Quantitative gait dysfunction and risk of cognitive decline and dementia

Department of Neurology, Albert Einstein College of Medicine, 1165 Morris Park Avenue, Room 338, Bronx, New York 10461, USA.
Journal of neurology, neurosurgery, and psychiatry (Impact Factor: 6.81). 10/2007; 78(9):929-35. DOI: 10.1136/jnnp.2006.106914
Source: PubMed


Identifying quantitative gait markers of preclinical dementia may lead to new insights into early disease stages, improve diagnostic assessments and identify new preventive strategies.
To examine the relationship of quantitative gait parameters to decline in specific cognitive domains as well as the risk of developing dementia in older adults.
We conducted a prospective cohort study nested within a community based ageing study. Of the 427 subjects aged 70 years and older with quantitative gait assessments, 399 were dementia-free at baseline.
Over 5 years of follow-up (median 2 years), 33 subjects developed dementia. Factor analysis was used to reduce eight baseline quantitative gait parameters to three independent factors representing pace, rhythm and variability. In linear models, a 1 point increase on the rhythm factor was associated with further memory decline (by 107%), whereas the pace factor was associated with decline on executive function measured by the digit symbol substitution (by 29%) and letter fluency (by 92%) tests. In Cox models adjusted for age, sex and education, a 1 point increase on baseline rhythm (hazard ratio (HR) 1.48; 95% CI 1.03 to 2.14) and variability factor scores (HR 1.37; 95% CI 1.05 to 1.78) was associated with increased risk of dementia. The pace factor predicted the risk of developing vascular dementia (HR 1.60; 95% CI 1.06 to 2.41).
Our findings indicate that quantitative gait measures predict future risk of cognitive decline and dementia in initially non-demented older adults.

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    • "Identifying and grouping different walking conditions is extremely important in the generation and statistical analysis of representative data given that they will utilize different joint and foot kinematics . Without this function, it is not possible to effectively compare across participants (as in this study) or to longitudinally track individuals for the early identification/screening of neuro-musculoskeletal injury or cognitive decline [1], [2]. Currently, no systems appear to facilitate this. "
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    ABSTRACT: Within this paper we demonstrate the effectiveness of a novel body-worn gait monitoring and analysis framework to both accurately and automatically assess gait during 'free-living' conditions. Key features of the system include the ability to automatically identify individual steps within specific gait conditions, and the implementation of continuous waveform analysis within an automated system for the generation of temporally normalized data and their statistical comparison across subjects.
    37th IEEE Conference in Engineering in Medicine and Biology Society, Milan, Italy; 08/2015
    • "Indeed, gait is a complex motor behavior and presents many different measurable facets besides proper motor facets (e.g., velocity), such as an important relationship to different aspects of cognition (Holtzer et al., 2006). Particularly, pace seems to be associated with attention and executive functions and with general cognitive decline and incident dementia as well (Verghese et al., 2007), whereas rhythm seems to be associated to information processing speed (Verlinden et al., 2014). As suggested by Shumway-Cook and Woollacott (2000), indeed, attentional demands for postural control increase with aging whereas sensory information decreases. "

    ICT4AgeingWell 2015 – International Conference on Information and Communication Technologies for Ageing Well and e-Health; 05/2015
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    • "Finally we determined a battery of validated gait characteristics [12] collected during the endurance task also described as sensitive to ageing/pathology [18] [19]. The proposed methodology (adoption of standardised tests and iCap) may have practical utility in a wide range of clinical and public health surveys/studies (including interventions) where assessment/data could be conducted/collected and compared across many settings. "
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    ABSTRACT: The aims of this study were to (i) investigate instrumented physical capability (iCap) as a valid method during a large study and (ii) determine whether iCap can provide important additional features of postural control and gait to categorise cohorts not previously possible with manual recordings. Cross-sectional analysis involving instrumented testing on 74 adults who were recruited as part of a pilot intervention study; LiveWell. Participants wore a single accelerometer-based monitor (lower back) during standardised physical capability tests so that outcomes could be compared directly with manual recordings (stopwatch and measurement tape) made concurrently. Time, distance, postural control and gait characteristics. Agreement between manual and iCap ranged from moderate to excellent (0.649-0.983) with mean differences between methods low and deemed acceptable. Additionally, iCap successfully quantified (i) postural control characteristics which showed sensitivity to distinguish between 5 variations of the standing balance test and (ii) 14 gait characteristics known to be sensitive to age/pathology. Our findings show that iCap can provide robust quantitative data about physical capability during standardised tests while also providing sensitive (age/pathology) postural control and gait characteristics not previously quantifiable with manual recordings. The methodology which we propose may have practical utility in a wide range of clinical and public health surveys and studies, including intervention studies, where assessment could be undertaken within diverse settings. This will need to be tested in further validation studies in a wider range of settings. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
    Maturitas 04/2015; 34(1). DOI:10.1016/j.maturitas.2015.04.003 · 2.94 Impact Factor
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