Dual-Task Performance, Balance and Aerobic Capacity as Predictors of Falls in Older Adults with Cardiovascular Disease: A Comparative Study.

Cardiovascular diseases (CVD) are highly prevalent and strongly associated with the risk of falls in the elderly. Falls are associated with impairments in cognition and functional or gait performance; however, little is known about these associations in the elderly population with CVD. In this study, we aimed to clarify the possible associations of physical capacity and functional and cognitive outcomes with the incidence of falls in older adults with CVD. In this comparative study, 72 elderly patients were divided into fallers (n = 24 cases) and non-fallers (n = 48 controls) according to the occurrence of falls within one year. Machine learning techniques were adopted to formulate a classification model and identify the most important variables associated with the risk of falls. Participants with the worst cardiac health classification, older age, the worst cognitive and functional performance, balance and aerobic capacity were prevalent in the case group. The variables of most importance for the machine learning model were VO2max, dual-task in seconds and the Berg Scale. There was a significant association between cognitive-motor performance and the incidence of falls. Dual-task performance, balance, and aerobic capacity levels were associated with an increased risk of falls, in older adults with CVD, during a year of observation.

Association among race/color, gender, and intrinsic capacity: results from the ELSI-Brazil study.

OBJECTIVE: To investigate associations among race/color, gender, and intrinsic capacity (IC) (total and by domains) in middle-aged and older adults from a Brazilian cohort. As a secondary objective, we investigate these associations across Brazilian regions. METHODS: This is a cross-sectional study conducted with baseline data from the 2015-2016 Brazilian Longitudinal Study of Aging (ELSI-Brazil). IC was investigated via cognitive (verbal fluency), physical (gait velocity/handgrip), and psychosocial (Center for Epidemiological Studies Depression) domains. Moreover, IC sensory domain was evaluated via self-reported sensory disease diagnoses (vision and/or hearing impairment) and race/color was identified via self-reported criteria. RESULTS: We evaluated a total of 9,070 participants (aged ≥ 50 years). Black and Brown participants were 80% and 41% more likely to show a worse IC cognitive domain than white controls, respectively (OR = 1.80, 95%CI: 1.42-2.28, p < 0.001 and OR = 1.41, 95%CI: 1.21-1.65, p < 0.001). Moreover, Black and Brown women had almost a threefold greater chance of showing a worse IC than white men (OR = 2.91, 95%CI: 1.89-4.47, p < 0.001 and OR = 2.51, 95%CI: 2.09 - 3.02, p < 0.001) and a 62% (OR = 1.62, 95%CI: 1.02-2.57) and 32% (OR = 1.32, 95%CI: 1.10-1.57) greater risk of falling below our IC score cutoff point than white women. We found the greatest differences in the Brazilian South, whereas its North showed the lowest associations among race/color, gender, and IC. CONCLUSION: IC racial and gender disparities reinforce the need for public health policies to guarantee equality during aging. Promoting greater access to good health care requires understanding how racism and sexism can contribute to health inequities and their consequences in different Brazilian regions.

Association among race/color, gender, and intrinsic capacity: results from the ELSI-Brazil study

ABSTRACT OBJECTIVE To investigate associations among race/color, gender, and intrinsic capacity (IC) (total and by domains) in middle-aged and older adults from a Brazilian cohort. As a secondary objective, we investigate these associations across Brazilian regions. METHODS This is a cross-sectional study conducted with baseline data from the 2015-2016 Brazilian Longitudinal Study of Aging (ELSI-Brazil). IC was investigated via cognitive (verbal fluency), physical (gait velocity/handgrip), and psychosocial (Center for Epidemiological Studies Depression) domains. Moreover, IC sensory domain was evaluated via self-reported sensory disease diagnoses (vision and/or hearing impairment) and race/color was identified via self-reported criteria. RESULTS We evaluated a total of 9,070 participants (aged ≥ 50 years). Black and Brown participants were 80% and 41% more likely to show a worse IC cognitive domain than white controls, respectively (OR = 1.80, 95%CI: 1.42-2.28, p < 0.001 and OR = 1.41, 95%CI: 1.21-1.65, p < 0.001). Moreover, Black and Brown women had almost a threefold greater chance of showing a worse IC than white men (OR = 2.91, 95%CI: 1.89-4.47, p < 0.001 and OR = 2.51, 95%CI: 2.09 - 3.02, p < 0.001) and a 62% (OR = 1.62, 95%CI: 1.02-2.57) and 32% (OR = 1.32, 95%CI: 1.10-1.57) greater risk of falling below our IC score cutoff point than white women. We found the greatest differences in the Brazilian South, whereas its North showed the lowest associations among race/color, gender, and IC. CONCLUSION IC racial and gender disparities reinforce the need for public health policies to guarantee equality during aging. Promoting greater access to good health care requires understanding how racism and sexism can contribute to health inequities and their consequences in different Brazilian regions.

