The motor signature of mild cognitive impairment: results from the gait and brain study

Manuel Montero-Odasso, Afua Oteng-Amoako, Mark Speechley, Karen Gopaul, Olivier Beauchet, Cedric Annweiler, Susan W Muir-Hunter, Manuel Montero-Odasso, Afua Oteng-Amoako, Mark Speechley, Karen Gopaul, Olivier Beauchet, Cedric Annweiler, Susan W Muir-Hunter

Abstract

Background: Early motor changes associated with aging predict cognitive decline, which suggests that a "motor signature" can be detected in predementia states. In line with previous research, we aim to demonstrate that individuals with mild cognitive impairment (MCI) have a distinct motor signature, and specifically, that dual-task gait can be a tool to distinguish amnestic (a-MCI) from nonamnestic MCI.

Methods: Older adults with MCI and controls from the "Gait and Brain Study" were assessed with neurocognitive tests to assess cognitive performance and with an electronic gait mat to record temporal and spatial gait parameters. Mean gait velocity and stride time variability were evaluated under simple and three separate dual-task conditions. The relationship between cognitive groups (a-MCI vs nonamnestic MCI) and gait parameters was evaluated with linear regression models and adjusted for confounders.

Results: Ninety-nine older participants, 64 MCI (mean age 76.3±7.1 years; 50% female), and 35 controls (mean age 70.4±3.9 years; 82.9% female) were included. Forty-two participants were a-MCI and 22 were nonamnestic MCI. Multivariable linear regression (adjusted for age, sex, physical activity level, comorbidities, and executive function) showed that a-MCI was significantly associated with slower gait and higher dual-task cost under dual-task conditions.

Conclusion: Participants with a-MCI, specifically with episodic memory impairment, had poor gait performance, particularly under dual tasking. Our findings suggest that dual-task assessment can help to differentiate MCI subtyping, revealing a motor signature in MCI.

Keywords: Cognition-motor decline.; Dual-task; Gait speed; Gait variability; Mild cognitive impairment.

© The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America.

Figures

Figure 1.
Figure 1.
Dual-task cost for gait velocity during three dual-task conditions in controls and mild cognitive impairment subtypes.

