Falls, gait and dual-tasking in older adults with mild
dementia: A cross-sectional study.
Vicky Booth1, Pip Logan1, Tahir Masud2, Victoria Hood3, Veronika van der Wardt1, Rachael Taylor2 and Rowan
Harwood2.
1Division
of Rehabilitation and Aging, University of Nottingham, 2Nottingham University Hospitals (NUH) NHS Trust, 3Physiotherapy and Rehabilitation
Sciences, University of Nottingham.
INTRODUCTION
Older adults with cognitive impairment have an increased
risk of falls. Gait speed and step variability, particularly in a
dual-task paradigm, are considered quantifiable measures to
evaluate the role of cognition on gait. The dual-task
paradigm provides insight into the influence of cognition on
gait. Previous literature is limited and inconsistent in
reporting dual-task assessments, particularly in older adults
with mild dementia.
AIM
The aim was to investigate the relationship between falls risk
and gait measures in single and dual-task conditions in older
adults with mild dementia.
METHOD
Falls risk [Physiological Profile Assessment (PPA); previous 6
months fall history] and global cognition (MOCA) were
measured in a cross-sectional study of older adults with mild
dementia (MOCA 15-25) recruited from memory and falls
services (Balance and the Mind study).
Spatiotemporal gait parameters using the GAITRite system
were recorded in:
• single task (normal gait)
• dual-task counting backwards (from 50 to 0 in 1’s)
• dual-task verbal fluency (words beginning with letter)
Dual-task cost (DTC) was calculated for both the motor (gait
speed [m/s]) and cognitive (counting time [secs] or total
number of words given) components to calculate the mean
DTC (mDTC) for each dual-task condition.
After testing for normal distribution and linear relationships
between pairs, Pearson’s r coefficients were undertaken.
RESULTS
The 69 participants (mean age=80.75 years;38 women) with
mild dementia had an increased risk of falls (median falls in
previous 6 months=1.5; mean PPA falls risk score=2.48) and
poor gait pattern (Table 1).
mDTC was
identified during
both cognitive
task gait
conditions, with
verbal-fluency
producing the
greatest cost to
gait speed
(26.62%).
There is a statistically significant relationship between gait
parameters, falls risk (all p<0.05) and global cognition (all
p<0.05).
.
CONCLUSIONS
Negative changes to gait pattern are evident and are
associated with an increased risk of falls and global cognition
in older adults with mild dementia. A mDTC exceeding levels
for healthy older adults is present suggesting a benefit of
such measures in falls intervention research with this
population.
ACKNOWLEDGEMENTS
This study was completed as part of the Balance and the
Mind PDG with funding from the NIHR and NUH NHS Trust.
The author is funded through a Clinical Training Fellowship
from the Alzheimer’s Society with support from the
Healthcare Management Trust, and in association with the
University of Nottingham and NUH NHS Trust.