Relationship between cognitive domains, physical performance, and gait in elderly and demented subjects.

Cognitive function declines with age, with studies linking decreases in cognitive function to increased fall risk. The association between declines in specific cognitive domains and the development of gait and physical performance deficits has not been established. The current cross-sectional study was designed to address these issues using well characterized control subjects (n = 50), and individuals with early stage dementia (n = 50) tightly matched for age, gender, and education. All participants received detailed cognitive assessments for global cognitive function, as well as for processing speed, verbal fluency, and executive function. Additionally, participants were administered single- and dual-task gait assessments (GAITRite) and Short Physical Performance Battery (SPPB) measures of physical performance (gait, balance, chair stands). Data show that all measures of cognitive function correlated significantly with measures of gait and physical performance when analyzed in all subjects or just subjects with dementia. However, data also reveal that measures of processing speed and verbal fluency correlated significantly with multiple aspects of motor performance in non-demented, control subjects, even when corrected for age. There was no correlation between global cognitive function and motor performance, and only limited relationship between executive function and motor performance in non-demented, control subjects. These studies reveal the complex interactions between cognitive function and gait/physical performance in the context of aging and dementia, and suggest that impairments in specific cognitive domains might undermine gait and physical performance and thus exacerbate fall risk in the elderly.

[1]  A M Jette,et al.  Moderate exercise improves gait stability in disabled elders. , 1998, Archives of physical medicine and rehabilitation.

[2]  D. Goff,et al.  The treatment of cognitive impairment in schizophrenia , 2011, Pharmacology Biochemistry and Behavior.

[3]  F. Shaw.  Falls in cognitive impairment and dementia. , 2002, Clinics in geriatric medicine.

[4]  F. Lattanzio,et al.  Prognostic significance of the short physical performance battery in older patients discharged from acute care hospitals. , 2012, Rejuvenation research.

[5]  B. Reisberg,et al.  Measuring cognition in advanced Alzheimer's disease for clinical trials. , 2002, Journal of neural transmission. Supplementum.

[6]  J. Talbott,et al.  Cardiorespiratory fitness and brain atrophy in early Alzheimer disease , 2009 .

[7]  Corby K. Martin,et al.  Memory for names test provides a useful confrontational naming task for aging and continuum of dementia. , 2011, Journal of Alzheimer's disease : JAD.

[8]  Nick C Fox,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 , 2011 .

[9]  Jeffrey M. Hausdorff,et al.  The Role of Higher-Level Cognitive Function in Gait: Executive Dysfunction Contributes to Fall Risk in Alzheimer’s Disease , 2007, Dementia and Geriatric Cognitive Disorders.

[10]  Roee Holtzer,et al.  Effect of cognitive remediation on gait in sedentary seniors. , 2010, The journals of gerontology. Series A, Biological sciences and medical sciences.

[11]  F. Horak.  Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? , 2006, Age and ageing.

[12]  Jeffrey M. Hausdorff.  Gait dynamics, fractals and falls: finding meaning in the stride-to-stride fluctuations of human walking. , 2007, Human movement science.

[13]  Kazumi Iseki,et al.  Gait disturbance associated with white matter changes: A gait analysis and blood flow study , 2010, NeuroImage.

[14]  J. Morris,et al.  Test-retest reliability of the Wechsler Memory Scale, Form I. , 1981, Journal of clinical psychology.

[15]  Mauro Di Bari,et al.  Cognitive and functional impairment in hypertensive brain microangiopathy , 2007, Journal of the Neurological Sciences.

[16]  L. Hebert,et al.  Change in direct measures of physical performance among persons with Alzheimer's disease , 2008, Aging & mental health.

[17]  C. Richards,et al.  Brain activations during motor imagery of locomotor‐related tasks: A PET study , 2003, Human brain mapping.

[18]  Robert H Logie,et al.  Dual-task performance in Alzheimer's disease, mild cognitive impairment, and normal ageing. , 2011, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[19]  L. Ferrucci,et al.  A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. , 1994, Journal of gerontology.

[20]  E. Salmon,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 , 2010, Clinical physiology and functional imaging.

[21]  D. Benson,et al.  Interictal memory and language impairment in temporal lobe epilepsy , 1980, Neurology.

[22]  J. Correa,et al.  Assessment of Cognition, Physical Performance, and Gait in the Context of Mild Cognitive Impairment and Dementia , 2012, Journal of the American Geriatrics Society.

