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The relationship between gait dynamics and future cognitive decline: a prospective pilot study in geriatric patients

  • Lisette H. J. Kikkert (a1) (a2) (a3), Nicolas Vuillerme (a2) (a4), Jos P. van Campen (a3), Bregje A. Appels (a5), Tibor Hortobágyi (a1) and Claudine J. C. Lamoth (a1)...
Abstract
Background:

Walking ability recently emerged as a sub-clinical marker of cognitive decline. Hence, the relationship between baseline gait and future cognitive decline was examined in geriatric patients. Because a “loss of complexity” (LOC) is a key phenomenon of the aging process that exhibits in multiple systems, we propose the idea that age- and cognition-related LOC may also become manifested in gait function. The LOC theory suggests that even healthy aging is associated with a (neuro)physiological breakdown of system elements that causes a decline in variability and an overall LOC. We used coordination dynamics as a conceptual framework and hypothesized that a LOC is reflected in dynamic gait outcomes (e.g. gait regularity, complexity, stability) and that such outcomes could increase the specificity of the gait-cognition link.

Methods:

19 geriatric patients (age 80.0±5.8) were followed for 14.4±6.6 months. An iPod collected three-dimensional (3D) trunk accelerations while patients walked for 3 minutes. Cognition was evaluated with the Mini-Mental State Examination (MMSE) and the Seven-Minute screen (7MS) test. The Reliable Change Index (RCI) quantified the magnitude of cognitive change. Spearman's Rho coefficients (ρ) indexed correlations between baseline gait and future cognitive change.

Results:

Seven patients showed reliable cognitive decline (“Cognitive Decline” group), and 12 patients remained cognitively stable (“Cognitive Stable” group) over time. Future cognitive decline was correlated with a more regular (ρ = 0.579*) and predictable (ρ = 0.486*) gait pattern, but not with gait speed.

Conclusions:

The increase in gait regularity and predictability possibly reflects a LOC due to age- and cognition-related (neuro)physiological decline. Because dynamic versus traditional gait outcomes (i.e. gait speed and (variability of) stride time) were more strongly correlated with future cognitive decline, the use of wearable sensors in predicting and monitoring cognitive and physical health in vulnerable geriatric patients can be considered promising. However, our results are preliminary and do require replication in larger cohorts.