Sedentary behavior and physical activity: barriers and facilitators for active behavior during the COVID-19 pandemic / Comportamento sedentário e atividade física: barreiras e facilitadores para o comportamento ativo durante a pandemia de COVID-19

ABSTRACT Objectives: The objectives of the present study were to assess sedentary behavior and physical activity levels before and during the COVID-19 pandemic in healthy individuals and in those with self-reported diagnosis of anxiety and/or depression, and also identify facilitators and barriers to physical activity in these populations. Methods: This is a cross-sectional survey based on a self-report questionnaire applied during the COVID-19 pandemic period. Results: In the total sample (N = 1,285) the prevalence of sedentary behavior (>8 hours/day) increased by 25% during social isolation. Social isolation increased sedentary time and decreased physical activity levels in healthy individuals and in those with self-reported diagnosis of anxiety and/or depression. In both groups, the most prevalent facilitators were supervised physical activity (before the pandemic) and activities and equipment to practice at home (during the pandemic). The most prevalent barriers were the lack of time to perform physical activities (before the pandemic) and inaccessible or distance places to practice (during the pandemic). Conclusion: The COVID-19 pandemic is related to an increased sedentary behavior and reduced physical activity levels. Significant changes in perceived barriers and facilitators to exercise were observed during the social isolation period.

RESUMO Objetivos: Os objetivos do presente estudo foram avaliar o comportamento sedentário e os níveis de atividade física antes e durante da pandemia de COVID-19 em indivíduos saudáveis e com diagnóstico autorreportado de ansiedade e/ou depressão e identificar os facilitadores e barreiras para a prática de atividade física nessas populações. Métodos: Trata-se de uma pesquisa de corte transversal baseada em um questionário de autorrelato aplicado durante o período de pandemia da COVID-19. Resultados: Na amostra total (N = 1.285), a prevalência de comportamento sedentário (>8 horas/dia) aumentou em 25% durante o isolamento social. O isolamento social aumentou o tempo sedentário e diminuiu os níveis de atividade física em indivíduos saudáveis, com ansiedade e/ou depressão autorreportada. Nos dois grupos, os facilitadores mais prevalentes foram a atividade física supervisionada (antes da pandemia) e as atividades e equipamentos para a prática em casa (durante a pandemia). As barreiras mais prevalentes foram a falta de tempo para realizar atividades físicas (antes da pandemia) e os locais inacessíveis ou distantes para a prática (durante a pandemia). Conclusão: A pandemia de COVID-19 está relacionada a aumento do comportamento sedentário e redução dos níveis de atividade física. Mudanças significativas nas barreiras percebidas e facilitadores ao exercício foram observadas durante o período de isolamento social.

Spatial navigation in older adults with mild cognitive impairment and dementia: A systematic review and meta-analysis.

In this systematic review and meta-analysis, we compared the spatial navigation performance of older adults with mild cognitive impairment (MCI), Alzheimer's Disease (AD), and other dementias, using healthy older adults as controls. In addition, we evaluated the possible influence of the environment type (virtual and real), protocol (object- or environment-based), and the navigation mode (active and passive navigation) on spatial navigation task performance. In total, 1372 articles were identified and 24 studies were included in the meta-analysis. We found a large effect size on the spatial navigation performance of patients with cognitive decline (standardized mean difference (SMD) = 0.87, confidence interval (CI95%) = 0.62-1.09, p < 0.001), especially amnestic MCI (SMD = 1.10, CI95% = 0.71-1.49, p < 0.001) and patients with AD (SMD = 1.60, CI95% = 1.25-1.95, p < 0.001). However, the tasks did not identify mixed and vascular dementia (SMD = 0.92, CI95% = -0.33-2.18, p = 0.15 and SMD = 0.65, CI95% = -0.67-1.97, p = 0.33, respectively). Spatial navigation ability assessed using the Floor Maze Test showed the largest effect size in differentiating healthy older adults and patients with cognitive decline (SMD = 1.98,CI95% = 1.00-2.97, p < 0.001). In addition, tasks that require walking showed the greatest differences between the two groups. These results suggest that spatial navigation impairment is important, but disease-specific behavioral biomarker of the dementia pathology process that can be identified even in the early stages.

Relationship Between Aerobic Capacity, Mobility, and Spatial Navigation in Healthy Individuals and Older Adults With Mild Cognitive Impairment: A Cross-Sectional Study.

This study aimed to investigate the relationship between physical ability and spatial navigation in older adults with mild cognitive impairment and healthy controls, using the floor maze test. Study participants (n = 58) were subjected to the following tests: floor maze test, sit-to-stand, 8-foot up-and-go, and aerobic steps. Factorial analyses showed that performance of the physical tests combined explained approximately 87% of the sample variability. Mobility (R2 = .22, p ≤ .001) and aerobic capacity (R2 = .27, p ≤ .001) were both associated with delayed maze time in the floor maze test. Low levels of aerobic capacity were also associated with an increased odds to perform poorly in the delayed maze time after controlling for age, sex, and mild cognitive impairment diagnosis (odds ratio = 3.1; 95% confidence interval [1.0, 9.5]; p = .04). Aerobic capacity and mobility are associated with spatial navigation in patients with mild cognitive impairment and healthy older adults.

Beyond the Mini-Mental State Examination: The Use of Physical and Spatial Navigation Tests to Help to Screen for Mild Cognitive Impairment and Alzheimer's Disease.

