-Tao Hong
- Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, 200030, China
| | - Yun Xiang
- School of Exercise and Health, Shanghai University of Sport, Yangpu District, 650 Qing Yuan Huan Rd, Shanghai, 200438, China.,School of Physical Education, Hubei Engineering University, Xiaogan, 432000, Hubei, China
| | - Chunhua Zhang
- School of Exercise and Health, Shanghai University of Sport, Yangpu District, 650 Qing Yuan Huan Rd, Shanghai, 200438, China.
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Longhurst JK, Cummings JL, John SE, Poston B, Rider JV, Salazar AM, Mishra VR, Ritter A, Caldwell JZ, Miller JB, Kinney JW, Landers MR. Dual Task Performance Is Associated with Amyloidosis in Cognitively Healthy Adults. J Prev Alzheimers Dis 2022; 9:297-305. [PMID: 35543003 PMCID: PMC9286710 DOI: 10.14283/jpad.2022.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preclinical Alzheimer's disease (AD) provides an opportunity for the study and implementation of interventions and strategies aimed at delaying, mitigating, and preventing AD. While this preclinical state is an ideal target, it is difficult to identify efficiently and cost-effectively. Recent findings have suggested that cognitive-motor dual task paradigms may provide additional inference. OBJECTIVES Investigate the relationship between dual task performance and amyloidosis, suggestive of preclinical Alzheimer's disease and whether dual task performance provides additional information beyond a cognitive composite, to help in the identification of amyloidosis. DESIGN Cross-sectional. SETTING Outpatient specialty brain health clinical research institution in the United States. PARTICIPANTS 52 cognitively healthy adults. MEASUREMENTS The data included demographics, amyloid standardized uptake value ratio obtained via florbetapir-PET, neuropsychological testing, apolipoprotien E genotype, and dual task performance measures. Data were analyzed via hierarchal multiple linear regression or logistic regression, controlling for age, education, and apolipoprotien E genotype. Receiver operating characteristic curves were plotted, and sensitivity and specificity calculated via 2x2 contingency tables. RESULTS There was a moderate relationship (rs>.30) between motor and cognitive dual task effects and amyloid standardized uptake value ratio (ps<.042). A strong relationship (r=.58) was found between combined dual task effect, a measure of automaticity derived from dual task performance, and amyloid standardized uptake value ratio (p<.001). Additionally, combined dual task effect showed promise in its unique contributions to amyloid standardized uptake value ratio, accounting for 7.8% of amyloid standardized uptake value ratio variance beyond cognitive composite scores (p=.018). Additionally, when incorporated into the cognitive composite, combined dual task effect resulted in improved diagnostic accuracy for determining elevated amyloid standardized uptake value ratio, and increased the sensitivity and specificity of the cognitive composite. CONCLUSSION Dual task performance using the combined dual task effect, a measure of automaticity, was a moderate predictor of cerebral amyloidosis, which suggests that it has utility in the screening and diagnosis of individuals for preclinical AD. Additionally, when combined with the cognitive composite, the combined dual task effect improves diagnostic accuracy. Further research is warranted.
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Affiliation(s)
- J K Longhurst
- Jason K. Longhurst, PT, DPT, PHD, Department of Physical Therapy and Athletic Training, Saint Louis University, Saint Louis, Missouri, USA, 63104, , tel: 314-977-8533, fax: 314-977-8513
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Ramírez F, Gutiérrez M. Dual-Task Gait as a Predictive Tool for Cognitive Impairment in Older Adults: A Systematic Review. Front Aging Neurosci 2021; 13:769462. [PMID: 35002676 PMCID: PMC8740025 DOI: 10.3389/fnagi.2021.769462] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/06/2021] [Indexed: 01/21/2023] Open
Abstract
The use of the dual-task model as a cognitive-motor interface has been extensively investigated in cross-sectional studies as a training task in cognitive impairment. However, few existing longitudinal studies prove the usefulness of this tool as a clinical marker of cognitive impairment in older people. What is the evidence in prospective studies about dual-task gait as a predictor of cognitive impairment in older adults? This study aims to review and discuss the current state of knowledge in prospective studies on the use of dual-task gait as a predictive tool for cognitive impairment in older adults. The methodology used was a systematic review, according to the PRISMA criteria for the search, summarize and report. A search in 3 databases (Pubmed, Web of Science, and Scopus) was carried out until April 2021. The search terms used were: "(gait OR walking) AND (cognitive decline) AND (dual-task) AND (follow-up OR longitudinal OR long-term OR prospective OR cohort OR predict)." We included prospective research articles with older people with cognitive evaluation at the beginning and the end of the follow-up and dual-task gait paradigm as initial evaluation associated with the presentation of cognitive impairment prediction using any dual-task gait parameters. After exclusion criteria, 12 studies were reviewed. The results indicate that eight studies consider dual-task gait parameters a useful cognitive-motor tool, finding that some of the evaluated parameters of dual-task gait significantly correlate with cognitive impairment over time. The most promising DT parameters associated with cognitive impairment prediction seem to be gait speed, speed cost, DT time, numbers of words during DT, among others. In sum, this study reviews the variety of dual-task gait parameters and their relevance as a simple tool for early cognitive impairment screening, opening a diagnostic window for the screening of cognitive impairment in older people.
