Combining Physical and Cognitive Functions to Discriminate Level of Gait Independence in Hospitalized Patients with Alzheimer’s Disease

Abstract

Introduction: Both physical and cognitive functions are required to be assessed to determine the level of gait independence in patients with Alzheimer’s disease (AD); nonetheless, a method to achieve this assessment has not been established. This study aimed to investigate the accuracy of an assessment method that combined muscle strength, balance ability, and cognitive function parameters in discriminating the level of gait independence in a real-world setting in hospitalized patients with AD. Methods: In this cross-sectional study, 63 patients with AD (mean age: 86.1 ± 5.8 years) were classified into three groups according to their gait level: independent, modified independent (independent walking with walking aids), and dependent groups. Discrimination accuracy was calculated for single items of muscle strength, balance ability, and cognitive function tests and for combinations of each. Results: The combined accuracy of muscle strength, balance ability, and cognitive function had a positive predictive value of 100.0% and a negative predictive value of 67.7% between the independent and modified independent groups. The positive and negative predictive values were 100.0% and 72.4 %, respectively, between the modified independent and dependent groups. Conclusion: This study emphasizes the importance of assessing the level of gait independence in a real-world setting in patients with AD from the perspective of both physical and cognitive functions and proposes a novel method for discriminating an optimal state.

Discriminant Accuracy of Standing Balance Tests for the Level of Gait Dependency in Hospitalized Patients with Alzheimer’s Disease

“…The study was a post hoc analysis of an observational study [7]. This study included 63 patients with AD who were admitted to a single hospital between October 2021 and September 2022.…”

“…This study included 63 patients with AD who were admitted to a single hospital between October 2021 and September 2022. The participant criteria are described elsewhere [7]. Participants were selected from several wards: dementia care ward, general ward, medical care ward, and long-term care ward.…”

“…As in the previous study, we presented the clinical characteristics of our pre-calculated sample size of 63 participants in Table 1 [7]. In addition, the results for each standing holding time per gait level are shown (Table 1).…”

“…Increasing gait independence increases walking activity [5], but in patients with AD, it is necessary to diagnose the appropriate gait independence for their ability as falls management with changes in gait ability must also be considered [6]. We previously demonstrated that gait independence can be distinguished with excellent accuracy by combining physical and cognitive functions [7]. On the other hand, considering the diverse clinical conditions of patients with AD [8], there is a need to select short, simple tests for cases where multiple tests are difficult to perform, but evidence is lacking.…”

“…Comprehensive balance assessment has been associated with walking ability in patients with AD [9][10][11] and has an excellent negative predictive value (NPV) in discriminating the gait level [7]. On the other hand, the balance ability of patients with AD can also be assessed by measuring the standing holding time.…”