The Influence of a Cognitive Dual Task on the Gait Parameters of Healthy Older Adults: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 25 (4) ◽  
pp. 671-686 ◽  
Author(s):  
Erin Smith ◽  
Tara Cusack ◽  
Caitriona Cunningham ◽  
Catherine Blake
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Dual Task ◽  
Gait Speed ◽  
Meta Analysis ◽  
Data Sets ◽  
Dual Task Condition ◽  
Healthy Older Adults ◽  
Gait Parameters ◽  
Task Assessment

This review examines the effect of a dual task on the gait parameters of older adults with a mean gait speed of 1.0 m/s or greater, and the effect of type and complexity of task. A systematic review of Web of Science, PubMed, SCOPUS, Embase, and PsycINFO was performed in July 2016. Twenty-three studies (28 data sets) were reviewed and pooled for meta-analysis. The effect size on seven gait parameters was measured as the raw mean difference between single- and dual-task performance. Gait speed significantly reduced with the addition of a dual task, with increasing complexity showing greater decrements. Cadence, stride time, and measures of gait variability were all negatively affected under the dual-task condition. In older adults, the addition of a dual task significantly reduces gait speed and cadence, with possible implications for the assessment of older people, as the addition of a dual task may expose deficits not observed under single-task assessment.

scholarly journals Repeated Gait Perturbation Training in Parkinson's Disease and Healthy Older Adults: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 15 ◽  
Author(s):  
Femke Hulzinga ◽  
Veerle de Rond ◽  
Britt Vandendoorent ◽  
Moran Gilat ◽  
Pieter Ginis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Gait Speed ◽  
Stride Length ◽  
Meta Analysis ◽  
Gait Training ◽  
Healthy Older Adults ◽  
Perturbation Training

Background: Gait impairments are common in healthy older adults (HOA) and people with Parkinson's disease (PwPD), especially when adaptations to the environment are required. Traditional rehabilitation programs do not typically address these adaptive gait demands in contrast to repeated gait perturbation training (RGPT). RGPT is a novel reactive form of gait training with potential for both short and long-term consolidation in HOA and PwPD. The aim of this systematic review with meta-analysis is to determine whether RGPT is more effective than non-RGPT gait training in improving gait and balance in HOA and PwPD in the short and longer term.Methods: This review was conducted according to the PRISMA-guidelines and pre-registered in the PROSPERO database (CRD42020183273). Included studies tested the effects of any form of repeated perturbations during gait in HOA and PwPD on gait speed, step or stride length. Studies using balance scales or sway measures as outcomes were included in a secondary analysis. Effects of randomized controlled trials (RCT) on RGPT were pooled using a meta-analysis of final measures.Results: Of the 4421 studies, eight studies were deemed eligible for review, of which six could be included in the meta-analysis, totaling 209 participants (159 PwPD and 50 HOA). The studies were all of moderate quality. The meta-analysis revealed no significant effects of RGPT over non-RGPT training on gait performance (SMD = 0.16; 95% CI = −0.18, 0.49; Z = 0.92; P = 0.36). Yet, in some individual studies, favorable effects on gait speed, step length and stride length were observed immediately after the intervention as well as after a retention period. Gait variability and asymmetry, signifying more direct outcomes of gait adaptation, also indicated favorable RGPT effects in some individual studies.Conclusion: Despite some promising results, the pooled effects of RGPT on gait and balance were not significantly greater as compared to non-RGPT gait training in PwPD and HOA. However, these findings could have been driven by low statistical power. Therefore, the present review points to the imperative to conduct sufficiently powered RCT's to verify the true effects of RGPT on gait and balance in HOA and PwPD.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php? Identifier: CRD42020183273.

