Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.
Department of Neurology and Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan.
Eur J Phys Rehabil Med. 2021 Aug;57(4):560-567. doi: 10.23736/S1973-9087.20.06550-8. Epub 2020 Dec 1.
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.
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.
Prospective observational study.
Outpatient department of neurology or psychology.
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.
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.
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.
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.
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.
认知障碍者易发生跌倒。既往关于平衡和步态的研究纳入了不同痴呆严重程度的患者。对认知障碍者平衡和步态表现的量化可帮助识别其姿势不稳和跌倒风险。
我们调查了认知正常、遗忘型轻度认知障碍和轻度阿尔茨海默病性痴呆老年人之间的平衡和步态差异。
前瞻性观察性研究。
神经病学或心理学的门诊。
使用简易精神状态检查和临床痴呆评定量表评估的独立行走的老年人（年龄≥65 岁）。排除有其他神经或肌肉骨骼疾病的患者。
参与者分为三组：30 名健康对照者、30 名轻度认知障碍者和 30 名轻度痴呆者。平衡通过功能测试（Berg 平衡量表[BBS]）和实验室测试（动态姿势描记术）进行评估。步态通过可穿戴设备进行评估。肌肉力量和质量通过握力、小腿围和身体成分进行测量。
BBS（P=0.04）、跌倒风险指数（FR）的动态姿势描记术（P=0.01）和睁眼、硬表面（EOFIS，P=0.009）、睁眼、泡沫表面（EOFOS，P=0.003）的感觉综合指数在三组之间差异显著。轻度痴呆者的 EOFIS 和 EOFOS 平衡指数显著差于 MCI。三组间的步态速度（P=0.04）和步长（P=0.04）差异显著。事后分析显示，认知障碍者的所有上述平衡和步态指标均显著差于健康对照组。三组间握力、小腿围和身体成分-肌肉质量无显著差异。
认知功能障碍，甚至在记忆减退的早期阶段，可能对平衡和步态有一定的不良影响，而与肌肉骨骼问题的影响无关。
了解不同认知障碍严重程度患者与健康对照组之间特定平衡和步态指标的差异，有助于为早期认知障碍老年人制定更好的以平衡为导向的康复方案。
