Hippocampal volume, early cognitive decline and gait variability: Which association?

BACKGROUND: In contrast to its prominent function in cognition, the involvement of the hippocampus in gait control is still a matter of debate. The present study aimed to examine the association of the hippocampal volume with mean values and coefficients of variation (CoV) of spatio-temporal gait parameters among cognitively healthy individuals (CHI) and patients with mild cognitive impairment (MCI). METHODS: A total of 90 individuals (47 CHI with a mean age of 69.7±3.6years and 48.9% women, and 43 MCI individuals with a mean age of 70.2±3.7years and 62.8% women) were included in this cross-sectional study. The hippocampal volume was quantified from a three-dimensional T1-weighted MRI using semi-automated software. Mean values and CoV of stride time, swing time and stride width were measured at self-selected pace with a 10m electronic portable walkway (GAITRite®). Age, gender, body mass index, number of drugs daily taken, Mini-Mental State Examination (MMSE) score, history of falls, walking speed and white matter signal-intensity abnormality scoring with Manolio scale were used as covariates. RESULTS: Patients with MCI had a lower MMSE score (P0.650). CONCLUSIONS: Our findings revealed a positive association between a greater (i.e., better morphological structure) hippocampal volume and a greater (i.e., worse performance) stride time variability among CHI, but not among MCI individuals

Respective and combined effects of impairments in sensorimotor systems and cognition on gait performance: a population-based cross-sectional study.

BACKGROUND: Respective and combined effects of impairments in sensorimotor systems and cognition on gait performance have not been fully studied. This study aims to describe the respective effects of impairments in muscle strength, distance vision, lower-limb proprioception and cognition on the Timed Up & Go (TUG) scores (i.e., performed TUG [pTUG], imagined TUG [iTUG] and the time difference between these two tests [delta TUG]) in older community-dwellers; and to examine their combined effects on TUG scores. METHODS: Based on a cross-sectional design, 1792 community-dwellers (70.2±4.8 years; 53.6% female) were recruited. Gait performance was assessed using pTUG, iTUG and delta TUG. Participants were divided into healthy individuals and 15 subgroups of individuals according to the presence of impairment in one or more subsystems involved in gait control (i.e., muscle strength and/or distance vision and/or lower-limb proprioception and/or cognition [episodic memory and executive performance]). Impairment in muscle strength, distance vision and lower-limb proprioception was defined as being in the lowest tertile of performance. Impairment in cognition was defined as abnormal episodic memory and executive tests. RESULTS: A total of 191 (10.7%) exhibited impairment in muscle strength, 188 (10.5%) in distance vision, 302 (16.9%) in lower-limb proprioception, and 42 (2.3%) in cognition. Linear regressions showed that cognitive impairment as well as dual combinations of impairments were associated with increased pTUG (P CONCLUSION: Cognitive integrity is central for efficient gait control and stability, whereas lower-limb proprioception seems to be central for gait imagery

Motoric Cognitive Risk Syndrome: Could It Be Defined Through Increased Five-Times-Sit-to-Stand Test Time, Rather Than Slow Walking Speed?

Background: Slow walking speed, time to perform the five-times-sit-to-stand (FTSS) test and motoric cognitive risk syndrome (MCR; defined as slow gait speed combined with subjective cognitive complaint) have been separately used to screen older individuals at risk of cognitive decline. This study seeks to (1) compare the characteristics of older individuals with MCR, as defined through slow walking speed and/or increased FTSS time; and (2) examine the relationship between MCR and its motor components as well as amnestic (a-MCI) and non-amnestic (na-MCI) Mild Cognitive Impairment.Methods: A total of 633, individuals free of dementia, were selected from the cross-sectional “Gait and Alzheimer Interactions Tracking” study. Slow gait speed and increased FTSS time were used as criteria for the definition of MCR. Participants were separated into five groups, according to MCR status: MCR as defined by (1) slow gait speed exclusively (MCRs); (2) increased FTSS time exclusively (MCRf); (3) slow gait speed and increased FTSS time (MCRsaf); (4) MCR; irrespective of the mobility test used (MCRsof); and (5) the absence of MCR. Cognitive status (i.e., a-MCI, na-MCI, cognitively healthy) was also determined.Results: The prevalence of MCRs was higher, when compared to the prevalence of MCRf (12.0% versus 6.2% with P ≤ 0.001). There existed infrequent overlap (2.4%) between individuals exhibiting MCRs and MCRf, and frequent overlap between individuals exhibiting MCRs and na-MCI (up to 50%). a-MCI and na-MCI were negatively [odd ratios (OR) ≤ 0.17 with P ≤ 0.019] and positively (OR ≥ 2.41 with P ≤ 0.019) related to MCRs, respectively.Conclusion: Individuals with MCRf are distinct from those with MCRs. MCRf status does not relate to MCI status in the same way that MCRs does. MCRs is related negatively to a-MCI and positively to na-MCI. These results suggest that FTTS cannot be used to define MCR when the goal is to predict the risk of cognitive decline, such as future dementia

