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Andreas Mbili

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Aug 3, 2024, 4:37:09 PM8/3/24

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Cognitive age-related decline is linked to dementia development and gait has been proposed to measure the change in brain function. This study aimed to investigate if spatiotemporal gait variables could be used to differentiate between the three cognitive status groups.

Spatiotemporal gait variables showed discriminative ability between dementia and cognitively intact groups in both single and dual-tasks. This suggests that gait could potentially be used as a clinical differentiation marker for individuals with cognitive problems.

Dementia affects approximately 47 million people worldwide, with 10 million new cases reported each year [1]. In East Asia, the prevalence of dementia is increasing which has been shown to be associated with cardiovascular risk factors [2] or exposure to air pollution [3]. In contrast, the declination of dementia incidence was reported in high-income countries such as the United States, the United Kingdom, Sweden, the Netherlands, France, and Iceland [2, 4]. In Thailand, the majority of cases were caused by Alzheimer's disease (AD), followed by vascular dementia, dementia with Lewy bodies, frontotemporal dementia, and others [5]. Dementia is a group of different progressive diseases that currently has no cure and is arguably the most pressing public health challenge [2, 6]. It is a syndrome that primarily affects older people and is characterized by a decline in cognitive performance that affects the individual's ability related to cognitive and physical functions [1, 7,8,9,10]. Dementia and falls were reported as the top five causes of disability-adjusted life-years (DALYs) in people aged 75 and older [11]. This is an important cause of disability and dependency and has an impact on family and carers' physical, psychological and social well-being [1, 6, 12]. Among the various problems faced, individuals with dementia frequently experience gait and balance issues, which contribute to a significantly increased risk of falling [13,14,15,16], leading to fractures, hospitalization, functional dependence, or death [1, 14, 15].

Early detection of dementia is frequently challenging, as the functional deficits required for such diagnoses can be caused or exacerbated by comorbidities and social circumstances [17,18,19]. Progression of the disease escalates over time if individuals are misdiagnosed, which leads to inappropriate clinical management [10, 20,21,22]. As a result, it is crucial to detect dementia quickly and accurately, as well as to monitor the disease progression. substantial evidence demonstrates that timely diagnosis and treatment can prevent the progression of dementia or its consequences [16, 21, 23, 24]. A non-invasive, sensitive, and cost-effective marker is therefore required to help identify and classify individuals with cognitive decline [25].

Gait performance has been studied to determine its efficacy in screening individuals with cognitive dysfunction. Clinical and epidemiologic evidence supports the concept that gait is interrelated with cognitive ability in the elderly [26,27,28,29]. It has been reported that healthy younger individuals can preserve their primary walking when faced with a secondary cognitive task, whereas older adults have difficulty in preserving their gait performance during dual tasks, and this capability is greatly reduced in those with cognitive dysfunction [21, 30,31,32]. An attempt to investigate the relationship between gait and cognition not only provides a better understanding of function but also provides an assessment of safety during movement. Decreased ability to walk during a single- or cognitive dual-task has been reported to be a contributing factor to falls in older adults and individuals with cognitive decline [33, 34]. Dual-task gait assessment, where individuals have to perform a secondary attentional challenging task while walking, was shown to be more challenging as the tasks interfere with each other and divide the cortical control resources of the brain [35]. Gait modifications, such as reduced gait speed, rhythm, sway, instability, or stopping walking, can occur while performing the second task together, especially in individuals with cognitive decline [35,36,37]. In addition, a meta-analysis has demonstrated the importance of gait and cognition factors with the dual decline of gait speed and memory having the highest predictive risk of developing dementia among older individuals [31].

