Effects of white matter lesions on trunk stability during dual-task walking among older adults with mild cognitive impairment

Abstract

The linkage between gait and cognition has been shown in cases of white matter lesion (WML) that affect gait in older adults. Dual-task walking is believed to be cognitively demanding and to alter trunk movement, and gait impairment in people with mild cognitive impairment (MCI) is highlighted under this condition. However, the association between dual-task walking and structural changes in the brain, particularly with WML, in people with MCI is still unclear. The aim of this study was to examine the association between trunk stability during dual-task walking and WML in 560 older adults with MCI. We measured magnetic resonance imaging (MRI) and gait variables. Gait variables included harmonic ratio in vertical, mediolateral, and anteroposterior directions, analyzed using a tri-axial accelerometer attached to the lower trunk. Walking conditions were normal walking and dual-task walking (counting backwards while walking) conditions. Demographical data and brain atrophy were measured as covariates. Subjects were classified into non-severe WML (n=451, mean age=73.2 years) and severe WML (n=109, mean age=75.9 years) groups. Linear mixedeffects model analysis controlled for covariates showed dual-task-related changes in all harmonic ratios associated with WML (p<0.05). Even after adjustment for executive function, harmonic ratio in the mediolateral direction was significantly associated with WML (p<0.05). Our findings revealed that WMLs were associated with trunk stability in dual-task walking. Further studies are required to investigate the neural basis for deficits in gait ability among MCI subjects.

Circulating IGF-1 deficiency exacerbates hypertension-induced microvascular rarefaction in the mouse hippocampus and retrosplenial cortex: implications for cerebromicrovascular and brain aging

“…Circulating IGF-1 levels and blood pressure measurements Although the factors responsible for the deleterious effects of aging on behavior and neuronal function (Baciu et al 2016;Berghuis et al 2015;Campbell et al 2014;Doi et al 2015;Haider et al 2014;Hofmann et al 2014;Kumar and Thakur 2015;Lopez et al 2014;Manich et al 2014;Salminen et al 2014;Samaras et al 2014;Sarubbo et al 2015;Loprinzi 2016;Wallis et al 2016) are not completely understood, there is strong evidence that in elderly humans a decline in circulating IGF-1 levels (Franco et al 2014) plays a critical pathophysiological role. To understand the effects of IGF-1 deficiency on the cerebral microcirculation in the present study, we used a novel mouse model of adult-onset isolated endocrine IGF-1 deficiency, which phenotypically better mimics age-related IGF-1 deficiency observed in humans that most other available rodent models of GH/IGF-1 deficiency (Arum et al 2014a;Hill et al 2015;Rojanathammanee et al 2014;Wiesenborn et al 2014;Arum et al 2014b;Schneider et al 2014).…”

Association between Various Brain Pathologies and Gait Disturbance

“…The associations between spatial, temporal, and spatiotemporal gait parameters and reduced cortical thickness have been widespread across cortical regions. Six studies reported that lower total GM volume was associated with poorer performance on multiple gait measures [17,19,33–36] (Table 1). Seven studies showed that smaller GM volume in frontal regions was associated with poorer gait [33,34,37–41].…”

Smoothness of Gait in Healthy and Cognitively Impaired Individuals: A Study on Italian Elderly Using Wearable Inertial Sensor

“…There is instead a scarcity of data regarding the relationship between HR and cognitive measures, even though a number of studies have investigated the alterations of trunk accelerations in cognitively impaired people using a variety of metrics, including some quite similar in principle to HR [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ], concluding that gait outcomes related to speed, regularity, predictability, and stability of trunk accelerations may suitably integrate other physical, cognitive, and behavioral measures, to better identify the extent of a cognitive impairment in the elderly. To the best of our knowledge, only Ijmker and Lamoth [ 35 ] attempted to investigate the existence of a possible relationship between HRs and MMSE score.…”

“…Several studies also attempted to correlate trunk accelerations features, acquired during walking tests, with clinical characteristics of older adults with cognitive impairments. Their main findings can be summarized as follows: in comparison with unaffected individuals, older adults with cognitive impairments exhibit significant reduced value of the root mean square (RMS) and structure variability of the medio-lateral trunk acceleration [33], significant association of trunk stability measures with the white matter lesions [34] and with cognitive performance [35]. In particular, the study of Ijmker and Lamoth [35] showed that the presence of a cognitive impairment is accompanied by a decrease in smoothness of gait along the walking direction (anteroposterior, AP), as indicated by the significantly reduced value of the corresponding HR.…”

“…Nevertheless, since this result was not discussed in detail by the authors, we can only speculate that factors such as a different composition of the sample (i.e., presence/different proportion of individuals with Alzheimer's disease or vascular cognitive impairment and a different woman/man ratio), as well as environmental and socio-economic backgrounds of the countries in which the studies were performed, might partly explain such a discrepancy. Generally speaking, the reduction of smoothness of gait can be attributed to alterations in limb dynamics and overall function, which can be present even in the early stages of cognitive impairment [26,54], as well as in trunk stability, especially in the presence of brain structural changes such as severe white matter lesions [34]. Moreover, individuals at increased risk of falls, such as those with cognitive impairment [55,56], have difficulties in controlling the rhythmic displacements of the trunk during gait [45], which is thus another factor able to worsen the overall smoothness of gait.…”