References

    1. Montero-Odasso M, Bergman H, Phillips NA, Wong CH, Sourial N, Chertkow H. Dual-tasking and gait in people with mild cognitive impairment. The effect of working memory. BMC Geriatr. 2009;9:41. 10.1186/1471-2318-9-41
    1. Beauchet O, Allali G, Launay C, Herrmann FR, Annweiler C. Gait variability at fast-pace walking speed: a biomarker of mild cognitive impairment? J Nutr Health Aging. 2013;17:235–239. 10.1007/s12603-013-0390-3
    1. Aggarwal NT, Wilson RS, Beck TL, Bienias JL, Bennett DA. Motor dysfunction in mild cognitive impairment and the risk of incident Alzheimer disease. Arch Neurol. 2006;63:1763–1769. 10.1001/archneur.63.12.1763
    1. Pettersson AF, Olsson E, Wahlund LO. Motor function in subjects with mild cognitive impairment and early Alzheimer’s disease. Dement Geriatr Cogn Disord. 2005;19:299–304. 10.1159/000084555
    1. Verghese J, Wang C, Lipton RB, Holtzer R. Motoric cognitive risk syndrome and the risk of dementia. J Gerontol A Biol Sci Med Sci. 2013;68:412–418. 10.1093/gerona/gls191
    1. Waldemar G, Phung KT, Burns A, et al. Access to diagnostic evaluation and treatment for dementia in Europe. Int J Geriatr Psychiatry. 2007;22:47–54. 10.1002/gps.1652
    1. Marquis S, Moore MM, Howieson DB, et al. Independent predictors of cognitive decline in healthy elderly persons. Arch Neurol. 2002;59:601–606. 10.1001/archneur.59.4.601
    1. Camicioli R, Howieson D, Oken B, Sexton G, Kaye J. Motor slowing precedes cognitive impairment in the oldest old. Neurology. 1998;50:1496–1498. 10.1212/WNL.50.5.1496
    1. Verghese J, Lipton RB, Hall CB, Kuslansky G, Katz MJ, Buschke H. Abnormality of gait as a predictor of non-Alzheimer’s dementia. N Engl J Med. 2002;347:1761–1768. 10.1056/NEJMoa020441
    1. Waite LM, Grayson DA, Piguet O, Creasey H, Bennett HP, Broe GA. Gait slowing as a predictor of incident dementia: 6-year longitudinal data from the Sydney Older Persons Study. J Neurol Sci. 2005;229-230:89–93. 10.1016/j.jns.204.11.009
    1. Montero-Odasso M, Verghese J, Beauchet O, Hausdorff JM. Gait and cognition: a complementary approach to understanding brain function and the risk of falling. J Am Geriatr Soc. 2012;60:2127–2136. 10.1111/j.1532-5415.2012.04209.x
    1. Verghese J, Robbins M, Holtzer R, et al. Gait dysfunction in mild cognitive impairment syndromes. J Am Geriatr Soc. 2008;56:1244–1251. 10.1111/j.1532-5415.2008.01758.x
    1. Hausdorff JM, Schweiger A, Herman T, Yogev-Seligmann G, Giladi N. Dual-task decrements in gait: contributing factors among healthy older adults. J Gerontol A Biol Sci Med Sci. 2008;63:1335–1343
    1. Montero-Odasso M, Casas A, Hansen KT, et al. Quantitative gait analysis under dual-task in older people with mild cognitive impairment: a reliability study. J Neuroeng Rehabil. 2009;6:35. 10.1186/1743-0003-6-35
    1. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179–186
    1. Dubois B, Albert ML. Amnestic MCI or prodromal Alzheimer’s disease? Lancet Neurol. 2004;3:246–248. 10.1016/S1474-4422(04)00710-0
    1. Petersen RC. Clinical practice. Mild cognitive impairment. N Engl J Med. 2011;364:2227–2234. 10.1056/NEJMcp0910237
    1. Reitan R, Wolfson D. The Halstead-Reitan Neuropsychological Test Battery. Tucson, AZ: Neuropsychology Press; 1985
    1. Estévez-González A, Kulisevsky J, Boltes A, Otermín P, García-Sánchez C. Rey verbal learning test is a useful tool for differential diagnosis in the preclinical phase of Alzheimer’s disease: comparison with mild cognitive impairment and normal aging. Int J Geriatr Psychiatry. 2003;18:1021–1028. 10.1002/gps.1010
    1. Kaplan E, Goodglass H, Weintraub S. The Boston Naming Test. 3rd ed. Philadelphia, PA: Lea and Febiger; 1983
    1. Weschler D. The Wechsler Adult Intelligence Scale. 4th ed. San Antonio, TX: Pearson Assessments; 2008
    1. Montero-Odasso M, Muir SW, Speechley M. Dual-task complexity affects gait in people with mild cognitive impairment: the interplay between gait variability, dual tasking, and risk of falls. Arch Phys Med Rehabil. 2012;93:293–299. 10.1016/j.apmr.2011.08.026
