Objective measurement of gait parameters in healthy and cognitively impaired elderly using the dual-task paradigm

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Abstract

Objectives

The present study explores the differences in gait parameters in elderly subjects with or without cognitive impairment measured by means of ambulatory actigraphy while performing a single and a dual task.

Methods

Sixty-nine participants of which 23 individuals were diagnosed with Alzheimer’s disease (AD), 24 individuals with mild cognitive impairment (MCI), and 22 healthy controls performed a single and dual walking task while wearing a wrist-worn accelerometer. Objective measures of gait features such as walking speed, cadence (i.e., number of steps per minute), and step variance (i.e., variance in time between two consecutive steps) were derived and analyzed.

Results

While differences in several gait parameters, namely walking speed, were found between MCI and AD patients, no differences between healthy elderly and MCI patients were found.

Conclusion

Walking speed seems to be a gait-related feature that differs significantly between MCI and AD patients and thus could be used as an additional measurement in clinical assessment. However, differences in gait may not be salient enough in the early stages of dementia to be detected by actigraphy. More research comparing different methods to measure gait in early stages of dementia under different dual task conditions is neccessary.

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Most cited references 24

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Attention and executive deficits in Alzheimer's disease. A critical review.

R Perry, J Hodges (1999)

In this review we summarize the progress that has been made in the research on attentional and executive deficits in Alzheimer's disease. Like memory, attention is now recognized as consisting of subtypes that differ in their function and anatomical basis. We base our review upon a classification of three subtypes of attention: selective, sustained and divided. This model derives from lesion studies, animal electrophysiological recordings and functional imaging. We examine how these subcomponents of attention can be reconciled with neuropsychological models of attentional control, particularly the Supervisory Attentional System and the Central Executive System of Shallice and Baddeley, respectively. We also discuss the relationship of attention to the concept of executive function. Current evidence suggests that after an initial amnesic stage in Alzheimer's disease, attention is the first non-memory domain to be affected, before deficits in language and visuospatial functions. This is consistent with the possibility that difficulties with activities of daily living, which occur in even mildly demented patients, may be related to attentional deficits. It appears that divided attention and aspects of selective attention, such as set-shifting and response selection, are particularly vulnerable while sustained attention is relatively preserved in the early stages. The phenomenon of cognitive slowing in Alzheimer's disease and normal ageing emphasizes the need to discriminate quantitative changes in attention dysfunction from qualitative changes which may be specifically related to the disease process. The neuropathological basis of these attentional deficits remains unsettled, with two competing hypotheses: spread of pathology from the medial temporal to basal forebrain structures versus corticocortical tract disconnection. Finally we discuss the difficulties of comparing evidence across studies and look at the implications for the design of future studies and future directions that may be fruitful in the research on attention in Alzheimer's disease.

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Disrupted daily activity/rest cycles in relation to daily cortisol rhythms of home-dwelling patients with early Alzheimer's dementia.

C Hatfield, J. Herbert, E J W van Someren … (2004)

Disturbed sleep cycles are the principal cause of institutionalization in dementia, and therefore represent a major clinical problem. They may arise from dysfunction within the circadian clock of the hypothalamus that times and consolidates wakefulness, or from neuropathology in output pathways and/or target sites of the clock specifically controlling sleep and wakefulness. To determine the relationship of disturbed activity cycles to other circadian clock-controlled rhythms, cross-sectional and longitudinal actigraphy and serial sampling of saliva were used to compare the impact of early Alzheimer's dementia on activity/rest and cortisol rhythms in home-dwelling subjects. Mildly demented subjects had daily activity rhythms comparable to those of healthy age-matched subjects. Moderately demented subjects exhibited a range of disturbances of the activity/rest cycle, with reduced stability, increased fragmentation and loss of amplitude. Within the moderately demented group, however, the degree of circadian disruption was not correlated with the individual severity of dementia. All groups of subjects, mild, moderate with normal activity cycles and moderate with abnormal activity cycles, exhibited robust daily profiles of salivary cortisol, with highest levels in the morning (08:00 h) and an evening nadir (20:00-24:00 h). Salivary cortisol levels tended to be higher in the moderately demented subjects in the afternoon, but this effect was not specific to those with abnormal activity/rest patterns. The actimetric data confirm that deterioration of activity/rest cycles is a common and progressive feature in home-dwelling Alzheimer's patients, occurring early in the disease but after the measurable onset of dementia. The maintenance of highly rhythmic daily cortisol profiles in association with disturbed activity profiles, both on an individual and on a group basis, demonstrates that loss of circadian control to activity/rest cycles is not a consequence of global circadian disruption in early dementia. Rather, pathology may develop in discrete elements of the circadian clockwork and/or its output systems that control activity/rest, sleep and wakefulness. Further characterization of this pathology will facilitate more effective management of sleep patterns in home-dwelling demented patients.

