Six-month change in gait speed to discriminate between those with and without falls history in older people with Mild Cognitive Impairment and mild Alzheimer disease.

BACKGROUND AND PURPOSE: The purposes of this study were to identify differences in gait speed performance over 6 months between older people with Preserved Cognition (PrC), with Mild Cognitive Impairment (MCI) and with Alzheimer disease (AD) in mild stage; and to verify if the change in gait speed could discriminate fallers in older people with MCI and AD in a mild stage METHODS: A longitudinal study was conducted with community-dwelling older adults, including 40 with PrC, 36 with MCI and 34 with AD in the mild stage. Gait speed (in m/s) changes were captured through a 10-meter walk test. We documented the number of self-reported falls by monthly calendars that were returned after a 6-month follow-up. During this period, the participants received monthly telephone calls to remind them to fill in the calendar RESULTS: There was a significant difference in terms of sex and age between the groups: 23%, 31% and 19% were female and had a mean age of 72.8, 75.9 and 76.9 years in the PrC, MCI and AD groups respectively. During the follow-up, 45%, 52.7% and 52.9% of the PrC, MCI and AD groups fell. The MCI and AD groups presented lower gait speed compared to the PrC Group at both moments. There was no significant difference in the change of gait speed between groups. In the model adjusted by age, the change in gait speed failed to discriminate fallers in older people with MCI and with AD CONCLUSION: Older people with MCI and AD in the mild stage present lower gait speed compared to older people with PrC. Changes in gait speed over a short period of time do not discriminate fallers in older people with MCI or AD in a mild stage.

Progression of Gait Changes in Older Adults With Mild Cognitive Impairment: A Systematic Review.

BACKGROUND AND PURPOSE: The identification of altered gait and its progression over time is important to gaining a better understanding of the clinical aspects of mild cognitive impairment (MCI) in older adults. The aim of the present systematic review was to determine changes in gait variables over time among older adults with MCI. METHODS: The PubMed, Web of Science, Scopus, and Science Direct databases were searched for relevant articles using the following keywords and Medical Subject Headings: Aged AND "Mild cognitive impairment" AND (gait OR locomotion). A hand search was also performed of the reference lists of the selected articles in an attempt to find additional records. The following were the inclusion criteria: longitudinal studies and clinical trials involving a control group without intervention; samples of individuals 65 years or older; and characterization of gait using a single or dual task. RESULTS AND DISCUSSION: The initial search led to the retrieval of 6979 studies, 9 of which met the inclusion criteria. The duration of follow-up among the studies ranged from 6 months to 2 years. Most trials investigated gait speed. Other gait variables were step length, time required to walk a given distance, and mean weekly gait speed. Altered gait progressed in older adults with MCI. The main alterations were gait speed and variability in daily number of steps in follow-up periods lasting more than 1 year. No significant changes in gait variables were found in shorter follow-up periods (up to 6 months). CONCLUSIONS: The progression of gait changes in older adults with MCI has been underinvestigated. MCI leads to reduced gait speed in longer follow-up periods. Such information can contribute to the determination of motor interventions for older adults with MCI, especially in the early stages.

Risk Factors for Falls in Older Adults With Mild Cognitive Impairment and Mild Alzheimer Disease.

BACKGROUND AND PURPOSE: Understanding fall risk factors in people with mild cognitive impairment (MCI) and Alzheimer disease (AD) can help to establish specific plans for prevention of falls. The purpose of this study was to identify fall risk factors in older adults with MCI and mild AD. METHODS: A prospective study was conducted with community-dwelling older adults (40 MCI; 38 mild AD). The assessments consisted of sociodemographic and health variables, caloric expenditure, functional status, functional mobility (10-m walk test, dual-task test, and transition Timed Up and Go phases), cognitive domains, and depressive symptoms. Falls were recorded for 6 months by a falls calendar and monthly telephone calls. RESULTS: Falls were reported in 52.6% and 51.4% of people with MCI and mild AD, respectively. Among people with MCI, lower functional status, higher time spent on walk and dual task tests, and higher depressive symptom scores were associated with falls. Higher time spent on the dual-task test was independently associated with falls. Among people with mild AD, falls were associated with lower time spent on the walk test and turn-to-sit phase, and a higher visuospatial domain score. Lower time spent on the turn-to-sit phase was identified as an independent predictor of falls. CONCLUSIONS: Careful attention should be given to dual-task and turn-to-sit activities when detecting risk of falls among older people with MCI and mild AD.

Dual-task as a predictor of falls in older people with mild cognitive impairment and mild Alzheimer's disease: a prospective cohort study.

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.