BACKGROUND: Spatial navigation and dual-task (DT) performance may represent a low-cost approach to the identification of the cognitive decline in older adults and may support the clinical diagnosis of mild cognitive impairment (MCI) and Alzheimer's disease (AD). OBJECTIVE: To assess the accuracy of different types of motor tasks in differentiating older persons with MCI and AD from healthy peers. METHODS: Older adults aged 60 years or over (n = 105; healthy = 39; MCI = 23; AD = 43) were evaluated by the floor maze test (FMT), the senior fitness test, and DT performance. Receiver operating characteristic curve (ROC) analysis was used to evaluate the accuracy of the tests. We also performed principal component analysis (PCA) and logistic regression analysis to explore the variance and possible associations of the variables within the sample. RESULTS: FMT (AUC = 0.84, sensitivity = 75.7%, specificity = 76.1%, p < 0.001) and DT (AUC = 0.87, sensitivity = 80.4%, specificity = 86.9%, p < 0.001) showed the highest performance for distinguishing MCI from AD individuals. Moreover, FMT presented better sensitivity in distinguishing AD patients from their healthy peers (AUC = 0.93, sensitivity = 94%, specificity = 85.6%, p < 0.001) when compared to the Mini-Mental State Examination. PCA revealed that the motor test performance explains a total of 73.9% of the variance of the sample. Additionally, the results of the motor tests were not influenced by age and education. CONCLUSION: Spatial navigation tests showed better accuracy than usual cognitive screening tests in distinguishing patients with neurocognitive disorders.

Spatial navigation and dual-task performance in patients with Dementia that present partial dependence in instrumental activity of daily living.

BACKGROUND: Instrumental activities of daily living (IADLs) ability impairments are clearly related to cognitive and motor decline, as well as to the progression of Dementia. However, more low-cost assessments are necessary to better understand the process of IADL in patients with Dementia. OBJECTIVE: To compare cognitive, motor and cognitive-motor performance at different stages of dependence on IADL in patients with Dementia. METHODS: Dementia patients (n = 53, age range: 63-94) and healthy older adults (n = 39, age range: 62-97) were included, and those with Dementia were separated into IADL 1 (n = 18), IADL 2 (n = 17), IADL 3 (n = 18). All groups performed cognitive (Trail making test A, semantic verbal fluency, and Stroop test), motor (sit to stand, aerobic steps, and 8-foot up-and-go), and cognitive-motor tests (dual-task, and spatial navigation). One-way ANOVA, Kruskal-Wallis, and Bonferroni post-hoc tests were used to compare groups. Also, an effect size (ES) has been applied to evaluate differences among the dementia groups while the healthy older adults were used as a reference group. RESULTS: Only cognitive-motor and cognitive tests showed significant differences among groups (IADL 1 x IADL 2 x IADL 3). Compared with the healthy group, the ES analysis exposed that patients in different stages of IADL showed the worst performance on tests combining motor and cognitive demand, but not for motor and cognitive function separately. CONCLUSION: Poor dual-task and spatial navigation abilities are present in partial dependence in IADL, and these tasks should be considered as a functionality screening tool in patients with Dementia.

Floor Maze Test as a predictor of cognitive decline in older adults living in nursing homes / Floor Maze Test como preditor de declínio cognitivo em idosos residentes de instituições de longa permanência

OBJETIVO: Pesquisas em instituições de longa permanência para idosos (ILPI) mostram uma associação entre o aumento de risco de declínio cognitivo e o comprometimento das habilidades de navegação espacial dos idosos. A navegação espacial pode ser definida como uma habilidade complexa, que depende de funções cognitivas e motoras, emergindo como um importante marcador de estadiamento da demência. O presente estudo teve por objetivo comparar a navegação espacial de idosos saudáveis; institucionalizados e com demência MÉTODOS: Foi realizado um estudo de corte transversal com 78 idosos (saudáveis = 37, demência = 22, institucionalizados = 19) avaliados por meio do Miniexame do estado mental (MEEM), Floor Maze Test (FMT) e 8-foot-up-and-go (8UG). Uma ANOVA One-way foi realizada para comparar os grupos. RESULTADOS: Como esperado, o grupo saudável foi mais ágil, tanto no FMT imediato (X2 = 31,23; p < 0,01) quanto no tardio (X2 = 41,21; p < 0,01). Quando comparados os grupos demência e institucionalizados, não houve diferença significativa no MEEM e FMT tardio. Porém, os idosos institucionalizados mostraram piores resultados que o grupo demência no FMT imediato (p < 0,01) e no teste 8UG (p < 0,01). CONCLUSÃO: Os resultados indicam um pior desempenho na navegação espacial, função executiva e habilidades motoras dos idosos em ILPI e com demência. A possibilidade de idosos institucionalizados serem subdiagnosticados deve ser considerada.

