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Potvin-Desrochers A, Atri A, Clouette J, Hepple RT, Taivassalo T, Paquette C. Resting-state Functional Connectivity of the Motor and Cognitive Areas is Preserved in Masters Athletes. Neuroscience 2024; 546:53-62. [PMID: 38522662 DOI: 10.1016/j.neuroscience.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024]
Abstract
Aging is characterized by a decline in physical and cognitive functions, often resulting in decreased quality of life. Physical activity has been suggested to potentially slow down various aspects of the aging process, a theory that has been supported by studies of Masters Athletes (MA). For example, MA usually have better cognitive and physical functions than age-matched sedentary and healthy older adults (OA), making them a valuable model to gain insights into mechanisms that promote physical and cognitive function with aging. The purpose of this study was to identify differences in resting-state functional connectivity (rs-FC) of motor and cognitive regions between MA and OA and determine if these differences in the resting brain are associated with differences in cognitive and physical performance between groups. Fifteen MA (9 males) and 12 age-matched OA (six males) were included. rs-FC images were compared to identify significant between-groups differences in brain connectivity. There was higher connectivity between the cognitive and motor networks for the OA group, whereas the MA group had stronger connectivity between different regions within the same network, both for the cognitive and the motor networks. These results are in line with the literature suggesting that aging reduces the segregation between functional networks and causes regions within the same network to be less strongly connected. High-level physical activity practiced by the MA most likely contributes to attenuating aging-related changes in brain functional connectivity, preserving clearer boundaries between different functional networks, which may ultimately favor maintenance of efficient cognitive and sensorimotor processing.
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Affiliation(s)
- Alexandra Potvin-Desrochers
- Department of Kinesiology and Physical Education, McGill University, 475 Pine Ave., Montreal, Quebec, Canada; Jewish Rehabilitation Hospital Site of CISSS-Laval and Research Site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), 3205 Place Alton-Goldbloom, Laval, Quebec, Canada; Integrated Program in Neuroscience (IPN), McGill University, 1033 Pine Ave, Montreal, Quebec, Canada
| | - Alisha Atri
- Department of Kinesiology and Physical Education, McGill University, 475 Pine Ave., Montreal, Quebec, Canada; Jewish Rehabilitation Hospital Site of CISSS-Laval and Research Site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), 3205 Place Alton-Goldbloom, Laval, Quebec, Canada
| | - Julien Clouette
- Department of Kinesiology and Physical Education, McGill University, 475 Pine Ave., Montreal, Quebec, Canada; Jewish Rehabilitation Hospital Site of CISSS-Laval and Research Site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), 3205 Place Alton-Goldbloom, Laval, Quebec, Canada
| | - Russell T Hepple
- Department of Physical Therapy, University of Florida, 101 Newell Dr, Gainesville, FL, USA; Department of Physiology and Functional Genomics, University of Florida, 1600 SW Archer Rd, Gainesville, FL, USA
| | - Tanja Taivassalo
- Department of Physiology and Functional Genomics, University of Florida, 1600 SW Archer Rd, Gainesville, FL, USA
| | - Caroline Paquette
- Department of Kinesiology and Physical Education, McGill University, 475 Pine Ave., Montreal, Quebec, Canada; Jewish Rehabilitation Hospital Site of CISSS-Laval and Research Site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), 3205 Place Alton-Goldbloom, Laval, Quebec, Canada; Integrated Program in Neuroscience (IPN), McGill University, 1033 Pine Ave, Montreal, Quebec, Canada.
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Leroy V, Chen Y, Bouteloup V, Skrobala E, Puisieux F, Fougère B. What Tools Can We Use to Screen for Fall Risk in Older Patients with Mild Cognitive Impairment? Findings from the MEMENTO Cohort. J Am Med Dir Assoc 2023; 24:1028-1034.e18. [PMID: 36682387 DOI: 10.1016/j.jamda.2022.12.020] [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: 05/20/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Identifying risk factors for falls can improve outcomes in older patients without cognitive decline. Yet this has not been demonstrated in older people with mild cognitive impairment (MCI). We therefore sought to better identify risk factors for falls in this particular group. DESIGN The analysis was conducted on the MEMENTO cohort, which is a large, French, prospective cohort. SETTING AND PARTICIPANTS We included older people (>65 years old) with MCI (defined from neuropsychological scores) and a Short Physical Performance Battery (SPPB) score at baseline. METHODS Fallers were defined as participants having fallen at least once during the study's 2-year follow-up period. We compared clinical, neuropsychological, and biological data at baseline in fallers vs nonfallers. Additional analyses were performed on the following subgroups: women, men, people aged ≥75 years. RESULTS Of the 1416 people included in our study, 194 (13.5%) fell at least once. A bivariate analysis showed that fallers were older, predominantly women, less independent in activities of daily living, and more apathetic. Fallers performed less well in executive function, balance, and gait tests. In a multivariable analysis, only age, gender, the number of limitations in instrumental activities of daily living, and living alone were significantly associated with falls. In a multivariable analysis of the subgroup of oldest patients and of the subgroup of men, executive function was significantly worse in fallers than in nonfallers. CONCLUSION AND IMPLICATIONS Our results demonstrate that easily attainable risk factors can be used to identify individuals with MCI with a higher risk of falls and for whom prevention could be beneficial. Future studies are needed to further evaluate the role of mild executive dysfunction in certain subgroups, such as men and oldest patients.
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Affiliation(s)
- Victoire Leroy
- Division of Geriatric Medicine, Tours University Hospital, Tours, France; Education, Ethics, Health (EA 7505), University of Medicine of Tours, Tours, France; Memory Clinic, Tours University Hospital, Tours, France.
| | - Yaohua Chen
- Department of Gerontology, Lille University Hospital, Lille, France; INSERM UMR-S 1172, Vascular and Degenerative Cognitive Disorders, University Lille, Lille, France; Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Vincent Bouteloup
- INSERM U1219, PHARes team, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), University Bordeaux, Bordeaux, France; CIC 1401 EC, Pôle Santé Publique, Bordeaux University Hospital, Bordeaux, France
| | - Emilie Skrobala
- INSERM URM_S1172, CHU Lille Memory Clinic, Distalz Licend, Lille University, Lille, France
| | - François Puisieux
- Department of Gerontology, Lille University Hospital, Lille, France; EA2694, University Lille, Lille, France
| | - Bertrand Fougère
- Division of Geriatric Medicine, Tours University Hospital, Tours, France; Education, Ethics, Health (EA 7505), University of Medicine of Tours, Tours, France
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Levin O, Vints WAJ, Ziv G, Katkutė G, Kušleikienė S, Valatkevičienė K, Sheoran S, Drozdova-Statkevičienė M, Gleiznienė R, Pääsuke M, Dudonienė V, Himmelreich U, Česnaitienė VJ, Masiulis N. Neurometabolic correlates of posturography in normal aging and older adults with mild cognitive impairment: Evidence from a 1H-MRS study. Neuroimage Clin 2023; 37:103304. [PMID: 36580713 PMCID: PMC9827054 DOI: 10.1016/j.nicl.2022.103304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/03/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
Proton magnetic resonance spectroscopy (1H-MRS) holds promise for revealing and understanding neurodegenerative processes associated with cognitive and functional impairments in aging. In the present study, we examined the neurometabolic correlates of balance performance in 42 cognitively intact older adults (healthy controls - HC) and 26 older individuals that were diagnosed with mild cognitive impairment (MCI). Neurometabolite ratios of total N-acetyl aspartate (tNAA), glutamate-glutamine complex (Glx), total choline (tCho) and myo-inositol (mIns) relative to total creatine (tCr) were assessed using single voxel 1H-MRS in four different brain regions. Regions of interest were the left hippocampus (HPC), dorsal posterior cingulate cortex (dPCC), left sensorimotor cortex (SM1), and right dorsolateral prefrontal cortex (dlPFC). Center-of-pressure velocity (Vcop) and dual task effect (DTE) were used as measures of balance performance. Results indicated no significant group differences in neurometabolite ratios and balance performance measures. However, our observations revealed that higher tCho/tCr and mIns/tCr in hippocampus and dPCC were generic predictors of worse balance performance, suggesting that neuroinflammatory processes in these regions might be a driving factor for impaired balance performance in aging. Further, we found that higher tNAA/tCr and mIns/tCr and lower Glx/tCr in left SM1 were predictors of better balance performance in MCI but not in HC. The latter observation hints at the possibility that individuals with MCI may upregulate balance control through recruitment of sensorimotor pathways.
