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Gagliardo A, Grippo A, Di Stefano V, Carrai R, Scarpino M, Martini M, Falsini C, Rimmaudo G, Brighina F. Spatial and Temporal Gait Characteristics in Patients Admitted to a Neuro-Rehabilitation Department with Age-Related White Matter Changes: A Gait Analysis and Clinical Study. Neurol Int 2023; 15:708-724. [PMID: 37368328 DOI: 10.3390/neurolint15020044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/01/2023] [Accepted: 05/16/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Patients with age-related white matter changes (ARWMC) frequently present a gait disorder, depression and cognitive impairment. Our aims are to define which alterations in the gait parameters are associated with motor or neuro-psychological impairment and to assess the role of motor, mood or cognitive dysfunction in explaining the variance of the gait parameters. METHODS Patients with gait disorders admitted to a Neuro-rehabilitation Department, affected by vascular leukoencephalopathy who had ARWMC confirmed by a brain MRI, were consecutively enrolled, classified by a neuroradiological scale (Fazekas 1987) and compared to healthy controls. We excluded subjects unable to walk independently, subjects with hydrocephalus or severe aphasia, with orthopaedic and other neurological pathologies conditioning the walking pattern. Patients and controls were assessed by clinical and functional scales (Mini Mental State Examination, Geriatric Depression Scale, Nevitt Motor Performance Scale, Berg Balance Scale, Functional Independence Measure), and computerised gait analysis was performed to assess the spatial and temporal gait parameters in a cross-sectional study. RESULTS We recruited 76 patients (48 males, aged 78.3 ± 6.2 years) and 14 controls (6 males, aged 75.8 ± 5 years). In the multiple regression analysis, the gait parameter with overall best model summary values, associated with the ARWMC severity, was the stride length even after correction for age, sex, weight and height (R2 = 0.327). The motor performances justified at least in part of the gait disorder (R2 change = 0.220), but the mood state accounted independently for gait alterations (R2 change = 0.039). The increase in ARWMC severity, the reduction of motor performance and a depressed mood state were associated with a reduction of stride length (R = 0.766, R2 = 0.587), reduction of gait speed (R2 = 0.573) and an increase in double support time (R2 = 0.421). CONCLUSION The gait disorders in patients with ARWMC are related to motor impairment, but the presence of depression is an independent factor for determining gait alterations and functional status. These data pave the way for longitudinal studies, including gait parameters, to quantitatively assess gait changes after treatment or to monitor the natural progression of the gait disorders.
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Affiliation(s)
- Andrea Gagliardo
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- Clinical Neurophysiology Unit, "Clinical Course", 90143 Palermo, Italy
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
| | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscoloscheletrico e degli Organi di Senso, AOU Careggi, 50134 Firenze, Italy
| | - Vincenzo Di Stefano
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
| | - Riccardo Carrai
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscoloscheletrico e degli Organi di Senso, AOU Careggi, 50134 Firenze, Italy
| | - Maenia Scarpino
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscoloscheletrico e degli Organi di Senso, AOU Careggi, 50134 Firenze, Italy
| | - Monica Martini
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
| | | | - Giulia Rimmaudo
- Clinical Neurophysiology Unit, "Clinical Course", 90143 Palermo, Italy
| | - Filippo Brighina
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
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Frederiksen KS, Verdelho A, Madureira S, Bäzner H, O'Brien JT, Fazekas F, Scheltens P, Schmidt R, Wallin A, Wahlund LO, Erkinjunttii T, Poggesi A, Pantoni L, Inzitari D, Waldemar G. Physical activity in the elderly is associated with improved executive function and processing speed: the LADIS Study. Int J Geriatr Psychiatry 2015; 30:744-50. [PMID: 25363336 DOI: 10.1002/gps.4220] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 09/05/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Physical activity reduces the risk of cognitive decline but may affect cognitive domains differently. We examined whether physical activity modifies processing speed, executive function and memory in a population of non-dementia elderly subjects with age-related white matter changes (ARWMC). METHODS Data from the Leukoaraiosis And DISability (LADIS) study, a multicenter, European prospective cohort study aimed at examining the role of ARWMC in transition to disability, was used. Subjects in the LADIS study were clinically assessed yearly for 3 years including MRI at baseline and 3-year follow-up. Physical activity was assessed at baseline, and cognitive compound scores at baseline and 3-year assessment were used. RESULTS Two-hundred-eighty-two subjects (age, y (mean (SD)): 73.1 (± 5.1); gender (f/m): 164/118); MMSE (mean (SD)): 28.3 (± 1.7)) who had not progressed to MCI or dementia, were included. Multiple variable linear regression analysis with baseline MMSE, education, gender, age, stroke, diabetes and ARWMC rating as covariates revealed that physical activity was associated with better scores at baseline and 3-year follow-up for executive function (baseline: β: 0.39, 95% CI: 0.13-0.90, p = 0.008; follow-up: β: 0.24, 95% CI: 0.10-0.38, p = 0.001) and processing speed (baseline: β: 0.48, 95% CI: 0.14-0.89, p = 0.005; follow-up: β: 0.15, 95% CI: 0.02-0.29, p = 0.02) but not memory. When including baseline cognitive score as a covariate in the analysis of 3-year follow-up scores, executive function remained significant (β: 0.11, 95% CI: 0-0.22, p = 0.04). CONCLUSION Our findings confirm previous findings of a positive effect of physical activity on cognitive functions in elderly subjects, and further extends these by showing that the association is also present in patients with ARWMC.
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Affiliation(s)
- Kristian Steen Frederiksen
- Memory Disorders Research Group, Danish Dementia Research Center, Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ana Verdelho
- Department of Neurosciences, University of Lisbon, Santa Maria Hospital, Lisbon, Portugal
| | - Sofia Madureira
- Department of Neurosciences, University of Lisbon, Santa Maria Hospital, Lisbon, Portugal
| | - Hansjörg Bäzner
- Department of Neurology, University of Heidelberg, Klinikum Mannheim, Mannheim, Germany
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge and Cambridgeshire and Peterborough NHS Trust, Cambridge, UK
| | - Franz Fazekas
- Department of Neurology, Medical University Graz, Austria
| | - Philip Scheltens
- Department of Neurology, VU Medical Center, Amsterdam, The Netherlands
| | | | - Anders Wallin
- Institute of Clinical Neuroscience, Göteborg University, Göteborg, Sweden
| | - Lars-Olof Wahlund
- Department of Clinical Neuroscience, NEUROTEC, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden
| | - Timo Erkinjunttii
- Memory Research Unit, Department of Clinical Neurosciences, Helsinki University, Helsinki, Finland
| | - Anna Poggesi
- Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
| | - Leonardo Pantoni
- Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
| | - Domenico Inzitari
- Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
| | - Gunhild Waldemar
- Memory Disorders Research Group, Danish Dementia Research Center, Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
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