Spatial-Temporal Parameters of Gait Associated With Alzheimer Disease: A Longitudinal Analysis

2020 ◽  
Vol 34 (1) ◽  
pp. 46-59
Author(s):  
Chorong Oh ◽  
Richard J. Morris ◽  
Leonard L. LaPointe ◽  
Julie A. G. Stierwalt
Keyword(s):  
Cognitive Load ◽  
Dual Task ◽  
Rating Scale ◽  
Early Stage ◽  
Behavioral Changes ◽  
Double Support ◽  
Mixed Effects Modeling ◽  
Double Support Time ◽  
Aging World ◽  
Functional Ambulation Profile

Alzheimer’s disease (AD) is one of the biggest social and medical concerns in the aging world. A dual task of walking and talking is a particularly practical means to assess AD considering the cognitive and behavioral changes that characterize the disease. The purpose of the study was to assess the effect of the dual task of walking and talking on people with early stage AD under differing cognitive load levels of talking. Participants (9 women and 5 men, mean age (years) = 78.03, standard deviation [SD] = 12.06) with mild or moderate AD (mean Dementia Rating Scale 2 score = 88.14, SD = 7.07) completed 12 monthly walking sessions under no, low, or high cognitive load. They also completed the low and high cognitive load tasks while seated. Linear mixed-effects modeling revealed that values in the Functional Ambulation Profile, stride length, and velocity decreased as tasks became more complex and double support time increased at the same rate. The walking and seated conditions comparison indicated that participants’ performance on both low and high cognitive tasks was poor when they were walking rather than seated. The results show that people with early stage AD exhibited gait impairments that increased over time and when completing tasks with greater cognitive load.

The efficacy of cognitive-cycling dual-task training in patients with early-stage Parkinson’s disease: A pilot study

2020 ◽  
Vol 47 (4) ◽  
pp. 415-426
Author(s):  
Hsiu-Chen Chang ◽  
Chiung-Chu Chen ◽  
Yi-Hsin Weng ◽  
Wei-Da Chiou ◽  
Ya-Ju Chang ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Performance ◽  
Dual Task ◽  
Rating Scale ◽  
Early Stage ◽  
Freezing Of Gait ◽  
Timed Up And Go ◽  
Gait Performance ◽  
The Mean

BACKGROUND: Recent studies have suggested that cognitive-motor dual-task (DT) training might improve gait performance, locomotion automaticity, balance, and cognition in patients with Parkinson’s disease (PD). OBJECTIVE: We aimed to investigate the efficacy of cognitive-cycling DT training in patients with early-stage PD. METHODS: Participants were scheduled to perform cognitive tasks simultaneously with the cycling training twice per week for eight weeks for a total of 16 sessions during their on-states. Clinical assessments were conducted using the unified Parkinson’s disease rating scale (UPDRS), modified Hoehn and Yahr stage, Timed Up and Go (TUG) test, gait and cognitive performances under dual-task paradigm, the new freezing of gait questionnaire, Schwab and England Activities of Daily Living scale, 39-item Parkinson’s disease questionnaire, and cognitive performance. RESULTS: Thirteen eligible patients were enrolled in the study. The mean age was 60.64±5.32 years, and the mean disease duration was 7.02±3.23 years. Twelve PD patients completed 16 serial cognitive-cycling sessions for two months. After 16 sessions of training (T2), the UPDRS III scores improved significantly in both the off- and on-states, and TUG were significantly less than those at pretraining (T0). During both the single-task and the DT situations, gait performance and spatial memory cognitive performance significantly improved from T0 to T2. CONCLUSION: The present study demonstrated that cognitive-cycling DT training improves the motor functions, gait and cognitive performances of PD patients.

scholarly journals Gait parameters and characteristics associated with increased risk of falls in people with dementia: a systematic review

2018 ◽  
Vol 31 (9) ◽  
pp. 1287-1303 ◽  
Author(s):  
Shirin Modarresi ◽  
Alison Divine ◽  
Jessica A. Grahn ◽  
Tom J. Overend ◽  
Susan W. Hunter
Keyword(s):  
Systematic Review ◽  
Rating Scale ◽  
Future Research ◽  
Time Variability ◽  
Double Support ◽  
People With Dementia ◽  
Gait Parameters ◽  
Increased Risk ◽  
Double Support Time ◽  
Support Time

