scholarly journals The Impact of Mild Cognitive Impairment on Gait and Balance: A Systematic Review and Meta-Analysis of Studies Using Instrumented Assessment

Gerontology ◽  
2016 ◽  
Vol 63 (1) ◽  
pp. 67-83 ◽  
Author(s):  
Lindsay Bahureksa ◽  
Bijan Najafi ◽  
Ahlam Saleh ◽  
Marwan Sabbagh ◽  
David Coon ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Dual Task ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Motor Assessment ◽  
Gait Parameters ◽  
Task Conditions ◽  
Cognitively Intact

Background: In addition to cognitive deficits, people with mild cognitive impairment (MCI) can experience motor dysfunction, including deficits in gait and balance. Objective, instrumented motor performance assessment may allow the detection of subtle MCI-related motor deficits, allowing early diagnosis and intervention. Motor assessment under dual-task conditions may increase diagnostic accuracy; however, the sensitivity of different cognitive tasks is unclear. Objective: To systematically review the extant literature focusing on instrumented assessment of gait and balance parameters for discriminating MCI patients from cognitively intact peers. Methods: Database searches were conducted in PubMed, EMBASE, Cochrane Library, PsycINFO and Web of Science. Inclusion criteria were: (1) clinically confirmed MCI; (2) instrumented measurement of gait and/or balance; (3) English language, and (4) reporting gait or balance parameters which could be included in a meta-analysis for discriminating between MCI patients and cognitively intact individuals based on weighted effect size (d). Results: Fourteen studies met the inclusion criteria and reported quantitative gait (n = 11) or postural balance (n = 4) parameters to be included in the meta-analysis. The meta-analysis revealed that several gait parameters including velocity (d = -0.74, p < 0.01), stride length (d = -0.65, p < 0.01), and stride time (mean: d = 0.56, p = 0.02; coefficient of variation: d = 0.50, p < 0.01) discriminated best between MCI and healthy controls under single-task conditions. Importantly, dual-task assessment increased the discriminative power of gait variables wherein gait variables with counting tasks appeared to be more sensitive (range d = 0.84-1.35) compared to verbal fluency tasks such as animal naming (range d = 0.65-0.94). Balance parameters identified as significant discriminators were anterior-posterior (d = 0.49, p < 0.01) and mediolateral (d = -0.34, p = 0.04) sway position in the eyes-open condition but not eyes-closed condition. Conclusion: Existing studies provide evidence that MCI affects specific gait parameters. MCI-related gait changes were most pronounced when subjects are challenged cognitively (i.e., dual task), suggesting that gait assessment with an additional cognitive task is useful for diagnosis and outcome analysis in the target population. Static balance seems to also be affected by MCI, although limited evidence exists. Instrumented motor assessment could provide a critical opportunity for MCI diagnosis and tailored intervention targeting specific deficits and potentially slowing progression to dementia. Further studies are required to confirm our findings.

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.

scholarly journals Meta-Analysis of Neurochemical Changes Estimated via Magnetic Resonance Spectroscopy in Mild Cognitive Impairment and Alzheimer's Disease

2021 ◽  
Vol 13 ◽  
Author(s):  
Huanhuan Liu ◽  
Dandan Zhang ◽  
Huawei Lin ◽  
Qi Zhang ◽  
Ling Zheng ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Magnetic Resonance ◽  
Magnetic Resonance Spectroscopy ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Resonance Spectroscopy ◽  
Neurochemical Changes

The changes of neurochemicals in mild cognitive impairment (MCI) and Alzheimer's disease (AD) patients has been observed via magnetic resonance spectroscopy in several studies. However, whether it exists the consistent pattern of changes of neurochemicals in the encephalic region during the progression of MCI to AD were still not clear. The study performed meta-analysis to investigate the patterns of neurochemical changes in the encephalic region in the progress of AD. We searched the PubMed, Embase, Cochrane Library, and Web of Science databases, and finally included 63 studies comprising 1,086 MCI patients, 1,256 AD patients, and 1,907 healthy controls. It showed that during the progression from MCI to AD, N-acetyl aspartate (NAA) decreased continuously in the posterior cingulate (PC) (SMD: −0.42 [95% CI: −0.62 to −0.21], z = −3.89, P &lt; 0.05), NAA/Cr (creatine) was consistently reduced in PC (SMD: −0.58 [95% CI: −0.86 to −0.30], z = −4.06, P &lt; 0.05) and hippocampus (SMD: −0.65 [95% CI: −1.11 to −0.12], z = −2.44, P &lt; 0.05), while myo-inositol (mI) (SMD: 0.44 [95% CI: 0.26–0.61], z = 4.97, P &lt; 0.05) and mI/Cr (SMD: 0.43 [95% CI: 0.17–0.68], z = 3.30, P &lt; 0.05) were raised in PC. Furthermore, these results were further verified by a sustained decrease in the NAA/mI of PC (SMD: −0.94 [95% CI: −1.24 to −0.65], z = −6.26, P &lt; 0.05). Therefore, the levels of NAA and mI were associated with the cognitive decline and might be used as potentially biomarkers to predict the possible progression from MCI to AD.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42020200308.

