Increased spatiotemporal variability during unplanned gait speed transition in older adults with mild cognitive impairment
Article Sidebar
Main Article Content
Abstract
Background: Walking in real-life situation requires an ability to rapidly change gait speed to achieve task goals or overcome environmental constraints. Gait speed transition may be compromised in older adults with Mild Cognitive Impairment (MCI) as it requires high demands on motor and cognitive integration to maintain gait stability. Gait variability is proposed to be a robust marker of cortical flexibility in regulating gait. Therefore, assessing gait variability during rapid increase in gait speed may hold promise in detecting deficits related to gait control among older adults with MCI.
Objectives: To investigate spatiotemporal parameters of gait variability during unexpected gait speed transition in older adults with and without MCI.
Materials and methods: Seventeen older adults with MCI (mean age=69.12±4.24 yrs.) and 17 cognitively intact controls (mean age=68.88±5.31 yrs.) participated in the study. The slow to fast speed transition was measured by asking participants to start walking at a slow pace and then instantaneously changing to fast pace in response to an unexpected auditory cue. Mean and coefficients of variation (CV) of step length, step width, step time and swing time were measured during slow to fast speed transition using 3-dimensional motion analysis. The Mann-Whitney U test was conducted to compare spatiotemporal gait parameters between the two groups. The statistical significance was set at p<0.05.
Results: Older adults with MCI demonstrated greater variability of step width (MCI group=38.81±9.44, Control group=31.45±7.67, p=0.04) and swing time (MCI group=16.02±5.11, Control group=12.14±3.52, p=0.02) than controls during fast speed transition. However, mean spatiotemporal parameters were similar between the two groups.
Conclusion: Older adults with MCI demonstrated increased step width and swing time variability during slow to fast gait speed transition. This finding suggests an impaired ability to regulate gait consistency which may predispose them to falls.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Personal views expressed by the contributors in their articles are not necessarily those of the Journal of Associated Medical Sciences, Faculty of Associated Medical Sciences, Chiang Mai University.
References
Petersen RC. Mild cognitive impairment as a diagnostic entity. JIM 2004; 256: 183-94.
Maquet D, Lekeu F, Warzee E, Gillain S, Wojtasik V, Salmon E, et al. Gait analysis in elderly adult patients with mild cognitive impairment and patients with mild Alzheimer's disease: Simple versus dual task: A preliminary report. Clin Physiol Funct I 2010; 30: 51-6.
Montero-Odasso M, Bergman H, Phillips NA, Wong CH, Sourial N, Chertkow H. Dual-tasking and gait in people with mild cognitive impairment. The effect of working memory. BMC Geriatr 2009; 9: 41.
Verghese J, Robbins M, Holtzer R, Zimmerman M, Wang C, Xue X, et al. Gait dysfunction in mild cognitive impairment syndromes. J Am Geriatr Soc 2008; 56: 1244-51.
Waite LM, Grayson DA, Piguet O, Creasey H, Bennett HP, Broe GA. Gait slowing as a predictor of incident dementia: 6-year longitudinal data from the Sydney older persons study. J Neurol Sci 2005; 229: 89-93.
Herman T, Mirelman A, Giladi N, Schweiger A, Hausdorff JM. Executive control deficits as a prodrome to falls in healthy older adults: A prospective study linking Thinking, walking, and falling. J Gerontol A-Biol 2010; 65: 1086-92.
Black SA, Rush RD. Cognitive and functional decline in adults aged 75 and older. J Am Geriatr Soc 2002; 50: 1978-86.
Asher L, Aresu M, Falaschetti E, Mindell J. Most older pedestrians are unable to cross the road in time: A cross-sectional study. Age Ageing 2012; 41: 690-4.
Montufar J, Arango J, Porter M, Nakagawa S. Pedestrians’ normal walking speed and speed when crossing a street. Transport Res Rec 2007; 2002: 90-7.
Hoxie RE, Rubenstein LZ. Are older pedestrians allowed enough time to cross intersections safely? J Am Geriatr Soc 1994; 42: 241-4.
Grant TL, Edwards N, Sveistrup H, Andrew C, Egan M. Neighborhood walkability: Older people's perspectives from four neighborhoods in Ottawa, Canada. J Aging Phys Act 2010; 18: 293-312.
Willems D, Vandervoort A. Balance as a contributing factor to gait speed in rehabilitation of the elderly. Physiother Can 1996; 48: 179-84.
Shkuratova N, Morris ME, Huxham F. Effects of age on balance control during walking. Arch Phys Med Rehab 2004; 85: 582-8.
Ferrandez AM, Durup M, Farioli F. Modulations of gait and ageing. In: Ferrandez AM, Teasdale N. Changes in sensorimotor behavior in aging. Amsterdam: Elsevier; 1996.