OBJECTIVE: Long-term care facilities (LTCF) are associated with an increased risk of cognitive decline and impairment in spatial navigation abilities. Recent studies have demonstrated that spatial navigation as a complex skill, involving cognitive and motor functions, emerging as a new marker for the progression of dementia. The present study aims to compare spatial navigation in healthy, institutionalized, and AD elderly subjects. METHODS: In a cross-sectional study, we evaluated 78 elderly individuals (healthy = 37, AD = 22, institutionalized = 19) using the Mini-Mental State Examination (MMSE), Floor Maze Test (FMT) and 8-foot-up-and-gotest (8UG) to assess global cognitive function, spatial navigation and motor function, respectively. RESULTS: In the FMT, the immediate maze time (IMT) and delay maze time (DMT) were significantly shorter in the healthy group than those of the institutionalized and AD groups (X2 = 31.23; p < 0.01) and (X2 = 41.21; p < 0.01), while there were no significant differences between the AD and institutionalized groups in terms of the DMT and MMSE results. However, the institutionalized group showed worse results in terms of IMT (p < 0.01) and 8UG (p < 0.01) than those in the dementia group. CONCLUSION: Our results indicate that both institutionalized older people and patients with Dementia have a deficit in the spatial navigation ability, cognitive functions and motor skills. We should consider that there might be a possibility of underdiagnosis in institutionalized older people.

Gait analysis with videogrammetry can differentiate healthy elderly, mild cognitive impairment, and Alzheimer's disease: A cross-sectional study.

Gait parameters have been investigated as an additional tool for differential diagnosis in neurocognitive disorders, especially among healthy elderly (HE), those with mild cognitive impairment (MCI), and Alzheimer's disease (AD) patients. A videogrammetry system could be used as a low-cost and clinically practical equipment to capture and analyze gait in older adults. The aim of this study was to select the better gait parameter to differentiate these groups among different motor test conditions with videogrammetry analyses. Different motor conditions were used in three specific assessments: 10-meter walk test (10mWT), timed up and go test (TUGT), and treadmill walk test (TWT). These tasks were compared among HE (n=17), MCI (n=23), and AD (n=23) groups. One-way ANOVA, Kruskal-Wallis, and Bonferroni post-hoc tests were used to compare variables among groups. Then, an effect size (ES) and a linear regression analysis were calculated. The gait parameters showed significant differences among groups in all conditions, but not in TWT. Controlled by confounding variables, the gait velocity in 10mWT at usual speed, and TUGT in dual-task condition, predicts 39% and 53% of the difference among diagnoses, respectively. Finally, these results suggest that a low-cost and practical video analysis could be able to differentiate HE, those with MCI, and AD patients in clinical assessments.

Utility of handgrip strength cut-offs for identification of weakness and disability in community-dwelling older people with mild cognitive impairment and Alzheimer's disease / Utilidade de pontos de corte de força de preensão palmar para identificar fraqueza e incapacidade em idosos da comunidade com transtorno cognitivo leve e doença de Alzheimer

ABSTRACT Objectives To evaluate the utility of handgrip strength cut-offs for the identification of weakness and Instrumental Activities of Daily Living (IADL) disability in elderly people with neurocognitive disorders. Methods Cross-sectional study of community-dwelling elderly individuals with Alzheimer's disease (AD, n = 40) and mild cognitive impairment (MCI, n = 22); healthy individuals (n = 36) were recruited as controls. Handgrip cut-offs included European Working Group for Sarcopenic Older People (EWGSOP2), Cardiovascular Healthy Study (CHS) and the Frailty in Brazilian Older People Study from Rio de Janeiro (FIBRA RJ) cut-offs. Handgrip strength indexes were calculated by dividing handgrip strength values by cut-off values and the weakness prevalence for each cut-off value was compared among groups. Correlation analyses were employed to evaluate the relationship between Lawton Scale and handgrip strength (crude value and indexes). Results All handgrip strength indexes were lower in the AD group (p < 0.05), whereas the prevalence of weakness was significantly higher in the AD group only when the CHS cut-off was applied (AD = 47.5%, MCI and control = 18.2%, p < 0.01). Significantly positive correlations were identified between the Lawton ADL scale and handgrip indexes for all cut-offs (p < 0.05), but not between Lawton scale and crude handgrip (p = 0.75). Conclusions Only the CHS cut-off allowed proper differentiation of the weakness prevalence between groups. In addition, adjusting handgrip strength values according to cut-offs was necessary to determine the correlation between strength and disability in cognitively impaired elderly individuals.

RESUMO Objetivos Avaliar a utilidade de pontos de corte (PC) de força de preensão palmar (FPP) para identificar fraqueza e incapacidade em atividades instrumentais de vida diária (AIVDs) em idosos com transtorno neurocognitivo. Métodos Neste estudo de corte transversal, foram recrutados idosos saudáveis (n = 36), com comprometimento cognitivo leve (CCL, n = 22) e doença de Alzheimer (DA, n = 40). Os PCs incluídos foram o European Working Group for Sarcopenic Older People (EWGSOP2), o Cardiovascular Healthy Study (CHS) e o Frailty in Brazilian Older People Study do Rio de Janeiro (FIBRA RJ). Índices de FPP foram calculados dividindo-se o valor da FPP pelos valores de PC, e a prevalência de fraqueza para cada PC foi comparada entre os grupos. Análises de correlação foram empregadas para avaliar a relação entre a escala de Lawton e a FPP (valores brutos e índices). Resultados Todos os índices de FPP foram menores no grupo DA (p < 0,05), enquanto a prevalência de fraqueza foi significativamente maior na DA apenas quando o PC do CHS foi aplicado (DA = 47,5%, CCL e controles = 18,2%, p < 0,01). Foi identificada uma correlação significativa positiva entre a escala de Lawton e índices com todos os PCs (p < 0,05), porém não entre escala de Lawton e valor bruto da FPP (p = 0,75). Conclusões Apenas o PC do CHS permitiu diferenciação apropriada na prevalência de fraqueza entre os grupos. Além disso, o ajuste da FPP de acordo com os PCs foi necessário para determinar a correlação entre força e incapacidade em AIVDs em indivíduos idosos com comprometimento cognitivo.