Digital Biomarkers of Cognitive Frailty: The Value of Detailed Gait Assessment Beyond Gait Speed

Gerontology ◽  
2021 ◽  
pp. 1-10
Author(s):  
He Zhou ◽  
Catherine Park ◽  
Mohammad Shahbazi ◽  
Michele K. York ◽  
Mark E. Kunik ◽  
...  
Keyword(s):  
Older Adults ◽  
Steady State ◽  
Dual Task ◽  
Gait Speed ◽  
Stride Length ◽  
Cognitive Frailty ◽  
Single Task ◽  
Double Support ◽  
Gait Parameters ◽  
Digital Biomarkers

<b><i>Background:</i></b> Cognitive frailty (CF), defined as the simultaneous presence of cognitive impairment and physical frailty, is a clinical symptom in early-stage dementia with promise in assessing the risk of dementia. The purpose of this study was to use wearables to determine the most sensitive digital gait biomarkers to identify CF. <b><i>Methods:</i></b> Of 121 older adults (age = 78.9 ± 8.2 years, body mass index = 26.6 ± 5.5 kg/m<sup>2</sup>) who were evaluated with a comprehensive neurological exam and the Fried frailty criteria, 41 participants (34%) were identified with CF and 80 participants (66%) were identified without CF. Gait performance of participants was assessed under single task (walking without cognitive distraction) and dual task (walking while counting backward from a random number) using a validated wearable platform. Participants walked at habitual speed over a distance of 10 m. A validated algorithm was used to determine steady-state walking. Gait parameters of interest include steady-state gait speed, stride length, gait cycle time, double support, and gait unsteadiness. In addition, speed and stride length were normalized by height. <b><i>Results:</i></b> Our results suggest that compared to the group without CF, the CF group had deteriorated gait performances in both single-task and dual-task walking (Cohen’s effect size <i>d</i> = 0.42–0.97, <i>p</i> &#x3c; 0.050). The largest effect size was observed in normalized dual-task gait speed (<i>d</i> = 0.97, <i>p</i> &#x3c; 0.001). The use of dual-task gait speed improved the area under the curve (AUC) to distinguish CF cases to 0.76 from 0.73 observed for the single-task gait speed. Adding both single-task and dual-task gait speeds did not noticeably change AUC. However, when additional gait parameters such as gait unsteadiness, stride length, and double support were included in the model, AUC was improved to 0.87. <b><i>Conclusions:</i></b> This study suggests that gait performances measured by wearable sensors are potential digital biomarkers of CF among older adults. Dual-task gait and other detailed gait metrics provide value for identifying CF above gait speed alone. Future studies need to examine the potential benefits of gait performances for early diagnosis of CF and/or tracking its severity over time.

scholarly journals Repetition Priming in Individuals with Amnestic Mild Cognitive Impairment and Alzheimer’s Dementia: a Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Liselotte De Wit ◽  
Vitoria Piai ◽  
Pilar Thangwaritorn ◽  
Brynn Johnson ◽  
Deirdre O’Shea ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Repetition Priming ◽  
Meta Analysis ◽  
Healthy Older Adults ◽  
Amnestic Mci ◽  
Standard Mean Difference ◽  
Priming Paradigm

AbstractThe literature on repetition priming in Alzheimer’s disease (AD) is inconsistent, with some findings supporting spared priming while others do not. Several factors may explain these inconsistencies, including AD severity (e.g., dementia vs. Mild Cognitive Impairment; MCI) and priming paradigm-related characteristics. This systematic review and meta-analysis provides a quantitative summary of repetition priming in AD. We examined the between-group standard mean difference comparing repetition priming in AD dementia or amnestic MCI (aMCI; presumably due to AD) to controls. Thirty-two studies were selected, including 590 individuals with AD dementia, 267 individuals with amnestic MCI, and 703 controls. Our results indicated that both individuals with aMCI and AD dementia perform worse on repetition priming tasks than cognitively older adults. Paradigm-related moderators suggested that the effect size between studies comparing the combined aMCI or AD dementia group to cognitively healthy older adults was the highest for paradigms that required participants to produce, rather than identify, primes during the test phase. Our results further suggested that priming in AD is impaired for both conceptual and perceptual priming tasks. Lastly, while our results suggested that priming in AD is impaired for priming tasks that require deep processing, we were unable to draw firm conclusions about whether priming is less impaired in aMCI or AD dementia for paradigms that require shallow processing.