ABSTRACTBackground:People with dementia fall twice as often and have more serious fall-related injuries than healthy older adults. While gait impairment as a generic term is understood as a fall risk factor in this population, a clear elaboration of the specific components of gait that are associated with falls risk is needed for knowledge translation to clinical practice and the development of fall prevention strategies for people with dementia.Objective:To review gait parameters and characteristics associated with falls in people with dementia.Methods:Electronic databases CINAHL, EMBASE, MedLine, PsycINFO, and PubMed were searched (from inception to April 2017) to identify prospective cohort studies evaluating the association between gait and falls in people with dementia.Results:Increased double support time variability, use of mobility aids, walking outdoors, higher scores on the Unified Parkinson’s Disease Rating Scale, and lower average walking bouts were associated with elevated risk of any fall. Increased double support time and step length variability were associated with recurrent falls. The reviewed articles do not support using the Performance Oriented Mobility Assessment and the Timed Up-and-Go tests to predict any fall in this population. There is limited research on the use of dual-task gait assessments for predicting falls in people with dementia.Conclusion:This systematic review shows the specific spatiotemporal gait parameters and features that are associated with falls in people with dementia. Future research is recommended to focus on developing specialized treatment methods for these specific gait impairments in this patient population.

Influence of Concurrent Tasks on Gait: A Dual-Task Approach

1995 ◽  
Vol 81 (1) ◽  
pp. 107-113 ◽  
Author(s):  
Georg Ebersbach ◽  
Milan R. Dimitrijevic ◽  
Werner Poewe
Keyword(s):  
Dual Task ◽  
Digit Span ◽  
Stride Frequency ◽  
Fine Motor ◽  
Stride Time ◽  
Motor Tasks ◽  
Double Support ◽  
Concurrent Tasks ◽  
Double Support Time ◽  
Support Time

We studied the effect of concurrent tasks on motor control of gait with dual-task methodology. Ten healthy subjects were instructed to perform different cognitive and motor tasks during gait on a conductive walkway. Footswitch signals were recorded and stride time and double-support time were calculated. It was assumed that the former reflects gait-patterning mechanisms and the latter relates to balance control. Statistical analysis showed an increase in double-support time when a memory-retention task (digit-span) and a fine motor task (buttoning) were executed simultaneously during gait. During gait performance of the cognitive task declined compared to baseline conditions. Attentional demand of concurrent cognitive and motor tasks appeared to force subjects to modulate their gait strategy to ensure control of balance. Stride time was consistent across task conditions except when subjects performed fast finger-tapping during gait. Then all but one subject showed a decrease in stride time and an increase in stride-frequency that was repeatable on retest. Since different rhythmic movements are likely to share common neurobiological networks, we assumed that the modulation of stride-frequency was due to structural interference.

Physiological and Cognitive Determinants of Dual-Task Costs for Gait Parameters: The Yishun Study

Gerontology ◽  
2021 ◽  
pp. 1-10
Author(s):  
Lay Khoon Lau ◽  
Jagadish Ullal Mallya ◽  
Wei Jun Benedict Pang ◽  
Kexun Kenneth Chen ◽  
Khalid bin Abdul Jabbar ◽  
...  
Keyword(s):  
Dual Task ◽  
Gait Speed ◽  
Postural Sway ◽  
Step Length ◽  
Double Support ◽  
Immediate Memory ◽  
Gait Parameters ◽  
Primary Determinant ◽  
Double Support Time ◽  
Support Time

Background: Studies indicate that physiological and cognitive aging are causally related and functionally interdependent. However, the relative contribution of physiological factors and cognition to dual-task costs (DTC) of gait parameters has not been well studied. In this cross-sectional study, we examined the trajectory of DTC of gait parameters across the adult age spectrum for both sexes and identified the contributions of physical and cognitive performance to DTC of gait. Methods: A total of 492 community-dwelling adults, aged 21–90 years, were randomly recruited into the study. Participants were divided into 7 age groups, with 10-year age range for each group. Demographic data, height, body mass, education level, and information on comorbidities were recorded. Cognition was measured using the Repeatable Battery for the Assessment of Neuropsychological Status. Physical performance included visual contrast sensitivity, postural sway, hand reaction time, handgrip strength, knee extensor strength, and single-task and dual-task gait assessments. Stepwise multivariable regression was used to examine the association between physical and cognitive performance with DTC of gait parameters. Results: Women were found to have significantly higher DTC of gait speed (p = 0.01), cadence (p < 0.01), and double support time (p < 0.01) than men. However, significant aging effect on DTC of gait speed (p = 0.01), step length (p = 0.01), and double support time (p = 0.01) was observed in men but not in women. Immediate memory was the primary determinant for the DTC of gait speed (β = −0.25, p < 0.01), step length (β = −0.22, p < 0.01), and cadence (β = −0.15, p = 0.03) in men. Besides immediate memory, postural sway (β = −0.13, p = 0.03) and hand reaction (β = 0.14, p = 0.02) were also significantly associated with DTC of step length and cadence, respectively, in women. Conclusion: There were sex differences in the amplitude and trajectories of DTC of gait parameters. The DTC increased with age in men but not in women. Immediate memory was the primary determinant of DTC of gait parameters in men while immediate memory, postural sway, and reaction time were associated with DTC of gait in women. Future studies should investigate the clinical implications of the sex differences in the DTC with fall risks.