Dual task in healthy elderly, depressive and Alzheimer's disease patients / Dupla tarefa em idosos saudáveis, depressivos e pacientes com doença de Alzheimer

ABSTRACT Objective To investigate whether the DT performance can be affected by the diagnosis of major depressive disorder (MDD) and Alzheimer's disease (AD). Methods Cross-sectional data with 108 individuals [Healthy (HE) = 56, MDD =19, AD = 33] aged 60 and older of both sexes diagnosis with AD, MDD, and HE without a clinical diagnosis of mental disorders, residents of the city of Rio de Janeiro. DT performance, was measured by mean velocity (m/s), DT cost and the number of evoked words (DTanimals). One-way ANOVA was used to compare groups. In addition, a logistic regression was used to verify the association between the performance in the DT variables and the risk of MD and AD, controlled by age and scholarity. Results There was a significant difference between the HE and AD groups in the DT variables. The worst performance in the DTC and DTanimals variables increased risk of AD, regardless of age and scholarity (DTC, OR = 5.6, 95% CI = 1.4-22.2, p = 0.01 and DTanimals, OR = 3.6, 95% CI = 0.97-14.0, p = 0.05). Conclusion The ability to perform two tasks simultaneously appears to be impaired in patients with Alzheimer's disease, and unaffected by the major depressive disorder.

RESUMO Objetivo Avaliar o quanto o desempenho em dupla tarefa pode ser afetado pelo diagnóstico do transtorno depressivo maior (TDM) e pela doença de Alzheimer (DA). Métodos Estudo de corte transversal com 108 indivíduos [Saudáveis (IS) = 56, TDM = 19, DA = 33] com 60 anos ou mais, de ambos os sexos, diagnosticados com doença de Alzheimer, transtorno depressivo maior e sem diagnóstico de doenças mentais, residentes na cidade do Rio de Janeiro. O desempenho em DT foi avaliado pela velocidade média (m/s), custo da dupla tarefa (CDT) e número de animais evocados por segundo (DTanimais). ANOVA one-way foi feita para a comparação dos grupos. Além disso, foi utilizada uma regressão logística para verificar a associação entre o desempenho nas variáveis em DT e o risco de TDM e DA, controlado pela idade e escolaridade. Resultados Houve diferença significativa entre os grupos IS e DA nas variáveis em DT. O pior desempenho no CDT e no número de animais evocados em DT aumentou o risco de DA, independentemente da idade e escolaridade (CDT, OR = 5,6, IC de 95% = 1,4-22,2, p = 0,01 e DTanimals, OR = 3,6, IC de 95% = 0,97-14,0, p = 0,05). Conclusão A capacidade de realizar duas tarefas de forma simultânea parece ser prejudicada em pacientes com doença de Alzheimer e não afetada em pacientes com TDM.

Stages of mild cognitive impairment and Alzheimer's disease can be differentiated by declines in timed up and go test: A systematic review and meta-analysis.

Motor dysfunction increases in the moderate and severe stages of dementia. However, there is still no consensus on changes in mobility during its early stages. This meta-analysis aimed to measure the level of single-task functional mobility in older subjects with mild cognitive impairment (MCI) and/or Alzheimer's disease (AD). In a search of the PubMed, ISI Web of Knowledge, and Scopus databases, 2728 articles were identified. At the end of the selection, a total of 18 studies were included in the meta-analysis. Functional mobility was investigated using the timed up and go (TUG) test in all studies. When compared to healthy elderly (HE) adults, the following mean differences (MD) in seconds were found for the investigated subgroups: no amnestic MCI (MD = 0.26; CI95% = -0.77, 1.29), amnestic MCI (MD = 0.86; CI95% = -0.02, 1.73), very mild AD (MD = 1.32; CI95% = 0.63, 2.02), mild AD (MD = 2.43; CI95% = 1.84, 3.01), mild-moderate AD (MD = 3.01; CI95% = 2.47, 3.55), and mild-severe AD (MD = 4.51; CI95% = 1.14, 7.88); for the groups, the following MD were found: MCI (MD = 0.97; CI95% = 0.51, 1.44) and AD (MD = 2.66; CI95% = 2.16, 3.15). These results suggest a transition period in motor capacity between healthy aging and dementia, wherein functional mobility analysis in a single-task (TUG) can contribute to the diagnosis and staging of predementia states and AD.

Posturographic analysis of older adults without dementia and patients with Alzheimer's disease: A cross-sectional study.

