Gait and Balance in Alzheimer\u27s Disease: A Retrospective Analysis Across Varying Levels of Cognitive Impairment

Background: It was once thought that Alzheimer’s disease (AD) affected mostly cognition with minor motor impairment; however, it is becoming apparent that motor impairment may also be a prominent feature. Determining the extent of motor impairments throughout the continuum of cognitive impairment is critical in developing timely interventions for this population. Purpose/Hypothesis: The aim of this study was to gain a greater understanding of motor impairment in AD by exploring the relationships among gait, balance, and falls. Specifically, we explored the association of fall history to measures of cognition and performance-based balance measures in individuals with AD. We hypothesized that falls would increase as balance impairments became more severe. Additionally, we mapped the trajectory of gait and balance function along the continuum of cognitive impairment in individuals with AD. We hypothesized that balance and gait would be worse for those in the lower quartiles of cognitive function compared to those in the upper quartiles. Lastly, we sought to determine if fall history worsened as cognition declined. We hypothesized that falls history would be worse in lower quartiles of cognitive impairment compared to upper quartiles of cognitive impairment. Subjects: Retrospective data of 419 patients with brain health conditions and an initial evaluation for physical therapy at the Cleveland Clinic Lou Ruvo Center for Brain Health were extracted from electronic records. Of those 419, 155 were diagnosed by a neurologist with AD (age=77.4 ± 9.5; 69 males, 86 females) and were subsequently analyzed for this study. Materials/Methods: Patients were stratified into cognitive quartiles using scores from the Montreal Cognitive Assessment (MoCA): 0-9 (very severe cognitive impairment), 10-14 (severe cognitive impairment), 15-20 (Moderate to severe impairment), 21-30 (mild to moderate impairment). These cognitive function quartiles were then compared across the following measures: fall history (falls in last year, falls in the last 30 days, and fall injuries in the last year), 5 times Sit To Stand (5STS), Timed Up and Go (TUG), TUG cognitive (TUGcog), Preferred Gait Speed (PGS), Fast Gait Speed (FGS), 6 Minute Walk Test (6MWT), and Mini Balance Evaluation Systems Test (MBT). Results: For our first aim, there were no statistically significant differences between fallers and non-fallers for cognition, age, and measures of gait and balance (ps≥.068), except non-fallers walked farther on the 6MWT (p=.030). There were no statistically significant differences for recent (last 30 days) fallers and non-fallers across the same measures (ps≥.082). Fallers who had experienced an injury as a result of a fall in the last year performed more poorly on the 6MWT (p=.034) and MBT SOT (p=.008); all other comparisons were not statistically significant (ps≥.085). For our second aim, there were no statistically significant differences among the four cognitive quartiles for 5STS (p=.456), TUG (p=.060), FGS (p=.181), 6MWT (p=.468), MBT (p=.321); however, there were for TUGcog (p=.046) and PGS (p=.033). The mild to moderate impairment quartile was significantly faster than the severe quartile (p=.006) for the TUGcog. For PGS, the mild to moderate was significantly faster than the very severe quartile (p=.039) and the moderate to severe was significantly faster than the severe and the very severe quartiles (severe, p=.036; and, very severe, p=.016). For our third aim, there were no statistically significant differences in the proportions of fallers (p=.636), recent fallers (p=.868), and injured fallers (p=.565) across the four cognitive quartiles. Discussion: Despite impairments recognized in our study compared to normative data, patients in the study with a fall history were not significantly worse across most measures of gait and balance, except fallers had poorer walking endurance as measured in the 6MWT. Additionally, the proportion of fallers did not increase as severity of cognitive impairment increased, although walking impairment as measured with PGS and TUGcog, especially with cognitive demand, is more prominent in those with more severe cognitive impairment. Conclusions: Balance and gait dysfunction were prominent at all levels of cognitive impairment in our study of patients with AD and appears to become more prominent at the most severe cognitive impairment levels. These progressive deficits represent potentially mitigable motor impairment features of AD that warrant physical therapy

An observation on n-permutability

We prove that in a regular category all reflexive and transitive relations are symmetric if and only if every internal category is an internal groupoid. In particular, these conditions hold when the category is n-permutable for some n.Comment: 6 page

Estado del arte de psicología comunitaria en la Universidad Católica de Colombia. 2011-2013

Psicología Comunitaria-Servicio SocialEl interés del presente trabajo es hacer una revisión de las tesis elaboradas por los estudiantes de la Facultad de Psicología de la Universidad Católica de Colombia, entre 2011 – 2013, marcan gran presencia de elementos teóricos, en contraste con la tenue conceptualización de la comunidad y la poca presencia de las vivencias diarias de los practicantes de psicología.PregradoPsicólog

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Diseño de una propuesta de documentación del sistema de gestión de seguridad y salud en el trabajo, bajo los lineamientos del Decreto 1072 de 2015 y la Resolución 0312 de 2019 para la empresa Dispomed SF del municipio de Dosquebradas

El presente proyecto consiste en la propuesta para la documentación del sistema de gestión de seguridad y salud en el trabajo, bajo los lineamientos del decreto 1072 de 2015 y la Resolución 0312 de 2019 en la empresa DISPOMED SF. Se inició por la creación de la política y los objetivos establecidos bajo los requisitos del decreto 1072 y la Resolución 0312 de 2019, luego se continuó con la definición de la metodología para la identificación de peligros, valoración de riesgos y determinación de los controles en sistema de gestión de seguridad y salud en el trabajo, y finalmente se crearon los documentos exigidos para dar cumplimiento a cada requisito. Este trabajo busca elaborar una metodología adecuada para el cuidado de los trabajadores y recursos de la empresa, la cual permita un continuo desarrollo siempre rigiéndose por las normas legales vigentes que fortalezcan el crecimiento de la empresa

On the integrated behaviour of non-stationary volatility in stock markets

This paper analyses the behaviour of volatility for several international stock market indexes, namely the SP 500 (USA), the Nikkei (Japan), the PSI 20 (Portugal), the CAC 40 (France), the DAX 30 (Germany), the FTSE 100 (UK), the IBEX 35 (Spain) and the MIB 30 (Italy), in the context of non-stationarity. Our empirical results point to the evidence of the existence of integrated behaviour among several of those stock market indexes of different dimensions. It seems, therefore, that the behaviour of these markets tends to some uniformity, which can be interpreted as the existence of a similar behaviour facing to shocks that may affect the worldwide economy. Whether this is a cause or a consequence of market globalization is an issue that may be stressed in future work.Comment: 10 pages, 3 figures. Paper presented in the APFA 5 conferenc

On the integrated behaviour of non-stationary volatility in stock markets

This paper analyses the behaviour of volatility for several international stock market indexes, namely the SP 500 (USA), the Nikkei (Japan), the PSI 20 (Portugal), the CAC 40 (France), the DAX 30 (Germany), the FTSE 100 (UK), the IBEX 35 (Spain) and the MIB 30 (Italy), in the context of non-stationarity. Our empirical results point to the evidence of the existence of integrated behaviour among several of those stock market indexes of different dimensions. It seems, therefore, that the behaviour of these markets tends to some uniformity, which can be interpreted as the existence of a similar behaviour facing to shocks that may affect the worldwide economy. Whether this is a cause or a consequence of market globalization is an issue that may be stressed in future work.Comment: 10 pages, 3 figures. Paper presented in the APFA 5 conferenc