Balanse og parkinsonistiske tegn hos pasienter med Alzheimers sykdom

Bakgrunn og formål: Pasienter med Alzheimer sykdom har redusert balanse og økt forekomst av parkinsonistiske tegn sammenlignet med friske jevnaldrende. Sammenhengen mellom disse to ulike uttrykkene for motorisk dysfunksjon er ikke undersøkt. Formålet med denne studien er derfor å undersøke sammenhenger mellom parkinsonistiske tegn og balanse hos pasienter med Alzheimers sykdom. Metode: Dette er en pilotstudie, og er designet som en tverrsnittsstudie. Tjue pasienter med Alzheimer sykdom ble inkludert fra geriatriske avdelinger ved Sykehuset Asker og Bærum HF og Ullevål Universitetssykehus. Pasientene hadde ingen andre medisinske tilstander som forårsaket redusert balanse. Balanse ble undersøkt ved hjelp av Bergs balanseskala. Parkinsonistiske tegn ble undersøkt ved hjelp av Motorisk undersøkelse fra Unified Parkinson s Disease Rating Scale (UPDRS). Skår for rigiditet, bradykinesi og tremor ble utledet fra UPDRS ved å beregne prosentandelen av total oppnåelig poengsum for hvert tegn. Gjennomsnittet av disse tre skårene ble brukt som skår for samlet parkinsonisme. Korrelasjoner ble beregnet ved hjelp av Pearson s korrelasjons koeffisient. Resultater: Balanse var signifikant korrelert med parkinsonisme (r = -0.47, p<0.05), men ikke med rigiditet (r = -0.33), bradykinesi (r = -0.40) eller tremor (r = -0.38). Balanse var også korrelert med alder (r =-0.46, p<0.05). Konklusjon: Det er sammenheng mellom balanse og parkinsonisme, men ikke mellom balanse og hvert enkelt parkinsonistisk tegn. Større studier er nødvendig for å bekrefte disse funnene

Mobility and associations with levels of cerebrospinal fluid amyloid β and tau in a memory clinic cohort

BackgroundMobility impairments, in terms of gait and balance, are common in persons with dementia. To explore this relationship further, we examined the associations between mobility and cerebrospinal fluid (CSF) core biomarkers for Alzheimer’s disease (AD).MethodsIn this cross-sectional study, we included 64 participants [two with subjective cognitive decline (SCD), 13 with mild cognitive impairment (MCI) and 49 with dementia] from a memory clinic. Mobility was examined using gait speed, Mini-Balance Evaluation Systems test (Mini-BESTest), Timed Up and Go (TUG), and TUG dual-task cost (TUG DTC). The CSF biomarkers included were amyloid-β 42 (Aβ42), total-tau (t-tau), and phospho tau (p-tau181). Associations between mobility and biomarkers were analyzed through correlations and multiple linear regression analyses adjusted for (1) age, sex, and comorbidity, and (2) SCD/MCI vs. dementia.ResultsAβ42 was significantly correlated with each of the mobility outcomes. In the adjusted multiple regression analyses, Aβ42 was significantly associated with Mini-BESTest and TUG in the fully adjusted model and with TUG DTC in step 1 of the adjusted model (adjusting for age, sex, and comorbidity). T-tau was only associated with TUG DTC in step 1 of the adjusted model. P-tau181 was not associated with any of the mobility outcomes in any of the analyses.ConclusionBetter performance on mobility outcomes were associated with higher levels of CSF Aβ42. The association was strongest between Aβ42 and Mini-BESTest, suggesting that dynamic balance might be closely related with AD-specific pathology

Trajectories of physical performance in nursing home residents with dementia

Background In nursing homes (NH) the prevalence of dementia ranges from 50 to 84% and most residents have extensive physical-performance impairments. However, from time of admission, development of physical performance in NH residents with dementia remains unexplored. Aims To explore the overall trend in physical performance, associated characteristics, and groups following distinct trajectories from time of admission, in NH residents with dementia. Methods We followed newly admitted NH residents diagnosed with dementia (N=583) from 47 NHs across Norway for 3 years. Individual assessments were conducted biannually, and main outcome measure was the Short Physical Performance Battery (SPPB). Facility-level characteristics included unit size, staf-to-resident ratio, and quality of the physical environment (Special Care Unit Environmental Quality Scale, SCUEQS). Results From time of admission, NH residents with dementia showed a signifcant overall decline in physical performance. Further, we identifed three distinct trajectory groups with signifcantly diferent baseline physical-performance status (“good,” “moderate,” and “poor”), diferences between groups maintained and all declined across time. Younger age, good general medical health, less-severe dementia, and less musculoskeletal pain were associated with both an average higher overall trend and better baseline group-belonging. Additionally, less apathy and more psychosis were associated with a higher overall trend, and agitation was associated with poorer baseline group-belonging. Conclusions To prevent excessive decline in physical performance in this population, NH clinicians should focus eforts specifcally on assessment of physical performance at admission and on identifcation and management of musculoskeletal pain and neuropsychiatric symptoms. Keywords Physical performance · Trajectories · Dementia · Nursing homepublishedVersio

