Gait Parameters Change can be an Early Marker of Cognitive Impairment.

BACKGROUND AND OBJECTIVE: Gait impairment leads to increased dependence, morbidity, institutionalization, and mortality in older people. We intended to assess gait parameters with the continuum of cognitive impairment and observe variation with the severity of cognitive impairment. MATERIALS AND METHODS: This cross-sectional, observational study was conducted at the memory clinic of a tertiary care center. One hundred and twelve subjects were recruited, and cognition was assessed by the Clinical Dementia Rating scale. Usual gait was assessed by a 6-m walk test, and the dynamic gait was assessed using Biodex Gait Trainer™. Apart from crude analysis, adjusted linear regression was used to find the association of spatiotemporal gait parameters with cognitive decline. RESULTS: Subjects were divided into subjective cognitive decline (SCD; n = 38), mild cognitive impairment (MCI; n = 40), and major neurocognitive disorder (MNCD; n = 34) groups. History of falls (23.7% vs. 30.0% vs. 67.7%, P < 0.001) and impaired activities of daily living (ADLs) (5.3% vs. 15.0% vs. 100%, P < 0.001) were significantly higher with cognitive decline. Age- and gender-adjusted regression analysis revealed that usual gait speed (0.8 vs. 0.6 vs. 0.5, P < 0.001) (m/s), total time (3.9 vs. 2.9 vs. 2.6, P = 0.022) (min), total distance (65.6 vs. 55.8 vs. 46.6, P = 0.025) (m), step cycle time (0.6 vs. 0.8 vs. 0.8, P = 0.020) (cycles/s), and step lengths were significant. CONCLUSION: Gait speed and other parameters worsened with increasing cognitive impairment. Changes in gait parameters might be a useful marker of declining cognition, though a long-term follow-up study is required to establish this association. Early intervention could be beneficial in preserving autonomy in patients with cognitive impairment.

Prevalence and Factors Associated with Impairment in Intrinsic Capacity among Community-Dwelling Older Adults: An Observational Study from South India.

Background: Intrinsic capacity (IC) is conceptualized by World Health Organization (WHO) with a focus on healthy aging. Identifying impairment could help in making a person-centred plan for the care of older adults. Objectives: Establish the prevalence of IC among community-dwelling older adults age >60, the prevalence of impairment in each domain, and identify factors associated with an impairment in IC. Methods: This cross-sectional observational study in the community setting included 1000 older adults aged 60 years and above in two-year study period. The 6 domains of IC including cognition, locomotor capacity, psychological, vitality, hearing, and vision were derived from the comprehensive geriatric assessment. The IC composite score was calculated based on these domains, and a higher IC score indicated greater IC. Results: During the study period, 1000 older adults, with the median age of 66.5 (IQR-63-73) were included, and 629 (62.9%) were women. Only in 157 (15.7%) community-dwelling older adults, all 6 domains were intact. Impairment in one, two, and three domains was seen in 442 (42.2%), 305 (30.5%), and 91 (9.1%), respectively. The most prevalent impaired domain was locomotor (593, 59.3%), followed by vision (441, 44.1%), hearing (193, 19.3%), cognition (106, 10.6%), mood (38, 3.8%), and vitality (37, 3.7%). The factors associated with lower IC included increasing age (ß-coefficient -0.01, 95% CI: -0.02 to -0.01, p value = 0.002), impaired activities of daily living (ß-coefficient -0.13, 95% CI: -0.49 to -0.18, p value <0.001), and chronic neurologic illness (ß-coefficient -0.10, 95% CI: -0.77 to -0.18, p value = 0.001). Conclusions: In conclusion, we found that impairment in IC was frequent in community-dwelling older adults, and it is associated with age, presence of chronic neurologic illness, and declining functionality. The adoption of IC should be seen as an opportunity to disseminate geriatric care in our healthcare systems which lack the necessary attention to the needs of older persons.

Association of geriatric syndromes in older adults with chronic obstructive pulmonary disease.

Background: Geriatric syndromes (GS) are multi-factorial conditions that make older adults vulnerable to morbidities and poor outcomes. The main objective was to observe the frequency of GS in older patients with COPD. Methods: A case-control study was conducted in the Geriatric department of a tertiary care hospital in India to evaluate geriatric syndromes including falls, cognitive impairment, frailty, functional impairment, urinary incontinence, malnutrition, and depression in patients with COPD and controls without COPD. The factors having a significant association with the occurrence of these GS in COPD patients were observed. Results: In this study, 150 cases and 150 controls were included. The mean age of the participant was 65.85±5.54, with 76% males. Functional impairment, cognitive impairment, frailty, urinary incontinence, and malnutrition were significantly higher in COPD patients. The independent variables which increased the odds of geriatric syndromes were dyspnoea (≥2 mMRC grade) (AOR:3.54,95% CI:1.06-11.8) and low socioeconomic status (AOR: 4.14, 95% CI: 1.03-16.54), while male gender showed inverse association (AOR: 0.08,95% CI: 0.01-0.99). Conclusion: Geriatric syndromes are common in older COPD patients, and assessment for them should be done routinely in these patients.