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Rudisch J, Fröhlich S, Kutz DF, Voelcker-Rehage C. Force Fluctuations During Role-Differentiated Bimanual Movements Reflect Cognitive Impairments in Older Adults: A Cohort Sequential Study. J Gerontol A Biol Sci Med Sci 2024; 79:glae137. [PMID: 38912976 PMCID: PMC11372707 DOI: 10.1093/gerona/glae137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Indexed: 06/25/2024] Open
Abstract
During role-differentiated bimanual movements (RDBM), an object is typically stabilized with 1 hand and manipulated with the other. RDBM require coupling both hands for coordinated action (achieved through interhemispheric connections), but also inhibition of crosstalk to avoid involuntary movements in the stabilizing hand. We investigated how healthy cognitive aging and mild cognitive impairments (MCI) affect force stabilization during an RDBM in a cohort sequential study design with up to 4 measurement points over 32 months. In total, 132 older adults (>80 years) participated in this study, 77 were cognitively healthy individuals (CHI) and 55 presented with MCI. Participants performed a visuomotor bimanual force-tracking task. They either produced a constant force with both hands (bimanual constant) or a constant force with 1 and an alternating force with the other hand (role-differentiated). We investigated force fluctuations of constant force production using the coefficient of variation (CV), detrended fluctuation analysis (DFA), and sample entropy (SEn). Results showed higher CV and less complex variability structure (higher DFA and lower SEn) during the role-differentiated compared to the bimanual constant task. Furthermore, CHI displayed a more complex variability structure during the bimanual constant, but a less complex structure during the role-differentiated task than MCI. Interestingly, this complexity reduction was more pronounced in CHI than MCI individuals, suggesting different changes in the control mechanisms. Although understanding these changes requires further research, potential causes might be structural deteriorations leading to less efficient (intra- and interhemispheric) networks because of MCI, or an inability to appropriately divert the focus of attention.
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Affiliation(s)
- Julian Rudisch
- Department of Neuromotor Behavior and Exercise, Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany
| | - Stephanie Fröhlich
- Department of Neuromotor Behavior and Exercise, Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany
| | - Dieter F Kutz
- Department of Neuromotor Behavior and Exercise, Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany
| | - Claudia Voelcker-Rehage
- Department of Neuromotor Behavior and Exercise, Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany
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Rudd KD, Lawler K, Callisaya ML, Bindoff AD, Chiranakorn-Costa S, Li R, McDonald JS, Salmon K, Noyce AJ, Vickers JC, Alty J. Hand Motor Dysfunction Is Associated with Both Subjective and Objective Cognitive Impairment across the Dementia Continuum. Dement Geriatr Cogn Disord 2024:1-11. [PMID: 39074458 DOI: 10.1159/000540412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/14/2024] [Indexed: 07/31/2024] Open
Abstract
INTRODUCTION Motor dysfunction is an important feature of early-stage dementia. Gait provides a non-invasive biomarker across the dementia continuum. Gait speed and rhythm aid risk stratification of incident dementia in subjective cognitive impairment (SCI) and are associated with cognitive domains in mild cognitive impairment (MCI) and dementia. However, hand movement analysis, which may be more accessible, has never been undertaken in SCI and rarely in MCI or dementia. We aimed to address this gap and improve understanding of hand motor-cognitive associations across the dementia continuum. METHODS A total of 208 participants were recruited: 50 with dementia, 58 MCI, 40 SCI, and 60 healthy controls. Consensus diagnoses were made after comprehensive gold-standard assessments. A computer key-tapping test measured frequency, dwell-time, rhythm, errors, and speed. Associations between key-tapping and cognitive domains and diagnoses were analysed using regression. Classification accuracy was measured using area under receiver operating characteristic curves. RESULTS Hand frequency and speed were associated with memory and executive domains (p ≤ 0.001). Non-dominant hand rhythm was associated with all cognitive domains. Frequency, rhythm, and speed were associated with SCI, MCI, and dementia. Frequency and speed classified ≥94% of dementia and ≥88% of MCI from controls. Rhythm of the non-dominant hand classified ≥86% of dementia and MCI and 69% of SCI. CONCLUSION Our findings show hand motor dysfunction occurs across the dementia continuum and, similar to gait, is associated with executive and memory domains and with cognitive diagnoses. Key-tapping performance differentiated dementia and MCI from healthy controls. More research is required before recommending key-tapping as a non-invasive motor biomarker of cognitive impairment.