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Affiliation(s)
- Oron Levin
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania; Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Heverlee 3001, Belgium
| | - Wouter A J Vints
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania; Department of Rehabilitation Medicine Research School CAPHRI, Maastricht University P.O. Box 616, 6200 MD Maastricht, the Netherlands; Centre of Expertise in Rehabilitation and Audiology, Adelante Zorggroep, Hoensbroek, The Netherlands.
| | - Gal Ziv
- The Academic College at Wingate, Netanya 4290200, Israel
| | - Gintarė Katkutė
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania
| | - Simona Kušleikienė
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania
| | - Kristina Valatkevičienė
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Samrat Sheoran
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania; Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | | | - Rymantė Gleiznienė
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mati Pääsuke
- Institute of Sport Sciences and Physiotherapy, University of Tartu, Estonia
| | - Vilma Dudonienė
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania
| | - Uwe Himmelreich
- Biomedical MRI Unit, Department of Imaging and Pathology, Group Biomedical Sciences, KU Leuven, Leuven 3000, Belgium
| | - Vida J Česnaitienė
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania
| | - Nerijus Masiulis
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, LT-44221 Kaunas, Lithuania; Department of Rehabilitation, Physical and Sports Medicine, Institute of Health Science, Vilnius University, Vilnius, Lithuania
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Nagano H, Said CM, James L, Sparrow WA, Begg R. Biomechanical Correlates of Falls Risk in Gait Impaired Stroke Survivors. Front Physiol 2022; 13:833417. [PMID: 35330930 PMCID: PMC8940193 DOI: 10.3389/fphys.2022.833417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/11/2022] [Indexed: 12/03/2022] Open
Abstract
Increased falls risk is prevalent among stroke survivors with gait impairments. Tripping is the leading cause of falls and it is highly associated with mid-swing Minimum Foot Clearance (MFC), when the foot’s vertical margin from the walking surface is minimal. The current study investigated MFC characteristics of post-stroke individuals (n = 40) and healthy senior controls (n = 21) during preferred speed treadmill walking, using an Optotrak 3D motion capture system to record foot-ground clearance. In addition to MFC, bi-lateral spatio-temporal gait parameters, including step length, step width and double support time, were obtained for the post-stroke group’s Unaffected and Affected limb and the control group’s Dominant and Non-dominant limbs. Statistical analysis of MFC included central tendency (mean, median), step-to-step variability (standard deviation and interquartile range) and distribution (skewness and kurtosis). In addition, the first percentile, that is the lowest 1% of MFC values (MFC 1%) were computed to identify very high-risk foot trajectory control. Spatio-temporal parameters were described using the mean and standard deviation with a 2 × 2 (Group × Limb) Multivariate Analysis of Variance applied to determine significant Group and Limb effects. Pearson’s correlations were used to reveal any interdependence between gait variables and MFC control. The main finding of the current research was that post-stroke group’s affected limb demonstrated lower MFC 1% with higher variability and lower kurtosis. Post-stroke gait was also characterised by shorter step length, larger step width and increased double support time. Gait retraining methods, such as using real-time biofeedback, would, therefore, be recommended for post-stroke individuals, allowing them to acquire optimum swing foot control and reduce their tripping risk by elevating the swing foot and improving step-to-step consistency in gait control.
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Affiliation(s)
- Hanatsu Nagano
- Institute for Health and Sports (IHeS), Victoria University, Melbourne, VIC, Australia
- *Correspondence: Hanatsu Nagano,
| | - Catherine M. Said
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia
- Department of Physiotherapy, Western Health, St. Albans, VIC, Australia
- Australian Institute for Musculoskeletal Science, St. Albans, VIC, Australia
- Department of Physiotherapy, Austin Health, Heidelberg, VIC, Australia
| | - Lisa James
- Institute for Health and Sports (IHeS), Victoria University, Melbourne, VIC, Australia
| | - William A. Sparrow
- Institute for Health and Sports (IHeS), Victoria University, Melbourne, VIC, Australia
| | - Rezaul Begg
- Institute for Health and Sports (IHeS), Victoria University, Melbourne, VIC, Australia
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Risk factors for falls in older people with cognitive impairment living in the community: Systematic review and meta-analysis. Ageing Res Rev 2021; 71:101452. [PMID: 34450352 DOI: 10.1016/j.arr.2021.101452] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/21/2021] [Accepted: 08/22/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE This systematic review aimed to identify risk factors for prospectively ascertained falls, focusing on those that are potentially modifiable (physical and neuropsychological factors), in older people with cognitive impairment living in the community. RESULTS A comprehensive search of five databases identified 16 high quality (Newcastle-Ottawa Scale ≥8/9) relevant articles. Meta-analyses were undertaken for five potential fall risk factors. Of these, fallers had significantly poorer balance (standardized mean difference = 0.62, 95 %CI 0.45, 0.79) with low heterogeneity. Global cognition was not significantly associated with faller status in a meta-analysis with low heterogeneity. Meta-analyses of mobility (Timed Up-and-Go), gait speed and depressive symptoms had high heterogeneity and were not statistically significant or were borderline significant (p = 0.05). Sensitivity analyses (removing one study sample's results that differed markedly from the other included samples) reduced heterogeneity to 0% and revealed fallers had significantly poorer mobility and more depressive symptoms than non-fallers. Fallers also walked significantly slower, but heterogeneity remained high. CONCLUSIONS In older people with cognitive impairment, fallers presented with balance deficits, poor mobility, slow gait speed and depressive symptoms. Reduced global cognition was not associated with falls. These findings suggest that interventions should target balance impairment and reveal that more high-quality research is needed.
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Lee S. Falls associated with indoor and outdoor environmental hazards among community-dwelling older adults between men and women. BMC Geriatr 2021; 21:547. [PMID: 34641812 PMCID: PMC8507100 DOI: 10.1186/s12877-021-02499-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/21/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hazardous environmental exposures are recognized risk factors for falls among older adults. However, the gender differences in the associations of falls with indoor and outdoor environmental hazards are scarce. This study examined the indoor and outdoor environmental risk factors for falls and compared the data for men and women among U.S. older adults using nationally representative data. METHODS We used the 2011 National Health and Aging Trends Study (NHATS) for a cross-sectional analysis of 6680 community-dwelling adults aged ≥65 years in the United States. A series of logistic regressions was used to identify the indoor and outdoor environmental hazards associated with falls stratified by gender after adjusting for sociodemographic, health, and behaviors. We also tested for significant interactions with gender. RESULTS Compared to men, women had a higher prevalence of falls. In the model adjusted for sociodemographic, health, and behavioral conditions, there were gender differences in the association of falls with the presence of indoor and outdoor environmental hazards. Gender-specific analyses showed that women with the presence of indoor environmental hazards (OR = 1.37, 95% CI = 1.04.-1.79) had higher odds of falls, whereas for men, the presence of outdoor environmental hazards (OR = 1.34, 95% CI = 1.02-1.75) was associated with falls. We also found a significant interaction term between outdoor environmental hazards and gender (OR = 0.65, 95% CI = 0.47-0.90). The interaction plot indicated that the presence of outdoor environmental hazards increased the risks of falling in men but not in women. CONCLUSIONS Significant gender differences exist in the association of falls with indoor and outdoor environmental hazards among older men and women. Our findings suggest that gender-tailored prevention programs to increase awareness of the environmental hazards and gender-specific environmental interventions are needed to help prevent falls.
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Affiliation(s)
- Sungmin Lee
- Department of Landscape Architecture and Urban Planning, Texas A&M University, 3137 TAMU, College Station, TX, 77840, USA.
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7
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Ma Y, Li X, Pan Y, Zhao R, Wang X, Jiang X, Li S. Cognitive frailty and falls in Chinese elderly people: a population-based longitudinal study. Eur J Neurol 2020; 28:381-388. [PMID: 33030300 DOI: 10.1111/ene.14572] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 09/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Falling is considered an important public health problem among older people. A recent cross-sectional study suggested that cognitive frailty (CF) is associated with falls. We aimed to explore whether CF is a risk factor for falls in a population-based longitudinal study. METHODS Using data from the Rugao Longevity and Aging Study, physical frailty was assessed according to the modified Fried's phenotype, and the 20% of participants with the lowest scores on the Revised Hasegawa Dementia Scale were defined as having cognitive impairment (CoI). Cognitive frailty (CF) was defined as the coexistence of physical frailty and CoI, but excluded severe CoI (revised Hasegawa Dementia Scale score ≤ 10). The outcome of number of falls in the previous 12 months was measured using a questionnaire. RESULTS At baseline, the prevalence of CF was 2.6% and the prevalence of two or more falls was 6.7%. Cross-sectional analysis found that two or more falls was associated with physical frailty without CoI (odds ratio [OR] 6.79, 95% confidence interval [CI] 3.17-14.56), pre-frailty with CoI (OR 4.54, 95% CI 2.44-8.44) and CF (OR 3.51, 95% CI 1.18-10.44). Slow gait with CoI was associated with two or more falls (OR 2.21, 95% CI 1.08-4.53). At 3-year follow-up, the prevalence of two or more falls was 10.6%. Logistic regression analysis showed that, compared with the robust and non-CoI elderly groups, the CF elderly group had a higher risk of two or more falls (OR 3.41, 95% CI 1.11-10.50). CONCLUSIONS Cognitive frailty was associated with two or more falls at baseline and might be a risk factor for two or more falls after 3 years. Early screening of CF might be beneficial in the prevention of falls.