Mobility and cognition in patients with cognitive impairment and Alzheimer’s disease

Background: The number of people with cognitive impairment and dementia is increasing worldwide. This development will put considerable strain on health services, and it will be increasingly important to help people with dementia to live safely at home for as long as possible. One of the main threats to independent living is impairments in abilities related to mobility, such as balance, walking, and spatial navigation. These abilities are scarcely studied in clinical practice. Increased knowledge of the character of such mobility impairments in patients with mild cognitive impairment and dementia of various severity may help in the development of interventions aimed at postponing the loss of mobility skills. Aims: The overall aims of this thesis were (1) to explore how mobility performance differs between groups with different levels of cognitive impairment (papers II and III) and how mobility changes over one year in people with early onset Alzheimer’s disease (AD) (paper I), and (2) to explore the relationship between mobility and different domains of cognitive function (papers II and III). Methods: This thesis includes three papers which all apply a cross-sectional design. We also applied a one-year longitudinal follow-up in paper I. The samples in the three studies mainly consist of patients recruited from memory clinics in Malmø, Sweden (paper I) and in Oslo, Norway (papers II and III). Paper I included 72 patients with early onset dementia in the cross-sectional part, and 25 of the 42 patients with early onset AD also attended a one-year follow-up. Paper II included 170 patients in three groups: 33 with subjective cognitive impairment (SCI) or mild cognitive impairment (MCI), 99 with mild AD, and 38 with moderate AD. In paper III, we used a subsample of 128 patients from the sample included in paper II: 19 with SCI, 20 with MCI, and 89 with mild AD. Outcomes: In all three papers, we used performance-based measures of mobility. In paper I, we used timed measures of several mobility tasks. In paper II, we used the Balance Evaluation Systems Test (BESTest) to assess the various aspects of balance. In paper III, we used the Floor Maze Test to assess spatial navigation during walking. The cognitive domains were in papers II and III assessed using tests from the test battery in the Norwegian Dementia Register. Statistical analyses: Between-group differences were analyzed using different versions of analysis of variance (papers I and II), Chi-square tests (papers I and III) and the Mann- Whitney U-test (paper III). The relationship between the mobility measures and the cognitive domains were analyzed using multiple regression analysis (papers II and III). Changes over time were analyzed using the paired samples t-test (paper I). Results: Paper I: Patients with early onset AD had inferior mobility performance compared to patients with other forms of early onset dementia. The performance of the patients with early onset AD deteriorated from baseline to the one-year follow-up. Papers II and III: We found between-group differences (based on severity of cognitive impairment) in all aspects of balance measured by the BESTest and also in spatial navigation measured by the Floor Maze Test. The worst performance was in the group with the most pronounced cognitive impairment. Executive function was the only cognitive domain independently associated with all the mobility outcomes in the multivariate models. Conclusions: We found differences between each of the groups in all aspects of balance (paper II) and also in spatial navigation (paper III). In our longitudinal study of early onset AD we also saw a small decline in mobility over one year (paper I). Although our findings from these cross-sectional indicate a decline in mobility through the stages from SCI to MCI, mild AD, and moderate AD, these findings need to be confirmed in longitudinal studies. With regard to the second aim, executive function was associated with all aspects of balance, and also with spatial navigation. The explained variances were generally high in the models of the aspects of balance. However, for spatial navigation, the models provided only minor explained variances. Future studies are needed to validate the Floor Maze Test against reallife navigation

Fysisk aktive eldre og treningsvaner?

