Mc Ardle Ríona, Pratt Stephanie, Buckley Christopher, Del Din Silvia, Galna Brook, Thomas Alan, Rochester Lynn, Alcock Lisa
Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
Front Bioeng Biotechnol. 2021 Mar 11;9:639337. doi: 10.3389/fbioe.2021.639337. eCollection 2021.
Accurately differentiating dementia subtypes, such as Alzheimer's disease (AD) and Lewy body disease [including dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD)] is important to ensure appropriate management and treatment of the disease. Similarities in clinical presentation create difficulties for differential diagnosis. Simple supportive markers, such as balance assessments, may be useful to the diagnostic toolkit. This study aimed to identify differences in balance impairments between different dementia disease subtypes and normal aging using a single triaxial accelerometer.
Ninety-seven participants were recruited, forming four groups: cognitive impairment due to Alzheimer's disease (AD group; = 31), dementia with Lewy bodies (DLB group; = 26), Parkinson's disease dementia (PDD group; = 13), and normal aging controls ( = 27). Participants were asked to stand still for 2 minutes in a standardized position with their eyes open while wearing a single triaxial accelerometer on their lower back. Seven balance characteristics were derived, including jerk (combined, mediolateral, and anterior-posterior), root mean square (RMS; combined, mediolateral, and anterior-posterior), and ellipsis. Mann-Whitney tests identified the balance differences between groups. Receiver operating characteristics and area under the curve (AUC) determined the overall accuracy of the selected balance characteristics.
The PDD group demonstrated higher RMS [combined ( = 0.001), mediolateral ( = 0.005), and anterior-posterior ( = 0.001)] and ellipsis scores ( < 0.002) than the AD group (AUC = 0.71-0.82). The PDD group also demonstrated significantly impaired balance across all characteristics ( ≤ 0.001) compared to the controls (AUC = 0.79-0.83). Balance differences were not significant between PDD and DLB (AUC = 0.69-0.74), DLB and AD (AUC = 0.50-0.65), DLB and controls (AUC = 0.62-0.68), or AD and controls (AUC = 0.55-0.67) following Bonferroni correction.
Although feasible and quick to conduct, key findings suggest that an accelerometer-based balance during quiet standing does not differentiate dementia disease subtypes accurately. Assessments that challenge balance more, such as gait or standing with eyes closed, may prove more effective to support differential diagnosis.
准确区分痴呆亚型，如阿尔茨海默病（AD）和路易体病[包括路易体痴呆（DLB）和帕金森病痴呆（PDD）]对于确保疾病的适当管理和治疗很重要。临床表现的相似性给鉴别诊断带来了困难。简单的支持性标志物，如平衡评估，可能对诊断工具包有用。本研究旨在使用单个三轴加速度计确定不同痴呆疾病亚型与正常衰老之间平衡障碍的差异。
招募了97名参与者，分为四组：阿尔茨海默病所致认知障碍（AD组；n = 31）、路易体痴呆（DLB组；n = 26）、帕金森病痴呆（PDD组；n = 13）和正常衰老对照组（n = 27）。参与者被要求在标准化姿势下睁眼静止站立2分钟，同时在其下背部佩戴单个三轴加速度计。得出了七个平衡特征，包括急动度（综合、内外侧和前后向）、均方根（RMS；综合、内外侧和前后向）和椭圆度。Mann-Whitney U检验确定了组间的平衡差异。受试者工作特征曲线和曲线下面积（AUC）确定了所选平衡特征的总体准确性。
PDD组的RMS[综合（P = 0.001）、内外侧（P = 0.005）和前后向（P = 0.001）]和椭圆度评分（P < 0.002）高于AD组（AUC = 0.71 - 0.82）。与对照组相比，PDD组在所有特征上的平衡也明显受损（P ≤ 0.001）（AUC = 0.79 - 0.83）。经Bonferroni校正后，PDD与DLB（AUC = 0.69 - 0.74）、DLB与AD（AUC = 0.50 - 0.65）、DLB与对照组（AUC = 0.62 - 0.68）或AD与对照组（AUC = 0.55 - 0.67）之间的平衡差异不显著。
尽管基于加速度计的安静站立平衡测试可行且实施快速，但主要研究结果表明，它不能准确区分痴呆疾病亚型。对平衡挑战更大的评估，如步态或闭眼站立，可能对支持鉴别诊断更有效。