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Affiliation(s)
- Y Ma
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - X Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Y Pan
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - R Zhao
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - X Wang
- Ministry of Education Key Laboratory of Contemporary Anthropology, Human Phenome Institute, Fudan University, Shanghai, China
| | - X Jiang
- Department of Pathology and Pathophysiology, Tongji University School of Medicine, Shanghai, China.,Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine, Shanghai, China
| | - S Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Nocera JR, Arsik I, Keskinocak P, Lepley-Flood A, Lah JJ, Levey AI, Esper GJ. The Feasibility of Measuring Gait in an Outpatient Cognitive Neurology Clinical Setting. J Alzheimers Dis 2020; 71:S51-S55. [PMID: 31322564 DOI: 10.3233/jad-190106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is increasing interest in gait evaluations in clinical settings given the associations between gait and health outcomes. However, efforts examining implementation of gait evaluation in neurological clinics are lacking. Herein, gait implementation within a cognitive neurology clinic is presented. Over a 21-month period, a gait evaluation was collected on 81% of eligible patients (n = 2,622; mean age 73.2±9.5; age range 49-94 years; 47% female). Patients and staff reported being satisfied with the gait assessment. These finding have implications for gait evaluations in clinical settings and for clinical research aimed at understanding the impact of cognitive symptomatology on gait.
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Affiliation(s)
- Joe R Nocera
- Emory University, Department of Neurology, Atlanta, GA, USA.,Emory University, Department of Rehabilitation Medicine, Atlanta, GA, USA.,Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Atlanta, GA, USA
| | - Idil Arsik
- Georgia Institute of Technology, School of Industrial and Systems Engineering, Atlanta, GA, USA
| | - Pinar Keskinocak
- Georgia Institute of Technology, School of Industrial and Systems Engineering, Atlanta, GA, USA
| | | | - James J Lah
- Emory University, Department of Neurology, Atlanta, GA, USA
| | - Allan I Levey
- Emory University, Department of Neurology, Atlanta, GA, USA
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Adcock M, Sonder F, Schättin A, Gennaro F, de Bruin ED. A usability study of a multicomponent video game-based training for older adults. Eur Rev Aging Phys Act 2020; 17:3. [PMID: 31938075 PMCID: PMC6955093 DOI: 10.1186/s11556-019-0233-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 12/19/2019] [Indexed: 12/31/2022] Open
Abstract
Background Aging is often accompanied by a decline in sensory, motor and cognitive functions. These age- and lifestyle-related impairments may lead to reduced daily life functioning including gait disturbances, falling and injuries. Most daily life activities, e.g. walking, are tasks which require the concurrent interplay of physical and cognitive functions. Promising options for combined physical-cognitive training are video game-based physical exercises, so-called exergames. This study aimed to [i] determine the usability of a newly developed multicomponent exergame and [ii] explore its effects on physical functions, cognition and cortical activity. Methods Twenty-one healthy and independently living older adults were included (10 female, 71.4 ± 5.8 years, range: 65–91) and performed 21 training sessions (each 40 min) over seven weeks. The multicomponent exergame included strength and balance training with Tai Chi-inspired and dance exercises. Participants rated the usability of the exergame (System Usability Scale) and reported on their emotional experience (Game Experience Questionnaire). Attendance and attrition rates were calculated to determine training compliance. Before and after the intervention, physical and cognitive functions as well as resting state electroencephalography (EEG) were assessed. Results Results showed a high training attendance rate (87.1%, 18/21 training sessions on average) and a low attrition rate (9.5%, 2 drop-outs). System usability was rated high with a mean score of 75/100. Affective game experience was rated favorable. Gait speed under dual-task condition, lower extremity muscle strength and reaction times in a cognitive task (divided attention) showed significant improvements (p < .05). No significant pre-post differences were found for resting state EEG. Conclusions The newly developed exergame seems usable for healthy older adults. Nevertheless, some aspects of the exergame prototype can and should be improved. The training showed to positively influence physical and cognitive functions in a small convenience sample. Future trials are warranted which evaluate the feasibility and usability of the exergame training in a more “real-life” in-home setting and assess the behavioral and neuroplastic changes in a larger population after a longer training period with comparison to a control group.
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Affiliation(s)
- Manuela Adcock
- 1Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093 Zurich, Switzerland
| | - Floriana Sonder
- 1Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093 Zurich, Switzerland
| | - Alexandra Schättin
- 1Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093 Zurich, Switzerland
| | - Federico Gennaro
- 1Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093 Zurich, Switzerland
| | - Eling D de Bruin
- 1Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093 Zurich, Switzerland.,2Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Alfred Nobels Alle 23, 14183 Huddinge, Sweden
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Niermeyer MA, Suchy Y. Walking, talking, and suppressing: Executive functioning mediates the relationship between higher expressive suppression and slower dual-task walking among older adults. Clin Neuropsychol 2019; 34:775-796. [DOI: 10.1080/13854046.2019.1704436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Yana Suchy
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
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Adcock M, Thalmann M, Schättin A, Gennaro F, de Bruin ED. A Pilot Study of an In-Home Multicomponent Exergame Training for Older Adults: Feasibility, Usability and Pre-Post Evaluation. Front Aging Neurosci 2019; 11:304. [PMID: 31824295 PMCID: PMC6882741 DOI: 10.3389/fnagi.2019.00304] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/24/2019] [Indexed: 11/13/2022] Open
Abstract
Aging is associated with sensory, motor and cognitive impairments that may lead to reduced daily life functioning including gait disturbances, falls, injuries and mobility restrictions. A strong need exists for implementing effective evidence-based interventions for healthy aging. Therefore, the aim of this study was to (i) evaluate the feasibility and usability of an in-home multicomponent exergame training and (ii) explore its effects on physical functions, cognition and cortical activity. Twenty-one healthy and independently living older adults were included (11 female, 74.4 ± 7.0 years, range: 65-92 years) and performed 24 trainings sessions (each 40 min) over eight weeks. The first part was conducted in a living lab (home-like laboratory environment), the second part at participants' home. The multicomponent exergame included Tai Chi-inspired exercises, dance movements and step-based cognitive games to train strength, balance and cognition. Attendance and attrition rates were calculated and safety during training was evaluated to determine feasibility. Participants rated the usability of the exergame (System Usability Scale) and reported on their game experience (Game Experience Questionnaire). Physical and cognitive functions and cortical activity (resting state electroencephalopathy) were assessed pre and post intervention. Results showed a high training attendance rate for the living lab and the home-based setting (91.7 and 91.0%, respectively) with a rather high attrition rate (28.6%, six drop-outs). Half of the drop-out reasons were related to personal or health issues. System usability was rated acceptable with a mean score of 70.6/100. Affective game experience was rated favorable. Significant improvements were found for minimal toe clearance, short-term attentional span, and information processing speed (p < 0.05). No significant pre-post differences were found for cortical activity. To summarize, the exergame is generally feasible and usable for healthy older adults applied in an in-home setting and provides an overall positive emotional game experience. Nevertheless, flawless technical functionality should be a mandatory consideration. Additionally, the training might have potential positive influence on specific functions in older adults. However, the efficacy has to be evaluated in a future randomized controlled trial assessing the behavioral and neuroplastic changes in a larger population after a longer training period.
