Gait variability across neurodegenerative and cognitive disorders: Results from the Canadian Consortium of Neurodegeneration in Aging (CCNA) and the Gait and Brain Study

Frederico Pieruccini-Faria, Sandra E Black, Mario Masellis, Eric E Smith, Quincy J Almeida, Karen Z H Li, Louis Bherer, Richard Camicioli, Manuel Montero-Odasso, Frederico Pieruccini-Faria, Sandra E Black, Mario Masellis, Eric E Smith, Quincy J Almeida, Karen Z H Li, Louis Bherer, Richard Camicioli, Manuel Montero-Odasso

Abstract

Introduction: Gait impairment is common in neurodegenerative disorders. Specifically, gait variability-the stride-to-stride fluctuations in distance and time-has been associated with neurodegeneration and cognitive impairment. However, quantitative comparisons of gait impairments across the cognitive spectrum of dementias have not been systematically investigated.

Methods: Older adults (N = 500) with subjective cognitive impairment, Parkinson disease (PD), mild cognitive impairment (MCI), PD-MCI, Alzheimer's disease (AD), PD-dementia, Lewy body dementia, and frontotemporal dementia, as well cognitive normal controls, who were assessed for their gait and cognitive performance.

Results: Factor analyses grouped 11 quantitative gait parameters and identified four independent gait domains: rhythm, pace, variability, and postural control, for group comparisons and classification analysis. Among these domains, only high gait variability was associated with lower cognitive performance and accurately discriminated AD from other neurodegenerative and cognitive conditions.

Discussion: Our findings indicate that high gait variability is a marker of cognitive-cortical dysfunction, which can help to identify Alzheimer's disease dementia.

Keywords: biomarker; cognition; dementia; gait variability; neurodegenerative diseases.

Conflict of interest statement

The authors have declared no conflict of interest.

© 2021 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.

Figures

FIGURE 1
FIGURE 1
Gait domains performance as factors scores (Z‐scores) for each clinical group adjusted for covariates. Circles represent means and error bars represent 95% confidence interval. Positive scores for variability relate to high gait variability or worse variability performance. Negative values for other domains relate to worse gait performance
FIGURE 2
FIGURE 2
Compared with rhythm and postural control domains, gait variability accurately classified individuals with Alzheimer's disease (AD) from other clinical groups in both receiver‐operating characteristic (ROC) curves. Covariates (ie, age, sex, years of education, number of co‐morbidities, and gait speed) were used to adjust ROCs (graph on the right). ROC curves representing the true positive fraction (sensitivity) and false positive fraction (1‐specificity) of gait domains that were significantly different between all clinical groups (see Table 2). Black straight diagonal line (reference line) indicates area under the curves (AUCs) = .50, the point where variables are nonvalid/non‐accurate as classifiers. The higher the AUC, the better is the gait parameter to classify a neurodegenerative condition

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