    1. Verghese J, Wang C, Lipton RB, Holtzer R, Xue X. Quantitative gait dysfunction and risk of cognitive decline and dementia. J Neurol Neurosurg Psychiatry. 2007;78:929–935. 10.1136/jnnp.2006.106914
    1. Watson NL, Rosano C, Boudreau RM, et al. ; Health ABC Study. Executive function, memory, and gait speed decline in well-functioning older adults. J Gerontol A Biol Sci Med Sci. 2010;65:1093–1100. 10.1093/gerona/glq111
    1. Buracchio T, Dodge HH, Howieson D, Wasserman D, Kaye J. The trajectory of gait speed preceding mild cognitive impairment. Arch Neurol. 2010;67:980–986. 10.1001/archneurol.2010.159
    1. Gillain S, Warzee E, Lekeu F, et al. The value of instrumental gait analysis in elderly healthy, MCI or Alzheimer’s disease subjects and a comparison with other clinical tests used in single and dual-task conditions. Ann Phys Rehabil Med. 2009;52:453–474. 10.1016/j.rehab.2008.10.004
    1. Maquet D, Lekeu F, Warzee E, et al. Gait analysis in elderly adult patients with mild cognitive impairment and patients with mild Alzheimer’s disease: simple versus dual task: a preliminary report. Clin Physiol Funct Imaging. 2010;30:51–56. 10.1111/j.1475-097X.2009.00903.x
    1. Muir SW, Speechley M, Wells J, Borrie M, Gopaul K, Montero-Odasso M. Gait assessment in mild cognitive impairment and Alzheimer’s disease: the effect of dual-task challenges across the cognitive spectrum. Gait Posture. 2012;35:96–100. 10.1016/j.gaitpost.2011.08.014
    1. Persad CC, Jones JL, Ashton-Miller JA, Alexander NB, Giordani B. Executive function and gait in older adults with cognitive impairment. J Gerontol A Biol Sci Med Sci. 2008;63:1350–1355
    1. Mielke MM, Roberts RO, Savica R, et al. Assessing the temporal relationship between cognition and gait: slow gait predicts cognitive decline in the Mayo Clinic Study of Aging. J Gerontol A Biol Sci Med Sci. 2013;68:929–937. 10.1093/gerona/gls256
    1. Holtzer R, Wang C, Lipton R, Verghese J. The protective effects of executive functions and episodic memory on gait speed decline in aging defined in the context of cognitive reserve. J Am Geriatr Soc. 2012;60:2093–2098. 10.1111/j.1532-5415.2012.04193.x
    1. Montero-Odasso M, Schapira M, Duque G, Soriano ER, Kaplan R, Camera LA. Gait disorders are associated with non-cardiovascular falls in elderly people: a preliminary study. BMC Geriatr. 2005;5:15. 10.1186/1471-2318-5-15
    1. Studenski S, Perera S, Wallace D, et al. Physical performance measures in the clinical setting. J Am Geriatr Soc. 2003;51:314–322. 10.1046/j.1532-5415.2003.51104.x
    1. Studenski S, Perera S, Patel K, et al. Gait speed and survival in older adults. JAMA. 2011;305:50–58. 10.1001/jama.2010.1923
    1. Montero-Odasso M, Schapira M, Varela C, et al. Gait velocity in senior people. An easy test for detecting mobility impairment in community elderly. J Nutr Health Aging. 2004;8:340–343
    1. Annweiler C, Beauchet O, Bartha R, et al. Motor cortex and gait in mild cognitive impairment: a magnetic resonance spectroscopy and volumetric imaging study. Brain. 2013;136(Pt 3):859–871. 10.1093/brain/aws373
    1. Zimmerman ME, Lipton RB, Pan JW, Hetherington HP, Verghese J. MRI- and MRS-derived hippocampal correlates of quantitative locomotor function in older adults. Brain Res. 2009;1291:73–81. 10.1016/j.brainres.2009.07.043
    1. Lafleur MF, Jackson PL, Malouin F, Richards CL, Evans AC, Doyon J. Motor learning produces parallel dynamic functional changes during the execution and imagination of sequential foot movements. Neuroimage. 2002;16:142–157. 10.1006/nimg.2001.1048
    1. Montero-Odasso M, Hachinski V. Preludes to brain failure: executive dysfunction and gait disturbances. Neurol Sci. 2014;35:601–604. 10.1007/s10072-013-1613-4
    1. Hausdorff JM, Buchman AS. What links gait speed and MCI with dementia? A fresh look at the association between motor and cognitive function. J Gerontol A Biol Sci Med Sci. 2013;68:409–411. 10.1093/gerona/glt002
    1. Rosso AL, Studenski SA, Chen WG, et al. Aging, the central nervous system, and mobility. J Gerontol A Biol Sci Med Sci. 2013;68:1379–1386. 10.1093/gerona/glt089

Source: PubMed

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