scholarly journals Normative Data for a Tablet-Based Dual-Task Assessment in Healthy Older Adults

2020 ◽  
Author(s):  
Maxime Lussier ◽  
Kathia Saillant ◽  
Tudor Vrinceanu ◽  
Carol Hudon ◽  
Louis Bherer
Keyword(s):  
Older Adults ◽  
Dual Task ◽  
Normative Data ◽  
Healthy Older Adults ◽  
Highly Educated ◽  
Coefficient Of Variability ◽  
French And English ◽  
Task Assessment ◽  
English Speaking ◽  
The Relationship

Abstract Objective The objective of this study is to provide normative data for a tablet-based dual-task assessment in older adults without cognitive deficits. Method In total, 264 participants aged between 60 and 90 years, French and English-speaking, were asked to perform two discrimination tasks, alone and concurrently. The participants had to answer as fast as possible to one or two images appearing in the center of the tablet by pressing to the corresponding buttons. Normative data are provided for reaction time (RT), coefficient of variation, and accuracy. Analyses of variance were performed by trial types (single-pure, single-mixed, dual-mixed), and linear regressions assessed the relationship between performance and sociodemographic characteristics. Results The participants were highly educated and a large proportion of them were women (73.9%). The accuracy on the task was very high across all blocks. RT data revealed both a task-set cost and a dual-task cost between the blocks. Age was associated with slower RT and with higher coefficient of variability. Men were significantly slower on dual-mixed trials, but their coefficient of variability was lower on single-pure trials. Education was not associated with performance. Conclusions This study provides normative data for a tablet-based dual-task assessment in older adults without cognitive impairment, which was lacking. All participants completed the task with good accuracy in less than 15 minutes and thus, the task is transferable to clinical and research settings.

Dual-task training on gait, motor symptoms, and balance in patients with Parkinson’s disease: a systematic review and meta-analysis

2020 ◽  
Vol 34 (11) ◽  
pp. 1355-1367
Author(s):  
Zhenlan Li ◽  
Tian Wang ◽  
Haoyang Liu ◽  
Yan Jiang ◽  
Zhen Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Dual Task ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Motor Symptoms ◽  
Gait Parameters ◽  
Task Training ◽  
Dual Task Training

Objective: The aim of the present study was to systematically evaluate and quantify the effectiveness of dual-task training on gait parameters, motor symptoms and balance in individuals diagnosed with Parkinson’s disease. Data resources: A systematic review of published literature was conducted until May 2020, using PubMed, EMBASE, Cochrane Library, Web of Science, EBSCO and CNKI databases. Methods: We included randomized controlled trials (RCTs) and non-RCTs to evaluate the effects of dual-task training compared with those of non-intervention or other forms of training. The measurements included gait parameters, motor symptoms and balance parameters. Methodological quality was assessed using the PEDro scale. Outcomes were pooled by calculating between-group mean differences using fixed- or random-effects models based on study heterogeneity. Results: A total of 11 RCTs comprising 322 subjects were included in the present meta-analysis. Results showed that dual-task training significantly improved gait speed (standardized mean difference [SMD], −0.23; 95% confidence interval [CI], −0.38 to −0.08; P = 0.002), cadence (SMD, −0.25; 95% CI, −0.48 to −0.02; P = 0.03), motor symptoms (SMD, 0.56; 95% CI, 0.18 to 0.94; P = 0.004) and balance (SMD, −0.44; 95% CI, −0.84 to −0.05; P = 0.03). However, no significant changes were detected in step length or stride length. Conclusion: Dual-task training was effective in improving gait performance, motor symptoms and balance in patients with Parkinson’s disease relative to other forms of training or non-intervention.

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