scholarly journals Effect of computerised cognitive training on cognitive outcomes in mild cognitive impairment: a systematic review and meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e027062 ◽  
Author(s):  
Haifeng Zhang ◽  
Jonathan Huntley ◽  
Rohan Bhome ◽  
Benjamin Holmes ◽  
Jack Cahill ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cognitive Impairment ◽  
Executive Function ◽  
Mild Cognitive Impairment ◽  
Cognitive Function ◽  
Cognitive Training ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Cochrane Library ◽  
Future Research

ObjectivesTo determine the effect of computerised cognitive training (CCT) on improving cognitive function for older adults with mild cognitive impairment (MCI).DesignSystematic review and meta-analysis.Data sourcesPubMed, Embase, Web of Science and the Cochrane Library were searched through January 2018.Eligibility criteriaRandomised controlled trials comparing CCT with control conditions in those with MCI aged 55+ were included.Data extraction and synthesisTwo independent reviewers extracted data and assessed the risk of bias. Effect sizes (Hedges’ g and 95% CIs) were calculated and random-effects meta-analyses were performed where three or more studies investigated a comparable intervention and outcome. Heterogeneity was quantified using the I2 statistic.Results18 studies met the inclusion criteria and were included in the analyses, involving 690 participants. Meta-analysis revealed small to moderate positive treatment effects compared with control interventions in four domains as follows: global cognitive function (g=0.23, 95% CI 0.03 to 0.44), memory (g=0.30, 95% CI 0.11 to 0.50), working memory (g=0.39, 95% CI 0.12 to 0.66) and executive function (g=0.20, 95% CI −0.03 to 0.43). Statistical significance was reached in all domains apart from executive function.ConclusionsThis meta-analysis provides evidence that CCT improves cognitive function in older people with MCI. However, the long-term transfer of these improvements and the potential to reduce dementia prevalence remains unknown. Various methodological issues such as heterogeneity in outcome measures, interventions and MCI symptoms and lack of intention-to-treat analyses limit the quality of the literature and represent areas for future research.

scholarly journals Serum Ghrelin in Mild Cognitive Impairment and Alzheimer's Disease A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Xiaodong Chen ◽  
Yunfeng Luo
Keyword(s):  
Systematic Review ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Meta Analysis ◽  
Serum Levels ◽  
Cochrane Library ◽  
Significant Heterogeneity ◽  
Serum Ghrelin

Abstract Background Serum ghrelin levels have been reported to be altered in Alzheimer’s disease (AD) patients and individuals with Mild cognitive impairment (MCI). However, whether serum ghrelin can be used as a biomarker of AD is inconsistent and conflicting. Methods We carried out a systematic review and meta-analysis to examine the serum levels of ghrelin and acylated ghrelin (AG) in patients with AD or MCI, in comparison with normal controls (NC). We searched PubMed, The Cochrane Library, Web of Science and Chinese National Knowledge Infrastructure (CNKI) from 1999 to March 2021. Results 10 relevant studies were included for this study. 8 studies reported serum levels of ghrelin (417 AD or MCI patients and 382 controls) and 5 studies reported serum levels of AG (142 AD or MCI patients and 152 controls). We found that AD and MCI patients had a tendency toward a decrease in the serum levels of ghrelin (SMD=-1.04; 95%CI (-2.30, 0.23); P = 0.11; significant heterogeneity: I2 = 98%), but no statistical significance was found. AG levels in the serum level of AD and MCI patients were significantly higher than NC subjects (SMD = 0.99; 95%CI (0.21, 1.77); P = 0.01; significant heterogeneity: I2 = 87%). Conclusion This meta-analysis suggested that AG may be a potential MCI or early AD biomarker and confirmed previous findings that ghrelin became desensitized in AD patients. This meta-analysis was limited to small sample sizes and lacked of stratifying the level of heterogeneity in AD and MCI patients. More and large sample, multi-center case-control studies on the relationship between serum AG and AD or MCI patients are still needed in the future.

