Abstract:Introduction: Mild cognitive impairment (MCI) is characterized by subjective memory complaints and is considered an intermediate stage between normal and pathological cognitive function. The decline in cognitive function may be associated with low functional performance and alterations in body composition in older adults. Objective: To assess muscle strength, lower extremity functional performance and body composition in elderly women with MCI. Methods: Forty-three elderly women (aged 60-80 years) participated… Show more
“…These findings suggest that coordination abilities, which are essential to performing optimal turns, are not greatly influenced by the presence of cognitive impairments when the individual is relatively young, while they always significantly affect TUG phases, which rely more on postural control and lower limb strength. This is likely due to a reduction in muscle strength (which was previously observed in individuals with MCI of similar age [74,75]), and is also probably influenced by a limited amount of physical activity [76] and poor balance abilities [77]. It was also observed that old-old participants with cognitive impairments required longer times to perform 180° turns, as they probably adopted a cautious strategy to avoid loss of balance and falls.…”
Aim
The main purpose of the present study was to verify the feasibility of wearable inertial sensors (IMUs) in a clinical setting to screen gait and functional mobility in Italian older persons. In particular, we intended to verify the capability of IMUs to discriminate individuals with and without cognitive impairments and assess the existence of significant correlations between mobility parameters extracted by processing trunk accelerations and cognitive status.
Methods
This is a cross-sectional study performed on 213 adults aged over 65 years (mean age 77.0 ± 5.4; 62% female) who underwent cognitive assessment (through Addenbrooke’s Cognitive Examination Revised, ACE-R) instrumental gait analysis and the Timed Up and Go (TUG) test carried out using a wearable IMU located in the lower back.
Results
Individuals with cognitive impairments exhibit a peculiar gait pattern, characterized by significant reduction of speed (− 34% vs. healthy individuals), stride length (− 28%), cadence (− 9%), and increase in double support duration (+ 11%). Slight, but significant changes in stance and swing phase duration were also detected. Poorer performances in presence of cognitive impairment were observed in terms of functional mobility as overall and sub-phase TUG times resulted significantly higher with respect to healthy individuals (overall time, + 38%, sub-phases times ranging from + 22 to + 34%), although with some difference associated with age. The severity of mobility alterations was found moderately to strongly correlated with the ACE-R score (Spearman’s rho = 0.58 vs. gait speed, 0.54 vs. stride length, 0.66 vs. overall TUG time).
Conclusion
The findings obtained in the present study suggest that wearable IMUs appear to be an effective solution for the clinical assessment of mobility parameters of older persons screened for cognitive impairments within a clinical setting. They may represent a useful tool for the clinician in verifying the effectiveness of interventions to alleviate the impact of mobility limitations on daily life in cognitively impaired individuals.
“…These findings suggest that coordination abilities, which are essential to performing optimal turns, are not greatly influenced by the presence of cognitive impairments when the individual is relatively young, while they always significantly affect TUG phases, which rely more on postural control and lower limb strength. This is likely due to a reduction in muscle strength (which was previously observed in individuals with MCI of similar age [74,75]), and is also probably influenced by a limited amount of physical activity [76] and poor balance abilities [77]. It was also observed that old-old participants with cognitive impairments required longer times to perform 180° turns, as they probably adopted a cautious strategy to avoid loss of balance and falls.…”
Aim
The main purpose of the present study was to verify the feasibility of wearable inertial sensors (IMUs) in a clinical setting to screen gait and functional mobility in Italian older persons. In particular, we intended to verify the capability of IMUs to discriminate individuals with and without cognitive impairments and assess the existence of significant correlations between mobility parameters extracted by processing trunk accelerations and cognitive status.
Methods
This is a cross-sectional study performed on 213 adults aged over 65 years (mean age 77.0 ± 5.4; 62% female) who underwent cognitive assessment (through Addenbrooke’s Cognitive Examination Revised, ACE-R) instrumental gait analysis and the Timed Up and Go (TUG) test carried out using a wearable IMU located in the lower back.
Results
Individuals with cognitive impairments exhibit a peculiar gait pattern, characterized by significant reduction of speed (− 34% vs. healthy individuals), stride length (− 28%), cadence (− 9%), and increase in double support duration (+ 11%). Slight, but significant changes in stance and swing phase duration were also detected. Poorer performances in presence of cognitive impairment were observed in terms of functional mobility as overall and sub-phase TUG times resulted significantly higher with respect to healthy individuals (overall time, + 38%, sub-phases times ranging from + 22 to + 34%), although with some difference associated with age. The severity of mobility alterations was found moderately to strongly correlated with the ACE-R score (Spearman’s rho = 0.58 vs. gait speed, 0.54 vs. stride length, 0.66 vs. overall TUG time).
