To compare the trajectory of motor decline, as measured by gait speed and finger-tapping speed, between elderly people who developed mild cognitive impairment (MCI) and those who remained cognitively intact. We also sought to determine the approximate time at which the decline in motor function accelerated in persons who developed MCI.
Physical performance measures predict health and function in older populations. Walking speed in particular has consistently predicted morbidity and mortality. However, single brief walking measures may not reflect a person’s typical ability. Using a system that unobtrusively and continuously measures walking activity in a person’s home we examined walking speed metrics and their relation to function. In 76 persons living independently (mean age, 86) we measured every instance of walking past a line of passive infra-red motion sensors placed strategically in their home during a four-week period surrounding their annual clinical evaluation. Walking speeds and the variance in these measures were calculated and compared to conventional measures of gait, motor function and cognition. Median number of walks per day was 18 ± 15. Overall mean walking speed was 61 ± 17 cm/sec. Characteristic fast walking speed was 96 cm/sec. Men walked as frequently and fast as women. Those using a walking aid walked significantly slower and with greater variability. Morning speeds were significantly faster than afternoon/evening speeds. In-home walking speeds were significantly associated with several neuropsychological tests as well as tests of motor performance. Unobtrusive home walking assessments are ecologically valid measures of walking function. They provide previously unattainable metrics (periodicity, variability, range of minimum and maximum speeds) of everyday motor function.
There is a paucity of data regarding trends in dementia and its subtype prevalence in Japan. Our aims in the current paper are to: (1) summarize epidemiological studies of dementia in Japan including relevant details of study protocol and diagnostic criteria, (2) compare the age-specific prevalence of all-cause dementia among studies, and (3) assess the trends in Alzheimer's disease (AD) versus vascular dementia (VaD) over time. We reviewed diagnostic criteria, all-cause dementia prevalence, and the AD/VaD ratio from 8 large population studies of dementia in Japan. Compared with the Okinawa 1992 study, studies conducted in 1994, 1998, 2005, and 2008 had a higher prevalence of all-cause dementia using Poisson regression models, after controlling for age and sex. In contrast to the US and some European countries, all-cause dementia prevalence is increasing in Japan. The prevalence of AD as opposed to VaD seems to be increasing over time, but large variability in diagnostic criteria, possible regional variability, and differences in prevalence of subtypes of dementia between men and women make it difficult to draw a conclusion about this trend at the national level. Further studies, for example, comparing the population attributable risk of vascular diseases to the prevalence and incidence of dementia could help to clarify the regional variations in etiological subtypes.
BackgroundExecutive dysfunction has previously been found to be a risk factor for falls. The aim of this study is to investigate the association between executive dysfunction and risk of falling and to determine if this association is independent of balance.MethodsParticipants were 188 community-dwelling individuals aged 65 and older. All participants underwent baseline and annual evaluations with review of health history, standardized neurologic examination, neuropsychological testing, and qualitative and quantitative assessment of motor function. Falls were recorded prospectively using weekly online health forms.ResultsDuring 13 months of follow-up, there were 65 of 188 participants (34.6%) who reported at least one fall. Univariate analysis showed that fallers were more likely to have lower baseline scores in executive function than non-fallers (p = 0.03). Among participants without balance impairment we found that higher executive function z-scores were associated with lower fall counts (p = 0.03) after adjustment for age, sex, health status and prior history of falls using negative binomial regression models. This relationship was not present among participants with poor balance.ConclusionsLower scores on executive function tests are a risk factor for falls in participants with minimal balance impairment. However, this effect is attenuated in individuals with poor balance where physical or more direct motor systems factors may play a greater role in fall risk.