Dual-Task Gait Assessment in a Clinical Sample: Implications for Improved Detection of Mild Cognitive Impairment

2019 ◽  
Vol 75 (7) ◽  
pp. 1372-1381 ◽  
Author(s):  
Deborah A Lowe ◽  
Rebecca K MacAulay ◽  
Dana M Szeles ◽  
Nicholas J Milano ◽  
Mark T Wagner
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Performance ◽  
Dual Task ◽  
Gait Speed ◽  
Medical Setting ◽  
Executive Attention ◽  
Cognitive Complaints ◽  
Gait Assessment ◽  
Task Conditions

Abstract Objectives Research has longitudinally linked dual-task gait dysfunction to mild cognitive impairment (MCI) and dementia risk. Our group previously demonstrated that dual-task gait speed assessment distinguished between subjective cognitive complaints (SCC) and MCI in a memory clinic setting, and also found that differences in dual-task gait speed were largely attributable to executive attention processes. This study aimed to reproduce these findings in a larger diverse sample and to extend them by examining whether there were group differences in single- versus dual-task cognitive performance (number of letters correctly sequenced backward). Method Two-hundred fifty-two patients (M age = 66.01 years, SD = 10.46; 119 MCI, 133 SCC) presenting with cognitive complaints in an academic medical setting underwent comprehensive neuropsychological and gait assessment (single- and dual-task conditions). Results Patients with MCI walked slower and showed greater decrement in cognitive performance than those with SCC during dual-task conditions. Neuropsychological measures of executive attention accounted for significant variance in dual-task gait performance across diagnostic groups beyond demographic and health risk factors. Discussion Reproduction of our results within a sample over four times the previous size provides support for the use of dual-task gait assessment as a marker of MCI risk in clinical settings.

scholarly journals Alzheimer’s Disease, Mild Cognitive Impairment and Mediterranean Diet. A Systematic Review and Dose-Response Meta-Analysis

2021 ◽  
Vol 10 (20) ◽  
pp. 4642
Author(s):  
Natalia García-Casares ◽  
Paloma Gallego Fuentes ◽  
Miguel Ángel Barbancho ◽  
Rosa López-Gigosos ◽  
Antonio García-Rodríguez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Mediterranean Diet ◽  
Lower Risk ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Qualitative Synthesis

Alzheimer’s Disease (AD) is a pathology with increasing prevalence in the context of a more long-lived society and it is the first cause of dementia in western countries. It is important to investigate factors that can be protective and may influence its development, in order to act on them trying to reduce AD incidence and its progression. The aim of this study was to conduct a systematic review and meta-analysis to determine the effects of a higher adherence to Mediterranean diet (MD) on Mild Cognitive Impairment (MCI) and AD. A literature search in PubMed, The Cochrane Library Plus and Scopus was conducted, selecting articles that analyzed associations between MD adherence and AD biomarkers (Volumetry assessed by MRI and betamiloide and Tau deposits by PET); cognitive performance in patients at risk or presenting MCI and AD; and incidence or progression from MCI to AD. Out of the 589 studies screened, 22 studies met eligibility criteria for the systematic review and qualitative synthesis. Finally, 11 studies were included in the meta-analysis (12,458 participants). Higher adherence to MD was associated with a significantly lower risk of MCI (RR = 0.91, 95%CI = 0.85–0.97) and lower risk of AD (RR = 0.89, 95% CI = 0.84–0.93). Our results enhance the importance of taking health-promoting lifestyle measures like following Mediterranean dietary patterns in order to reduce AD risk.

scholarly journals Risk factors for predicting progression from normal cognition to mild cognitive impairment: protocol for a systematic review and meta-analysis of cohort studies

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e027313 ◽  
Author(s):  
Jie Wang ◽  
Lina Wang ◽  
Xianglian Zhou ◽  
Xiaohong Wen ◽  
Xueting Zhen
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cohort Studies ◽  
Meta Analysis ◽  
Primary Data ◽  
Cochrane Library ◽  
The Impact ◽  
Normal Cognition

IntroductionMild cognitive impairment (MCI) often represents the earliest stage of Alzheimer’s disease. There has been considerable research investigating specific risk factors regarding the progression from normal cognition to MCI. However, different studies have come to different conclusions on the impact of particular risk factors. Therefore, it is necessary to conduct a meta-analysis of the risk factors that predict cognitive disruption in individuals based on associations with MCI.Methods and analysisWe will search seven electronic databases without time limit, including MEDLINE, EMBASE, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, the Wan Fang Database and China Biology Medicine. Two researchers will independently screen for eligibility and perform data extraction. Data were extracted from cohort studies meeting the inclusive criteria according to the Newcastle Ottawa Scale (NOS) methods. A third member of the research team will be contacted when a consensus cannot be reached. Any disagreement will be settled by consensus. The NOS will be used to assess the quality of the studies. All analyses were performed using Stata V.15.1.Ethics and disseminationWe will report this review in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. We will disseminate our findings through a publication in a peer-reviewed journal. This systematic review does not require ethical approval as no primary data are collected.PROSPERO registration numberCRD42018109099.