Hensikt: Undersøke hva som kjennetegner eldre personer som har trent regelmessig over tid og om helsemyndighetenes anbefalinger om fysisk aktivitet følges. Er det forskjell på de som trener hos fysioterapeut og de som har abonnement på treningssenter? Design: Tverrsnittstudie. Materiale: 105 personer over 70 år som har trent regelmessig i minst ett år. Median (range) alder var 74 (70-90) år. Metode: Spørreskjemaer og fysiske tester (styrke, utholdenhet, balanse, mobilitet). Resultat: Median (range) antall år med trening var 20 (1-70) år. 64% hadde muskelskjelettplager og 46% var kvinner. Oppgitt varighet, intensitet og hyppighet av trening samsvarer stort sett med myndighetenes anbefalinger. De fleste trente utholdenhet og styrke, kun halvparten oppga å trene balanse. En større andel av gruppen som trente hos fysioterapeut oppga medisinske grunner som motivasjon for trening. Det var ingen forskjell mellom gruppene på de fysiske testene. Konklusjon: Resultatene viser at oppgitt varighet, intensitet og frekvensen av treningen i stor grad samsvarer med anbefalingene fra Helsedirektoratet. Det var ingen forskjeller på eldre som trente hos fysioterapeut og de som trente på treningssenter, bortsett fra motivasjon for trening. Balanse og bevegelighet er dårligst ivaretatt og bør antagelig oppmuntres i større grad også hos aktive eldre

Measuring physical performance in highly active older adults: associations with age and gender?

Background Higher age is associated with reduced physical capability in the general population. The role of age and gender for physical performance in older adults who exercises regularly is, however, not clear, and there is also a lack of recommendations for outcomes to address physical performance for this population. Aims To explore the associations between physical performance, age and gender, and to examine the suitability and feasibility of clinical field tests for physical performance in active older adults. Methods In this cross-sectional study we included 105 persons, 70–90 years of age, who had exercised regularly for ≥ 12 months. The field tests were Short Physical Performance Battery (SPPB), Timed Up and Go and gait speed for mobility; One-leg standing (OLS) test and Mini-BESTest for balance; Stair test for endurance, 30 s sit-to-stand, and grip strength for muscle strength. Results We found associations between age and physical performance, and the associations were slightly stronger for women. Men performed better on tests of muscle strength, balance and endurance, while no gender differences were found in mobility. Grip strength was not associated with mobility tests for men. All tests were feasible, while SPPB and OLS had ceiling and floor effects that limit their suitability in this population. Conclusions Both age and gender were associated with physical performance. We recommend using the gait speed, Mini-BESTest, 30 s sit-to-stand, grip strength and stair tests to assess physical performance in physically active older adults

A Longitudinal Study of Physical Function in Patients with Early-Onset Dementia

Background: The aim of this study was to explore changes in mobility in terms of ambulation and transfer over 1 year in patients with early-onset Alzheimer’s disease (EOAD), and to compare mobility in EOAD with patients with other types of early-onset dementia (EOOD). Method: Forty-two patients with EOAD and 30 patients with EOOD were included. All patients were home-dwelling and had mild or moderate degree of dementia. Mobility was assessed using the Timed Up and Go Test (TUG), a modified version of the Clinical Outcome Variables Scale, timed stair walking, and timed rise from the floor. Results: The EOAD group performed significantly better than the EOOD group on all mobility tests. After 1 year, 25 persons with EOAD were tested again. The performance on TUG (p = 0.028) and stair walking (p = 0.02) had deteriorated at the 1-year follow-up in the EOAD group. Conclusion: Patients with EOAD performed better on mobility tasks than patients with EOOD, but their performance deteriorated at 1-year follow-up

Subjective memory impairment, instrumental activities of daily living and longitudinal effect on mortality among older adults in a population-based cohort study: The HUNT Study

Background: Subjective impairment in memory and instrumental activities in daily living (IADL) are associated with future cognitive decline and poorer mental health in older adults, but their association with mortality is uncertain. Our aim was to examine the associations between subjective memory and IADL impairments and all-cause mortality, as well as the mortality risk for reporting both memory and IADL impairments. Methods: Data from the 70-year-old and older cohort in the third survey of a population-based study, the Nord-Trøndelag Health Study (HUNT3), were linked to the Norwegian Causes of Death Registry. A total of 5802 older adults had complete data from HUNT3 (70.8% of the 70+ cohort). The mean follow-up time was 8.0 years, and 1870 respondents had died. Associations between subjective memory and ADL impairments with mortality were analysed in Cox regression models adjusted for covariates with attained age as the timescale. Analyses were performed separately for two age groups – 70–79 and 80+ years – to fulfil the proportional hazards assumption. Results: Subjective impairments in short-term memory and IADL were significantly associated with mortality both separately and combined. These associations were strongest in the 70- to 79-year-old group, where reporting impairment on one short-term memory item increased the mortality risk by 51% (hazard ratio=1.51; 95% confidence interval 1.20–1.91). Long-term memory impairments were not associated with mortality in the adjusted models. Conclusions: Subjective short-term memory impairments and IADL impairments are associated with increased mortality risk. Neither of these symptoms should be regarded as benign aspects of ageing, and concerns should be properly addressed