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Affiliation(s)
- Manuela Adcock
- Institute of Human Movement Science and Sport, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Melanie Thalmann
- Institute of Human Movement Science and Sport, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Alexandra Schättin
- Institute of Human Movement Science and Sport, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Federico Gennaro
- Institute of Human Movement Science and Sport, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Eling D. de Bruin
- Institute of Human Movement Science and Sport, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Gait parameters and characteristics associated with increased risk of falls in people with dementia: a systematic review. Int Psychogeriatr 2019; 31:1287-1303. [PMID: 30520404 DOI: 10.1017/s1041610218001783] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND People with dementia fall twice as often and have more serious fall-related injuries than healthy older adults. While gait impairment as a generic term is understood as a fall risk factor in this population, a clear elaboration of the specific components of gait that are associated with falls risk is needed for knowledge translation to clinical practice and the development of fall prevention strategies for people with dementia. OBJECTIVE To review gait parameters and characteristics associated with falls in people with dementia. METHODS Electronic databases CINAHL, EMBASE, MedLine, PsycINFO, and PubMed were searched (from inception to April 2017) to identify prospective cohort studies evaluating the association between gait and falls in people with dementia. RESULTS Increased double support time variability, use of mobility aids, walking outdoors, higher scores on the Unified Parkinson's Disease Rating Scale, and lower average walking bouts were associated with elevated risk of any fall. Increased double support time and step length variability were associated with recurrent falls. The reviewed articles do not support using the Performance Oriented Mobility Assessment and the Timed Up-and-Go tests to predict any fall in this population. There is limited research on the use of dual-task gait assessments for predicting falls in people with dementia. CONCLUSION This systematic review shows the specific spatiotemporal gait parameters and features that are associated with falls in people with dementia. Future research is recommended to focus on developing specialized treatment methods for these specific gait impairments in this patient population.
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Ansai JH, Vassimon-Barroso V, Farche ACS, Buto MSDS, Andrade LPD, Rebelatto JR. Accuracy of mobility tests for screening the risk of falls in patients with mild cognitive impairment and alzheimer’s disease. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/18006726032019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Identifying gait and balance disorders in the earlier stages of Alzheimer’s disease (AD) and Mild Cognitive Impairment (MCI) could reduce or prevent falls in older adults. This cross-sectional study aimed to determine which mobility tests best discriminate the risk of falls in MCI and mild AD. Functional mobility was assessed by the timed up and go test (TUG) and 10-meter walk test (10MWT). A calendar of falls was produced, with follow-up via telephone calls during 6 months. For the MCI Group (n=38), time spent on the 10MWT was the best variable for discriminating fallers, with a cut-off point of 10.69 seconds associated with the highest accuracy (76.3%). In the AD Group (n=37), 10MWT cadence was the best variable for discriminating fallers, with a cut-off point of 101.39 steps per minute associated with an accuracy of 81.1%. As a conclusion, 10MWT time and cadence were the most accurate variables for screening the risk of falls in MCI and mild AD, respectively. The 10MWT is a functional, simple and easy test and it should be widely used in clinical practice.
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14
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Ansai JH, Andrade LPD, Masse FAA, Gonçalves J, Takahashi ACDM, Vale FAC, Rebelatto JR. Risk Factors for Falls in Older Adults With Mild Cognitive Impairment and Mild Alzheimer Disease. J Geriatr Phys Ther 2019; 42:E116-E121. [DOI: 10.1519/jpt.0000000000000135] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Araújo RS, Nascimento ÉRD, Barros RDS, Ritter SRF, Abreu AMS, Garcia PA. Can clinical and physical-functional factors predict falls in cognitively impaired older adults? REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2019. [DOI: 10.1590/1981-22562019022.190211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: to investigate the frequency of falls and clinical and physical-functional factors associated with falls, and the accuracy of such factors to identify the risk of falling in cognitively impaired older adults. Method: a cross-sectional study with cognitively impaired older adults was carried out using the Mini-Mental State Examination. The dependent variable was a history of falls in the previous six months. The independent variables were self-reported mental confusion, hearing and visual impairment, physical fatigue, muscle weakness, dizziness, body imbalance, insecurity when walking, diagnosed depression, hospitalizations, continuous use medications (form from study used), muscle mass (calf circumference) and handgrip strength (dynamometry), functional capacity (Pfeffer) and mobility (SAM-Br). Descriptive statistics were applied. The groups were compared using the Mann Whitney U test, the risk factors were identified by univariate and multivariate logistic regression, and the area under the ROC curve (AUC) was calculated for the associated factors. Results: 216 cognitively impaired older adults were included in the analysis, 41.7% of whom were fallers. Multivariate regression analyzes indicated that complaints of visual impairment (OR=2.8; p=0.015) and body imbalance (OR=2.7; p=0.004), and greater medication use (OR=1.1; p=0.038) were associated with a history of falls. The AUC found poor accuracy for quantity of medications as a screening tool for fallers (AUC=0.6 [0.5; 0.7]; p=0.028). Conclusion: cognitively impaired older adults had a high frequency of falls. Complaints of visual impairment, body imbalance and polypharmacy were predictors of falls. The early assessment of these factors can contribute to the identification of cognitively-impaired older adults at risk of falling in clinical practice and research.
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Groessl EJ, Maiya M, Schmalzl L, Wing D, Jeste DV. Yoga to prevent mobility limitations in older adults: feasibility of a randomized controlled trial. BMC Geriatr 2018; 18:306. [PMID: 30541474 PMCID: PMC6291934 DOI: 10.1186/s12877-018-0988-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/21/2018] [Indexed: 12/19/2022] Open
Abstract
Background The loss of mobility during aging impacts independence and leads to further disability, morbidity, and reduced life expectancy. Our objective was to examine the feasibility and safety of conducting a randomized controlled trial of yoga for older adults at risk for mobility limitations. Methods Sedentary older adults (n = 46; age 60–89) were recruited and randomized to either yoga or a health education comparison group. Yoga sessions (60-min) occurred 2x weekly, and 90-min health education sessions occurred weekly, for 10 weeks. The primary outcomes were recruitment rate, intervention attendance, and retention at assessments. Adverse event rates and participant satisfaction were also measured. Physical performance measures of gait, balance, and strength and self-report outcome measures were administered at baseline and 10-weeks. Results Recruitment lasted 6 months. Retention of participants at the 10-week follow-up was high (89% - performance measures; 98% - self-report questionnaires). Attendance was good with 82% of yoga and 74% of health education participants attending at least 50% of the sessions. No serious adverse events were reported. Patient satisfaction with the interventions was high. The mean effect size for the physical performance measures was 0.35 with some over 0.50. The mean effect size for self-report outcome measures was 0.36. Conclusions Results indicate that it is feasible to conduct a larger RCT of yoga for sedentary older adults at risk for mobility problems. The yoga and comparison interventions were safe, well accepted, and well attended. Effect sizes suggest yoga may have important benefits for this population and should be studied further. Trial Registration ClinicalTrials # NCT03544879; Retrospectively registered 4 June, 2018.
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Affiliation(s)
- Erik J Groessl
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr. #0994, La Jolla, CA, 92093, USA. .,HSR&D, VA San Diego Healthcare System, San Diego, CA, USA. .,UCSD Stein Institute for Research on Aging, La Jolla, CA, USA.
| | - Meghan Maiya
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr. #0994, La Jolla, CA, 92093, USA
| | - Laura Schmalzl
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr. #0994, La Jolla, CA, 92093, USA.,College of Science and Integrative Health, Southern California University of Health Sciences, Whittier, CA, USA
| | - David Wing
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr. #0994, La Jolla, CA, 92093, USA.,UCSD Exercise and Physical Activity Resource Center (EPARC), La Jolla, CA, USA
| | - Dilip V Jeste
- UCSD Stein Institute for Research on Aging, La Jolla, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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The Impact of Paratonia on Fine and Gross Motor Function in Older Adults With Mild and Moderate Dementia. Alzheimer Dis Assoc Disord 2018; 33:54-61. [PMID: 30371515 DOI: 10.1097/wad.0000000000000278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Dementia is associated with impairment in gait, balance, and fine motor function. Paratonia, a form of hypertonia, is often present in severe dementia. However, little is known about muscle tone in early dementia, and the eventual relation between muscle tone abnormalities and changes in fine and gross motor function. METHODS Three groups of participants were included in the study: healthy controls (n=60), participants with mild dementia (MiD) (n=31), and participants with moderate dementia (n=31). Measurements of fine motricity (Purdue pegboard test), balance and gait (Dynaport Hybrid), the presence of paratonia (PAI), and muscle tone measurements (MyotonPRO) were performed. RESULTS Paratonia was present in 42% of participants with MiD and in 58% of participants with moderate dementia. Participants with paratonia had lower Purdue Pegboard scores (P<0.001), lower balance coordination in semitandem stance (P<0.001), lower walking speed at a fast pace (P=0.001), and lower step regularity at normal (P=0.025) and fast (P<0.001) pace. CONCLUSIONS Paratonia is already present in participants with MiD and is associated with a decline in both fine and gross motor performance. Early detection of paratonia might be helpful to detect persons at higher risk of motor deterioration and falls.