Cystatin C and Risk of Mild Cognitive Impairment: A Systematic Review and Meta-Analysis

2020 ◽  
pp. 1-12
Author(s):  
Pallavi Nair ◽  
Shubham Misra ◽  
Manabesh Nath ◽  
Deepti Vibha ◽  
Achal Kumar Srivastava ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cystatin C ◽  
Meta Analysis ◽  
Strong Association ◽  
Random Effect ◽  
Asian Population ◽  
Cochrane Library ◽  
Quality Of Evidence

<b><i>Introduction:</i></b> Cystatin C (Cys C) has been found as a novel biomarker of neurodegenerative diseases, such as dementia and Alzheimer’s disease. Published studies on the role of Cys C as a biomarker of mild cognitive impairment (MCI) have not been reviewed systematically. <b><i>Objective:</i></b> Present meta-analysis was performed to elucidate the association between Cys C and risk of MCI. <b><i>Methods:</i></b> A comprehensive search was performed in PubMed, EMBASE, Cochrane Library, Trip databases, Worldwide Science, and Google Scholar from January 1, 1950, to April 30, 2020. Standardized mean difference (SMD) with 95% confidence interval (CI) using fixed or random effect models were used to calculate summary estimates. Quality of evidence was also assessed using the Diagnostic Accuracy Quality Scale (DAQS) and grading quality of evidence and strength of recommendations approach. <b><i>Results:</i></b> In our meta-analysis, 12 studies with a total of 2,433 MCI patients and 1,034 controls were included. Our findings suggest a strong association between increased levels of Cys C and risk of MCI as compared to control subjects (SMD = 2.39, 95% CI = 0.22–4.57). Subgroup analysis based on ethnicity, a significant association for the high level of Cys C with the risk of MCI was observed in the Asian population (SMD = 1.63, 95% CI = 0.44–2.82) but not in the Caucasian population (SMD = 2.80, 95% CI = [−0.66]−6.26). <b><i>Conclusion:</i></b> Cys C was associated with MCI, and it could be considered as a predictor for the risk of cognitive impairment.

Meta-analysis: Resistance Training Improves Cognition in Mild Cognitive Impairment

2020 ◽  
Vol 41 (12) ◽  
pp. 815-823
Author(s):  
Lulu Zhang ◽  
Bin Li ◽  
Jingjing Yang ◽  
Fengling Wang ◽  
Qianyun Tang ◽  
...  
Keyword(s):  
Working Memory ◽  
Cognitive Impairment ◽  
Executive Function ◽  
Mild Cognitive Impairment ◽  
Cognitive Function ◽  
Resistance Training ◽  
Meta Analysis ◽  
Mean Difference ◽  
Cochrane Library ◽  
Standardized Mean Difference

AbstractThis study investigated the benefits of resistance training on cognition in patients with mild cognitive impairment. We searched the PubMed, Embase and Cochrane Library databases, and seven randomized controlled trials were reviewed. We evaluated the risk of bias using the Cochrane Collaboration’s bias assessment tool. Standard mean differences with 95% confidence intervals were calculated for statistical analysis. This meta-analysis assessed three variables: general cognitive function, executive function and working memory. The results indicate that general cognitive function improved significantly (standardized mean difference: 0.53, P=0.04), and further subgroup analyses on frequency and duration per session showed that the subgroups ‘twice a week’ (P=0.01) and ‘duration per session >60 min’ (P=0.0006) exhibited better performance than the subgroups ‘three time a week’ (P=0.47) and ‘duration per session <60 min’ (P=0.53). Additionally, a moderate effect size was found in executive function (standardized mean difference: 0.50, P=0.0003), and there was non-significant effect in working memory (P=0.14). In summary, resistance training may mitigate mild cognitive impairment by improving cognition. Larger-scale studies are recommended to demonstrate the relationship between resistance training and cognition in mild cognitive impairment.

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