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Affiliation(s)
- Felipe Ramírez
- Programa Magíster en Kinesiología Gerontológica, Facultad de Ciencias, Universidad Mayor, Santiago, Chile
| | - Myriam Gutiérrez
- Escuela de Kinesiología, Facultad de Ciencias de la Salud, Universidad de Las Américas, Santiago, Chile
- Centro de Estudio del Movimiento Humano, Escuela de Kinesiología, Facultad de Odontología y Salud, Universidad Diego Portales, Santiago, Chile
- Unidad de Cerebro Saludable, Hospital Clínico Universidad de Chile, Santiago, Chile
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Kasiukiewicz A, Magnuszewski L, Swietek M, Wojszel ZB. The Performance of Dual-Task Tests Can Be a Combined Neuro-Psychological and Motor Marker of Mild Cognitive Impairment, Depression and Dementia in Geriatric Patients-A Cross-Sectional Study. J Clin Med 2021; 10:5358. [PMID: 34830639 PMCID: PMC8620119 DOI: 10.3390/jcm10225358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/25/2021] [Accepted: 11/10/2021] [Indexed: 01/10/2023] Open
Abstract
The study aims to assess the performance of dual-task tests in the geriatric population and their association with the cognitive status of the patients. METHODS Patients admitted to the Department of Geriatrics, Hospital of the Ministry of Interior and Administration on Bialystok, Poland, in 2019 and 2020 were enrolled in the study. Data on the patients' clinical, functional, and cognitive status were collected based on the comprehensive geriatric assessment. Dual-task tests included Timed Up and Go (TUG) test while counting backward (CB7), enumerating animals (EA), and holding a cup (TUG M). RESULTS 250 patients were included in the study, with a median age of 81.5 years (IQR 76-86) and most above 75 years of age (80.8%). Only 29 (11.6%) of study participants had no cognitive or mood disorders. Depression was diagnosed in 30.4%, MCI in 12%, and dementia in 38.4% of cases with median Mini-Mental Score Evaluation (MMSE) 17 (12-20) points. Dual-task TUG CB7 results did not differ between cognitive conditions of patients. TUG EA differed between healthy controls and other cognitive groups and TUG between healthy controls and depression and dementia, but not mild cognitive impairment (MCI). The performance of all dual-task tests differed in patients with and without dementia. Ability to finish TUG CB7 was low even in the group without dementia. There were statistically significant differences in median scores of MMSE and Clock Drawing Test (CDT) between patients who were able or not to finish single and dual-task gait tests. CONCLUSION Dual-task test results and the performance of these tasks can differentiate patients with depression, MCI and dementia compared to healthy controls in the geriatric population.
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Affiliation(s)
- Agnieszka Kasiukiewicz
- Department of Geriatrics, Medical University of Bialystok, 15-471 Bialystok, Poland;
- Department of Geriatrics, Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland; (L.M.); (M.S.)
| | - Lukasz Magnuszewski
- Department of Geriatrics, Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland; (L.M.); (M.S.)
- Doctoral Studies, Department of Geriatrics, Faculty of Health Sciences, Medical University of Bialystok, 15-471 Bialystok, Poland
| | - Marta Swietek
- Department of Geriatrics, Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland; (L.M.); (M.S.)
- Doctoral Studies, Department of Geriatrics, Faculty of Health Sciences, Medical University of Bialystok, 15-471 Bialystok, Poland
| | - Zyta Beata Wojszel
- Department of Geriatrics, Medical University of Bialystok, 15-471 Bialystok, Poland;
- Department of Geriatrics, Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland; (L.M.); (M.S.)