[23]  S. Iliffe,et al.  The effect of exercise on behavioral and psychological symptoms of dementia: towards a research agenda , 2011, International Psychogeriatrics.

[24]  S. Studenski,et al.  Gait Variability Is Associated with Subclinical Brain Vascular Abnormalities in High-Functioning Older Adults , 2007, Neuroepidemiology.

[25]  Navrag B. Singh,et al.  Kinematic measures for assessing gait stability in elderly individuals: a systematic review , 2011, Journal of The Royal Society Interface.

[26]  Denise C. Park,et al.  Toward defining the preclinical stages of Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease , 2011, Alzheimer's & Dementia.

[27]  Jeffrey M. Hausdorff,et al.  The role of executive function and attention in gait , 2008, Movement disorders : official journal of the Movement Disorder Society.

[28]  Joanne Azulay,et al.  Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008. , 2011, Archives of physical medicine and rehabilitation.

[29]  Guanghua Xiao,et al.  A serum protein-based algorithm for the detection of Alzheimer disease. , 2010, Archives of neurology.

[30]  David A Bennett,et al.  Total Daily Activity Measured With Actigraphy and Motor Function in Community-dwelling Older Persons With and Without Dementia , 2012, Alzheimer disease and associated disorders.

[31]  S. Waring,et al.  Decreased C-Reactive Protein Levels in Alzheimer Disease , 2010, Journal of geriatric psychiatry and neurology.

[32]  Otto W. Witte,et al.  Falls and gait disorders in geriatric neurology , 2010, Clinical Neurology and Neurosurgery.

[33]  Mike Martin,et al.  Simultaneously Measuring Gait and Cognitive Performance in Cognitively Healthy and Cognitively Impaired Older Adults: The Basel Motor–Cognition Dual‐Task Paradigm , 2011, Journal of the American Geriatrics Society.

[34]  Farzaneh A. Sorond,et al.  Neurovascular coupling is impaired in slow walkers: The MOBILIZE Boston Study , 2011, Annals of neurology.

[35]  Li-Shan Chou,et al.  Cognitive task effects on gait stability following concussion , 2006, Experimental Brain Research.

[36]  H. Chertkow,et al.  Can an 18-point clock-drawing scoring system predict dementia in elderly individuals with mild cognitive impairment? , 2008, Journal of clinical and experimental neuropsychology.

[37]  D. Dawbarn,et al.  Neurobiology of alzheimer's disease , 1995 .

[38]  J. Yesavage,et al.  Proposed Factor Structure of the Geriatric Depression Scale , 1991, International Psychogeriatrics.

[39]  Keiichiro Yamaguchi,et al.  Postural and Gait Disturbance Correlated with Decreased Frontal Cerebral Blood Flow in Alzheimer Disease , 1997, Alzheimer disease and associated disorders.

[40]  D Maquet,et al.  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. , 2009, Annals of physical and rehabilitation medicine.

[41]  J. Guralnik,et al.  Predictive value of the Short Physical Performance Battery following hospitalization in older patients. , 2011, The journals of gerontology. Series A, Biological sciences and medical sciences.

[42]  John H Hollman,et al.  Age-related differences in dual task walking: a cross sectional study , 2008, Journal of NeuroEngineering and Rehabilitation.

[43]  Jeffrey M. Hausdorff,et al.  Increased gait unsteadiness in community-dwelling elderly fallers. , 1997, Archives of physical medicine and rehabilitation.

[44]  J. Giacino,et al.  Evidence-based cognitive rehabilitation: updated review of the literature from 1998 through 2002. , 2005, Archives of physical medicine and rehabilitation.

[45]  M. Thorogood,et al.  A systematic review of the effects of physical activity on physical functioning, quality of life and depression in older people with dementia , 2011, International journal of geriatric psychiatry.

[46]  S. Billinger,et al.  Cardiorespiratory fitness is associated with atrophy in Alzheimer's and aging over 2 years , 2012, Neurobiology of Aging.

[47]  E. Scherder,et al.  Review of Effects of Physical Activity on Strength, Balance, Mobility and ADL Performance in Elderly Subjects with Dementia , 2010, Dementia and Geriatric Cognitive Disorders.

[48]  J. Verghese,et al.  Neurovascular coupling: Key to gait slowing in aging? , 2011, Annals of neurology.