scholarly journals Perturbation-based balance assessment: Examining reactive balance control in older adults with mild cognitive impairments

2021 ◽  
Author(s):  
Lakshmi N Kannan ◽  
Tanvi S Bhatt
Keyword(s):  
Older Adults ◽  
Young Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Balance Control ◽  
Step Length ◽  
Subjective Memory ◽  
Step Initiation ◽  
Risk Of Falls ◽  
Reactive Balance

Abstract Background Older adults with mild cognitive impairment (OAwMCI) present subtle balance and gait deficits along with subjective memory decline. Although these presentations might not affect activities of daily living (ADLs), they attribute to a two-folded increase in falls. While changes occurring in volitional balance control during ADLs have been extensively examined among OAwMCI, reactive balance control, required to recover from external perturbations, has received little attention. Therefore, this study examined reactive balance control in OAwMCI compared to their healthy counterparts. Methods Fifteen older adults with mild cognitive impairment (OAwMCI), fifteen cognitively intact older adults (CIOA) (>55 years), and fifteen young adults (18–30 years) were exposed to stance perturbations at three different intensities. Behavioral outcomes postural COM state stability, step length, step initiation, and step execution were computed. Results Postural COM state stability was the lowest in OAwMCI compared to CIOA and young adults, and it deteriorated at higher perturbation intensities (P < 0.001). Step length was the lowest among OAwMCI and was significantly different from young adults (P < 0.001) but not from CIOA. Unlike OAwMCI, CIOA and young adults increased their step length at higher perturbation intensities (P < 0.001). OAwMCI showed longer recovery step initiation times and shorter execution times compared to CIOA and young adults at higher perturbation intensities (P < 0.001). Conclusion OAwMCI exhibit exacerbated reactive instability and are unable to modulate their responses as the threat to balance control altered. Thus, they are at a significantly higher risk of falls than their healthy counterparts.

Qualitative Evaluation Informs Understanding of Motor Cognition and Therapies in Older Adults with Mild Cognitive Impairment

2021 ◽  
pp. 1-13
Author(s):  
David Lazris ◽  
Molly M. Perkins ◽  
Allison A. Bay ◽  
Madeleine E. Hackney
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Black Women ◽  
Qualitative Evaluation ◽  
Social Benefit ◽  
Lifestyle Changes ◽  
Cognitive Integration ◽  
Subjective Memory ◽  
Predominantly Black

Background: 10%to 20%of Americans aged 65 and older have mild cognitive impairment (MCI) with 10%progressing to Alzheimer’s disease (AD) each year. Underserved groups, including African Americans (AAs), are among the most vulnerable to MCI and AD. Although evidence continues to amass, the benefits of exercise and movement for AD is still understudied in AD. Objective: Understanding the attitudes, perceptions, and beliefs about motor-cognitive integration and examining the physical activity of a sample of predominantly Black women community members with self-reported memory problems will allow improved recruitment and refinement of multimodal interventions designed to improve motor-cognitive and cognitive function. Methods: We conducted focus groups with older adults who reported subjective memory complaints (n = 15; Black: n = 12, White: n = 3, mean age 71.7±5.8). Results: Findings from thematic analysis showed most participants knew of benefits of exercise. However, most participants reported not getting adequate exercise due to factors such as pain, increased responsibilities, and fears of injury. Despite barriers, participants expressed enthusiasm for multimodal interventions designed to target body and brain health and provided several suggestions to improve or enhance the proposed interventions. Conclusion: Results provide useful insights regarding improving participation among historically under-represented groups in clinical movement-based research. Participants’ discussion focused primarily on the way motor-cognitive integration prevents falls, maintains memory, and provides a social benefit. The reported perceived benefits and limitations of exercise, as this population understands it, can help researchers and physicians better engage the community for lifestyle changes that will support greater motor-cognitive health.

Mild Cognitive Impairment Affects Obstacle Negotiation in Older Adults: Results from “Gait and Brain Study”

Gerontology ◽  
2018 ◽  
Vol 65 (2) ◽  
pp. 164-173 ◽  
Author(s):  
Frederico Pieruccini-Faria ◽  
Yanina Sarquis-Adamson ◽  
Manuel Montero-Odasso
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Executive Function ◽  
Mild Cognitive Impairment ◽  
Dual Task ◽  
Gait Speed ◽  
Step Length ◽  
Gait Control ◽  
Dual Tasking ◽  
Brain Study

