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Walking Irregularities a Harbinger of Cognitive Decline?

Discussion in 'Gerontology' started by CamWhite, Jul 17, 2012.

  1. CamWhite

    CamWhite Active Member

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    In PM News this morning, and later on MSNBC's "Morning Joe", people are talking about gait disturbances among the elderly are are potential early warning signs for cognitive decline, including Alzheimers.

    I'm not in disagreement that a diseased brain probably affects ambulation, but there are so many other pathologies that affect gait that probably have no impact on mental health. Hallux rigidus, peripheral neuropathy, and a multitude of other pathologies affect gait, but I'm not sure they lead to cognitive decay. My father-in-law is in his late 80's. He has Meniere's disease. If spinal fluid builds up too much, it affects his gait, balance and cognitive abilities. Once the pressure is released, he is fine and very aware of his surroundings.

    If gait disturbances can help identify early onset Alzheimer's disease, then I hope it is part of a multidisciplinary approach in getting an accurate diagnosis. I have seen way too many elderly people with disturbed gait that are sharp as they can be. I would hate to see them rounded up, evaluated and medicated if they have occasional "senior moments".

    I'm not disputing the findings of the studies, they seem fairly obvious. The more diseased a brain becomes, the more it affects gait. I'm just concerned that poor gait, or changing gait patterns can lead people to drawing erroneous conclusions.
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    Reproducibility of gait variability measures in people with Alzheimer's disease
    Joanne E. Wittwer, Kate E. Webster, Keith Hill
    Gait & Posture; Article in Press

  5. The usual thing. The study reports correlation and the press infer causation, or unique correlation.
  6. NewsBot

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    Gait Speed And Cognitive Decline Over 2 Years In The Ibadan Study Of Ageing
    Akin Ojagbemi, Catherine D’Este, Emese Verdes, Somnath Chatterji, Oye Gureje
    Gait and Posture; Article in Press
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    The impact of time of day on the gait and balance control of Alzheimer's patients.
    Paillard T et al
    Chronobiol Int. 2016 Jan 19:1-8
  9. NewsBot

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    What can gait tell us about dementia? Review of epidemiological and neuropsychological evidence
    Vyara Valkanova, , Klaus P Ebmeier
    Gait & Posture; 9 February 2017
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    NewsBot The Admin that posts the news.

    Lawson and Western researchers suggest walking and talking can be an early predictor of dementia
    Early dementia detection can lead to halting its progression

    For Immediate Release
    May 10, 2017

    London, Ontario – In a new study, researchers at Lawson Health Research Institute and Western University are demonstrating that gait, or motion testing, while simultaneously performing a cognitively demanding task can be an effective predictor of progression to dementia and eventually help with earlier diagnosis. To date, there is no definitive way for health care professionals to forecast the onset of dementia in a patient with memory complaints.

    Dr. Manuel Montero-Odasso, a Lawson scientist, geriatrician at St. Joseph’s Health Care London, and associate professor in the Division of Geriatric Medicine at Western University’s Schulich School of Medicine & Dentistry, is leading the “Gait and Brain Study.” His team is assessing up to 150 seniors with mild cognitive impairment (MCI), a slight decline of memory and other mental functions which is considered a pre-dementia syndrome, in order to detect an early predictor of cognitive and mobility decline and progression to dementia.

    “Finding methods to detect dementia early is vital to our ability to slow or halt the progression of the disease,” says Dr. Montero-Odasso. The study, funded by the Canadian Institutes of Health Research, followed participants for six years and included bi-annual visits. Researchers asked participants to walk while simultaneously performing a cognitively demanding task, such as counting backwards or naming animals. Those individuals with MCI that slow down more than 20 per cent while performing a cognitively demanding task are at a higher risk of progressing to dementia.

    “While walking has long been considered an automatic motor task, emerging evidence suggests cognitive function plays a key role in the control of walking, avoidance of obstacles and maintenance of navigation,” says Dr. Montero-Odasso. “We believe that gait, as a complex brain-motor task, provides a golden window of opportunity to see brain function.”

