ORIGINAL ARTICLE   Free access

European Journal of Physical and Rehabilitation Medicine 2021 August;57(4):560-7

DOI: 10.23736/S1973-9087.20.06550-8

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Balance and gait performance in older adults with early-stage cognitive impairment

Yi-Chun KUAN ^{1, 2, 3, 4, 5, 6}, Li-Kai HUANG ^{1, 2, 7, 8}, Yuan-Hung WANG ^{9, 10}, Chaur-Jong HU ^{1, 2, 3}, Ing-Jy TSENG ¹¹, Hung-Chou CHEN ^{1, 12, 13}, Li-Fong LIN ^{11, 12, 14, 15} ✉

¹ Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan; ² Department of Neurology and Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan; ³ Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; ⁴ Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; ⁵ Center for Evidence-Based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; ⁶ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan, Taiwan; ⁷ Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan; ⁸ College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, Taipei, Taiwan; ⁹ Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; ¹⁰ Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan; ¹¹ School of Gerontology Health Management College of Nursing, Taipei Medical University, Taipei, Taiwan; ¹² Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan; ¹³ Department of Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; ¹⁴ Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan; ¹⁵ Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan

BACKGROUND: People with cognitive impairment are susceptible to fall. Previous studies regarding balance and gait enrolled patients with various severity of dementia. Quantification of the balance and gait performance of people with cognitive impairment may help identify their postural instability and fall risks.
AIM: We investigated the differences in balance and gait among older adults with preserved cognition, amnestic mild cognitive impairment, and mild dementia due to Alzheimer’s disease.
DESIGN: Prospective observational study.
SETTING: Outpatient department of neurology or psychology.
POPULATION: Older adults (aged ≥65 years) with independent gait were evaluated using the Mini-Mental State Examination and Clinical Dementia Rating scale. People with other neurological or musculoskeletal disorders were excluded.
METHODS: Participants were classified into three groups: 30 healthy controls, 30 mild cognitive impairment and 30 mild dementia. Balance were evaluated through functional test (Berg Balance Scale [BBS]) and laboratory test (posturography). Gait was assessed by wearable device. Muscle strength and mass were measured through grip force, calf circumstance, and body composition.
RESULTS: The BBS (P=0.04), posturography of fall risk index (FR, P=0.01) and sensory integration indices in eyes open and firm surface (EOFIS, P=0.009), eyes open and foam surface (EOFOS, P=0.003) were substantially different among three groups. EOFIS and EOFOS indices of balance in mild dementia were significantly worse than in MCI. The gait speed (P=0.04) and stride length (P=0.04) were significantly different among three groups. The post-hoc analyses revealed that all above balance and gait indices in subjects with cognitive impairments were significantly worse than in healthy controls. The grip force, calf circumstance and body composition-muscle mass did not significantly differ among three groups.
CONCLUSIONS: It is a piece of evidence that cognitive dysfunction, even in early stage of memory decline, may have some bad impact on balance and gait regardless of the effect of musculoskeletal problems.
CLINICAL REHABILITATION IMPACT: Understanding the difference of specific indices of balance and gait among different severity of cognitive impairments and healthy controls could help to develop better balance-oriented rehabilitation programs in older adults at early-stage cognitive impairment.

KEY WORDS: Cognitive dysfunction; Gait; Dementia; Alzheimer disease