Additional clinical tools should be investigated to facilitate and aid the early diagnosis of cognitive decline. Postural control worsens with aging and this may be related to pathological cognitive impairment. OBJECTIVE: to compare the balance of older adults without dementia in a control group (CG) and with Alzheimer's disease (AD), to observe the possible association with the independent variables (diagnosis, age, gender, and global cognition) and to verify the best posturographic analyses to determine the difference between the groups. METHODS: 86 older adults (AD = 48; CG = 38) were evaluated using the Berg Balance Scale (BBS) and postural control was assessed by stabilometry on the Wii Balance Board ® (WBB). Independent T, Mann-Whitney U-tests, Effect Size (ES) and a linear regression were performed. RESULTS: there was a significant difference for Elliptical Area, Total Velocity, Medio-Lateral displacements with closed eyes and open eyes, antero-posterior, with closed eyes and BBS between groups. These variables showed a large effect size for BBS (-1.02), Elliptical Area (0.83) with closed eyes, Medio-Lateral (0.80, 0.96) and Total Velocity (0.92; 1.10) with eyes open and eyes closed, respectively. Regression indicated global cognition accompanied by age, gender, and diagnosis influenced postural control. CONCLUSION: patients with AD showed impaired postural control compared to Control Group subjects. Total Velocity with closed eyes was the most sensitive parameter for differentiating groups and should be better investigated as a possible motor biomarker of dementia in posturographic analysis with WBB.

Ferramentas clínicas adicionais devem ser investigadas para facilitar e auxiliar o diagnóstico prévio do declínio cognitivo. O controle postural piora com o envelhecimento e este fato pode estar relacionado com o comprometimento cognitivo patológico. OBJETIVO: comparar o equilíbrio de adultos idosos sem demência no grupo controle (GC) e com doença de Alzheimer (DA), observar as possíveis associações com as variáveis independentes (diagnóstico, idade, sexo e estado cognitivo global) e verificar as melhores análises posturográficas para determinar a diferença entre os grupos. MÉTODOS: 86 idosos (DA = 48; GC=38) foram avaliados utilizando a escala de equilíbrio Berg (EEB) e o controle postural pela estabilometria no Wii Balance Board ® (WBB). Testes T independente, Mann Whitney U, o tamanho de efeito (TE) e uma regressão linear foram realizados. RESULTADOS: houve diferença significativa para AE, VT, ML com OA e OF, AP com OF e EEB entre os grupos. Estas variáveis mostraram um TE grande para EEB (-1.02), AE (0,83) com OF, ML (0,80; 0,96) e VT (0,92; 1,10) com OA e OF, respectivamente. A regressão indicou que a cognição global acompanhada da idade, gênero e diagnóstico contribuem para as alterações do controle postural. CONCLUSÃO: pacientes com DA apresentam comprometimento do controle postural quando comparados a idosos saudáveis. A VT com OF foi o parâmetro mais sensível para diferenciar os grupos e deve ser melhor investigada como possível biomarcador motor de demência na análise posturográfica com o WBB.

Three months of multimodal training contributes to mobility and executive function in elderly individuals with mild cognitive impairment, but not in those with Alzheimer's disease: A randomized controlled trial.

OBJECTIVE: To investigate the effects of a 12-week multimodal physical exercise program on global cognition, executive function and mobility in elderly people with mild cognitive impairment (MCI) or Alzheimer's disease (AD). DESIGN: Randomized controlled trial (RCT) of two groups in parallel; single-blind. METHOD: Patients were allocated to a control group (CG; n = 28 comprising MCI = 14 and AD = 14) and an exercise group (EG; n = 28 comprising MCI = 14 and AD = 14). The participants' physical and cognitive abilities were evaluated before and three months after the intervention. The training consisted of a 1-hour supervised program of multimodal physical exercises (aerobic, strength, balance and flexibility) of moderate intensity, delivered twice a week. RESULTS: The independent t-test of the delta (Δ = post-intervention - pre-intervention) was used to compare the groups (CG x EG) for each diagnosis (MCI and AD). There was a significant difference only in the simple task mobility test (ΔCG: -0.18 ± 0.53; ΔEG: -1.05 ± 0.57; P = 0.03) and in the verbal fluency (ΔCG: -1.30 ± 2.49; ΔEG: 3.16 ± 1.72, P = 0.05) of the elderly with MCI, showing a beneficial effect of the multimodal exercise in this group. CONCLUSION: Our findings indicate that a 12-week multimodal physical exercise program contributed to improvements in the mobility and executive function of elderly individuals with MCI, but not of those with AD. Although more RCTs are needed, physical exercise should be recommended to those in the early stages of neurocognitive disorder.