Background: Older adults with Mild Cognitive Impairment (MCI) are at higher risk of falls and injuries, but the underlying mechanism is poorly understood. Inappropriate anticipatory postural adjustments to overcome balance perturbations are affected by cognitive decline. However, it is unknown whether anticipatory gait control to avoid an obstacle is affected in MCI. Objective: Using the dual-task paradigm, we aim to assess whether gait control is affected during obstacle negotiation challenges in older adults with MCI. Methods: Seventy-nine participants (mean age = 72.0 ± 2.7 years; women = 30.3%) from the “Gait and Brain Study” were included in this study (controls = 27; MCI = 52). In order to assess the anticipatory control behaviour for obstacle negotiation, a 6-m electronic walkway embedded with sensors recorded foot prints to measure gait speed and step length variability, during early (3 steps before the late phase) and late (3 steps before the obstacle) pre-crossing phases of an ad hoc obstacle, set at 15% of participant’s height. Participants walked under single- and dual-task gait (counting backwards by 1’s from 100 while walking) conditions. Three-way mixed repeated-measures analysis of variance models examined differences in gait performance between groups when transitioning between pre-crossing phases towards an obstacle during single- and dual-task conditions. Analyses were adjusted for age, sex, years of education, lower limb function, fear of falling, medical status, depressive symptoms, baseline gait speed and executive function. Results: A significant three-way interaction among groups, pre-crossing phases and task showed that participants with MCI attenuated the gait deceleration (p = 0.02) and performed fewer step length adjustments (p = 0.03) when approaching the obstacle compared with controls while dual-tasking. These interactions were attenuated when executive function performance was added as a covariate in the adjusted statistical model. Conclusion: Older adults with MCI attenuate the anticipatory gait adjustments needed to avoid an obstacle when dual-tasking. Deficits in higher-order cognitive processing may limit obstacle negotiation capabilities in MCI populations, being a potential falls risk factor.

scholarly journals Postural Control Dysfunction and Balance Rehabilitation in Older Adults with Mild Cognitive Impairment

2020 ◽  
Vol 10 (11) ◽  
pp. 873
Author(s):  
Xuan Liu ◽  
Michelle H. Chen ◽  
Guang H. Yue
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Rehabilitation Program ◽  
Significant Treatment ◽  
Increased Risk ◽  
Mapping Review ◽  
Risk Of Falls ◽  
Adequate Quality ◽  
Balance Rehabilitation

Older adults with mild cognitive impairment (MCI) are at an increased risk for falls and fall-related injuries. It is unclear whether current balance rehabilitation techniques largely developed in cognitively intact populations would be successful in older adults with MCI. This mapping review examined the available balance rehabilitation research conducted in older adults with MCI. Databases Medline, Cinahl, Cochrane, PubMed, Scopus, and PsycINFO were systematically searched from inception to August 2020. Twenty-one studies with 16 original randomized controlled trials (RCTs) involving 1201 older adults with MCI (>age 60) met the inclusion criteria, of which 17 studies showed significant treatment effects on balance functions. However, only six studies demonstrated adequate quality (at least single-blind, no significant dropouts, and intervention and control groups are equivalent at baseline) and evidence (medium or large effect size on at least one balance outcome) in improving balance in this population, and none of them are double- or triple-blind. Therefore, more high-quality RCTs are needed to inform future balance rehabilitation program development for older adults with MCI. Moreover, few studies examined the incidence of falls after the intervention, which limits clinical utility. Future RCTs should prospectively monitor falls or changes in risk of falls after the intervention.

Memory Compensation Strategies in Older People with Mild Cognitive Impairment

2020 ◽  
Vol 26 (1) ◽  
pp. 86-96
Author(s):  
Pinghsiu Lin ◽  
Haley M. LaMonica ◽  
Sharon L. Naismith ◽  
Loren Mowszowski
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Daily Life ◽  
Well Being ◽  
Strategy Use ◽  
Subjective Memory Complaints ◽  
Subjective Memory ◽  
Memory Complaints ◽  
Memory Strategy

AbstractObjectives:With the rapid growth of the older population worldwide, understanding how older adults with mild cognitive impairment (MCI) use memory strategies to mitigate cognitive decline is important. This study investigates differences between amnestic and nonamnestic MCI subtypes in memory strategy use in daily life, and how factors associated with cognition, general health, and psychological well-being might relate to strategy use.Methods:One hundred forty-eight participants with MCI (mean age = 67.9 years, SD = 8.9) completed comprehensive neuropsychological, medical, and psychological assessments, and the self-report ‘Memory Compensation Questionnaire’. Correlational and linear regression analyses were used to explore relationships between memory strategy use and cognition, general health, and psychological well-being.Results:Memory strategy use does not differ between MCI subtypes (p > .007) despite higher subjective everyday memory complaints in those with amnestic MCI (p = .03). The most marked finding showed that increased reliance-type strategy use was significantly correlated with more subjective memory complaints and poorer verbal learning and memory (p < .01) in individuals with MCI. Moreover, fewer subjective memory complaints and better working memory significantly predicted (p < .05) less reliance strategy use, respectively, accounting for 10.6% and 5.3% of the variance in the model.Conclusions:In general, the type of strategy use in older adults with MCI is related to cognitive functioning. By examining an individual’s profile of cognitive dysfunction, a clinician can provide more personalized clinical recommendations regarding strategy use to individuals with MCI, with the aim of maintaining their day-to-day functioning and self-efficacy in daily life.

scholarly journals Preventing Loss of Independence through Exercise (PLIÉ): A Pilot Trial in Older Adults with Subjective Memory Decline and Mild Cognitive Impairment

