The value of instrumental gait analysis in elderly healthy, MCI or Alzheimer's disease subjects and a comparison with other clinical tests used in single and dual-task conditions.

In the elderly, gait disorders and cognitive frailty may influence each other and increase the risk of falling. The aim of the present study was to determine gait parameters in elderly people with different cognitive profiles (controls, individuals with mild cognitive impairment [MCI] and Alzheimer's disease [AD] patients) with the Locometrix three-axis accelerometer and establish whether or not this tool is more useful than conventional clinical tests (the timed "get up and go" test, the pull test and the single-leg balance test). Study subjects were all over 65, living at home and free of known gait impairments. A neuropsychological battery was applied to 14 control subjects, 14 MCI subjects and six AD patients. A motor evaluation (in single- and dual-task paradigms) was performed with three conventional clinical tests and the Locometrix (standardized gait). Our results showed that in a single-task paradigm, the Locometrix was more accurate than validated, conventional tests and generated a characteristic gait profile for each of the three cognitive profiles. In a dual-task paradigm, the gait of MCI subjects more closely resembled that of AD patients than that of control subjects. We conclude that the Locometrix is a high-performance tool for defining gait profiles, which correspond to given cognitive profiles. The use of a dual-task paradigm is a good way to screen for gait abnormalities in MCI.

[1]  E. Barrey,et al.  Les troubles de la marche chez le patient atteint de fibromyalgie , 2006 .

[2]  S Fahn,et al.  Evaluation of the pull test technique in assessing postural instability in Parkinson’s disease , 2004, Neurology.

[3]  P. A. Hageman,et al.  Comparison of gait of young men and elderly men. , 1986, Physical therapy.

[4]  J. Morris The Clinical Dementia Rating (CDR) , 1993, Neurology.

[5]  B. Vellas,et al.  Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[6]  Auvinet,et al.  Chute de la personne âgée : de la nécessité d'un travail en réseau. , 2002 .

[7]  K. Aminian,et al.  Dual-task-related gait changes in the elderly: does the type of cognitive task matter? , 2005, Journal of motor behavior.

[8]  U S Nayak,et al.  Balance in elderly patients: the "get-up and go" test. , 1986, Archives of physical medicine and rehabilitation.

[9]  K. Sethi,et al.  The pull test: A history , 2006, Movement disorders : official journal of the Movement Disorder Society.

[10]  R. Baumgartner,et al.  One‐Leg Balance Is an Important Predictor of Injurious Falls in Older Persons , 1997, Journal of the American Geriatrics Society.

[11]  Christianna S. Williams,et al.  Falls, injuries due to falls, and the risk of admission to a nursing home. , 1997, The New England journal of medicine.

[12]  Hidetada Sasaki,et al.  Relationship between falls and stride length variability in senile dementia of the Alzheimer type. , 1996, Gerontology.

[13]  Martial Van der Linden,et al.  L'épreuve de rappel libre / rappel indicé à 16 items (RL/RI-16) , 2004 .

[14]  J. Croisier,et al.  Gait analysis during an original walking test , 2008 .

[15]  N Teasdale,et al.  Upright standing and gait: are there changes in attentional requirements related to normal aging? , 1996, Experimental aging research.

[16]  K. Aminian,et al.  Relationships between dual-task related changes in stride velocity and stride time variability in healthy older adults. , 2006, Human movement science.

[17]  M. Lawton,et al.  Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living , 1969 .

[18]  J. Morris,et al.  Current concepts in mild cognitive impairment. , 2001, Archives of neurology.

[19]  W. Enzensberger,et al.  Metronomtherapie bei Parkinson-Patienten , 1997, Der Nervenarzt.

[20]  C. Jack,et al.  Mild cognitive impairment – beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment , 2004, Journal of internal medicine.

[21]  R H Logie,et al.  Dual task effects of walking when talking in Alzheimer's disease. , 2004, Revue neurologique.

[22]  F. Mourey,et al.  Élaboration d'un test clinique de marche du sujet âgé fragile à partir d'une approche cognitive de la locomotion , 2002 .

[23]  G Denes,et al.  Concepts and facts in calculation. , 1994, Brain : a journal of neurology.

[24]  A. Baddeley,et al.  Attentional control in Alzheimer's disease. , 2001, Brain : a journal of neurology.

[25]  H. Buschke,et al.  Walking while talking: effect of task prioritization in the elderly. , 2007, Archives of physical medicine and rehabilitation.

[26]  J. Yesavage,et al.  Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. , 1986 .

[27]  K. Stecker,et al.  [Metronome therapy in patients with Parkinson disease]. , 1997, Der Nervenarzt.

