Pathological Gait Signatures of Post-stroke Dementia With Toe-Off and Heel-to-Ground Angles Discriminate From Alzheimer’s Disease

Abstract

Given the limited power of neuropsychological tests, there is a need for a simple, reliable means, such as gait, to identify mild dementia and its subtypes. However, gait characteristics of patients with post-stroke dementia (PSD) and Alzheimer’s disease (AD) are unclear. We sought to describe their gait signatures and to explore gait parameters distinguishing PSD from post-stroke non-dementia (PSND) and patients with AD. We divided 3-month post-stroke patients into PSND and PSD groups based on the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the activity of daily living (ADL). Thirty-one patients with AD and thirty-two healthy controls (HCs) were also recruited. Ten gait parameters in one single and two dual-task gait tests (counting-backward or naming-animals while walking) were compared among the groups, with adjustment for baseline demographic covariates and the MMSE score. The area under the receiver operating characteristic curve (AUC) was used to identify parameters discriminating PSD from individuals with PSND and AD. Patients with PSD and patients with AD showed impaired stride length, velocity, stride time, and cadence while patients with PSD had altered stance and swing phase proportions (all p ≤ 0.01, post hoc). Patients with AD had smaller toe-off (ToA) and heel-to-ground angles (HtA) (p ≤ 0.01) than HCs in dual-task gait tests. Individuals with PSD had a shorter stride length, slower velocity, and altered stance and swing phase percentages in all tests (p ≤ 0.01), but a higher coefficient of variation of stride length (CoVSL) and time (CoVST) only in the naming animals-task gait test (p ≤ 0.001) than individuals with PSND. ToA and HtA in the naming animals-task gait test were smaller in individuals with AD than those with PSD (p ≤ 0.01). Statistical significance persisted after adjusting for demographic covariates, but not for MMSE. The pace and the percentage of stance or swing phase in all tests, CoVST in the dual-task paradigm, and CoVSL only in the naming animals-task gait test (moderate accuracy, AUC > 0.700, p ≤ 0.01) could distinguish PSD from PSND. Furthermore, the ToA and HtA in the naming animals-task gait paradigm discriminated AD from PSD (moderate accuracy, AUC > 0.700, p ≤ 0.01). Thus, specific gait characteristics could allow early identification of PSD and may allow non-invasive discrimination between PSD and AD, or even other subtypes of dementia.

Daily life mobility detects frailty, falls, and functioning in ADT-treated prostate cancer survivors

“…Gait Pace and Rhythm accounted for the majority of variance in daily life mobility. The metrics within these domains, including gait speed, heel-strike angle, and toe-off angle, have been linked to fatigue and muscle weakness in populations with neurological diseases, 30,31,52 but this is the rst evidence that these mobility characteristics associate with worse clinical outcomes in prostate cancer survivors on ADT. Fatigue and deconditioning also contribute to low self-report activity levels in patients on ADT, and we observed fewer daily bouts and shorter bout length in participants in our sample who reported more falls, were frailer, and had lower functioning than participants with higher Activity scores.…”

Association Between the Loss of Gait Harmony and Cognitive Impairment: Cross-Sectional Study

“…Based on a previous study in Italy on people with and without PD, alterations in gait ratio were expected; Peppe et al [ 27 ] suggested that compared with healthy participants, patients with PD have prolonged stance phases (patients with PD: 68.1% vs patients without PD: 63.6%; P <.001) [ 27 ]. Another study in 31 patients older than 55 years in China [ 46 ] investigated the relationship between gait characteristics and dementia, such as poststroke dementia (PSD) and AD. Ni et al [ 46 ] showed that in all gait tests, the percentage of time spent in the stance phase was longer (patients with PSD: 63.95% vs patients with AD: 63.09% vs healthy adults: 62.15%; P =.002) and in the swing phase was shorter (patients with PSD: 36.04% vs patients with AD: 36.91% vs healthy adults: 37.86%; P =.002) among patients with dementia than among healthy controls.…”

“…Another study in 31 patients older than 55 years in China [ 46 ] investigated the relationship between gait characteristics and dementia, such as poststroke dementia (PSD) and AD. Ni et al [ 46 ] showed that in all gait tests, the percentage of time spent in the stance phase was longer (patients with PSD: 63.95% vs patients with AD: 63.09% vs healthy adults: 62.15%; P =.002) and in the swing phase was shorter (patients with PSD: 36.04% vs patients with AD: 36.91% vs healthy adults: 37.86%; P =.002) among patients with dementia than among healthy controls. Taken together, these studies highlight that older individuals with gait imbalance are relatively susceptible to a decrease in cognitive function.…”