2021 ◽  
pp. 1-15
Author(s):  
Linda L. Chao ◽  
Jennifer A. Lee ◽  
Steven Martinez ◽  
Cody Barlow ◽  
Margaret A. Chesney ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Functional Connectivity ◽  
Social Isolation ◽  
Self Regulation ◽  
Pilot Trial ◽  
Well Being ◽  
Subjective Memory ◽  
Memory Decline

Background: Preventing Loss of Independence through Exercise (PLIÉ) is a group movement program initially developed for people with mild-to-moderate dementia that integrates principles from several well-established traditions to specifically addresses the needs of people with cognitive impairment. Objective: To investigate whether PLIÉ would benefit cognitive and behavioral outcomes and functional brain connectivity in older adults with milder forms of cognitive impairment. Methods: Participants (≥55 y) with subjective memory decline (SMD) or mild cognitive impairment (MCI) were assessed with tests of cognitive and physical function, self-report questionnaires, and resting state functional magnetic resonance imaging (rs-fMRI) on a 3 Tesla scanner before and after participating in twice weekly PLIÉ classes for 12 weeks at the San Francisco Veterans Affairs Medical Center. Results: Eighteen participants completed the pre-post intervention pilot trial. We observed significant improvements on the Alzheimer’s Disease Assessment Scale cognitive subscale (ADAS-cog; effect size 0.34, p = 0.002) and enhanced functional connections between the medial prefrontal cortex (mPFC) and other nodes of the default mode network (DMN) after PLIÉ. Improvements (i.e., lower scores) on ADAS-cog were significantly correlated with enhanced functional connectivity between the mPFC and left lateral parietal cortex (Spearman’s ρ= –0.74, p = 0.001) and between the mPFC and right hippocampus (Spearman’s ρ= –0.83, p = 0.001). After completing PLIÉ, participants reported significant reductions in feelings of social isolation and improvements in well-being and interoceptive self-regulation. Conclusion: These preliminary findings of post-PLIÉ improvements in DMN functional connectivity, cognition, interoceptive self-regulation, well-being and reduced feelings of social isolation warrant larger randomized, controlled trials of PLIÉ in older adults with SMD and MCI.

scholarly journals ASSOCIATIONS OF DUAL TASK EXERGAMING WITH COGNITIVE-MOTOR INTERFERENCE IN OLDER ADULTS WITH MILD COGNITIVE IMPAIRMENT: A SINGLE-ARM PILOT STUDY

2021 ◽  
pp. 1-7
Author(s):  
L. Kannan ◽  
T. Bhatt
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Dual Task ◽  
Balance Control ◽  
Cognitive Task ◽  
Cognitive Tasks ◽  
Future Studies ◽  
Wii Fit ◽  
Sequencing Task

Purpose: To examine the feasibility and effectiveness of dual task (DT) exergaming to improve volitional balance control in older adults with mild cognitive impairment (MCI). Methods: Ten older adults with MCI were examined at baseline (week-0) and post-training (week-5) on volitional balance control (maximum excursion of center of gravity, MXE [%]) while performing cognitive task (auditory clock test or letter number sequencing task) and on the NIH-motor and cognitive toolboxes. DT exergaming training lasted for 12 sessions which consisted of performing explicit cognitive tasks while playing the Wii-Fit balance games. Results: From pre- to post-training, MXE improved (p<0.05); however, cognitive accuracy (cognitive task) remained the same (p>0.05). Improvement in NIH motor and cognitive toolbox tests was observed post-training (p<0.05). Conclusion: DT exergaming was associated to improvements in balance control under attention-demanding conditions in MCI. Future studies may focus on examining the efficacy of such training.

Proactive and retroactive interference in young adults, healthy older adults, and older adults with amnestic mild cognitive impairment

2009 ◽  
Vol 15 (1) ◽  
pp. 83-93 ◽  
Author(s):  
PATRICIA L. EBERT ◽  
NICOLE D. ANDERSON
Keyword(s):  
Older Adults ◽  
Young Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Retroactive Interference ◽  
Memory Performance ◽  
Verbal Learning ◽  
Amnestic Mild Cognitive Impairment ◽  
Healthy Older Adults ◽  
Memory Interference

AbstractThis study investigated memory interference in amnestic mild cognitive impairment (aMCI) and normal aging. Participants were 27 young adults, 44 healthy older adults, and 15 older adults with aMCI. Memory interference was examined on the California Verbal Learning Test (CVLT) and on a modified AB-AC paradigm. Despite significant differences in memory performance on the CVLT, interference measures on this test did not distinguish individuals with aMCI and healthy older adults. The AB-AC task involved first learning a list (AB list) of 12 semantically related word pairs (e.g., knee-bone). Twenty minutes later, a second list (AC list) was learned in which the same stimulus words were paired with new response words (e.g., knee-bend). Both lists were repeated until 100% accurate recall was achieved. Finally, participants recalled the first (AB) list. Proactive interference (PI) was greater among older than younger adults, and greater still among individuals with aMCI, but the older and aMCI groups showed similar levels of retroactive interference. This study suggests that PI contributes to the memory deficits seen in aMCI and that tests sensitive to PI may assist in the early identification of aMCI. Memory interventions aimed at alleviating PI may improve memory functioning in individuals with aMCI. (JINS, 2009, 15, 83–93.)

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