Emergency Room Evaluation and Recommendations and Risk Screening of Incident Major Neurocognitive Disorders in Older Females: Results of an Observational Population-Based Cohort Study

Background“Emergency Room Evaluation and Recommendations” (ER2) risk levels (i.e., low, moderate and high) may be used to screen for major neurocognitive disorders (MNCD) in older emergency department users, as a high ER2 risk level is associated with MNCD diagnosis. This study aims to examine the association of ER2 risk levels with incident MNCD in community-dwelling older adults.MethodsA total of 709 participants of the EPIDémiologie de l’OStéoporose (EPIDOS) study—an observational population-based cohort study—were recruited in Toulouse (France). ER2 low, moderate and high risk levels were determined at baseline. Incident MNCD and their type (i.e., Alzheimer’s disease (AD) vs. non-AD) were diagnosed after a 7-year follow-up period.ResultsThe overall incidence of MNCD was 29.1%. A low ER2 risk level was associated with low incidence of MNCD [Hazard ratio (HR) = 0.71 with P = 0.018] and AD (HR = 0.56 with P = 0.003), whereas a high risk level, both individually and when combined with a moderate risk level, was associated with high incidence of MNCD (HR ≥ 1.40 with P ≤0.018) and AD (HR ≥ 1.80 with P ≤ 0.003). No association was found with incident non-AD.ConclusionER2 risk levels were positively associated with incident MNCD in EPIDOS participants, suggesting that ER2 may be used for risk screening of MNCD in the older population

Guidelines for assessment of gait and reference values for spatiotemporal gait parameters in older adults: The biomathics and canadian gait consortiums initiative

Abstract: Background: Gait disorders, a highly prevalent condition in older adults, are associated with several adverse health consequences. Gait analysis allows qualitative and quantitative assessments of gait that improves the understanding of mechanisms of gait disorders and the choice of interventions. This manuscript aims (1) to give consensus guidance for clinical and spatiotemporal gait analysis based on the recorded footfalls in older adults aged 65 years and over, and (2) to provide reference values for spatiotemporal gait parameters based on the recorded footfalls in healthy older adults free of cognitive impairment and multi-morbidities.Methods: International experts working in a network of two different consortiums (i.e., Biomathics and Canadian Gait Consortium) participated in this initiative. First, they identified items of standardized information following the usual procedure of formulation of consensus findings. Second, they merged databases including spatiotemporal gait assessments with GAITRite® system and clinical information from the “Gait, cOgnitiOn & Decline” (GOOD) initiative and the Generation 100 (Gen 100) study. Only healthy—free of cognitive impairment and multi-morbidities (i.e., ≤ 3 therapeutics taken daily)—participants aged 65 and older were selected. Age, sex, body mass index, mean values, and coefficients of variation (CoV) of gait parameters were used for the analyses. Results: Standardized systematic assessment of three categories of items, which were demographics and clinical information, and gait characteristics (clinical and spatiotemporal gait analysis based on the recorded footfalls), were selected for the proposed guidelines. Two complementary sets of items were distinguished: a minimal data set and a full data set. In addition, a total of 954 participants (mean age 72.8 ± 4.8 years, 45.8% women) were recruited to establish the reference values. Performance of spatiotemporal gait parameters based on the recorded footfalls declined with increasing age (mean values and CoV) and demonstrated sex differences (mean values). Conclusions: Based on an international multicenter collaboration, we propose consensus guidelines for gait assessment and spatiotemporal gait analysis based on the recorded footfalls, and reference values for healthy older adults

Fear of Falling and Gait Variability in Older Adults: A Systematic Review and Meta-Analysis.

BACKGROUND: Fear of falling (FOF) and increased gait variability are both independent markers of gait instability. There is a complex interplay between both entities. The purposes of this study were (1) to perform a qualitative analysis of all published studies on FOF-related changes in gait variability through a systematic review, and (2) to quantitatively synthesize FOF-related changes in gait variability. METHODS: A systematic Medline literature search was conducted in May 2014 using the Medical Subject Heading (MeSH) terms Fear OR fear of falling combined with Accidental Falls AND Gait OR Gait Apraxia OR Gait Ataxia OR Gait disorders, Neurologic OR Gait assessment OR Functional gait assessment AND Self efficacy OR Self confidence AND Aged OR Aged, 80 and over. Systematic review and fixed-effects meta-analysis using an inverse-variance method were performed. RESULTS: Of the 2184 selected studies, 10 observational studies (including 5 cross-sectional studies, 4 prospective cohort studies, and 1 case-control study) met the selection criteria. All were of good quality. The number of participants ranged from 52 to 1307 older community-dwellers (26.2%-85.0% women). The meta-analysis was performed on 10 studies with a total of 999 cases and 4502 controls. In one study, the higher limits of the effect size\u27s confidence interval (CI) were lower than zero. In the remaining studies, the higher limits of the CI were positive. The summary random effect size of 0.29 (95% CI 0.13-0.45) was significant albeit of small magnitude, and indicated that gait variability was overall 0.29 SD higher in FOF cases compared with controls. CONCLUSIONS: Our findings show that FOF is associated with a statistically significant, albeit of small magnitude, increase in gait variability