[28]  Ann L. Hunt Do,et al.  The pull test: A history , 2006 .

[29]  B. Bloem,et al.  Systematic review of quantitative clinical gait analysis in patients with dementia , 2004, Zeitschrift für Gerontologie und Geriatrie.

[30]  Graham Lawton,et al.  Get up and go , 2006 .

[31]  W H Eisma,et al.  The Timed "up and go" test: reliability and validity in persons with unilateral lower limb amputation. , 1999, Archives of physical medicine and rehabilitation.

[32]  F Mourey,et al.  [Influence of a specific cognitive task on spatial-temporal walking parameters in elderly frail individuals]. , 2002, Presse medicale.

[33]  J. Hollman,et al.  Age-related differences in spatiotemporal markers of gait stability during dual task walking. , 2006, Gait & posture.

[34]  J. Hausdorff,et al.  Stride variability: beyond length and frequency. , 2004, Gait & posture.

[35]  H. Visser,et al.  Gait and balance in senile dementia of Alzheimer's type. , 1983, Age and ageing.

[36]  F. Rubino Gait disorders in the elderly. Distinguishing between normal and dysfunctional gaits. , 1993, Postgraduate medicine.

[37]  E. Olsson,et al.  Motor Function in Subjects with Mild Cognitive Impairment and Early Alzheimer’s Disease , 2005, Dementia and Geriatric Cognitive Disorders.

[38]  A P Marsh,et al.  The effect of age on the attentional demands of postural control. , 2000, Gait & posture.

[39]  A. Shumway-cook,et al.  Predicting the probability for falls in community-dwelling older adults. , 1997, Physical therapy.

[40]  S. Katz Studies of illness in the aged , 1963 .

[41]  O. Piguet,et al.  Gait slowing as a predictor of incident dementia: 6-year longitudinal data from the Sydney Older Persons Study , 2005, Journal of the Neurological Sciences.

[42]  M. Woollacott,et al.  Attention and the control of posture and gait: a review of an emerging area of research. , 2002, Gait & posture.

[43]  O. Spreen,et al.  A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary , 1991 .

[44]  Olivier Beauchet,et al.  Dual-Task-Related Gait Changes in , 2004, Gerontology.

[45]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[46]  Philippe Meert,et al.  Early evaluation of the risk of functional decline following hospitalization of older patients: development of a predictive tool. , 2006, European journal of public health.

[47]  Maria Victoria Sebastian,et al.  Attentional Dysfunction of the Central Executive in Ad: Evidence from Dual Task and Perseveration Errors , 2006, Cortex.

[48]  Diane Podsiadlo,et al.  The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons , 1991, Journal of the American Geriatrics Society.

[49]  J. Hollman,et al.  Age-related differences in spatiotemporal markers of gait stability during dual task walking. , 2006, Gait & posture.

[50]  M. Thaut,et al.  Rhythmic auditory-motor facilitation of gait patterns in patients with Parkinson's disease. , 1997, Journal of neurology, neurosurgery, and psychiatry.

[51]  David A Bennett,et al.  Motor dysfunction in mild cognitive impairment and the risk of incident Alzheimer disease. , 2006, Archives of neurology.

[52]  Olivier Beauchet,et al.  Changes in gait while backward counting in demented older adults with frontal lobe dysfunction. , 2007, Gait & posture.

[53]  Jeffrey M. Hausdorff,et al.  Influence of Executive Function on Locomotor Function: Divided Attention Increases Gait Variability in Alzheimer's Disease , 2003, Journal of the American Geriatrics Society.

[54]  B M Nigg,et al.  Gait characteristics of the elderly. , 1988, Clinical biomechanics.

[55]  L. Mollinger,et al.  Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. , 2002, Physical therapy.

[56]  M. Folstein,et al.  Clinical diagnosis of Alzheimer's disease , 1984, Neurology.

[57]  B. Reisberg,et al.  Equilibrium and Limb Coordination in Mild Cognitive Impairment and Mild Alzheimer's Disease , 1999, Journal of the American Geriatrics Society.

[58]  I. Melzer,et al.  Age-Related Changes of Postural Control: Effect of Cognitive Tasks , 2001, Gerontology.

[59]  Xiaonan Xue,et al.  Quantitative gait dysfunction and risk of cognitive decline and dementia , 2007, Journal of Neurology, Neurosurgery & Psychiatry.

[60]  B E Maki,et al.  Cognitive demands of executing postural reactions: does aging impede attention switching? , 2001, Neuroreport.

[61]  T. L. Brink,et al.  Clinical Gerontology: A Guide to Assessment and Intervention , 1986 .