Chiu MC, Wang MJ. The effect of gait speed and gender on perceived exertion, muscle activity, joint motion of lower extremity, ground reaction force and heart rate during normal walking. Gait Posture 2007; 25: 385-92.
Sheridan P, Solomont J, Kowall N, Hausdorff JM. Influence of executive function on locomotor function: Divided attention increases gait variability in Alzheimer's disease. J Am Geriatr Soc 2003; 51: 1633-7.
Yogev-Seligmann G, Hausdorff JM, Giladi N. The role of executive function and attention in gait. Mov Disord 2008; 23: 329-42.
Sheridan PL, Hausdorff JM. The role of higher-level cognitive function in gait: executive dysfunction contributes to fall risk in Alzheimer's disease. Dement Geriatr Cogn Disord 2007; 24: 125-37.
Shkuratova N, Morris ME, Huxham F. Effects of age on balance control during walking Arch Phys Med Rehabil 2004; 85: 582-8.
England SA, Granata KP. The influence of gait speed on local dynamic stability of walking. Gait Posture 2007; 25: 172-8.
Doi T, Shimada H, Makizako H, Tsutsumimoto K, Uemura K, Anan Y, et al. Cognitive function and gait speed under normal and dual task walking among older adults with mild cognitive impairment. BMC Neurol 2014; 14: 67.
Montero-Odasso M, Muir SW, Speechley M. Dual-task complexity affects gait in people with mild cognitive impairment: the interplay between gait variability, dual tasking, and risk of falls. Arch Phys Med Rehabil 2012; 93: 293-9.
Boripuntakul S, Lord SR, Brodie MA, Smith ST, Methapatara P, Wongpakaran N, et al. Spatial variability during gait initiation while dual tasking is increased in individuals with mild cognitive impairment. J Nutr Health Aging 2014; 18: 307-12.
Stansfield BW, Hillman SJ, Hazlewood ME, Robb JE. Regression analysis of gait parameters with speed in normal children walking at self-selected speeds. Gait Posture 2006; 23: 288-94.
Tulchin K, Orendurff M, Adolfsen S, Karol L. The effects of walking speed on multisegment foot kinematics in adults. J Appl Biomec 2009; 25: 377-86.
Schwartz MH, Rozumalski A, Trost JP. The effect of walking speed on the gait of typically developing children. J Biomech 2008; 41: 1639-50.
Hebenstreit F, Leibold A, Krinner S, Welsch G, Lochmann M, Eskofier BM. Effect of walking speed on gait sub phase durations. Hum Movement Sci 2015; 43: 118-24.
Orendurff MS, Segal AD, Klute GK, Berge JS, Rohr ES, Kadel NJ. The effect of walking speed on center of mass displacement. J Rehabil Res Dev 2004; 41: 829-34.
Hausdorff JM. Gait variability: methods, modeling and meaning. J Neuroeng Rehabil 2005; 2: 19.
Albert MS, DeKosky ST, Dickson D, Dubois B, Feldman HH, Fox NC, et al. The diagnosis of mild cognitive impairment due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement 2011; 7: 270-9.
Wongpakaran N, Wongpakaran T, Reekum RV. The use of GDS-15 in detecting MDD: A comparison between residents in a Thai long-term care home and geriatric outpatients. J Clin Med Res 2013; 5: 101-11.
Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther 2000; 80: 896-903.
Boongird P. Mental State Examination T10. Dementia Association of Thailand Newsletter. 2018.
Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53: 695-9.
Levin DT. Thinking and seeing: Visual metacognition in adults and children. Cambridge, MA: MIT Press; 2004.
Sugarman MA, Woodard JL, Nielson KA, Smith JC, Seidenberg M, Durgerian S, et al. Performance variability during a multitrial list-learning task as a predictor of future cognitive decline in healthy elders. J Clin Exp Neuropsychol 2014; 36: 236-43.
Ostrosky-Solı´s F, Lozano A. Digit Span: effect of education and culture. Int J Psychol 2006; 41: 333-41.
Kortte KB, Horner MD, Windham WK. The trail making test, Part B: cognitive flexibility or ability to maintain set? Appl Neuropsychol 2002; 9: 106-9.
Scarpina F, Tagini. The Stroop Color and Word Test. Front Psychol 2017; 8: 557.
Majumdar D, Banerjee PK, Majumdar D, Pal M, Kumar R, Selvamurthy W. Temporal spatial parameters of gait with barefoot, bathroom slippers and military boots. Indian J Physiol Pharmacol 2006; 50: 33-40.
Braune W, Fischer O. On the Centre of Gravity of the Human Body Translated (from 1889 original) by PGJ Maquet and R Furong. Berlin: Springer-Verlag; 1984.
Gabell A, Nayak USL. The effect of age on variability in gait. J Gerontol 1984; 39: 662-6.