Copyright
Corresponding author
Correspondence should be addressed to: Lisette H. J. Kikkert, University of Groningen, University Medical Centre Groningen, Center for Human Movement Sciences, Ant Deusinglaan 1, 9713 AV Groningen, The Netherlands. Phone: +31(0)50 363 2710. Email: l.h.j.kikkert@umcg.nl.
References
Hide All
Allali, G. et al. (2016). Gait phenotype from mild cognitive impairment to moderate dementia: results from the GOOD initiative. European Journal of Neurology, 23, 527541. doi: 10.1111/ene.12882.
Beauchet, O. et al. (2016). Poor gait performance and prediction of dementia: results from a meta-analysis. Journal of the American Medical Directors Association, 17, 482490. doi: 10.1016/j.jamda.2015.12.092.
Brach, J. S., Perera, S., Van Swearingen, J. M., Hile, E. S., Wert, D. M. and Studenski, S. A. (2011). Challenging gait conditions predict 1-year decline in gait speed in older adults with apparently normal gait. Physical Therapy, 91, 18571864. doi: 10.2522/ptj.20100387.
Cignetti, F., Decker, L. M. and Stergiou, N. (2012). Sensitivity of the Wolf's and Rosenstein's algorithms to evaluate local dynamic stability from small gait data sets. Annals of Biomedical Engineering, 40, 11221130. doi: 10.1007/s10439-011-0474-3.
Costa, M., Peng, C. -L., Goldberger, A. and Hausdorff, J. M. (2003). Multiscale entropy analysis of human gait dynamics. Physica A: Statistical Mechanics and its Applications, 330, 5360. doi: https://doi.org/10.1016/j.physa.2003.08.022.
de Groot, M. H., van Campen, J. P., Kosse, N. M., de Vries, O. J., Beijnen, J. H. and Lamoth, C. J. (2016). The association of medication-use and frailty-related factors with gait performance in older patients. PloS One, 11, e0149888. doi: 10.1371/journal.pone.0149888.
de Groot, M. H., van der Jagt-Willems, H. C., van Campen, J. P., Lems, W. F., Beijnen, J. H. and Lamoth, C. J. (2014). A flexed posture in elderly patients is associated with impairments in postural control during walking. Gait & Posture, 39, 767772. doi: 10.1016/j.gaitpost.2013.10.015.
Holtzer, R., Epstein, N., Mahoney, J. R., Izzetoglu, M. and Blumen, H. M. (2014). Neuroimaging of mobility in aging: a targeted review. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 69, 13751388. doi: 10.1093/gerona/glu052.
Hooghiemstra, A. M. et al. (2017). Gait speed and grip strength reflect cognitive impairment and are modestly related to incident cognitive decline in memory clinic patients with subjective cognitive decline and mild cognitive impairment: findings from the 4C study. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 72, 846854. doi: 10.1093/gerona/glx003.
Inouye, S. K., Studenski, S., Tinetti, M. E. and Kuchel, G. A. (2007). Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. Journal of the American Geriatrics Society, 55, 780791. doi: JGS1156 [pii].
Jacobson, N. S. and Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 1219.
Kang, H. G. et al. (2009). Frailty and the degradation of complex balance dynamics during a dual-task protocol. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 64, 13041311. doi: 10.1093/gerona/glp113.
Kikkert, L. H. J. et al. (2017). Gait dynamics to optimize fall risk assessment in geriatric patients admitted to an outpatient diagnostic clinic. PloS One, 12, e0178615. doi: 10.1371/journal.pone.0178615.
Kikkert, L. H., Vuillerme, N., van Campen, J. P., Hortobagyi, T. and Lamoth, C. J. (2016). Walking ability to predict future cognitive decline in old adults: a scoping review. Ageing Research Reviews, 27, 114. doi: S1568-1637(16)30009-5 [pii].
Kobsar, D., Olson, C., Paranjape, R., Hadjistavropoulos, T. and Barden, J. M. (2014). Evaluation of age-related differences in the stride-to-stride fluctuations, regularity and symmetry of gait using a waist-mounted tri-axial accelerometer. Gait & Posture, 39, 553557. doi: 10.1016/j.gaitpost.2013.09.008.
Kosse, N. M., Caljouw, S., Vervoort, D., Vuillerme, N. and Lamoth, C. J. (2015). Validity and reliability of gait and postural control analysis using the tri-axial accelerometer of the ipod touch. Annals of Biomedical Engineering, 43, 19351946. doi: 10.1007/s10439-014-1232-0.
Lamoth, C. J., Beek, P. J. and Meijer, O. G. (2002). Pelvis-thorax coordination in the transverse plane during gait. Gait & Posture, 16, 101114. doi: S0966636201001461 [pii].
Lamoth, C. J., van Deudekom, F. J., van Campen, J. P., Appels, B. A., de Vries, O. J. and Pijnappels, M. (2011). Gait stability and variability measures show effects of impaired cognition and dual tasking in frail people. Journal of Neuroengineering and Rehabilitation, 8, 2-0003-8-2. doi: 10.1186/1743-0003-8-2.
Lang, P. O., Michel, J. P. and Zekry, D. (2009). Frailty syndrome: a transitional state in a dynamic process. Gerontology, 55, 539549. doi: 10.1159/000211949.
Lipsitz, L. A. (2002). Dynamics of stability: the physiologic basis of functional health and frailty. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 57, B115125.
Lipsitz, L. A. and Goldberger, A. L. (1992). Loss of ‘complexity’ and aging: potential applications of fractals and chaos theory to senescence. JAMA, 267, 18061809. doi: 10.1001/jama.1992.03480130122036 [doi].
Manor, B. et al. (2010). Physiological complexity and system adaptability: evidence from postural control dynamics of older adults. Journal of Applied Physiology (Bethesda, Md.: 1985), 109, 17861791. doi: 10.1152/japplphysiol.00390.2010.
Montero-Odasso, M. et al. (2014). The motor signature of mild cognitive impairment: results from the gait and brain study. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 69, 14151421. doi: 10.1093/gerona/glu155.
Qualls, C. et al. (2017). Reversible states of physical and/or cognitive dysfunction: a 9-Year longitudinal study. The Journal of Nutrition, Health & Aging, 21, 271275. doi: 10.1007/s12603-017-0878-3 [doi].
Rispens, S. M., Pijnappels, M., van Schooten, K. S., Beek, P. J., Daffertshofer, A. and van Dieen, J. H. (2014). Consistency of gait characteristics as determined from acceleration data collected at different trunk locations. Gait & Posture, 40, 187192. doi: 10.1016/j.gaitpost.2014.03.182.
Riva, F., Toebes, M. J., Pijnappels, M., Stagni, R. and van Dieen, J. H. (2013). Estimating fall risk with inertial sensors using gait stability measures that do not require step detection. Gait & Posture, 38, 170174. doi: 10.1016/j.gaitpost.2013.05.002.
Savica, R. et al. (2017). Comparison of gait parameters for predicting cognitive decline: the mayo clinic study of aging. Journal of Alzheimer's Disease: JAD, 55, 559567. doi: JAD160697 [pii].
Sleimen-Malkoun, R., Temprado, J. J. and Hong, S. L. (2014). Aging induced loss of complexity and dedifferentiation: consequences for coordination dynamics within and between brain, muscular and behavioral levels. Frontiers in Aging Neuroscience, 6, 140. doi: 10.3389/fnagi.2014.00140.
Studenski, S. et al. (2011). Gait speed and survival in older adults. JAMA, 305, 5058. doi: 10.1001/jama.2010.1923.
van Schooten, K. S., Pijnappels, M., Rispens, S. M., Elders, P. J., Lips, P. and van Dieen, J. H. (2015). Ambulatory fall-risk assessment: amount and quality of daily-life gait predict falls in older adults. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 70, 608615. doi: 10.1093/gerona/glu225.
Verghese, J., Wang, C., Lipton, R. B. and Holtzer, R. (2013). Motoric cognitive risk syndrome and the risk of dementia. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 68, 412418.
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International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
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