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Extraction of gait parameters from marker-free video recordings of Timed Up-and-Go tests: Validity, inter- and intra-rater reliability. Gait Posture 2021; 90:489-495. [PMID: 34628196 DOI: 10.1016/j.gaitpost.2021.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND We study dual-task performance with marker-free video recordings of Timed Up-and-Go tests (TUG) and TUG combined with a cognitive/verbal task (TUG dual-task, TUGdt). RESEARCH QUESTION Can gait parameters be accurately estimated from video-recorded TUG tests by a new semi-automatic method aided by a technique for human 2D pose estimation based on deep learning? METHODS Thirty persons aged 60-85 years participated in the study, conducted in a laboratory environment. Data were collected by two synchronous video-cameras and a marker-based optoelectronic motion capture system as gold standard, to evaluate the gait parameters step length (SL), step width (SW), step duration (SD), single-stance duration (SSD) and double-stance duration (DSD). For reliability evaluations, data processing aided by a deep neural network model, involved three raters who conducted three repetitions of identifying anatomical keypoints in recordings of one randomly selected step from each of the participants. Validity was analysed using 95 % confidence intervals (CI) and p-values for method differences and Bland-Altman plots with limits of agreement. Inter- and intra-rater reliability were calculated as intraclass correlation coefficients (ICC) and standard errors of measurement. Smallest detectable change was calculated for inter-rater reliability. RESULTS Mean ddifferences between video and the motion capture system data for SW, DSD, and SSD were significant (p < 0.001). However, mean differences for all parameters were small (-6.4%-13.0% of motion capture system) indicating good validity. Concerning reliability, almost all 95 % CI of the ICC estimates exceeded 0.90, indicating excellent reliability. Only inter-rater reliability for SW (95 % CI = 0.892;0.973) and one rater's intra-rater reliability for SSD (95 % CI = 0.793;0.951) were lower, but still showed good to excellent reliability. SIGNIFICANCE The presented method for extraction of gait parameters from video appears suitable for valid and reliable quantification of gait. This opens up for analyses that may contribute to the knowledge of cognitive-motor interference in dual-task testing.
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Åhman HB, Berglund L, Cedervall Y, Giedraitis V, McKee KJ, Rosendahl E, Åberg AC. Timed "Up & Go" Dual-Task Tests: Age- and Sex-Specific Reference Values and Test-Retest Reliability in Cognitively Healthy Controls. Phys Ther 2021; 101:6323192. [PMID: 34272869 PMCID: PMC8557829 DOI: 10.1093/ptj/pzab179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/22/2021] [Accepted: 05/20/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of the study was to establish reference values for the Uppsala-Dalarna Dementia and Gait (UDDGait) Timed "Up & Go" dual-task (TUGdt) test variables in cognitively healthy adults and to assess these variables' test-retest reliability. METHODS For reference values, 166 participants were recruited with approximately equal numbers and proportions of women and men in the age groups 50 to 59, 60 to 69, 70 to 79, and 80+ years (mean age = 70 years, age range = 50-91 years, 51% women). For reliability testing, 43 individuals (mean age = 69 years, age range = 50-89 years, 51% women) were recruited. Two dt tests were carried out: TUGdt naming animals and TUGdt months backward, representing 8 test variables: time scores, costs (the relative difference between single-task and dt time scores), "number of animals," "number of months," "animals/10 seconds ," and "months/10 seconds ." Reference ranges for the variables were established by quantile regression in age- and sex-specific groups. For reliability, intraclass correlation coefficients (ICCs), standard error of measurement, minimal detectable change, and Bland-Altman plots were used. RESULTS Reference values for the TUGdt test variables are presented for the 2.5th and 97.5th percentiles. The reliability of TUGdt time scores was excellent (ICCs between 0.85 and 0.86). "Number of animals" and "animals/10 seconds" as well as "months/10 seconds" showed fair to good levels of reliability (ICCs between 0.45 and 0.58), whereas the reliability for both cost measures and "number of months" was poor (ICCs between 0.34 and 0.39). CONCLUSION Normative reference values, potentially useful for clinical and research purposes, were presented in 4 age- and sex-specific groups from 50 years and older. Reliability for the test variables varied between poor and excellent, the lower estimates partly explained by some variables being the ratio of 2 other variables. In UDDGait, TUGdt tests are intended for diagnostic and predictive purposes, for which these tests are promising and require further investigations. IMPACT Normative reference values and test-retest reliability results for the UDDGait TUGdt test variables were presented. These results should be useful for both clinical and research purposes.
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Affiliation(s)
- Hanna B Åhman
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden,Address all correspondence to Ms Åhman at:
| | - Lars Berglund
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden,School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Ylva Cedervall
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
| | - Vilmantas Giedraitis
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
| | - Kevin J McKee
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Erik Rosendahl
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Anna Cristina Åberg
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden,School of Health and Welfare, Dalarna University, Falun, Sweden
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