Conclusion
The findings obtained in the present study suggest that wearable IMUs appear to be an effective solution for the clinical assessment of mobility parameters of older persons screened for cognitive impairments within a clinical setting. They may represent a useful tool for the clinician in verifying the effectiveness of interventions to alleviate the impact of mobility limitations on daily life in cognitively impaired individuals.
“…This may explain why our cross-sectional study suggests a parallel decline in cognition and muscle strength but not in lean mass. However, in a Belgian study of men and women aged 60-80 years, differences in HGS were found between the group with MCI and the normal group; no differences were found in physical performance (gait speed and balance measured by Short Physical Performance Battery) or body composition (muscle and fat mass) 53 .…”
We aimed to examine muscle strength, function and mass in relation to cognition in older men. this cross-sectional data-set included 292 men aged ≥60 yr. Handgrip strength (kg) was measured by dynamometry, gait speed by 4-metre walk (m/s) and appendicular lean mass (kg) by dual-energy x-ray absorptiometry. cognition was assessed across four domains: psychomotor function, attention, visual learning and working memory. Composite scores for overall cognition were calculated. Bivariate analyses indicated that handgrip strength and gait speed were positively associated with cognitive function. After accounting for confounders, positive associations between individual muscle (or physical) measures and cognitive performance were sustained for handgrip strength and psychomotor function, gait speed and psychomotor function, gait speed and attention, handgrip strength and overall cognition, and gait speed and overall cognition. in multivariable models, handgrip strength and gait speed independently predicted psychomotor function and overall cognition. no associations were detected between lean mass and cognition after adjusting for confounders. thus, low muscle strength and slower gait speed, rather than low lean mass, were associated with poor cognition in older men.
“…In this study, bioimpedance changes in the lower extremity were observed and were more significantly associated with MCI than those in the upper extremity. A reduction in physical function in the lower extremity is likely to be related to a higher risk of cognitive decline ( 32 , 33 ); it suggests that more focus should be placed on impedance variable changes in the lower extremity in relation to the early stage of cognitive impairment.…”
Section: Discussionmentioning
confidence: 99%
“…Mereu et al demonstrated that bioimpedance results obtained for only the right arm would be similar to whole-body composition in patients with AD ( 31 ). Reduction of skeletal muscle mass or muscle strength in the lower limbs was associated with a higher MCI risk in women ( 32 , 33 ), whereas loss of skeletal muscle mass in the upper and lower limbs was associated with a higher risk of MCI in men ( 32 ). Lower extremity skeletal muscle mass was associated with lower cognitive performance and higher cortical beta-amyloid burden ( 34 , 35 ), whereas upper extremity skeletal muscle mass did not show any association ( 34 ).…”
ObjectiveTo examine the changes in body composition, water compartment, and bioimpedance in mild cognitive impairment (MCI) individuals.MethodsWe obtained seven whole-body composition variables and seven pairs of segmental body composition, water compartment, and impedance variables for the upper and lower extremities from the segmental multi-frequency bioelectrical impedance analysis (BIA) of 939 elderly participants, including 673 cognitively normal (CN) people and 266 individuals with MCI. Participants’ characteristics, anthropometric information, and the selected BIA variables were described and statistically compared between the CN participants and those with MCI. The correlations between the selected BIA variables and neuropsychological tests such as the Korean version of the Mini-Mental State Examination and Seoul Neuropsychological Screening Battery – Second Edition were also examined before and after controlling for age and sex. Univariate and multivariate logistic regression analyses with estimated odds ratios (ORs) were conducted to investigate the associations between these BIA variables and MCI prevalence for different sexes.ResultsParticipants with MCI were slightly older, more depressive, and had significantly poorer cognitive abilities when compared with the CN individuals. The partial correlations between the selected BIA variables and neuropsychological tests upon controlling for age and sex were not greatly significant. However, after accounting for age, sex, and the significant comorbidities, segmental lean mass, water volume, resistance, and reactance in the lower extremities were positively associated with MCI, with ORs [95% confidence interval (CI)] of 1.33 (1.02–1.71), 1.33 (1.03–1.72), 0.76 (0.62–0.92), and 0.79 (0.67–0.93), respectively; with presumably a shift of water from the intracellular area to extracellular space. After stratifying by sex, resistance and reactance in lower extremities remained significant only in the women group.ConclusionAn increase in segmental water along with segmental lean mass and a decrease in body cell strength due to an abnormal cellular water distribution demonstrated by reductions in resistance and reactance are associated with MCI prevalence, which are more pronounced in the lower extremities and in women. These characteristic changes in BIA variables may be considered as an early sign of cognitive impairment in the elderly population.
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