Savica Rodolfo, Wennberg Alexandra M V, Hagen Clinton, Edwards Kelly, Roberts Rosebud O, Hollman John H, Knopman David S, Boeve Bradley F, Machulda Mary M, Petersen Ronald C, Mielke Michelle M
Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
Department of Neurology, Mayo Clinic, Rochester, MN, USA.
J Alzheimers Dis. 2017;55(2):559-567. doi: 10.3233/JAD-160697.
Previous studies reported that slower gait speed might predict cognitive impairment and dementing illnesses, supporting the role of gait speed as a possible subclinical marker of cognitive impairment. However, the predictive value of other gait parameters for cognitive decline is unclear.
To investigate and compare the association with, and prediction of, specific gait parameters for cognition in a population-based sample.
The analysis included 3,426 cognitively normal participants enrolled in the Mayo Clinic Study of Aging. At baseline and every 15 months (mean follow-up = 1.93 years), participants had a study coordinator evaluation, neurological examination, and a neuropsychological assessment using nine tests that covered four domains. Gait parameters were assessed with the GAITRite® instrument. General linear mixed effects models were used to compute the annualized rate of change in cognitive domain z-scores, controlling for age, sex, education, depression, comorbidities, body mass index, APOE ɛ4 allele, and visit number, and excluding individuals with a history of stroke, alcoholism, Parkinson's disease, subdural hematoma, and normal pressure hydrocephalus.
Spatial (stride length), temporal (ambulatory time, gait speed, step count, cadence, double support time), and spatiotemporal (cadence) gait parameters, and greater intraindividual variability in stride length, swing time, and stance time were associated with a significant decline in global cognition and in specific domains including memory, executive function, visuospatial, and language.
Spatial, temporal, and spatiotemporal measures of gait and greater variability of gait parameters were associated with and predictive of both global- and domain-specific cognitive decline.
既往研究报告称,步态速度较慢可能预示着认知障碍和痴呆性疾病,这支持了步态速度作为认知障碍潜在亚临床标志物的作用。然而,其他步态参数对认知衰退的预测价值尚不清楚。
在基于人群的样本中,研究并比较特定步态参数与认知的关联及对认知的预测作用。
分析纳入了参加梅奥诊所衰老研究的3426名认知正常的参与者。在基线期以及每15个月(平均随访时间 = 1.93年),参与者接受研究协调员评估、神经学检查以及使用涵盖四个领域的九项测试进行的神经心理学评估。使用GAITRite®仪器评估步态参数。采用广义线性混合效应模型计算认知领域z分数的年化变化率,同时控制年龄、性别、教育程度、抑郁、合并症、体重指数、APOE ε4等位基因和访视次数,并排除有中风、酗酒、帕金森病、硬膜下血肿和正常压力脑积水病史的个体。
空间步态参数(步长)、时间步态参数(行走时间、步态速度、步数、步频、双支撑时间)、时空步态参数(步频),以及步长、摆动时间和站立时间的更大个体内变异性与整体认知以及包括记忆、执行功能、视觉空间和语言在内的特定领域的显著衰退相关。
步态的空间、时间和时空测量以及步态参数的更大变异性与整体和特定领域的认知衰退相关且具有预测作用。