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18
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Gonçalves J, Ansai JH, Masse FAA, Vale FAC, Takahashi ACDM, Andrade LPD. Dual-task as a predictor of falls in older people with mild cognitive impairment and mild Alzheimer's disease: a prospective cohort study. Braz J Phys Ther 2018; 22:417-423. [PMID: 29636306 DOI: 10.1016/j.bjpt.2018.03.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/07/2018] [Accepted: 03/22/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND A dual-task tool with a challenging and daily secondary task, which involves executive functions, could facilitate the screening for risk of falls in older people with mild cognitive impairment or mild Alzheimer's disease. OBJECTIVE To verify if a motor-cognitive dual-task test could predict falls in older people with mild cognitive impairment or mild Alzheimer's disease, and to establish cutoff scores for the tool for both groups. METHODS A prospective study was conducted with community-dwelling older adults, including 40 with mild cognitive impairment and 38 with mild Alzheimer's disease. The dual-task test consisted of the Timed up and Go Test associated with a motor-cognitive task using a phone to call. Falls were recorded during six months by calendar and monthly telephone calls and the participants were categorized as fallers or non-fallers. RESULTS In the Mild cognitive impairment Group, fallers presented higher values in time (35.2s), number of steps (33.7 steps) and motor task cost (116%) on dual-task compared to non-fallers. Time, number of steps and motor task cost were significantly associated with falls in people with mild cognitive impairment. Multivariate analysis identified higher number of steps spent on the test to be independently associated with falls. A time greater than 23.88s (sensitivity=80%; specificity=61%) and a number of steps over 29.50 (sensitivity=65%; specificity=83%) indicated prediction of risk of falls in the Mild cognitive impairment Group. Among people with Alzheimer's disease, no differences in dual-task between fallers and non-fallers were found and no variable of the tool was able to predict falls. CONCLUSION The dual-task predicts falls only in older people with mild cognitive impairment.
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Affiliation(s)
- Jessica Gonçalves
- Departamento de Fisioterapia, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Juliana Hotta Ansai
- Curso de Fisioterapia, Instituto Integrado de Saúde, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil.
| | | | | | | | - Larissa Pires de Andrade
- Departamento de Fisioterapia, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
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19
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Atay S, Vurur S, Erdugan N. Opinions of Nurses About the Evaluation of Risk of Falling Among Inpatients. Rehabil Nurs 2018; 42:E19-E24. [PMID: 27278821 DOI: 10.1002/rnj.281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patient falls and fall-related injuries are an important problem for patients, relatives, caregivers, and the health system at large. AIMS This study aims to identify opinions of nurses about the risk of falling among patients staying in hospitals. METHOD This study uses a qualitative descriptive design and employs a semistructured interview method to identify the opinions and experiences of nurses about patient falls. This study evaluated the opinions of a total of 12 staff nurses. FINDINGS It was found that nurses consider patients in the postoperative period to be most prone to falls. They think that most falls take place during transfers and that the medical diagnosis of the patient plays a crucial role in fall incidents. The most important problem associated with patient falls was symptoms of traumatic brain injury. According to the participating nurses, the risk of fall for every patient should be evaluated upon admission. Measures that the nurses take against patient falls include raising the bed's side rails and securing the bed brakes. CONCLUSIONS The findings of this research suggest that in-service training programs about the evaluation of the risk of falling should be organized for nurses. Guidelines should be developed for patients with different levels of risk of falling. It is suggested that nurses should be in charge of training patients who are conscious, their relatives, and caregiver personnel. CLINICAL RELEVANCE The training of nurses and caregivers helps to prevent the falls of inpatients.
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Affiliation(s)
- Selma Atay
- 1 School of Health Sciences, Çanakkale Onsekiz Mart University, Çanakkale, Turkey2 University Health Application and Research Center, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
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20
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Abstract
Dementia is a syndrome seen most commonly in older people and characterized by a decline in cognitive performance which impacts on the person's ability to function. There are approximately 47 million people worldwide with dementia and there are 10 million new cases every year. It is a major cause of disability and dependence and impacts on the physical, psychologic, and social well-being of families and carers. Alzheimer's disease is the most common form of dementia. Gait and balance impairments are common in people with dementia and contribute to the significantly elevated risk of falls. Older people with dementia are at increased risk of injury, institutionalization, hospitalization, morbidity, and death after a fall. There is preliminary evidence, predominantly from relatively small studies, that falls and disability can be prevented in this population. However, more good-quality research is needed, both to provide some certainty around the existing evidence base as well as to explore alternate approaches to prevention, including combined cognitive-motor training and cognitive pharmacotherapy.
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Affiliation(s)
- Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia; Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia; Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, NSW, Australia
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21
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Kim SJ, Cho SR, Yoo GE. The Applicability of Rhythm-Motor Tasks to a New Dual Task Paradigm for Older Adults. Front Neurol 2017; 8:671. [PMID: 29375462 PMCID: PMC5763040 DOI: 10.3389/fneur.2017.00671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 11/27/2017] [Indexed: 11/13/2022] Open
Abstract
Given the interplay between cognitive and motor functions during walking, cognitive demands required during gait have been investigated with regard to dual task performance. Along with the needs to understand how the type of concurrent task while walking affects gait performance, there are calls for diversified dual tasks that can be applied to older adults with varying levels of cognitive decline. Therefore, this study aimed to examine how rhythm-motor tasks affect dual task performance and gait control, compared to a traditional cognitive-motor task. Also, it examined whether rhythm-motor tasks are correlated with traditional cognitive-motor task performance and cognitive measures. Eighteen older adults without cognitive impairment participated in this study. Each participant was instructed to walk at self-paced tempo without performing a concurrent task (single walking task) and walk while separately performing two types of concurrent tasks: rhythm-motor and cognitive-motor tasks. Rhythm-motor tasks included instrument playing (WalkIP), matching to rhythmic cueing (WalkRC), and instrument playing while matching to rhythmic cueing (WalkIP+RC). The cognitive-motor task involved counting forward by 3s (WalkCount.f3). In each condition, dual task costs (DTC), a measure for how dual tasks affect gait parameters, were measured in terms of walking speed and stride length. The ratio of stride length to walking speed, a measure for dynamic control of gait, was also examined. The results of this study demonstrated that the task type was found to significantly influence these measures. Rhythm-motor tasks were found to interfere with gait parameters to a lesser extent than the cognitive-motor task (WalkCount.f3). In terms of ratio measures, stride length remained at a similar level, walking speed greatly decreased in the WalkCount.f3 condition. Significant correlations between dual task-related measures during rhythm-motor and cognitive-motor tasks support the potential of applying rhythm-motor tasks to dual task methodology. This study presents how rhythm-motor tasks demand cognitive control at different levels than those engaged by cognitive-motor tasks. It also indicates how these new dual tasks can effectively mediate dual task performance indicative of fall risks, while requiring increased cognitive resources but facilitating gait control as a compensatory strategy to maintain gait stability.
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Affiliation(s)
- Soo Ji Kim
- Music Therapy Education, Graduate School of Education, Ewha Womans University, Seoul, South Korea
| | - Sung-Rae Cho
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea.,Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, South Korea
| | - Ga Eul Yoo
- Department of Music Therapy, Graduate School, Ewha Womans University, Seoul, South Korea
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22
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Mahmoudi R, Novella JL, Manckoundia P, Ahssaini F, Lang PO, Blanchard F, Jolly D, Dramé M. Is functional mobility an independent mortality risk factor in subjects with dementia? Maturitas 2017; 103:65-70. [DOI: 10.1016/j.maturitas.2017.06.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 05/11/2017] [Accepted: 06/29/2017] [Indexed: 10/19/2022]
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Fernando E, Fraser M, Hendriksen J, Kim CH, Muir-Hunter SW. Risk Factors Associated with Falls in Older Adults with Dementia: A Systematic Review. Physiother Can 2017; 69:161-170. [PMID: 28539696 DOI: 10.3138/ptc.2016-14] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: People with dementia fall more often than cognitively healthy older adults, but their risk factors are not well understood. A review is needed to determine a fall risk profile for this population. The objective was to critically evaluate the literature and identify the factors associated with fall risk in older adults with dementia. Methods: Articles published between January 1988 and October 2014 in EMBASE, PubMed, PsycINFO, and CINAHL were searched. Inclusion criteria were participants aged 55 years or older with dementia or cognitive impairment, prospective cohort design, detailed fall definition, falls as the primary outcome, and multi-variable regression analysis. Two authors independently reviewed and extracted data on study characteristics, quality assessment, and outcomes. Adjusted risk estimates were extracted from the articles. Results: A total of 17 studies met the inclusion criteria. Risk factors were categorized into demographic, balance, gait, vision, functional status, medications, psychosocial, severity of dementia, and other. Risk factors varied with living setting and were not consistent across all studies within a setting. Conclusion: Falls in older adults with dementia are associated with multiple intrinsic and extrinsic risk factors, some shared with older adults in general and others unique to the disease. Risk factors vary between community- and institution-dwelling samples of adults with dementia or cognitive impairment.