Objectives To elucidate the mechanism through which vitamin D is associated with decreased falls. Design This was a convenience sample from a larger observational study examining correlations between vitamin D and 1) falls, 2) motor function, and 3) cognition (n=159). Setting Falls data were collected via weekly on-line surveys completed in the participants' homes. Yearly evaluations of motor and cognitive function were conducted in an out-patient setting of a large tertiary medical center. Participants Participants from the Intelligent Systems for Assessment of Aging Changes Study (ISAAC), a community-based cohort study of independently living older adults over age 70, who had vitamin D concentration within 6 months of clinical evaluations were included in the analysis. Results Participants mean age was 85 years and 74% were women. Fallers (n=37) had significantly lower vitamin D concentration (32.9 ng/ml) compared to non-fallers (39.2 ng/ml) (p<0.01). The relationship between vitamin D and falls remained significant after adjusting for age, health status (via CIRS), and supplement use (p=0.004). Vitamin D concentration were significantly associated with cognitive impairment (Clinical Dementia Rating = 0.5) (p=0.02) and MMSE (p<0.01) after adjusting for age, gender, and education. Vitamin D concentrations did not correlate with any motor measures. Conclusion Vitamin D concentrations correlated with cognition and falls, but not with motor measures. Further research is needed to demonstrate a causal relationship between vitamin D and cognitive function and determine if cognition plays a role in falls reduction.
Ocular misalignment and ophthalmoparesis result in the symptom of binocular diplopia. In the evaluation of diplopia, localization of the ocular motility disorder is the main objective. This requires a systematic approach and knowledge of the ocular motor pathways and actions of the extraocular muscles. This article reviews the components of the ocular motor pathway and presents helpful tools for localization and common sources of error in the assessment of ophthalmoparesis. Neurology Ophthalmoparesis and diplopia. Normal eye movements share the goal of placing an object of visual interest on each fovea simultaneously to allow visualization of a single, stable object. Clear and stable vision is sustained by mechanisms that hold the object on the fovea, such as fixation and the vestibuloocular reflex. Absent or inadequate ocular motility (ophthalmoplegia and ophthalmoparesis) often results in ocular misalignment, causing the visual symptom of binocular diplopia. Binocular diplopia occurs when an object of visual interest falls on the fovea in one eye and on an extrafoveal location in the other eye. Binocular diplopia suggests dysfunction of extraocular muscles, the neuromuscular junction, cranial nerves, cranial nerve nuclei, or internuclear and supranuclear connections. Correct localization of the underlying lesion is the first step to accurate diagnosis and requires a systematic approach and knowledge of the ocular motor pathways and actions of the extraocular muscles.History and examination of diplopia. When obtaining the history and examining the patient, it is important to determine if the diplopia is binocular or monocular. Binocular diplopia resolves with covering either eye and is the result of ocular misalignment. Proper evaluation of binocular diplopia should determine if it is horizontal, vertical, or oblique; worse in a particular direction of gaze; and worse at distance or near. Eye movement examination should include assessment of ocular motility in the nine diagnostic positions of gaze, ocular alignment (measured with the corneal light reflex test, cover test, or Maddox rod 1 ), and comitance of any ocular misalignment. In a comitant lesion, the amount of ocular deviation is the same regardless of gaze direction, while in an incomitant lesion, the amount of deviation varies with changes in gaze direction. Pearls• Binocular diplopia resolves with monocular covering of either eye, while monocular diplopia resolves with covering the affected eye.• Visual blurring that resolves completely with monocular covering of either eye has the same localizing value as binocular diplopia.• Monocular diplopia is non-neurologic in origin and is not caused by ocular misalignment. It is usually due to ocular pathology such as refractive error or intraocular causes such as cataracts. 2• Worsening diplopia in a particular gaze direction suggests that motility in that direction is impaired.• Esodeviation is a relative medial deviation of the eyes. Exodeviation is a relative lateral deviation of the eyes. Hyperdev...
Well-defined and reliable clinical outcome assessments are essential for determining whether a drug provides clinically meaningful treatment benefit for patients. In 2015, FDA convened a workshop, “Assessing Neurocognitive Outcomes in Inborn Errors of Metabolism.” Topics covered included special challenges of clinical studies of inborn errors of metabolism (IEMs) and other rare diseases; complexities of identifying treatment effects in the context of the dynamic processes of child development and disease progression; and the importance of natural history studies. Clinicians, parents/caregivers, and participants from industry, academia, and government discussed factors to consider when developing measures to assess treatment outcomes, as well as tools and methods that may contribute to standardizing measures. Many issues examined are relevant to the broader field of rare diseases in addition to specifics of IEMs.
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