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Affiliation(s)
- Kaylee D Rudd
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Katherine Lawler
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Michele L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Peninsula Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Aidan D Bindoff
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Renjie Li
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - James S McDonald
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Katharine Salmon
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
- Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Alastair J Noyce
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - James C Vickers
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Jane Alty
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Royal Hobart Hospital, Hobart, Tasmania, Australia
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Li Y, Huang Y, Wei F, Li T, Wang Y. Development and validation of a risk prediction model for motoric cognitive risk syndrome in older adults. Aging Clin Exp Res 2024; 36:143. [PMID: 39002102 PMCID: PMC11246282 DOI: 10.1007/s40520-024-02797-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 06/22/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVE The objective of this study was to develop a risk prediction model for motoric cognitive risk syndrome (MCR) in older adults. METHODS Participants were selected from the 2015 China Health and Retirement Longitudinal Study database and randomly assigned to the training group and the validation group, with proportions of 70% and 30%, respectively. LASSO regression analysis was used to screen the predictors. Then, identified predictors were included in multivariate logistic regression analysis and used to construct model nomogram. The performance of the model was evaluated by area under the receiver operating characteristic (ROC) curve (AUC), calibration curves and decision curve analysis (DCA). RESULTS 528 out of 3962 participants (13.3%) developed MCR. Multivariate logistic regression analysis showed that weakness, chronic pain, limb dysfunction score, visual acuity score and Five-Times-Sit-To-Stand test were predictors of MCR in older adults. Using these factors, a nomogram model was constructed. The AUC values for the training and validation sets of the predictive model were 0.735 (95% CI = 0.708-0.763) and 0.745 (95% CI = 0.705-0.785), respectively. CONCLUSION The nomogram constructed in this study is a useful tool for assessing the risk of MCR in older adults, which can help clinicians identify individuals at high risk.
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Affiliation(s)
- Yaqin Li
- School of Nursing, Jinan University, Guangzhou, Guangdong Province, China
| | - Yuting Huang
- School of Nursing, Jinan University, Guangzhou, Guangdong Province, China
| | - Fangxin Wei
- School of Nursing, Jinan University, Guangzhou, Guangdong Province, China
| | - Tanjian Li
- School of Nursing, Jinan University, Guangzhou, Guangdong Province, China
| | - Yu Wang
- The Community Service Center of Jinan University, The First Affiliated Hospital of Jinan University, Tianhe District, Guangzhou, Guangzhou Province, China.
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Alty J, Goldberg LR, Roccati E, Lawler K, Bai Q, Huang G, Bindoff AD, Li R, Wang X, St George RJ, Rudd K, Bartlett L, Collins JM, Aiyede M, Fernando N, Bhagwat A, Giffard J, Salmon K, McDonald S, King AE, Vickers JC. Development of a smartphone screening test for preclinical Alzheimer's disease and validation across the dementia continuum. BMC Neurol 2024; 24:127. [PMID: 38627686 PMCID: PMC11020184 DOI: 10.1186/s12883-024-03609-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Dementia prevalence is predicted to triple to 152 million globally by 2050. Alzheimer's disease (AD) constitutes 70% of cases. There is an urgent need to identify individuals with preclinical AD, a 10-20-year period of progressive brain pathology without noticeable cognitive symptoms, for targeted risk reduction. Current tests of AD pathology are either too invasive, specialised or expensive for population-level assessments. Cognitive tests are normal in preclinical AD. Emerging evidence