Adaptive Walking In Alzheimer's Disease

The aim of this study is to analyze dual-task effects on free and adaptive gait in Alzheimer's disease (AD) patients. Nineteen elders with AD participated in the study. A veteran neuropsychiatrist established the degree of AD in the sample. To determine dual-task effects on free and adaptive gait, patients performed five trials for each experimental condition: free and adaptive gait with and without a dual-task (regressive countdown). Spatial and temporal parameters were collected through an optoelectronic tridimensional system. The central stride was analyzed in free gait, and the steps immediately before (approaching phase) and during the obstacle crossing were analyzed in adaptive gait. Results indicated that AD patients walked more slowly during adaptive gait and free gait, using conservative strategies when confronted either with an obstacle or a secondary task. Furthermore, patients sought for stability to perform the tasks, particularly for adaptive gait with dual task, who used anticipatory and online adjustments to perform the task. Therefore, the increase of task complexity enhances cognitive load and risk of falls for AD patients. © 2012 Diego Orcioli-Silva et al.Cocchini, G., Della Sala, S., Logie, R.H., Pagani, R., Sacco, L., Spinnler, H., Dual task effects of walking when talking in Alzheimer's disease (2004) Revue Neurologique, 160 (1), pp. 74-80Della Sala, S., Spinnler, H., Venneri, A., Walking difficulties in patients with Alzheimer's disease might originate from gait apraxia (2004) Journal of Neurology, Neurosurgery and Psychiatry, 75 (2), pp. 196-201Pettersson, A.F., Olsson, E., Wahlund, L.-O., Effect of divided attention on gait in subjects with and without cognitive impairment (2007) Journal of Geriatric Psychiatry and Neurology, 20 (1), pp. 58-62. , DOI 10.1177/0891988706293528Maquet, D., Lekeu, F., Warzee, E., Gillain, S., Wojtasik, V., Salmon, E., Petermans, J., Croisier, J.L., Gait analysis in elderly adult patients with mild cognitive impairment and patients with mild Alzheimer's disease: Simple versus dual task: A preliminary report (2010) Clinical Physiology and Functional Imaging, 30 (1), pp. 51-56. , 2-s2.0-72549083959 10.1111/j.1475-097X.2009.00903.xImamura, T., Hirono, N., Hashimoto, M., Kazui, H., Tanimukai, S., Hanihara, T., Takahara, A., Mori, E., Fall-related injuries in dementia with Lewy bodies (DLB) and Alzheimer's disease (2000) European Journal of Neurology, 7 (1), pp. 77-79. , DOI 10.1046/j.1468-1331.2000.00021.xCamicioli, R., Licis, L., Motor impairment predicts falls in specialized Alzheimer care units (2004) Alzheimer Disease and Associated Disorders, 18 (4), pp. 214-218Van Dijk, P.T.M., Meulenberg, O.G.R.M., Van De Sande, H.J., Habbema, J.D.F., Falls in dementia patients (1993) Gerontologist, 33 (2), pp. 200-204Siu, K.C., Lugade, V., Chou, L.S., Van Donkelaar, P., Woollacott, M.H., Dual-task interference during obstacle clearance in healthy and balance-impaired older adults (2008) AgingClinical and Experimental Research, 20 (4), pp. 349-354. , 2-s2.0-56249114879Sheridan, P.L., Solomont, J., Kowall, N., Hausdorff, J.M., Influence of executive function on locomotor function: Divided attention increases gait variability in alzheimer's disease (2003) Journal of the American Geriatrics Society, 51 (11), pp. 1633-1637. , DOI 10.1046/j.1532-5415.2003.51516.xBle, A., Volpato, S., Zuliani, G., Guralnik, J.M., Bandinelli, S., Lauretani, F., Bartali, B., Ferrucci, L., Executive function correlates with walking speed in older persons: The InCHIANTI study (2005) Journal of the American Geriatrics Society, 53 (3), pp. 410-415. , DOI 10.1111/j.1532-5415.2005.53157.xPersad, C.C., Jones, J.L., Ashton-Miller, J.A., Alexander, N.B., Giordani, B., Executive function and gait in older adults with cognitive impairment (2008) Journals of Gerontology A, 63 (12), pp. 1350-1355. , 2-s2.0-62149152018(2000) Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TRed, , American Psychiatric Association, 4th Amer PsychiatricHughes, C.P., Berg, L., Danziger, W.L., A new clinical scale for the staging of dementia (1982) British Journal of Psychiatry, 140 (6), pp. 566-572Cummings, J.L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D.A., Gornbein, J., The neuropsychiatric inventory: Comprehensive assessment of psychopathology in dementia (1994) Neurology, 44 (12), pp. 2308-2314Folstein, M.F., Folstein, S.E., McHugh, P.R., 'Mini mental state. 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Variability In Obstacle Clearance May (not) Indicate Cognitive Disorders In Alzheimer Disease

The aim of this study was to investigate obstacle clearance and its variability in individuals with Alzheimer dementia (AD) as well as healthy elderly individuals while they approached and crossed an obstacle in their path. Fifteen people with AD and 15 age-matched/sex-matched healthy individuals (control group) participated in this study. Clinical assessment of both groups was performed by a neuropsychiatrist. Spatial-temporal parameters of 5 trials of unobstructed walking and 5 trials of obstacle crossing during walking (approach and crossing phases) were measured using a 3-dimensional optoelectronic system. The results indicated that individuals with AD showed higher variability in the approach phase for stride length and the horizontal distance from their trailing limb foot to the obstacle. However, their gait variability in the crossing phase was similar to the control group. In addition, the individuals with AD were found to walk slowly and with a short stride length in both conditions. In conclusion, individuals with AD had increased gait variability while approaching an obstacle during walking, indicating a deficit in planning to avoid obstacles that could be related to cognitive disorders. However, gait variability during the crossing phase may not be indicative of cognitive disorders in AD

Obstacle Crossing With Dual Tasking Is A Danger For Individuals With Alzheimer's Disease And For Healthy Older People

Background/Objective: The aim of this study was to analyze the effects of dual tasking on obstacle crossing during walking by individuals with Alzheimer's disease (AD) and by healthy older people. Methods: Thirty four elderly individuals (16 healthy subjects and 18 individuals with AD) were recruited to participate in this study. Three AD individuals and one control participant were excluded due to exclusion criteria. The participants were instructed to walk barefoot at their own speed along an 8 m long pathway. Each participant performed five trials for each condition (unobstructed walking, unobstructed walking with dual tasking, and obstacle crossing during walking with dual tasking). The trials were completely randomized for each participant. The mid-pathway stride was measured in the unobstructed walking trials and the stride that occurred during the obstacle avoidance was measured in the trials that involved obstacle crossing. Results/Conclusion: The behavior of the healthy elderly subjects and individuals with AD was similar for obstacle crossing during walking with dual tasking. Both groups used the 'posture first' strategy to prioritize stability and showed decreased attention to executive tasking while walking. 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