scholarly journals Diminished Locomotor Control Is Associated With Reduced Neurovascular Coupling in Older Adults

2019 ◽  
Vol 75 (8) ◽  
pp. 1516-1522 ◽  
Author(s):  
Azizah J Jor’dan ◽  
Brad Manor ◽  
Ikechukwu Iloputaife ◽  
Daniel A Habtemariam ◽  
Jonathan F Bean ◽  
...  
Keyword(s):  
Older Adults ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Dual Task ◽  
Step Width ◽  
Dual Tasking ◽  
Double Support ◽  
Walking Performance ◽  
Double Support Time ◽  
Support Time

Abstract Background Walking, especially while dual-tasking, requires functional activation of cognitive brain regions and their connected neural networks. This study examined the relationship between neurovascular coupling (NVC), as measured by the change in cerebral blood flow in response to performing a cognitive executive task, and dual-task walking performance. Methods Seventy community-dwelling older adults aged 84 ± 5 years within the Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly (MOBILIZE) Boston Study were divided into LOW (n = 35) and HIGH (n = 35) NVC. NVC was quantified by transcranial Doppler ultrasound and stratified by the median change in cerebral blood flow velocity of the middle cerebral artery induced by the performance of the n-back task of executive function. Walking metrics included walking speed, step width, stride length, stride time, stride time variability, and double-support time from single- and dual-task walking conditions, as well as the “cost” of dual-tasking. Results During both single- and dual-task walking, older adults with LOW NVC displayed narrower step width (p = .02 and p = .02), shorter stride length (p = .01 and p = .02), and longer double-support time (p = .03 and p = .002) when compared with the HIGH group. During single-task walking only, LOW NVC was also linked to slower walking speed (p = .02). These associations were independent of age, height, hypertension, atrial fibrillation, and assistive device. The LOW and HIGH NVC groups did not differ in dual-task costs to walking performance. Conclusion In older adults, diminished capacity to regulate cerebral blood flow in response to an executive function task is linked to worse walking performance under both single- and dual-task conditions, but not necessarily dual-task costs.

scholarly journals Assessment of gait in patients with fibromyalgia during motor and cognitive dual task walking: a cross-sectional study

2021 ◽  
Vol 61 (1) ◽  
Author(s):  
Goran Radunović ◽  
Zoran Veličković ◽  
Melanija Rašić ◽  
Saša Janjić ◽  
Vladana Marković ◽  
...  
Keyword(s):  
Functional Status ◽  
Dual Task ◽  
Stride Length ◽  
Clinical Symptoms ◽  
Gait Pattern ◽  
Dual Tasks ◽  
Double Support ◽  
Gait Parameters ◽  
Double Support Time ◽  
Support Time

Abstract Background The aim of the study was to assess gait pattern of patients diagnosed with fibromyalgia (FM) while performing demanding motor and/or cognitive dual tasks while walking. Further, idea was to explore possible correlations of dual task gait pattern alterations to patients’ functional status and presence or absence of clinical symptoms associated with FM. Methods Twenty-four female FM patients and 24 healthy female subjects performed a basic walking task, a dual motor, a dual mental (cognitive) and a combined, dual motor and cognitive task simultaneously. Quantitative spatial (stride length) and temporal (cycle time, swing time and double support time) gait parameters were measured using GAITRite walkway system and their variability was assessed. Patients underwent clinical examination including assessment of functional status, pain and fatigue level, psychiatric and cognitive manifestations. Results The motor, cognitive and combined dual tasks affect gait performance in FM patients. Difference in tasks between FM and healthy subjects was found as double support time prolongation. Comparison of tasks showing that cycle time in FM was longer than controls and stride length was shorter in patients for all conditions, while no changes were found in any of the gait parameters variability. Further, mental/cognitive dual tasks had a larger effect than motor tasks. Correlations were also found between depression and functional status of the patients and the gait parameters. Conclusions Gait is affected in FM patients while dual task walking. No changes in stride-to-stride variability point that patients preserve stability in complex walking situations. Analysis of gait may provide additional information for the FM identification based on presence of clinical features and cognitive status. Correlation of dual task gait alterations with occurrence of clinical symptoms and influence of cognitive changes on gait pattern could additionally define FM subgroups.