Posturographic analysis of older adults without dementia and patients with Alzheimer's disease: A cross-sectional study / Análise posturográfica de adultos idosos sem demência e com doença de Alzheimer: estudo de corte transversal

ABSTRACT. Additional clinical tools should be investigated to facilitate and aid the early diagnosis of cognitive decline. Postural control worsens with aging and this may be related to pathological cognitive impairment. Objective: to compare the balance of older adults without dementia in a control group (CG) and with Alzheimer's disease (AD), to observe the possible association with the independent variables (diagnosis, age, gender, and global cognition) and to verify the best posturographic analyses to determine the difference between the groups. Methods: 86 older adults (AD = 48; CG = 38) were evaluated using the Berg Balance Scale (BBS) and postural control was assessed by stabilometry on the Wii Balance Board ® (WBB). Independent T, Mann-Whitney U-tests, Effect Size (ES) and a linear regression were performed. Results: there was a significant difference for Elliptical Area, Total Velocity, Medio-Lateral displacements with closed eyes and open eyes, antero-posterior, with closed eyes and BBS between groups. These variables showed a large effect size for BBS (-1.02), Elliptical Area (0.83) with closed eyes, Medio-Lateral (0.80, 0.96) and Total Velocity (0.92; 1.10) with eyes open and eyes closed, respectively. Regression indicated global cognition accompanied by age, gender, and diagnosis influenced postural control. Conclusion: patients with AD showed impaired postural control compared to Control Group subjects. Total Velocity with closed eyes was the most sensitive parameter for differentiating groups and should be better investigated as a possible motor biomarker of dementia in posturographic analysis with WBB.

RESUMO. Ferramentas clínicas adicionais devem ser investigadas para facilitar e auxiliar o diagnóstico prévio do declínio cognitivo. O controle postural piora com o envelhecimento e este fato pode estar relacionado com o comprometimento cognitivo patológico. Objetivo: comparar o equilíbrio de adultos idosos sem demência no grupo controle (GC) e com doença de Alzheimer (DA), observar as possíveis associações com as variáveis independentes (diagnóstico, idade, sexo e estado cognitivo global) e verificar as melhores análises posturográficas para determinar a diferença entre os grupos. Métodos: 86 idosos (DA = 48; GC=38) foram avaliados utilizando a escala de equilíbrio Berg (EEB) e o controle postural pela estabilometria no Wii Balance Board ® (WBB). Testes T independente, Mann Whitney U, o tamanho de efeito (TE) e uma regressão linear foram realizados. Resultados: houve diferença significativa para AE, VT, ML com OA e OF, AP com OF e EEB entre os grupos. Estas variáveis mostraram um TE grande para EEB (-1.02), AE (0,83) com OF, ML (0,80; 0,96) e VT (0,92; 1,10) com OA e OF, respectivamente. A regressão indicou que a cognição global acompanhada da idade, gênero e diagnóstico contribuem para as alterações do controle postural. Conclusão: pacientes com DA apresentam comprometimento do controle postural quando comparados a idosos saudáveis. A VT com OF foi o parâmetro mais sensível para diferenciar os grupos e deve ser melhor investigada como possível biomarcador motor de demência na análise posturográfica com o WBB.

Association among 2-min step test, functional level and diagnosis of dementia.

Aerobic capacity declines significantly throughout life, beginning at the age of 30 years and accelerating from 60 years, where a decline of 17% per decade is expected thereafter. OBJECTIVE: To investigate the association between aerobic capacity and a diagnosis of mild cognitive impairment (MCI), mild AD or moderate AD in older adults, considering the risk classification of functional loss of the Step test. METHODS: In this cross-sectional study, 93 patients (age >60 years) were evaluated (Healthy=36; MCI=18, AD=39). The step test was used to assess aerobic capacity, while overall cognitive status was measured using the MMSE. The groups were divided according to the risk classifications of functional loss into below or above the standard cut-off point for aerobic capacity. RESULTS: Subjects in the functional loss risk group were approximately ten to fourteen times more likely to be diagnosed with mild (OR:10.7; p=0.001) or moderate (OR.=14.7; p=0.002) AD than their fitter counterparts. Low aerobic fitness was also associated with the MCI condition (OR=4.5; p=0.05), but only after controlling for educational level, age and sex. In the overall sample (N=93), there was an association between aerobic capacity and MMSE performance (R2=0.35; p<0.001) after controlling for confounding variables. CONCLUSION: low aerobic capacity was associated with cognitive decline, and older adults at risk of functional loss on the STEP test had greater chance of being diagnosed with MCI or AD after controlling for age, sex and education.

A capacidade aeróbica diminui significativamente ao longo da vida, começando com a idade de 30 anos e acelerando a partir dos 60 anos, onde se prevê um declínio de 17% por década. OBJETIVO: Investigar a associação entre a capacidade aeróbica medida e o risco de desenvolvimento de comprometimento cognitivo leve (CCL), DA leve e moderado em idosos, considerando as classificações de risco de perda funcional para o teste do STEP. MÉTODOS: Nesse estudo de corte-transversal, foram avaliados 93 idosos (>60 anos) (saudáveis=36; CCL=18, DA=39). Para acessar a capacidade aeróbica foi utilizado o teste de STEP e o estado cognitivo global foi medido através do MEEM. Os grupos foram divididos em relação às classificações de risco de perda funcional em abaixo ou acima do ponto de corte padronizado para idosos. RESULTADOS: Idosos incluídos no grupo de risco de perda funcional tinham aproximadamente dez a catorze vezes mais chances de serem diagnosticados com DA leve (O.R:10.7; p=0.001) e moderado (O.R.=14.7; p=0.002), do que os seus pares mais bem condicionados. Menores níveis de capacidade aeróbica também foram associados com o diagnostico de CCL (O.R=4.5; p=0.05), entretanto apenas após controle por idade, escolaridade e sexo. Na amostra total (N=93) houve uma associação entre a capacidade aeróbica e o MEEM (R2=0.35; p<0.001) depois de controlado pelas variáveis confundidoras. CONCLUSÃO: Idosos que se encontram dentro da classificação de risco de perda funcional medida através do teste de STEP possuem maiores chances de desenvolverem CCL, Alzheimer leve e moderado mesmo após controle por idade, sexo e escolaridade.

