Department of Medicine, Albert Einstein College of Medicine, Bronx, New York.
Department of Neurology, Albert Einstein College of Medicine, Bronx, New York.
Clin J Am Soc Nephrol. 2020 May 7;15(5):665-672. doi: 10.2215/CJN.12401019. Epub 2020 Mar 6.
Walking while talking is a dual cognitive-motor task that predicts frailty, falls, and cognitive decline in the general elderly population. Adults with CKD have gait abnormalities during usual walking. It is unknown whether they have greater gait abnormalities and cognitive-motor interference during walking while talking.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Community-dwelling, nondisabled adults (=330) ≥65 years of age underwent quantitative gait analysis, including walking while talking. Differences in walking-while-talking performance by CKD status were evaluated, and relative changes between walking-while-talking and walking alone performance were computed to quantify cognitive-motor interference (dual-task cost). Associations were tested using multivariable linear spline regression models, and independent gait domains were derived using factor analysis. CKD was defined as an eGFR<60 ml/min per 1.73 m.
CKD was present in 134 (41%) participants. Participants with CKD had slower gait speed along with various gait cycle abnormalities during walking while talking: among those with CKD, every 10-ml/min per 1.73 m lower eGFR was associated with 3.3-cm/s (95% confidence interval, 0.4 to 6.1) slower gait speed, 1.8-cm (95% confidence interval, 0.6 to 3.0) shorter step length, 1.1% (95% confidence interval, 0.6 to 1.7) less time in the swing phase, and 1.4% (95% confidence interval, 0.5 to 2.3) greater time in double support after multivariable adjustment. When comparing walking while talking with walking alone, every 10-ml/min per 1.73 m lower eGFR was associated with 1.8% (95% confidence interval, 0.5 to 3.2) greater decrease in time in the swing phase and 0.9% (95% confidence interval, 0.2 to 1.5) greater increase in time in the stance phase. Factor analysis identified three walking-while-talking domains and three dual-task cost domains: eGFR was associated specifically with the rhythm domain for both walking-while-talking and dual-task cost. Every 10-ml/min per 1.73 m lower eGFR was associated with a poorer performance of 0.2 SD (95% confidence interval, 0.1 to 0.3) for walking while talking and 0.2 SD (95% confidence interval, 0.03 to 0.3) for dual-task cost.
During walking while talking, CKD is associated with gait abnormalities, possibly due to increased cognitive-motor interference.
边说边走是一项双重认知-运动任务，它可以预测一般老年人群中的虚弱、跌倒和认知能力下降。患有 CKD 的成年人在日常行走时会出现步态异常。目前尚不清楚他们在边说边走时是否会出现更大的步态异常和认知-运动干扰。
设计、地点、参与者和测量：≥65 岁的社区居住、无残疾的成年人（n=330）接受了定量步态分析，包括边说边走。评估了 CKD 状态对边说边走表现的影响，并计算了边说边走和单独行走之间的相对变化，以量化认知-运动干扰（双重任务成本）。使用多变量线性样条回归模型进行关联测试，并使用因子分析得出独立的步态域。CKD 的定义为 eGFR<60 ml/min per 1.73 m。
134 名（41%）参与者存在 CKD。患有 CKD 的参与者在边说边走时的步态速度较慢，且各种步态周期异常：在那些患有 CKD 的参与者中，每 10-ml/min per 1.73 m 降低的 eGFR 与 3.3-cm/s（95%置信区间，0.4 至 6.1）的较慢的步态速度、1.8-cm（95%置信区间，0.6 至 3.0）的较短步长、1.1%（95%置信区间，0.6 至 1.7）的摆动阶段时间减少和 1.4%（95%置信区间，0.5 至 2.3）的双支撑阶段时间增加有关，经多变量调整后。与单独行走相比，每 10-ml/min per 1.73 m 降低的 eGFR 与摆动阶段时间减少 1.8%（95%置信区间，0.5 至 3.2）和站立阶段时间增加 0.9%（95%置信区间，0.2 至 1.5）有关。因子分析确定了三个边说边走的域和三个双重任务成本域：eGFR 与边说边走和双重任务成本的节奏域都有特定的关联。每 10-ml/min per 1.73 m 降低的 eGFR 与边说边走的表现降低 0.2 SD（95%置信区间，0.1 至 0.3）和双重任务成本的表现降低 0.2 SD（95%置信区间，0.03 至 0.3）有关。
在边说边走时，CKD 与步态异常有关，可能是由于认知-运动干扰增加所致。