demonstrates that movement analysis is sensitive to AD across the disease continuum, including preclinical AD. Our new smartphone test, TapTalk, combines analysis of hand and speech-like movements to detect AD risk. This study aims to [1] determine which combinations of hand-speech movement data most accurately predict preclinical AD [2], determine usability, reliability, and validity of TapTalk in cognitively asymptomatic older adults and [3], prospectively validate TapTalk in older adults who have cognitive symptoms against cognitive tests and clinical diagnoses of Mild Cognitive Impairment and AD dementia. METHODS Aim 1 will be addressed in a cross-sectional study of at least 500 cognitively asymptomatic older adults who will complete computerised tests comprising measures of hand motor control (finger tapping) and oro-motor control (syllabic diadochokinesis). So far, 1382 adults, mean (SD) age 66.20 (7.65) years, range 50-92 (72.07% female) have been recruited. Motor measures will be compared to a blood-based AD biomarker, phosphorylated tau 181 to develop an algorithm that classifies preclinical AD risk. Aim 2 comprises three sub-studies in cognitively asymptomatic adults: (i) a cross-sectional study of 30-40 adults to determine the validity of data collection from different types of smartphones, (ii) a prospective cohort study of 50-100 adults ≥ 50 years old to determine usability and test-retest reliability, and (iii) a prospective cohort study of ~1,000 adults ≥ 50 years old to validate against cognitive measures. Aim 3 will be addressed in a cross-sectional study of ~200 participants with cognitive symptoms to validate TapTalk against Montreal Cognitive Assessment and interdisciplinary consensus diagnosis. DISCUSSION This study will establish the precision of TapTalk to identify preclinical AD and estimate risk of cognitive decline. If accurate, this innovative smartphone app will enable low-cost, accessible screening of individuals for AD risk. This will have wide applications in public health initiatives and clinical trials. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT06114914, 29 October 2023. Retrospectively registered.
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Affiliation(s)
- Jane Alty
- Wicking Dementia Research and Education Centre, University of Tasmania, Liverpool Street, Hobart, TAS, 7001, Australia.
- School of Medicine, University of Tasmania, Hobart, TAS, 7001, Australia.
- Royal Hobart Hospital, Hobart, TAS, 7001, Australia.
| | - Lynette R Goldberg
- Wicking Dementia Research and Education Centre, University of Tasmania, Liverpool Street, Hobart, TAS, 7001, Australia
| | - Eddy Roccati
- Wicking Dementia Research and Education Centre, University of Tasmania, Liverpool Street, Hobart, TAS, 7001, Australia
| | - Katherine Lawler
- Wicking Dementia Research and Education Centre, University of Tasmania, Liverpool Street, Hobart, TAS, 7001, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Quan Bai
- School of Information and Communication Technology, University of Tasmania, Hobart, TAS, 7005, Australia
| | - Guan Huang
- Wicking Dementia Research and Education Centre, University of Tasmania, Liverpool Street, Hobart, TAS, 7001, Australia
| | - Aidan D Bindoff
- Wicking Dementia Research and Education Centre, University of Tasmania, Liverpool Street, Hobart, TAS, 7001, Australia
| | - Renjie Li
- Wicking Dementia Research and Education Centre, University of Tasmania, Liverpool Street, Hobart, TAS, 7001, Australia
- School of Information and Communication Technology, University of Tasmania, Hobart, TAS, 7005, Australia
| | - Xinyi Wang
- Wicking Dementia Research and Education Centre, University of Tasmania, Liverpool Street, Hobart, TAS, 7001, Australia
| | - Rebecca J St George
- School of Psychological Sciences, University of Tasmania, Hobart, TAS, 7005, Australia
| | - Kaylee Rudd
- Wicking Dementia Research and Education Centre, University of Tasmania, Liverpool Street, Hobart, TAS, 7001, Australia
| | - Larissa Bartlett
- Wicking Dementia Research and Education Centre, University of Tasmania, Liverpool Street, Hobart, TAS, 7001, Australia
| | - Jessica M Collins
- Wicking Dementia Research and Education Centre, University of Tasmania, Liverpool Street, Hobart, TAS, 7001, Australia
