A framework for secondary cognitive and motor tasks in dual-task gait testing in people with mild cognitive impairment

Abstract

BackgroundCognition is a key factor in the regulation of normal walking and dual-task gait assessment is an accepted method to evaluate the relationship. The objective of this study was to create a framework for task complexity of concurrent motor and cognitive tasks with gait in people with mild cognitive impairment (MCI).MethodsCommunity-dwelling people with MCI (n = 41, mean age = 76.20 ± 7.65 years) and cognitively normal controls (n = 41, mean age = 72.10 ± 3.80 years) participated in this study. Gait velocity was collected using an instrumented walkway under one single task and six combined tasks of motor and cognitive activities. The cognitive cost was the difference between the single gait task and each of the concurrent motor and cognitive challenges. A repeated two-way measure ANOVA assessed the effect of cognitive group and walking test condition for each gait task test.ResultsGait velocity was significantly slower in the MCI group under all tasks. For both groups, the concurrent motor task of carrying a glass of water conferred a challenge not different from the cognitive task of counting backwards by ones. Performance of the complex cognitive task of serial seven subtractions reduced gait velocity in both groups, but produced a greater change in the MCI group (31.8%).ConclusionsNot all concurrent tasks challenge cognition-motor interaction equivalently. This study has created a framework of task difficulty which allows for the translation of dual-task test conditions to future research and clinical practice to ensure the accuracy of assessing patient deficits and risk.

Dual-task tests discriminate between dementia, mild cognitive impairment, subjective cognitive impairment, and healthy controls – a cross-sectional cohort study

“…the relative time difference between single-and dual-task performances, did not discriminate between any of the groups in the current study. In previous studies, dual-task cost has been found to discriminate between mild AD and healthy controls [46] and between MCI and healthy controls [19,29], and has shown inconsistent results when discriminating between dementia disorders and MCI [18,19], and was not able to discriminate between MCI and SCI [18]. It may be argued that dual-task cost cannot differentiate between transitional diagnoses, because it captures subtle pathological changes and is therefore better considered an indicator of imminent cognitive decline [50].…”

“…The recorded data collection consisted of three different TUG tests; first TUGst, followed by TUG while simultaneously naming different animals (TUGdt NA), and finally TUG while simultaneously reciting months in reverse order (TUGdt MB). The choice of the verbal task NA was based on previous research [29,45,46], while to the best of our knowledge MB has not been used as a part of dual-task research [45]. Participants were instructed to execute all TUG tests at their own pace, with the simultaneous performance of the verbal task at a self-selected speed.…”

“…Previous studies investigating dual-task tests for discrimination between dementia disorder and different diagnoses of cognitive impairment have shown promising results for various outcomes: test time score [ 19 , 23 ], gait velocity [ 22 , 26 – 29 ], stride time [ 27 , 28 ], stride variability [ 27 , 28 ], and the relative time difference between single- and dual-task performance i.e. dual-task cost [ 18 , 19 , 29 ]. Individuals with SCI are rarely included in such dual-task research [ 18 , 30 ], despite being at a twofold risk of developing a dementia disorder compared to individuals without subjective complaints [ 8 ].…”

<p>Effects of Arch Support Insoles on Single- and Dual-Task Gait Performance Among Community-Dwelling Older Adults</p>

“…A study revealed that the difficulty level associated with walking while carrying a glass of water on a tray with one hand (a manual motor task) was the same as that associated with walking with the usual gait at a preferred walking speed in cognitively healthy adults. 40 Because gait velocity decrements during a dual task are related to the difficulty of the task, 40 we used a more challenging motor dual task (ie, carrying a tray of water with two hands); as expected, a decrease in gait speed was observed. With arch support, DTCs on both cadence and speed decreased, indicating a decrease in the percentage of loss in motor dual-task performance relative to single-task walking performance.…”

Perception of a Haptic Stimulus Presented Under the Foot Under Workload

“…One approach would be to choose another position that does not suffer from the perceptual conflict and would have a better haptic perception rate. To this, the literature offers connected jackets to communicate non-visual information [40][41][42][43] or the wrist [16]. This new method will have a wider range of applications including spatial orientation and guidance, attention management, haptic guidance, assistance, and better learnability [44,45].…”