    The “gait cost,” or speed at which participants completed a single task (walking) versus a dual-task, was higher in those MCI individuals with worse episodic memory and who struggle with executive functions such as attention keeping and time management.

    “Our results reveal a ‘motor signature’ of cognitive impairment that can be used to predict dementia,” adds Dr. Montero-Odasso. “It is conceivable that we will be able to diagnose Alzheimer’s disease and other dementias before people even have significant memory loss. Our hope is to combine these methods with promising new medications to slow or halt the progression of MCI to dementia.”

    The study, “Association of Dual-Task Gait with Incident Dementia in Mild Cognitive Impairment”, was published in the journal, JAMA NEUROLOGY.
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    β-amyloid deposition is Associated with Gait variability in Usual Aging
    Qu Tian et al
    Gait and Posture; Article in Press
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    Older adults who have slower walking speeds may have increased risk for dementia

    As of 2015, nearly 47 million people around the world had dementia, a memory problem significant enough to affect your ability to carry out your usual tasks. The most common cause of dementia is Alzheimer's disease, but other forms exist, too.

    Because there's currently no cure for dementia, it's important to know about the risk factors that may lead to developing it. For example, researchers have learned that older adults with slower walking speeds seem to have a greater risk of dementia than those with faster walking speeds. Recently, researchers from the United Kingdom teamed up to learn more about changes in walking speed, changes in the ability to think and make decisions, and dementia. They published their study in the Journal of the American Geriatrics Society.

    The researchers examined information collected from the English Longitudinal Study of Aging. The study included adults aged 60 and older who lived in England. In their study, the researchers used information collected from 2002 to 2015. They assessed participants' walking speed on two occasions in 2002-2003 and in 2004-2005, and whether or not the participants developed dementia after the tests from 2006-2015. Then, they compared the people who had developed dementia with those who had not.

    Researchers discovered that of the nearly 4,000 older adults they studied, those with a slower walking speed had a greater risk of developing dementia. And people who experienced a faster decline in walking speed over a two-year period were also at higher risk for dementia. People who had a poorer ability to think and make decisions when they entered the study--and those whose cognitive (thinking) abilities declined more quickly during the study--were also more likely to be diagnosed with dementia.

    The researchers concluded that older adults with slower walking speeds, and those who experienced a greater decline in their walking speed over time, were at increased risk for dementia. But, the researchers noted, changes in walking speed and changes in an older adult's ability to think and make decisions do not necessarily work together to affect the risk of developing dementia.
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    Press Release:
    Gait assessed with body-worn sensors may help detect Alzheimer’s
    Published on: 4 May 2018
    Body-worn sensors used at home and in clinic by people with mild Alzheimer’s to assess walking could offer a cost-effective way to detect early disease and monitor progression of the illness.

    Wearable sensors at home and in the clinic have the potential to change dementia research. The ability to assess gait and walking behaviours is a major step forwards in data collection
    Professor Lynn Rochester

    A pilot study involving Newcastle University has revealed low-cost wearable devices could improve clinical trial efficiency and encourage research investment.

    Identification of clinical biomarkers, such as changes in walking characteristics and behaviours, are known to be important factors when looking at early warning signs of dementia.

    Findings of a feasibility study, published in the Journal of Alzheimer’s Disease, shows that wearable sensors offer a good way to assess changes in how a person walks and also can be used for continuous ‘free-living’ monitoring of gait during everyday activities.

    Experts say this method has the potential for affordable, multi-centre and home-based monitoring that benefits patients, clinical management and the efficiency of clinical trials.

    Lynn Rochester, Professor of Human Movement Science at Newcastle University, leads the gait and wearable technology research across multiple sites in the study.

    The human movement laboratory at the Clinical Ageing Research Unit, based at the Campus for Ageing and Vitality, Newcastle University, is dedicated to the investigation of gait, balance and mobility.

    Professor Rochester said: “How someone walks is not routinely used in clinical trials because the tools needed are typically restricted to specialised labs and one-off testing, missing subtle fluctuations in symptoms.