Risk for short-term undesirable outcomes in older emergency department users : results of the ER2 observational cohort study

The "Emergency Room Evaluation and Recommendations" (ER2) is a clinical tool designed to determine prognosis for the short-term Emergency Department (ED) undesirable outcomes including long length of stay (LOS) in ED and in hospital, as well as the likelihood of hospital admission during an index ED visit. It is also designed to guide appropriate and timely tailor-made geriatric interventions. This study aimed to examine whether ER2 assessment part was: 1) usable by ED healthcare workers (e.g. nurses) and 2) scoring system associated with long LOS in ED and in hospital, as well as hospital admission in older ED users on stretchers.Published versionThe study was self funded by the Centre of Excellence on Longevity, through funds allocated to research by the Foundation of the Jewish General Hospital. The authors received no specific funding for this work. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Episodic memory and executive function impairments in non-demented older adults: which are the respective and combined effects on gait performances?

Gait control depends in part on cognition. This study aims to examine the separate and combined effects of episodic memory and executive function impairments on the mean value and the coefficient of variation (CoV) of stride time among non-demented older community dwellers. Based on a cross-sectional design, 1458 older community dwellers without dementia (70.6 ± 4.9 years; 49.2 % female) were recruited and separated into cognitively healthy individuals (CHI) and individuals with cognitive impairment. A score ≤5/6 on the Short Mini-Mental State Examination defined episodic memory impairment. Impaired executive function was defined by errors on the clock-drawing test. Mean value and CoV of stride time were measured by the GAITRite® system. A total of 517 participants (35.5 %) had cognitive impairment in at least one cognitive domain. Participants with memory impairment (P = 0.006) and those with combined cognitive impairments (P < 0.001) had greater (i.e., worse gait performance) mean value of stride time (P = 0.006) compared to CHI. Participants with combined cognitive impairment had a greater CoV of stride time (i.e., worse gait performance) compared to CHI (P = 0.004) and to those with separate memory impairment (P = 0.037). Among participants with combined cognitive impairments, mean value and CoV of stride time had the highest effect size (respectively, effect size = 0.49 [95 % confidence interval (CI) 0.27;0.71] and effect size = 0.40 [95 %CI 0.18;0.62]). Participants with episodic memory or executive impairments had a greater mean value and CoV of stride time compared to those with no cognitive impairment. Combined episodic memory and executive impairments exceeded the sum of separate impairments on gait performances, suggesting a complex interplay going beyond a simple additive effect

Motoric cognitive risk syndrome and incident hospitalization in Quebec's older population: results of the NuAge cohort study

Background: Screening older adults at risk of hospitalization is essential to prevention of this adverse event. Motoric cognitive risk syndrome (MCR) has been associated with incident dementia and falls, which are both risk factors of hospitalization. There is no information on the association of MCR with incident hospitalization in older adults. Objective: The study aims to examine the association of MCR with incident hospitalization in community-dwelling older adults. Design: Quebec older population-based observational cohort study with 3 years of follow-up. Setting: Community dwellings. Subjects: A subset of 999 participants recruited in the NuAge study. Methods: Participants with MCR (i.e., with slow gait and cognitive complaint without dementia or motor disability) were identified at baseline assessment. Incident hospitalization (i.e., ≥1) and its recurrence (i.e., ≥2) were collected annually over a 3 year follow-up period. Results: The prevalence of MCR was 5.0% at baseline. The overall incidence of hospitalization was 29.0% and its recurrence 4.8%. MCR was associated with incident recurrent hospitalization [adjusted Hazard Ratio (aHR) = 2.58 with 95% Confidence Interval (CI) = (1.09–6.09) and P = 0.031], but not with incident hospitalization [aHR = 1.48, with 95%CI = (0.95–2.28) and P = 0.081]. Conclusion: MCR is associated with incident recurrent hospitalization in NuAge participants, suggesting that MCR may be of clinical interest for screening individuals at risk for hospitalization in Quebec's older population.Published versionThe NuAge Study was funded by the Canadian Institutes of Health Research (CIHR; MOP-62842). The NuAge Database and Biobank are supported by the Fonds de recherche du Québec (FRQ; 2020-VICO-279753), the Quebec Network for Research on Aging, a thematic network funded by the FRQ-Santé, and by the Merck-Frosst Chair funded by La Fondation de l’Université de Sherbrooke. An access to this research bank can be asked by completing an access request on their website (https://nuage. recherche.usherbrooke.ca/en/). OB and GA were supported by the National Institute of Health/National Institute on Aging grants PO1 AG03949 and R01AG057548-01A1. The French Ministry of Health financially supported the study. The sponsor had no role in designing and conducting the study, nor in the collection, management, analysis, and interpretation of the data, nor in the preparation, review, or approval of the manuscript and writing of the study