Larissa Pires de Andrade

Caregiver report versus clinician impression: disagreements in rating neuropsychiatric symptoms in Alzheimer's disease patients

The measurement of neuropsychiatric symptoms (NPS) in dementia is often based on caregiver report. Challenges associated with providing care may bias the caregivers recognition and reporting of symptoms. Given potential problems associated with caregiver report, clinicians may improve measurement by drawing from a wider array of available data and by applying clinical judgment.

Gait, dual task and history of falls in elderly with preserved cognition, mild cognitive impairment, and mild Alzheimer's disease

Highlights • Dual tasks can be applicable to assess elderly with mild Alzheimers disease.• Patients with preserved cognition and mild cognitive impairment presented with similar mobility.• Specific local and consequences of falls were identified for each cognitive group.

The relationship between dual-task and cognitive performance among elderly participants who exercise regularly.

BACKGROUND: The dual-task performance is associated with the functionality of the elderly and it becomes more complex with age. OBJECTIVE: To investigate the relationship between the Timed Up and Go dual task (TUG-DT) and cognitive tests among elderly participants who exercise regularly. METHOD: This study examined 98 non-institutionalized people over 60 years old who exercised regularly. Participants were assessed using the TUG-DT (i.e. doing the TUG while listing the days of the week in reverse order), the Montreal Cognitive Assessment (MoCA), the Clock Drawing Test (CDT), and the Mini Mental State Examination (MMSE). The motor (i.e. time and number of steps) and cognitive (i.e. number of correct words) data were collected from TUG-DT . We used a significance level of α=0.05 and SPSS 17.0 for all data analyses. RESULTS: This current elderly sample featured a predominance of women (69.4%) who were highly educated (median=10 years of education) compared to Brazilian population and mostly non-fallers (86.7%). The volunteers showed a good performance on the TUG-DT and the other cognitive tests, except the MoCA, with scores below the cutoff of 26 points. Significant and weak correlations were observed between the TUG-DT (time) and the visuo-spatial/executive domain of the MoCA and the MMSE. The cognitive component of the TUG-DT showed strong correlations between the total MoCA performance score and its visuo-spatial/executive domain. CONCLUSIONS: The use of the TUG-DT to assess cognition is promising; however, the use of more challenging cognitive tasks should be considered when the study population has a high level of education.

Association Between Gait and Dual Task With Cognitive Domains in Older People With Cognitive Impairment

ABSTRACT The authors investigated whether impaired gait and dual-task performances are associated with specific cognitive domains among older people with preserved cognition (PC), mild cognitive impairment (MCI), and mild Alzheimers disease (AD). The sample comprised 40 older adults with PC, 40 with MCI, and 38 with mild AD. The assessment consisted of gait (measured by 10-m walk test and Timed Up and Go Test [TUGT]), dual task (measured by TUGT associated with a cognitive-motor task of calling a phone number), and cognition (domains of the Addenbrooke Cognitive Examination–Revised and Frontal Assessment Battery [FAB]). For data analysis, the Pearson product-moment correlation and the backward stepwise linear regression were conducted. Language, fluency, and visuospatial domains predicted the 10-m walk test measure specifically in PC, MCI, and AD groups. Only the visuospatial domain was independently associated with the TUGT measure in the MCI and AD groups. FAB score, language domain, and FAB score and fluency domain were the strongest predictors for the isolated cognitive-motor task measure in the PC, MCI, and AD groups, respectively. The visuospatial domain was independently associated with the dual-task test measure in all 3 groups. The study findings demonstrate the influence of specific cognitive domains in daily mobility tasks in people with different cognitive profiles.

Dual-task as a predictor of falls in older people with mild cognitive impairment and mild Alzheimer's disease: a prospective cohort study

BACKGROUND A dual-task tool with a challenging and daily secondary task, which involves executive functions, could facilitate the screening for risk of falls in older people with mild cognitive impairment or mild Alzheimers disease. OBJECTIVE To verify if a motor-cognitive dual-task test could predict falls in older people with mild cognitive impairment or mild Alzheimers disease, and to establish cutoff scores for the tool for both groups. METHODS A prospective study was conducted with community-dwelling older adults, including 40 with mild cognitive impairment and 38 with mild Alzheimers disease. The dual-task test consisted of the Timed up and Go Test associated with a motor-cognitive task using a phone to call. Falls were recorded during six months by calendar and monthly telephone calls and the participants were categorized as fallers or non-fallers. RESULTS In the Mild cognitive impairment Group, fallers presented higher values in time (35.2s), number of steps (33.7 steps) and motor task cost (116%) on dual-task compared to non-fallers. Time, number of steps and motor task cost were significantly associated with falls in people with mild cognitive impairment. Multivariate analysis identified higher number of steps spent on the test to be independently associated with falls. A time greater than 23.88s (sensitivity=80%; specificity=61%) and a number of steps over 29.50 (sensitivity=65%; specificity=83%) indicated prediction of risk of falls in the Mild cognitive impairment Group. Among people with Alzheimers disease, no differences in dual-task between fallers and non-fallers were found and no variable of the tool was able to predict falls. CONCLUSION The dual-task predicts falls only in older people with mild cognitive impairment.

Differences in Timed Up and Go Subtasks Between Older People With Mild Cognitive Impairment and Mild Alzheimer’s Disease

This study compared performances of timed up and go test subtasks between 40 older people with preserved cognition, 40 with mild cognitive impairment, and 38 with mild Alzheimers disease. The assessment consisted of anamneses and timed up and go test subtasks (sit-to-stand, walking forward, turn, walking back, and turn-to-sit). Data were captured by Qualisys Track Manager software and processed by Visual3D software. The MATLAB program was applied to detect and analyze timed up and go test subtasks. All subtasks differentiated people with Alzheimers disease and preserved cognition, except the sit-to-stand subtask, which did not distinguish any group. The walking forward subtask differed older people with preserved cognition from mild cognitive impairment, specifically on minimum peak of knee, average value of knee, and hip (pitch axis) during stance phase. The walking back, turn, and turn-to-sit subtasks distinguished subjects with Alzheimers disease from mild cognitive impairment. The separated analysis of transition and walking subtasks is important in identifying mobility patterns among cognitive profiles.

The Walking Ability in Healthy Older Adults: The Role of Aging and Physical Activity and Its Interface with Agility, Balance, Cognition, and Risk of Falls

Walking is the most basic and common means of locomotion. Walking requires integration and good levels of different physical and mental components and processes. A number of factors, including an inverse relationship with aging and the level of physical activity, can modulate the level of functionality of these components. In addition, the presence of chronic conditions such as sarcopenia, cognitive deficits, and specific changes mainly in frontal brain structures associated with the aging process may affect an individual’s walking pattern. Moreover, walking performance demands integration with the environment and requires reasonable levels of balance, agility, and cognitive skills. Furthermore, walking demands performance in a multiple-task manner which is affected during the aging process due to impaired sensorimotor integration. Impairment in walking pattern along with reduced levels of agility and balance leads to an increased risk of falls. Despite the negative effects of aging on the human organism, regular exercise has been recommended as a means of reducing the rate of decline and maintaining functionality in older adults. Acknowledging the role that aging, physical activity, agility, balance, and cognitive functioning play in walking and also in the risk of falls, this chapter (i) describes how aging and physical activity interfere with walking pattern (stride length, speed, variability), agility, balance, and cognitive functioning and (ii) describes how these components contribute to either increasing or reducing the risk of falls in older adults. To accomplish these goals, scientific literature was reviewed, analyzed, and summarized.