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Mild cognitive impairment: prevalence, prognosis, aetiology, and treatment.

Charles DeCarli (2002)

Mild cognitive impairment (MCI) is a recently described syndrome that is currently thought of as a transition phase between healthy cognitive ageing and dementia. Although this notion seems to be reasonable, the general nature of the term MCI--including its many definitions--makes accurate accounting of the prevalence, prognosis, and potential benefit from treatment somewhat difficult. The differences in cognitive profile and clinical progression among individuals with MCI are generally recognised. However, recent evidence also suggests that the aetiological heterogeneity among individuals with MCI could be greater than previously reported. For example, cerebrovascular disease seems to be underestimated as a potential cause of MCI. In this review, I attempt to recognise workable definitions of MCI to discuss the prevalence, pathophysiology, prognosis, and possibilities for treatment of this disorder.

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Author and article information

Contributors

Alexandra König: +33 (0)652 02 11 56 , a.konig@maastrichtuniversity.nl

Journal

Journal ID (nlm-ta): Aging Clin Exp Res

Journal ID (iso-abbrev): Aging Clin Exp Res

Title: Aging Clinical and Experimental Research

Publisher: Springer International Publishing (Cham )

ISSN (Print): 1594-0667

ISSN (Electronic): 1720-8319

Publication date (Electronic): 27 January 2017

Publication date PMC-release: 27 January 2017

Publication date (Print): 2017

Volume: 29

Issue: 6

Pages: 1181-1189

Affiliations

[1 ]ISNI 0000 0001 2337 2892, GRID grid.10737.32, CoBTeK Research Unit, , University of Nice, ; Sophia Antipolis, France

[2 ]ISNI 0000 0004 0398 9387, GRID grid.417284.c, Philips Research, ; Eindhoven, The Netherlands

[3 ]ISNI 0000 0001 2322 4179, GRID grid.410528.a, Centre Mémoire de Ressources et de Recherche, , CHU de Nice, ; Nice, France

Article

Publisher ID: 703

DOI: 10.1007/s40520-016-0703-6

PMC ID: 5674109

PubMed ID: 28130713

SO-VID: c1f8e8d2-4f7b-422d-9d81-73cc0e1b5d72

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 26 August 2016

Date accepted : 15 December 2016

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100004963, Seventh Framework Programme;

Award ID: Grant nr. 288199

Award Recipient : Philippe Robert

Custom metadata

Keywords: dementia,alzheimer ,mild cognitive impairment,motor function,gait,actigraphy,accelerometer,dual-task,attention

Data availability:

Keywords: dementia, alzheimer , mild cognitive impairment, motor function, gait, actigraphy, accelerometer, dual-task, attention

Objective measurement of gait parameters in healthy and cognitively impaired elderly using the dual-task paradigm

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Abstract

Objectives

Methods

Results

Conclusion

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Karger: Neurology and Neuroscience

Most cited references 24

Attention and executive deficits in Alzheimer's disease. A critical review.

Disrupted daily activity/rest cycles in relation to daily cortisol rhythms of home-dwelling patients with early Alzheimer's dementia.

Mild cognitive impairment: prevalence, prognosis, aetiology, and treatment.

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