Association among 2-min step test, functional level and diagnosis of dementia / Associação entre o nível de capacidade aeróbica e diagnóstico de demência

ABSTRACT: Aerobic capacity declines significantly throughout life, beginning at the age of 30 years and accelerating from 60 years, where a decline of 17% per decade is expected thereafter. Objective: To investigate the association between aerobic capacity and a diagnosis of mild cognitive impairment (MCI), mild AD or moderate AD in older adults, considering the risk classification of functional loss of the Step test. Methods: In this cross-sectional study, 93 patients (age >60 years) were evaluated (Healthy=36; MCI=18, AD=39). The step test was used to assess aerobic capacity, while overall cognitive status was measured using the MMSE. The groups were divided according to the risk classifications of functional loss into below or above the standard cut-off point for aerobic capacity. Results: Subjects in the functional loss risk group were approximately ten to fourteen times more likely to be diagnosed with mild (OR:10.7; p=0.001) or moderate (OR.=14.7; p=0.002) AD than their fitter counterparts. Low aerobic fitness was also associated with the MCI condition (OR=4.5; p=0.05), but only after controlling for educational level, age and sex. In the overall sample (N=93), there was an association between aerobic capacity and MMSE performance (R2=0.35; p<0.001) after controlling for confounding variables. Conclusion: low aerobic capacity was associated with cognitive decline, and older adults at risk of functional loss on the STEP test had greater chance of being diagnosed with MCI or AD after controlling for age, sex and education.

RESUMO: A capacidade aeróbica diminui significativamente ao longo da vida, começando com a idade de 30 anos e acelerando a partir dos 60 anos, onde se prevê um declínio de 17% por década. Objetivo: Investigar a associação entre a capacidade aeróbica medida e o risco de desenvolvimento de comprometimento cognitivo leve (CCL), DA leve e moderado em idosos, considerando as classificações de risco de perda funcional para o teste do STEP. Métodos: Nesse estudo de corte-transversal, foram avaliados 93 idosos (>60 anos) (saudáveis=36; CCL=18, DA=39). Para acessar a capacidade aeróbica foi utilizado o teste de STEP e o estado cognitivo global foi medido através do MEEM. Os grupos foram divididos em relação às classificações de risco de perda funcional em abaixo ou acima do ponto de corte padronizado para idosos. Resultados: Idosos incluídos no grupo de risco de perda funcional tinham aproximadamente dez a catorze vezes mais chances de serem diagnosticados com DA leve (O.R:10.7; p=0.001) e moderado (O.R.=14.7; p=0.002), do que os seus pares mais bem condicionados. Menores níveis de capacidade aeróbica também foram associados com o diagnostico de CCL (O.R=4.5; p=0.05), entretanto apenas após controle por idade, escolaridade e sexo. Na amostra total (N=93) houve uma associação entre a capacidade aeróbica e o MEEM (R2=0.35; p<0.001) depois de controlado pelas variáveis confundidoras. Conclusão: Idosos que se encontram dentro da classificação de risco de perda funcional medida através do teste de STEP possuem maiores chances de desenvolverem CCL, Alzheimer leve e moderado mesmo após controle por idade, sexo e escolaridade.

Spatial Navigation in the Elderly with Alzheimer's Disease: A Cross-Sectional Study.

BACKGROUND: Spatial navigation is a fundamental cognitive ability that allows an individual to maintain independence by facilitating the safe movement from one place to another. It emerges as one of the first deficits in patients with Alzheimer's disease (AD). OBJECTIVE: To compare spatial navigation performance in the healthy elderly and AD patients through use of the Floor Maze Test (FMT)- an easy-to-apply two-dimensional (2D) maze- and determine which cognitive and functional capacities were associated with performance in this task. METHODS: The FMT was administered to 24 AD patients and 36 healthy controls. Spatial navigation was evaluated through the FMT. Functional capacity was evaluated through the Senior Fitness Test battery of tests. Cognitive functions were evaluated through the Mini-Mental State Examination (MMSE), verbal fluency, digit span test, and the Rey Auditory Verbal Learning Test (RAVLT). RESULTS: The group with AD was significantly slower and presented more errors at all stages of the FMT. Planning Time (PT) performance was associated with cardiorespiratory resistance (Step test) and delayed memory according to the RAVLT (R2 = 0.395, p < 0.001). Performance in the Immediate Maze Time (IMT) and Delayed Maze Time (DMT) was associated with global cognitive status (MMSE) (R2 = 0.509) and delayed memory (R2 = 0.540). CONCLUSION: Patients with AD present significant spatial navigation deficits. Their performance on the FMT is influenced by cardiorespiratory capacity, memory, and global cognitive function. As exercise helps to improve executive function and functional capacity, future intervention studies should be carried out to analyze the possible effects of physical exercise on spatial navigation.