prevalence of gait impairments increases with age and is associated with mobility decline, fall risk and loss of independence. for geriatric patients, the risk of having gait disorders is even higher. consequently, gait assessment in the clinics has become increasingly important. the purpose of the present study was to classify healthy young-middle aged, older adults and geriatric patients based on dynamic gait outcomes. Classification performance of three supervised machine learning methods was compared. From trunk 3D-accelerations of 239 subjects obtained during walking, 23 dynamic gait outcomes were calculated. Kernel principal component Analysis (KpcA) was applied for dimensionality reduction of the data for Support Vector Machine (SVM) classification. Random Forest (RF) and Artificial Neural Network (ANN) were applied to the 23 gait outcomes without prior data reduction. Classification accuracy of SVM was 89%, RF accuracy was 73%, and ANN accuracy was 90%. Gait outcomes that significantly contributed to classification included: Root Mean Square (Anterior-Posterior, Vertical), cross entropy (Medio-Lateral, Vertical), Lyapunov exponent (Vertical), step regularity (Vertical) and gait speed. ANN is preferable due to the automated data reduction and significant gait outcome identification. For clinicians, these gait outcomes could be used for diagnosing subjects with mobility disabilities, fall risk and to monitor interventions. Over the last decades, medical and technical developments have extended human lifespan. However, with the increasing number of adults in society, there is a parallel increase in the number of people with serious impairments of mobility, gait, and postural control 1. Natural aging comes hand in hand with mobility decline and impairments in gait and postural control. When the level of decline in physical and cognitive functions exceeds the degree of decline expected due to the natural aging process, we speak of a geriatric condition. Typical geriatric patients are characterized by co-morbidities such as sarcopenia, cognitive impairment, osteoporosis, weight loss, and frailty 2,3. Gait disorders are common in older adults; prevalence increases with age and is associated with increased fall risk, mobility decline, and loss of independence 4. For geriatric patients, the risk of having gait disorders with an increased fall incidence is even higher 5. Consequently, objective gait assessment in the clinics has become increasingly important for the diagnosis of motor impairments and the assessment of mobility decline and fall risk 6 , as well as for the monitoring of the efficacy of interventions designed to improve mobility 7. The most often used gait parameter for disability is gait speed. After age 60, gait speed slows by 16% per decade 8. In geriatric patients, a gait speed below 1.0 m/s signifies an additional clinical or sub-clinical impairment, such as mobility decline, frailty, recurrent falling, loss of independence and institutionalization 9. Complementary to gait speed, aging impacts th...
Background: Diagnosing dementia in elderly immigrants is often difficult due to language and cultural barriers, low education, and illiteracy. We compared the diagnostic accuracy of the Rowland Universal Dementia Assessment Scale (RUDAS) to that of the Mini Mental State Examination (MMSE). Methods: A total of 144 patients (42 with intact cognition, 44 with mild cognitive impairment [MCI], and 58 with dementia) were administered both instruments and were diagnosed by specialists blinded for MMSE and RUDAS results. Results: Areas under the curve for discriminating intact cognition from MCI and dementia were comparable for RUDAS (0.81; 95% confidence interval 0.74–0.88) and MMSE (0.75; 95% confidence interval 0.69–0.85). Education and literacy were not correlated with the RUDAS but had a medium-large correlation with the MMSE (rho = 0.39). Conclusions: The study provides additional evidence for the usefulness of the RUDAS in a highly illiterate, culturally diverse geriatric outpatient population.
BackgroundDementia rates are growing rapidly in all regions of the world. In the Netherlands, the incidence of dementia among older immigrants will increase twice as fast compared with the native older population. It, therefore, needs special attention.AimTo describe the barriers for providing primary care to immigrant patients (Turkish, Moroccan and Surinamese) with dementia from the perspectives of GPs.Design & settingA mixed-method study, consisting of an online survey and focus groups.MethodAn online survey was performed among 76 GPs working in the four biggest cities of the Netherlands. The barriers to providing primary care for immigrants with dementia were identified. Subsequently, three focus groups were carried out among 17 primary care physicians to discuss this topic further, and identify possible solutions and recommendations to improve dementia care.ResultsGPs experience many obstacles in the care for the immigrant patient with dementia, namely in the diagnostic process, early detection, and assessment of care needs. Strong collaboration between primary care, community care organisations, specialised memory clinics, and municipalities is needed to optimise healthcare information provision, the availability of culturally sensitive facilities, and the enhancement of healthcare professionals' training and education.ConclusionImportant barriers were identified and recommendations were formulated for future healthcare policy. To be prepared and guarantee optimal care for the rising number of immigrant patients with dementia, recommendations should be implemented and effectiveness should be evaluated as soon as possible.
Longer cognitive tests, such as the Alzheimer's disease assessment scale (ADAS-cog) or the Cambridge cognitive examination (CAMCOG), are more precise but less efficient than briefer tests, such as the Mini Mental State Examination (MMSE). We examined if computerized adaptive testing (CAT) of cognitive impairment can combine brevity with precision by tailoring a precise test to each individual patient. We conducted a prospective study of 84 participants [normal aging, n = 41; mild cognitive impairment (MCI), n = 21; dementia, n = 22]. CAT estimated a participant's ability during testing by selecting only items of appropriate difficulty from either the CAMCOG or the CAMCOG supplemented with ADAS-cog items and neuropsychological tests (the CAMCOG-Plus). After tailored testing with CAT, the remaining CAMCOG and CAMCOG-Plus items not selected by CAT were administered. The time needed to complete the CAT was compared to that needed for the whole CAMCOG and CAMCOG-Plus. Results showed that testing time reductions achieved with CAT were 37% or more compared to the whole CAMCOG and 55% or more compared to the whole CAMCOG-Plus. Estimated ability levels with CAT were in excellent agreement with those based on the whole CAMCOG and CAMCOG-Plus (intraclass correlations 0.99 and 0.98, respectively). Diagnostic accuracy of detecting mild dementia and MCI seemed better for the CAT administered tests than for the MMSE, but the differences were not significant. We conclude that adaptive testing combines brevity with precision, especially in grading the severity of cognitive impairment.
The CAMCOG, ADAS-cog, and MMSE, designed to grade global cognitive ability in dementia have inadequate precision and accuracy in distinguishing mild dementia from normal ageing. Adding neuropsychological tests to their scale might improve precision and accuracy in mild dementia. We, therefore, pooled neuropsychological test-batteries from two memory clinics (ns = 135 and 186) with CAMCOG data from a population study and 2 memory clinics (n = 829) and ADAS-cog data from 3 randomized controlled trials (n = 713) to estimate a common dimension of global cognitive ability using Rasch analysis. Item difficulties and individuals' global cognitive ability levels were estimated. Difficulties of 57 items (of 64) could be validly estimated. Neuropsychological tests were more difficult than the CAMCOG, ADAS-cog, and MMSE items. Most neuropsychological tests had difficulties in the ability range of normal ageing to mild dementia. Higher than average ability levels were more precisely measured when neuropsychological tests were added to the MMSE than when these were measured with the MMSE alone. Diagnostic accuracy in mild dementia was consistently better after adding neuropsychological tests to the MMSE. We conclude that extending dementia specific instruments with neuropsychological tests improves measurement precision and accuracy of cognitive impairment in mild dementia.
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