    “Wearable sensors at home and in the clinic have the potential to change dementia research. The ability to assess gait and walking behaviours in all aspects of life is a major step forwards in data collection.

    “Free-living gait analysis at home is particularly useful as it allows objective observation of an individual’s day-to-day activity. It also has the benefit of providing continuous data over a prolonged time that may be more sensitive than one-off assessments.

    “This is an exciting project to be involved in. Gait assessed in this way could contribute to delivery of more cost-effective clinical trials and may encourage investment and increase the number of such studies in the future.”

    The feasibility study is part of the £6.9m Deep and Frequent Phenotyping Project, funded by the National Institute for Health Research and the Medical Research Council.

    This is the first major clinical study based on Dementias Platform UK and the results could be game changing for research in this area.

    Potential diagnostic tool
    Six centres from the National Institute for Health Research Translational Research Collaboration in Dementia initiative, including Newcastle University, recruited 20 patients with early Alzheimer’s disease.

    Volunteers wore a small wearable sensor on their lower back. They carried out walking tasks in the laboratory and then went home wearing the sensor for a week, carrying out everyday tasks.

    Gait is emerging as a potential diagnostic tool for cognitive decline. The tools to quantify gait in the clinic and home, and suitability for multi-centre application, have not been examined until now.

    Findings show data for comprehensive and clinically appropriate measures can be obtained for walking behaviour and pattern, and gait characteristics relating to the pace, timing, variability, and asymmetry of walking.

    Experts have concluded that it is feasible to assess quantitative gait characteristics in both the clinic and home environment in patients with early onset Alzheimer’s disease with body-worn sensors.

    Professor Rochester said: “Body-worn sensors can provide an enriched picture of an individual’s gait function and walking activities that could act as a complimentary diagnostic tools for clinicians.

    “Clinical use of body-worn sensors in annual health assessments could track gait changes over time and act as a red flag for cognitive impairment.”

    Further research is needed to assess the potential of free-living gait as a useful complementary diagnostic marker for dementia.

    An estimated 46.8m people worldwide were living with dementia in 2015, and with an ageing population in most developed countries, predictions suggest this number may double by 2050.

    Alzheimer’s disease starts long before it is noticed by those with the disease or their doctor. Previous studies have shown changes to the brain as early as 10 to 20 years before symptoms arise.

    If experts can identify the biomarkers present in this very early stage, there may be the chance of treating the disease earlier, which is vital to prevent damage to people’s memory and thinking.

    The Deep and Frequent Phenotyping Project, led by the University of Oxford, is working with eight universities and the Alzheimer’s Society, also receiving support from biopharma companies.

    New biomarkers will be used alone and alongside tests such as brain imaging and assessment of memory and other cognitive functions. They will allow the researchers to recognise the early stages of the disease and those who may be suitable for trials of possible treatments.

    Gait in Mild Alzheimer’s Disease: Feasibility of Multi-Centre Measurement in the Clinic and Home with Body-Worn Sensors: A Pilot Study

    Rıona Mc Ardle, Rosie Morris, Aodhan Hickey, Silvia Del Din, Ivan Koychev, Roger N. Gunn, Jennifer Lawson, Giovanna Zamboni, Basil Ridha, Barbara J. Sahakian, James B. Rowe, Alan Thomas, Henrik Zetterberg, Clare MacKay, Simon Lovestone, Lynn Rochester

    Journal of Alzheimer’s Disease. Doi: 10.3233/JAD-171116
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    The effect of walking path configuration on gait in adults with Alzheimer’s dementia
    Susan W. Hunter et al
    Gait and Posture; Article in Press
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    Interventions to Improve Gait in Older Adults with Cognitive Impairment: A Systematic Review
    Weihong Zhang MOT, MPH Lee‐Fay Low PhD Josephine Diana Gwynn PhD Lindy Clemson PhD
    J Am Geriatr Soc 00:1–11, 2018.: 02 December 2018

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