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Affiliation(s)
- Eresha Fernando
- School of Physical Therapy, University of Western Ontario, London, Ont
| | - Michelle Fraser
- School of Physical Therapy, University of Western Ontario, London, Ont
| | - Jane Hendriksen
- School of Physical Therapy, University of Western Ontario, London, Ont
| | - Corey H Kim
- School of Physical Therapy, University of Western Ontario, London, Ont
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What can gait tell us about dementia? Review of epidemiological and neuropsychological evidence. Gait Posture 2017; 53:215-223. [PMID: 28222369 DOI: 10.1016/j.gaitpost.2017.01.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 01/22/2017] [Accepted: 01/29/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cognitive impairment and gait disorders in people over the age of 65 represent major public health issues because of their high frequency, their link to poor outcomes and high costs. Research has demonstrated that these two geriatric syndromes are closely related. METHODS AND RESULTS We aim to review the evidence supporting the relationship between gait and cognitive impairment, particularly focusing on epidemiological and neuropsychological studies in patients with Mild cognitive impairment, Alzheimer's disease and Vascular dementia. The review demonstrates that gait and cognition are closely related, but our knowledge of their interrelationship is limited. Emerging evidence shows that gait analysis has the potential to contribute to diagnosis and prognosis of cognitive impairment. CONCLUSIONS An integrated approach for evaluating these major geriatric syndromes, based on their close relationship, will not only increase our understanding of cognitive-motor interactions, but most importantly may be used to aid early diagnosis, prognosis and the development of new interventions.
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Sousa LMM, Marques-Vieira CMA, Caldevilla MNGND, Henriques CMAD, Severino SSP, Caldeira SMA. Risk for falls among community-dwelling older people: systematic literature review. Rev Gaucha Enferm 2017; 37:e55030. [PMID: 28273251 DOI: 10.1590/1983-1447.2016.04.55030] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 10/17/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify the risk factors for falls of the community-dwelling elderly in order to update the Taxonomy II of NANDA International. METHOD A systematic literature review based on research using the following platforms: EBSCOHost®, CINAHL and MEDLINE, from December 2010 to December 2014. The descriptors used were (Fall* OR Accidental Fall) AND (Community Dwelling OR Community Health Services OR Primary health care) AND (Risk OR Risk Assessment OR Fall Risk Factors) AND (Fall* OR Accidental Fall) AND (Community Dwelling OR older) AND Nurs* AND Fall Risk Factors. RESULTS The sample comprised 62 studies and 50 risk factors have been identified. Of these risk factors, only 38 are already listed in the classification. CONCLUSIONS Two new categories of risk factors are proposed: psychological and socio-economical. New fall risk factors for the community-dwelling elderly have been identified, which can contribute to the updating of this nursing diagnosis of the Taxonomy II of NANDA International.
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Affiliation(s)
- Luís Manuel Mota Sousa
- Centro Hospital Lisboa Central, Polo Hospital Curry Cabral. Lisboa, Portugal
- Universidade Atlântica, Escola Superior de Saúde Atlântica. Barcarena, Oeiras, Portugal
| | | | | | - Cristina Maria Alves Dias Henriques
- Administração Regional de Saúde de Lisboa e Vale do Tejo, Equipa Coordenadora Regional da Rede Nacional de Cuidados Continuados Integrados. Lisboa, Portugal
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Holloway KL, Williams LJ, Brennan-Olsen SL, Morse AG, Kotowicz MA, Nicholson GC, Pasco JA. Anxiety disorders and falls among older adults. J Affect Disord 2016; 205:20-27. [PMID: 27391268 DOI: 10.1016/j.jad.2016.06.052] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/28/2016] [Accepted: 06/19/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Falls are common among older adults and can lead to serious injuries, including fractures. We aimed to determine associations between anxiety disorders and falls in older adults. METHODS Participants were 487 men and 376 women aged ≥60 years enrolled in the Geelong Osteoporosis Study, Australia. Using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Non-patient edition (SCID-I/NP), lifetime history of anxiety disorders was determined. Falls were determined by self-report. In men, a falls-risk score (Elderly Falls Screening Test (EFST)) was also calculated. RESULTS Among fallers, 24 of 299 (8.0%) had a lifetime history of anxiety disorder compared to 36 of 634 (5.7%) non-fallers (p=0.014). Examination of the association between anxiety and falls suggested differential relationships for men and women. In men, following adjustment for psychotropic medications, mobility and blood pressure, lifetime anxiety disorder was associated with falling (OR 2.96; 95%CI 1.07-8.21) and with EFST score (OR 3.46; 95%CI 1.13-10.6). In women, an association between lifetime anxiety disorder and falls was explained by psychotropic medication use, poor mobility and socioeconomic status. LIMITATIONS Sub-group analyses involving types of anxiety and anxiety disorders over the past 12-months were not performed due to power limitations. CONCLUSION Although anxiety disorders were independently associated with a 3-fold increase in likelihood of reported falls and high falls risk among men, an independent association was not detected among women. These results may aid in prevention of falls through specific interventions aimed at reducing anxiety, particularly in men.
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Affiliation(s)
| | | | - S L Brennan-Olsen
- Deakin University, Geelong, VIC, Australia; The Institute for Health and Ageing, Australian Catholic University, Melbourne, VIC, Australia; Melbourne Medical School, Western Campus, The University of Melbourne, VIC, Australia; Australian Institute of Musculoskeletal Sciences (AIMSS), The University of Melbourne, VIC, Australia
| | - A G Morse
- Deakin University, Geelong, VIC, Australia
| | - M A Kotowicz
- Deakin University, Geelong, VIC, Australia; Melbourne Medical School, Western Campus, The University of Melbourne, VIC, Australia; Barwon Health, Ryrie Street, Geelong, VIC, Australia
| | - G C Nicholson
- The Institute for Health and Ageing, Australian Catholic University, Melbourne, VIC, Australia; Rural Clinical School, The University of Queensland, Toowoomba, QLD, Australia
| | - J A Pasco
- Deakin University, Geelong, VIC, Australia; Melbourne Medical School, Western Campus, The University of Melbourne, VIC, Australia; Barwon Health, Ryrie Street, Geelong, VIC, Australia
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Booth V, Harwood R, Hood V, Masud T, Logan P. Understanding the theoretical underpinning of the exercise component in a fall prevention programme for older adults with mild dementia: a realist review protocol. Syst Rev 2016; 5:119. [PMID: 27435818 PMCID: PMC4952275 DOI: 10.1186/s13643-016-0212-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 02/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older adults with mild dementia are at an increased risk of falls. Preventing those at risk from falling requires complex interventions involving patient-tailored strength- and balance-challenging exercises, home hazard assessment, visual impairment correction, medical assessment and multifactorial combinations. Evidence for these interventions in older adults with mild cognitive problems is sparse and not as conclusive as the evidence for the general community-dwelling older population. The objectives of this realist review are (i) to identify the underlying programme theory of strength and balance exercise interventions targeted at those individuals that have been identified as falling and who have a mild dementia and (ii) to explore how and why that intervention reduces falls in that population, particularly in the context of a community setting. This protocol will explain the rationale for using a realist review approach and outline the method. METHODS A realist review is a methodology that extends the scope of a traditional narrative or systematic evidence review. Increasingly used in the evaluation of complex interventions, a realist enquiry can look at the wider context of the intervention, seeking more to explain than judge if the intervention is effective by investigating why, what the underlying mechanism is and the necessary conditions for success. In this review, key rough programme theories were articulated and defined through discussion with a stakeholder group. The six rough programme theories outlined within this protocol will be tested against the literature found using the described comprehensive search strategy. The process of data extraction, appraisal and synthesis is outlined and will lead to the production of an explanatory programme theory. DISCUSSION As far as the authors are aware, this is the first realist literature review within fall prevention research and adds to the growing use of this methodology within healthcare. This synthesis of evidence will provide a valuable addition to the evidence base surrounding the exercise component of a fall intervention programme for older adults with mild dementia and will ultimately provide clinically relevant recommendations for improving the care of people with dementia. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015030169.