The role of using gait in classifying individuals with or without cognitive decline has been shown in the studies [16, 38,39,40,41,42,43,44,45,46,47]. However, based on the different reports previously, the results varied from study to study. This may be a result of differences in participants' characteristics, measuring equipment, testing variables, and the walking data collection process. Yet most of the reported findings came from western countries [40,41,42,43,44,45,46,47] and less was done in Asian countries and reported on a small sample size [16, 38, 39]. Different biological structures, cultures, living behaviors, quality of life, pollution and environment, and education all could influence gait and cognitive profiles. Hence, data from the studies on different populations, especially people in Asian countries, are still needed. In addition, which gait variables are the most sensitive and practical to discriminate between groups of individuals with different cognitive levels is needed. This study therefore explored the use of gait profiles to differentiate people with different cognitive profiles within a South East Asian population.

Spatiotemporal gait variables were then collected at 100 Hz using the Force Distribution Measurement (FDM) platform which had a length of 307 cm and width of 60.5 cm (Zebris Medical GmbH, Germany). The platform was installed in the middle part of a 5 m walkway and was synchronized with a video camera (SYNCCam) placed in front of the participants to check walking patterns for each trial. The FDM platform is widely used for gait assessment in various neurological conditions and was used as a gold standard to another proposed tool [56,57,58,59]. To remove the effect of the acceleration and deceleration phases of walking, gait data were recorded from the middle part of the walkway. Spatiotemporal gait data were extracted and analyzed using the WinFDM software (Zebris Medical GmbH, Germany, version 1.18.48).

For the single-task condition, the participants were asked to walk at their own usual walking pace on the walking platform. For the dual-task condition, to monitor the compliance of the testing, participants were asked to count a number backward by one out loud while walking at their usual walking pace [39, 40]. A physical therapist walked slightly behind the participants to prevent slips, trips, and falls during the data collection. Three successful trials were recorded under each condition and the average of the three trials was used in the data analysis.

SPSS version 26.0 (IBM Corp, USA) was used for all analyses. Participant characteristics and clinical variables were descriptively analyzed. A two-way ANCOVA was used to determine the main effects and interaction effects of the cognitive status groups (MCI, dementia, and cognitively intact) and walking task (single and dual). Comparisons of gait variables between the MCI, dementia, and cognitively intact groups during single- and dual-task walking were explored using one-way ANCOVA tests. Regarding age, sex, and BMI are the biological important factors that could affect gait variables, so these factors were used as the covariates in the analysis and the adjusted mean values were reported.

We found a decrease in gait performance in individuals with cognitive decline when compared with those who were cognitively intact. Specifically decreases in step length, stride length, single support phase, cadence, and gait speed; and increases in stance phase, loading response, pre-swing, double support, step time, and stride time. However, there was no change in the foot rotation angle and step width. Similar to previous findings, these measures of decline in gait performance were noticeable during single-task walking but showed greater deterioration when tested under a dual-task walking condition [36, 40, 65,66,67]. From our findings, there were significant differences in several gait variables between the MCI and dementia groups and between dementia and cognitively intact groups when tested under single- and dual-task walking. However, there were no differences in gait variables between the MCI and cognitively intact groups, whether testing under single- or dual-task walking. This may be the result of several factors, including 1) differences in the sample criteria and classification, 2) variability of the data observed by a larger standard error, even though the mean differences were similar between the groups, 3) dual-task walking test procedure, in which counting backward with one might challenge cognitive function to a lesser extent than other counting tasks such as subtracting by seven [68]. Subtraction with one was chosen in this study because the technique can be used to assess the majority of individuals with dementia. Although the method seems to be very simple, there were five individuals with dementia unable to perform this task. However, our counting method may not cognitively challenge a large number of individuals in the MCI group, thus the results cannot be differentiated from the cognitively intact group. A recent systematic review with meta-analysis. reported that the spatiotemporal gait variables (e.g., gait speed, cadence, stride length, stride time, stride time variability, and stance time) could be used to classify normal and dementia groups when tested using a single task. In addition, the dual-task could differentiate between these two groups using gait speed, stride length, and stride time variability only [69]. Another point of consideration is that the mean values of the gait variables in our study were substantially different from previous reports from Western countries, which may be due to racial, anthropometric, and sociocultural differences.