Cognitive Load beim Lernen aus Lösungsbeispielen

2003 ◽  
Vol 17 (2) ◽  
pp. 93-101 ◽  
Author(s):  
Alexander Renkl ◽  
Hans Gruber ◽  
Sandra Weber ◽  
Thomas Lerche ◽  
Karl Schweizer
Keyword(s):  
Cognitive Load ◽  
Dual Task

Zusammenfassung: Die Effektivität des Lernens aus Lösungsbeispielen im Vergleich zum Lernen durch Problemlösen wird derzeit mit der Cognitive Load-Theorie erklärt: Beim Lernen aus Lösungsbeispielen wird das Arbeitsgedächtnis weniger belastet, daher bleibt mehr Raum für Lern- und Verstehensprozesse. Um diese These direkt experimentell zu überprüfen, wurde das dual task-Paradigma eingesetzt. 80 Studierende der Geistes- und Sozialwissenschaften wurden auf die Zellen eines 2 × 2-faktoriellen Designs (Faktor 1: Lernen aus Lösungsbeispielen vs. Lernen durch Problemlösen; Faktor 2: mit vs. ohne Zweitaufgabe) verteilt. Der Lernstoff war Wahrscheinlichkeitsrechnung. Der Lernerfolg wurde mit einem Nachtest erfasst. Das Befundmuster hinsichtlich des Lernerfolgs und der Reaktionszeiten auf eine Zweitaufgabe in den vier experimentellen Gruppen stimmte mit den aus der Cognitive-Load-Theorie abgeleiteten Hypothesen überein.

Assessment of Cognitive Load in Multimedia Learning Using Dual-Task Methodology

2002 ◽  
Vol 49 (2) ◽  
pp. 109-119 ◽  
Author(s):  
Roland Brünken ◽  
Susan Steinbacher ◽  
Jan L. Plass ◽  
Detlev Leutner
Keyword(s):  
Cognitive Load ◽  
Dual Task ◽  
Cognitive Load Theory ◽  
Multimedia Learning ◽  
Learning Systems ◽  
Learning Materials ◽  
New Approach ◽  
Direct Assessment ◽  
Load Theory ◽  
Audiovisual Presentation

Abstract. In two pilot experiments, a new approach for the direct assessment of cognitive load during multimedia learning was tested that uses dual-task methodology. Using this approach, we obtained the same pattern of cognitive load as predicted by cognitive load theory when applied to multimedia learning: The audiovisual presentation of text-based and picture-based learning materials induced less cognitive load than the visual-only presentation of the same material. The findings confirm the utility of dual-task methodology as a promising approach for the assessment of cognitive load induced by complex multimedia learning systems.

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 EEG Fractal Analysis Reflects Brain Impairment after Stroke

Entropy ◽  
2021 ◽  
Vol 23 (5) ◽  
pp. 592
Author(s):  
Maria Rubega ◽  
Emanuela Formaggio ◽  
Franco Molteni ◽  
Eleonora Guanziroli ◽  
Roberto Di Marco ◽  
...  
Keyword(s):  
Early Stage ◽  
Brain Activity ◽  
Phase 1 ◽  
Behavioral Changes ◽  
Stroke Survivors ◽  
Eeg Signals ◽  
Novel Treatments ◽  
Fractal Measures ◽  
Underlying Mechanisms ◽  
Random Fluctuations

Stroke is the commonest cause of disability. Novel treatments require an improved understanding of the underlying mechanisms of recovery. Fractal approaches have demonstrated that a single metric can describe the complexity of seemingly random fluctuations of physiological signals. We hypothesize that fractal algorithms applied to electroencephalographic (EEG) signals may track brain impairment after stroke. Sixteen stroke survivors were studied in the hyperacute (<48 h) and in the acute phase (∼1 week after stroke), and 35 stroke survivors during the early subacute phase (from 8 days to 32 days and after ∼2 months after stroke): We compared resting-state EEG fractal changes using fractal measures (i.e., Higuchi Index, Tortuosity) with 11 healthy controls. Both Higuchi index and Tortuosity values were significantly lower after a stroke throughout the acute and early subacute stage compared to healthy subjects, reflecting a brain activity which is significantly less complex. These indices may be promising metrics to track behavioral changes in the very early stage after stroke. Our findings might contribute to the neurorehabilitation quest in identifying reliable biomarkers for a better tailoring of rehabilitation pathways.

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