| | - Mimieveshiofuo Aiyede
- Wicking Dementia Research and Education Centre, University of Tasmania, Liverpool Street, Hobart, TAS, 7001, Australia
| | | | - Anju Bhagwat
- Royal Hobart Hospital, Hobart, TAS, 7001, Australia
| | - Julia Giffard
- Wicking Dementia Research and Education Centre, University of Tasmania, Liverpool Street, Hobart, TAS, 7001, Australia
| | - Katharine Salmon
- Wicking Dementia Research and Education Centre, University of Tasmania, Liverpool Street, Hobart, TAS, 7001, Australia
- Royal Hobart Hospital, Hobart, TAS, 7001, Australia
| | - Scott McDonald
- Wicking Dementia Research and Education Centre, University of Tasmania, Liverpool Street, Hobart, TAS, 7001, Australia
| | - Anna E King
- Wicking Dementia Research and Education Centre, University of Tasmania, Liverpool Street, Hobart, TAS, 7001, Australia
| | - James C Vickers
- Wicking Dementia Research and Education Centre, University of Tasmania, Liverpool Street, Hobart, TAS, 7001, Australia
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Li R, Wang X, Lawler K, Garg S, St George RJ, Bindoff AD, Bartlett L, Roccati E, King AE, Vickers JC, Bai Q, Alty J. Brief webcam test of hand movements predicts episodic memory, executive function, and working memory in a community sample of cognitively asymptomatic older adults. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12520. [PMID: 38274411 PMCID: PMC10809289 DOI: 10.1002/dad2.12520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Low-cost simple tests for preclinical Alzheimer's disease are a research priority. We evaluated whether remote unsupervised webcam recordings of finger-tapping were associated with cognitive performance in older adults. METHODS A total of 404 cognitively-asymptomatic participants (64.6 [6.77] years; 70.8% female) completed 10-second finger-tapping tests (Tasmanian [TAS] Test) and cognitive tests (Cambridge Neuropsychological Test Automated Battery [CANTAB]) online at home. Regression models including hand movement features were compared with null models (comprising age, sex, and education level); change in Akaike Information Criterion greater than 2 (ΔAIC > 2) denoted statistical difference. RESULTS Hand movement features improved prediction of episodic memory, executive function, and working memory scores (ΔAIC > 2). Dominant hand features outperformed nondominant hand features for episodic memory (ΔAIC = 2.5), executive function (ΔAIC = 4.8), and working memory (ΔAIC = 2.2). DISCUSSION This brief webcam test improved prediction of cognitive performance compared to age, sex, and education. Finger-tapping holds potential as a remote language-agnostic screening tool to stratify community cohorts at risk for cognitive decline.
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Affiliation(s)
- Renjie Li
- Wicking Dementia Research and Education CentreUniversity of TasmaniaHobartTasmaniaAustralia
- School of ICTUniversity of TasmaniaHobartTasmaniaAustralia
| | - Xinyi Wang
- Wicking Dementia Research and Education CentreUniversity of TasmaniaHobartTasmaniaAustralia
| | - Katherine Lawler
- Wicking Dementia Research and Education CentreUniversity of TasmaniaHobartTasmaniaAustralia
- School of Allied HealthHuman Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
| | - Saurabh Garg
- School of ICTUniversity of TasmaniaHobartTasmaniaAustralia
| | | | - Aidan D. Bindoff
- Wicking Dementia Research and Education CentreUniversity of TasmaniaHobartTasmaniaAustralia
| | - Larissa Bartlett
- Wicking Dementia Research and Education CentreUniversity of TasmaniaHobartTasmaniaAustralia
| | - Eddy Roccati
- Wicking Dementia Research and Education CentreUniversity of TasmaniaHobartTasmaniaAustralia
| | - Anna E. King
- Wicking Dementia Research and Education CentreUniversity of TasmaniaHobartTasmaniaAustralia
| | - James C. Vickers
- Wicking Dementia Research and Education CentreUniversity of TasmaniaHobartTasmaniaAustralia
| | - Quan Bai
- School of ICTUniversity of TasmaniaHobartTasmaniaAustralia
| | - Jane Alty
- Wicking Dementia Research and Education CentreUniversity of TasmaniaHobartTasmaniaAustralia
- School of MedicineUniversity of TasmaniaHobartTasmaniaAustralia
- Neurology DepartmentRoyal Hobart HospitalHobartTasmaniaAustralia
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