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Affiliation(s)
- Vicky Booth
- />Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, NG7 2UH United Kingdom
| | - Rowan Harwood
- />Geriatric Medicine, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH United Kingdom
| | - Victoria Hood
- />School of Health Sciences, University of Nottingham, Nottingham, NG5 1PB United Kingdom
| | - Tahir Masud
- />Geriatric Medicine, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH United Kingdom
| | - Philippa Logan
- />Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, NG7 2UH United Kingdom
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Zhang S, Qian J, Zhang Z, Shen L, Wu X, Hu X. Age- and Parkinson's disease-related evaluation of gait by General Tau Theory. Exp Brain Res 2016; 234:2829-40. [PMID: 27271504 DOI: 10.1007/s00221-016-4685-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 05/25/2016] [Indexed: 11/30/2022]
Abstract
The degeneration of postural control in the elderly and patients with Parkinson's disease (PD) can be debilitating and may lead to increased fall risk. This study evaluated the changes in postural control during gait affected by PD and aging using a new method based on the General Tau Theory. Fifteen patients with PD, 11 healthy old adults (HOs), and 15 healthy young adults (HYs) were recruited. Foot trajectories of each participant were monitored during walking by a three-camera Optotrak Certus(®) motion capture system. The anteroposterior direction of foot movement during stepping was analyzed by tau-G and tau-J guidance strategies. Two linear regression analyses suggested that the tau of the step-gap was strongly coupled onto the tau-J guidance during walking. The regression slope K could estimate the coupling ratio in the tau-coupling equation which reflects the performance of postural control during gait. The mean K value for the PD group, which was highest among the three groups, was approximately 0.5. Therefore, participants in the PD group walked with the poorest postural control and exhibited a relatively hard contact with the endpoint during stepping when compared with those in the HO and HY groups. The HY and HO groups obtained mean K values significantly lower than 0.5, which indicated that the gait was well controlled and ended at low speed with low deceleration. However, the HO group showed a decreased tendency for postural control, in which the mean K value was significantly higher than that of the HY group. The K value was moderately positively correlated with the double support time and negatively correlated with the stride length and walking speed. The tau-J coupling ratio can provide additional insight into gait disturbances and may serve as a reliable, objective, and quantitative tool to evaluate dynamic postural control during walking.
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Affiliation(s)
- Shutao Zhang
- School of Mechatronics and Automation, Shanghai University, Shanghai, China
| | - Jinwu Qian
- School of Mechatronics and Automation, Shanghai University, Shanghai, China.
| | - Zhen Zhang
- School of Mechatronics and Automation, Shanghai University, Shanghai, China
| | - Linyong Shen
- School of Mechatronics and Automation, Shanghai University, Shanghai, China
| | - Xi Wu
- Department of Neurosurgery, Changhai Hospital, Shanghai, China
| | - Xiaowu Hu
- Department of Neurosurgery, Changhai Hospital, Shanghai, China
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Lin YC, Hsu WC, Wu CK, Chang WH, Wu KPH, Wong AMK. Comparison of motor performance of upper and lower extremities in dual-task tests in patients with mild Alzheimer's dementia. Aging Clin Exp Res 2016; 28:491-6. [PMID: 26341489 DOI: 10.1007/s40520-015-0441-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 08/12/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Alzheimer's dementia (AD) is a progressive disease that threatens the self-care and quality of life of elderly people. Early diagnosis and early treatment are crucial. AIM To examine the difference in executive function of patients with AD by analyzing their performance in gait analysis (Vicon MX system) and a trial making test (TMT) while counting forward or backward. METHODS Ten elderly persons who had been diagnosed by neurological specialists with mild AD were selected as study participants. Of these patients, 2 were men and 8 were women, and the average age was 74.0 ± 8.6 years. An additional group of 10 elderly persons without AD and matched according to age and sex constituted a control group. RESULTS The average Mini-Mental State Examination score was 17.7 ± 4.1, and the average clinical dementia rating scale score was 0.8 ± 0.3. We found that backward counting of 3 digits during gait performance in mild AD patients elicited substantial changes in velocity, cadence, coefficient of variation of the stride length, and stride time compared with those of the control group. Regarding upper extremity performance, all TMT tasks were highly sensitive in revealing differences in reaction time between the mild AD group and the control group. DISCUSSION Dual-task challenges for examining gait parameters and TMT performance can reveal obvious impairment of executive motor function in patients with very mild AD. CONCLUSION Dual-task motor tests of the upper extremities can be used as screening tools for detecting AD at an early stage.
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Affiliation(s)
- Yin-Chou Lin
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, 5, Fu-Hsin St., Kwei-Shan, Tao-Yuan, 333, Taiwan, Republic of China
| | - Wen-Chuin Hsu
- Department of Neurology and Dementia Center, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Kwei-Shan, Tao-Yuan, 333, Taiwan, Republic of China
- School of Medicine, Chang Gung University, 5, Fu-Hsin St., Kwei-Shan, Tao-Yuan, 333, Taiwan, Republic of China
| | - Chih-Kuan Wu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, 5, Fu-Hsin St., Kwei-Shan, Tao-Yuan, 333, Taiwan, Republic of China
| | - Wei-Han Chang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taipei, 5, Fu-Hsin St., Kwei-Shan, Tao-Yuan, 333, Taiwan, Republic of China
| | - Katie Pei-Hsuan Wu
- School of Medicine, Chang Gung University, 5, Fu-Hsin St., Kwei-Shan, Tao-Yuan, 333, Taiwan, Republic of China
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, 5, Fu-Hsin St., Kwei-Shan, Tao-Yuan, 333, Taiwan, Republic of China
| | - Alice M K Wong
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, 5, Fu-Hsin St., Kwei-Shan, Tao-Yuan, 333, Taiwan, Republic of China.
- School of Medicine, Chang Gung University, 5, Fu-Hsin St., Kwei-Shan, Tao-Yuan, 333, Taiwan, Republic of China.
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30
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Booth V, Hood V, Kearney F. Interventions incorporating physical and cognitive elements to reduce falls risk in cognitively impaired older adults. ACTA ACUST UNITED AC 2016; 14:110-35. [DOI: 10.11124/jbisrir-2016-002499] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Baldewijns G, Luca S, Vanrumste B, Croonenborghs T. Developing a system that can automatically detect health changes using transfer times of older adults. BMC Med Res Methodol 2016; 16:23. [PMID: 26897003 PMCID: PMC4761129 DOI: 10.1186/s12874-016-0124-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 02/10/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND As gait speed and transfer times are considered to be an important measure of functional ability in older adults, several systems are currently being researched to measure this parameter in the home environment of older adults. The data resulting from these systems, however, still needs to be reviewed by healthcare workers which is a time-consuming process. METHODS This paper presents a system that employs statistical process control techniques (SPC) to automatically detect both positive and negative trends in transfer times. Several SPC techniques, Tabular cumulative sum (CUSUM) chart, Standardized CUSUM and Exponentially Weighted Moving Average (EWMA) chart were evaluated. The best performing method was further optimized for the desired application. After this, it was validated on both simulated data and real-life data. RESULTS The best performing method was the Exponentially Weighted Moving Average control chart with the use of rational subgroups and a reinitialization after three alarm days. The results from the simulated data showed that positive and negative trends are detected within 14 days after the start of the trend when a trend is 28 days long. When the transition period is shorter, the number of days before an alert is triggered also diminishes. If for instance an abrupt change is present in the transfer time an alert is triggered within two days after this change. On average, only one false alarm is triggered every five weeks. The results from the real-life dataset confirm those of the simulated dataset. CONCLUSIONS The system presented in this paper is able to detect both positive and negative trends in the transfer times of older adults, therefore automatically triggering an alarm when changes in transfer times occur. These changes can be gradual as well as abrupt.
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Affiliation(s)
- Greet Baldewijns
- KU Leuven Technology Campus Geel, AdvISe, Kleinhoefstraat 4, Geel, Belgium.
- KU Leuven, ESAT-STADIUS,, Leuven, Belgium.