Nutt JG, Marsden CD, Thompson PD. Human walking and higher-level gait disorders, particularly in the elderly. Neurology 1993; 43, 268-79.
Brach JS, Perera S, Studenski S, Newman AB. The reliability and validity of measures of gait variability in community-dwelling older adults. Arch Phys Med Rehabil 2008; 89: 2293-6.
Dang HV, Zivanovic S. Experimental characterisation of walking locomotion on rigid level surfaces using motion capture system. Eng Struct 2015; 91: 141-54.
Beauchet O, Allali G, Annweiler C, Bridenbaugh S, Assal F, Kressig RW, et al. Gait variability among healthy adults: Low and high stride-to-stride variability are both a reflection of gait stability. Gerontology 2009; 55: 702-6.
Nutt JG. Classification of gait and balance disorders. Adv Neurol 2001; 87: 135-41.
Hausdorff JM, Edelberg HK, Mitchell SL, Goldberger AL, Wei JY. Increased gait unsteadiness in community-dwelling elderly fallers. Arch Phys Med Rehabil 1997; 78: 278-83.
Young PMM, Wilken JM, Dingwell JB. Dynamic margins of stability during human walking in destabilizing environments. J Biomech 2012; 45: 1053-59.
Maioli F, Coveri M, Pagni P, Chiandetti C, Marchetti C, Ciarrocchi R, et al. Conversion of mild cognitive impairment to dementia in elderly subjects: A preliminary study in a memory and cognitive disorder unit. Arch Gerontol Geriatr 2007; 44: 233-41.
Saunders NL, Summers MJ. Attention and working memory deficits in mild cognitive impairment. J Clin Exp Neuropsychol 2010; 32: 350-7.
Belleville S, Chertkow H, Gauthier S. Working memory and control of attention in persons with Alzheimer's disease and mild cognitive impairment. Neuropsychology 2007; 21: 458-69.
Boripuntakul S, Lord SR, Methapatara P, Sungkarat S. Unplanned stopping strategy in individuals with mild cognitive impairment. WJST 2017; 14: 35-42.
Lenardt MH, Sousa JAV, Grden CRB, Betiolli SE, Carneiro NHK, Ribeiro DKMN. Gait speed and cognitive score in elderly users of the primary care service. Rev Bras Enferm 2015; 68: 851-6.
Pettersson AF, Olsson E, Wahlund LO. Motor function in subjects with mild cognitive impairment and early Alzheimer's disease. Dement Geriatr Cogn Disord 2005; 19: 299-304.
Pettersson AF, Olsson E, Wahlund LO. Effect of divided attention on gait in subjects with and without cognitive impairment. J Geriatr Psych Neur 2007; 20: 58-62.
Langlois JA, Keyl PM, Guralnik JM, Foley DJ, Marottoli RA, Wallace RB. Characteristics of older pedestrians who have difficulty crossing the street. Am J Public Health 1997; 87: 393-97.
Bohannon RW. Comfortable and maximum walking speed of adults aged 20-79 years: Reference values and determinants. Age Ageing 1997; 26: 15-9.
Abellan van Kan G, Rolland Y, Andrieu S, Bauer J, Beauchet O, Bonnefoy M, et al. Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people. J Nutr Health Aging 2009; 13: 881-9.
Sue AS, Erica D, Martha MS. Spinal cord injuries: Management and rehabilitation. New York: Elsevier; 2008.
Beauchet O, Annweiler C, Lecordroch Y, Allali G, Dubost V, Herrmann FR, et al. Walking speed-related changes in stride time variability: Effects of decreased speed. J Neuroeng Rehabil 2009; 6: 1.
Ghanavati T, Salavati M, Karimi N, Negahban H, Takamjani IE, Mehravar M, et al. Intra-limb coordination while walking is affected by cognitive load and walking speed. J Biomech 2014; 47: 2300-5.
Frenkel-Toledo S, Giladi N, Peretz C, Herman T, Gruendlinger L, Hausdorff JM. Effect of gait speed on gait rhythmicity in Parkinson's disease: Variability of stride time and swing time respond differently. J Neuroeng Rehabil 2005; 2: 23.
Owings TM, Grabiner MD. Step width variability, but not step length variability or step time variability, discriminates gait of healthy young and older adults during treadmill locomotion. J Biomech 2004; 37: 935-38.
Terrier P, Reynard F. Effect of age on the variability and stability of gait: a cross-sectional treadmill study in healthy individuals between 20 and 69 years of age. Gait Posture 2015; 41:170-4.
Arvin M, Mazaheri M, Hoozemans MJM, Pijnappels M, Burger BJ, Verschueren SMP, et al. Effects of narrow base gait on mediolateral balance control in young and older adults. J Biomech 2016; 49: 1264-7.