- iMinds Medical Information Technology Department, Leuven, Belgium.
| | - Stijn Luca
- KU Leuven Technology Campus Geel, AdvISe, Kleinhoefstraat 4, Geel, Belgium
- KU Leuven, ESAT-STADIUS,, Leuven, Belgium
| | - Bart Vanrumste
- KU Leuven Technology Campus Geel, AdvISe, Kleinhoefstraat 4, Geel, Belgium
- KU Leuven, ESAT-STADIUS,, Leuven, Belgium
- iMinds Medical Information Technology Department, Leuven, Belgium
| | - Tom Croonenborghs
- KU Leuven Technology Campus Geel, AdvISe, Kleinhoefstraat 4, Geel, Belgium
- KU Leuven, Department of Computer Science, DTAI, Leuven, Belgium
- Program in Translational NeuroPsychiatric Genomics, Brigham and Women's Hospital, Harvard Medical School, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
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Baldewijns G, Luca S, Nagels W, Vanrumste B, Croonenborghs T. Automatic detection of health changes using statistical process control techniques on measured transfer times of elderly. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:5046-9. [PMID: 26737425 DOI: 10.1109/embc.2015.7319525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
It has been shown that gait speed and transfer times are good measures of functional ability in elderly. However, data currently acquired by systems that measure either gait speed or transfer times in the homes of elderly people require manual reviewing by healthcare workers. This reviewing process is time-consuming. To alleviate this burden, this paper proposes the use of statistical process control methods to automatically detect both positive and negative changes in transfer times. Three SPC techniques: tabular CUSUM, standardized CUSUM and EWMA, known for their ability to detect small shifts in the data, are evaluated on simulated transfer times. This analysis shows that EWMA is the best-suited method with a detection accuracy of 82% and an average detection time of 9.64 days.
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Rowe J. “I’ve Fallen and I Can’t Get Up,” a Basic Primer for Caregivers to Understand Falls in Persons With Dementia, Alzheimer’s Disease, and Cognitive Impairment. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2015. [DOI: 10.1177/1084822314559833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article seeks to demystify the complexity of what constitutes dementia, Alzheimer’s disease, and cognitive impairment as it relates to identifying the basic contexts of these diseases in relationship with falls and fall prevention. It further will identify the new changes in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) that replaces the term dementia and provides the new diagnostic framework for major and mild neurocognitive functioning. This article additionally provides some practical strategies for caregivers to equip themselves to understand some of the difficulties and challenges that they face when dealing with loved ones or patients who become afflicted by these diseases.
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Affiliation(s)
- Jimmy Rowe
- State University of New York at Buffalo, USA
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34
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Xiang Y, Tang YP, Ma BQ, Yan HC, Jiang J, Tian XY. Remote safety monitoring for elderly persons based on omni-vision analysis. PLoS One 2015; 10:e0124068. [PMID: 25978761 PMCID: PMC4433324 DOI: 10.1371/journal.pone.0124068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/25/2015] [Indexed: 11/20/2022] Open
Abstract
Remote monitoring service for elderly persons is important as the aged populations in most developed countries continue growing. To monitor the safety and health of the elderly population, we propose a novel omni-directional vision sensor based system, which can detect and track object motion, recognize human posture, and analyze human behavior automatically. In this work, we have made the following contributions: (1) we develop a remote safety monitoring system which can provide real-time and automatic health care for the elderly persons and (2) we design a novel motion history or energy images based algorithm for motion object tracking. Our system can accurately and efficiently collect, analyze, and transfer elderly activity information and provide health care in real-time. Experimental results show that our technique can improve the data analysis efficiency by 58.5% for object tracking. Moreover, for the human posture recognition application, the success rate can reach 98.6% on average.
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Affiliation(s)
- Yun Xiang
- College of Information Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Yi-ping Tang
- College of Information Engineering, Zhejiang University of Technology, Hangzhou, China
- * E-mail:
| | - Bao-qing Ma
- College of Information Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Hang-chen Yan
- College of Information Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Jun Jiang
- College of Computer Science, Zhejiang University of Technology, Hangzhou, China
| | - Xu-yuan Tian
- College of Computer Science, Zhejiang University of Technology, Hangzhou, China
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35
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Steinmetz JP, Federspiel C. The effects of cognitive training on gait speed and stride variability in old adults: findings from a pilot study. Aging Clin Exp Res 2014; 26:635-43. [PMID: 24803285 PMCID: PMC4237920 DOI: 10.1007/s40520-014-0228-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 04/08/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The interrelationship between gait performance and higher-order cognitive functions has been established through a number of different investigations. In turn, enabling gait by improving cognition is a new and emerging field of research. AIMS Investigating if and to what extent a structured cognitive training program influences gait-related parameters in a sample of old and frail nursing home residents. METHODS Twenty-one nursing home residents were quasi-randomized to an intervention group following a 6-week structured cognitive training program or a control group. Gait was investigated during normal pace and under two dual-task conditions (simple and complex dual-task walking conditions), using the GAITRite(®) system at three predefined time points (pre-intervention, post-intervention, 3-month follow-up). Outcome measures were gait speed and stride variabilities. RESULTS Confirmation of the interrelationship between gait and cognition evidenced by decreased gait parameters during complex dual-task walking. Observation of clinical meaningful improvements in gait stability and gait speed after the training program under the complex dual-task situations, with only speed remaining stable over a period of 3 months. DISCUSSION This study on the effects of cognitive training on gait is promising, with several results going in the expected direction. Our data corroborate previous findings and extend them to the group of frail old nursing home residents. CONCLUSIONS The present pilot study's approach of improving gait under challenging walking situations by interventions designed to improve cognitions adds encouraging results to this emerging field of research, although restrictions in sample size and in the control group prevent us from drawing firm conclusions.
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Affiliation(s)
- Jean-Paul Steinmetz
- Department of Research and Development, ZithaSenior, 30 rue Ste Zithe, L-2763, Luxembourg, Luxembourg,
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Onushko T, Baweja HS, Christou EA. Practice improves motor control in older adults by increasing the motor unit modulation from 13 to 30 Hz. J Neurophysiol 2013; 110:2393-401. [PMID: 23986564 DOI: 10.1152/jn.00345.2013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Practice of a motor task decreases motor output variability in older adults and is associated with adaptations of discharge activity of single motor units. In this study we were interested in the practice-induced modulation of multiple motor units within 13-30 Hz because theoretically it enhances the timing of active motoneurons. Our purpose, therefore, was to determine the neural adaptation of multiple motor units and related improvements in movement control following practice. Nine healthy older adults (65-85 yr) performed 40 practice trials of a sinusoidal task (0.12 Hz) with their index finger (10° range of motion). Multi-motor unit activity was recorded intramuscularly from the first dorsal interosseus muscle. The mean spike rate (MSR), spike rate variability (CV(ISI)), and frequency modulation (5-60 Hz) of the spike rate were calculated from the multi-motor unit activity and were correlated with movement accuracy and variability of index finger position. A decrease in movement trajectory variability was associated with an increase in MSR (R(2) = 0.58), a decrease in CV(ISI) (R(2) = 0.58), and an increase in total power within a 13- to 30-Hz band (R(2) = 0.48). The increase in total power within a 13- to 30-Hz band was associated significantly (P < 0.005) with an increase in MSR (R(2) = 0.75) and the decrease in CV(ISI) (R(2) = 0.70). We demonstrate that practice-induced improvements in movement control are associated with changes in activity of multiple motor units. These findings suggest that practice-induced improvements in movement steadiness of older adults are associated with changes in the modulation of the motoneuron pool from 13 to 30 Hz.
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Affiliation(s)
- Tanya Onushko
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
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37
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Taylor ME, Delbaere K, Close JCT, Lord SR. Managing falls in older patients with cognitive impairment. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/ahe.12.68] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
With an aging population, both dementia and fall-related injury pose an international health challenge. Individuals with dementia fall twice as often as cognitively intact people and are more likely to have injurious falls. Higher morbidity and rates of mortality and institutionalization after falls have also been reported in this group. There is limited but emerging literature that is attempting to define and explain why fall risk is increased in this population. This will allow for targeted fall prevention programs. Currently, there are no published randomized controlled trials that have prevented falls in community-dwelling cognitively impaired older people, and conflicting evidence is reported in hospital and residential care trials. Recent exercise interventions have demonstrated significant benefits, such as improved gait speed, strength and balance in people with cognitive impairment/dementia, providing encouraging evidence for further research and clinical interventions.
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Affiliation(s)
- Morag E Taylor
- Falls & Balance Research Group, Neuroscience Research Australia, Barker Street, Randwick, University of New South Wales 2031, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Kim Delbaere
- Falls & Balance Research Group, Neuroscience Research Australia, Barker Street, Randwick, University of New South Wales 2031, Sydney, Australia
- School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
| | - Jacqueline CT Close
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
- Falls & Injury Prevention Group, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Stephen R Lord
- Falls & Balance Research Group, Neuroscience Research Australia, Barker Street, Randwick, University of New South Wales 2031, Sydney, Australia
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