认知障碍与肌萎缩侧索硬化症患者的步态变异性和跌倒风险相关。

Cognitive impairment is associated with gait variability and fall risk in amyotrophic lateral sclerosis.

作者信息

Dubbioso Raffaele, Spisto Myriam, Hausdorff Jeffrey M, Aceto Gabriella, Iuzzolino Valentina Virginia, Senerchia Gianmaria, De Marco Stefania, Marcuccio Laura, Femiano Cinzia, Iodice Rosa, Salvatore Elena, Santangelo Gabriella, Trojano Luigi, Moretta Pasquale

机构信息

Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy.

Department of Psychology, University of Campania Luigi Vanvitelli, Naples, Italy.

出版信息

Eur J Neurol. 2023 Oct;30(10):3056-3067. doi: 10.1111/ene.15936. Epub 2023 Jun 29.

DOI:10.1111/ene.15936

PMID:37335396

Abstract

BACKGROUND

In amyotrophic lateral sclerosis (ALS), gait abnormalities contribute to poor mobility and represent a relevant risk for falls. To date, gait studies in ALS patients have focused on the motor dimension of the disease, underestimating the cognitive aspects.

METHODS

Using a wearable gait analysis device, we compared gait patterns in ambulatory ALS patients with mild cognitive impairment (ALS MCI+; n = 18), and without MCI (ALS MCI-; n = 24), and healthy subjects (HS; n = 16) under two conditions: (1) normal gait (single task) and (2) walking while counting backward (dual task). Finally, we examined if the occurrence and number of falls in the 3 months following the baseline test were related to cognition.

RESULTS

In the single task condition, ALS patients, regardless of cognition, displayed higher gait variability than HS, especially for stance and swing time (p < 0.001). The dual task condition revealed additional differences in gait variability parameters between ALS MCI+ and ALS MCI- for cadence (p = 0.005), stance time (p = 0.04), swing time (p = 0.04) and stability index (p = 0.02). Moreover, ALS MCI+ showed a higher occurrence (p = 0.001) and number of falls (p < 0.001) at the follow-up. Regression analyses demonstrated that MCI condition predicted the occurrence of future falls (β = 3.649; p = 0.01) and, together with executive dysfunction, was associated with the number of falls (cognitive impairment: β = 0.63; p < 0.001; executive dysfunction: β = 0.39; p = 0.03), regardless of motor impairment at clinical examination.

CONCLUSION

In ALS, MCI is associated with exaggerated gait variability and predicts the occurrence and number of short-term falls.

摘要

背景

在肌萎缩侧索硬化症（ALS）中，步态异常导致行动能力下降，并构成跌倒的相关风险。迄今为止，对ALS患者的步态研究主要集中在疾病的运动维度，而低估了认知方面。

方法

使用可穿戴式步态分析设备，我们比较了轻度认知障碍的非卧床ALS患者（ALS MCI+；n = 18）、无MCI的ALS患者（ALS MCI-；n = 24）和健康受试者（HS；n = 16）在两种情况下的步态模式：（1）正常步态（单任务）和（2）倒着数数时行走（双任务）。最后，我们检查了基线测试后3个月内跌倒的发生情况和次数是否与认知有关。

结果

在单任务条件下，无论认知情况如何，ALS患者的步态变异性均高于HS，尤其是在站立和摆动时间方面（p < 0.001）。双任务条件显示，ALS MCI+和ALS MCI-在步态变异性参数方面存在额外差异，包括步频（p = 0.005）、站立时间（p = 0.04）、摆动时间（p = 0.04）和稳定性指数（p = 0.02）。此外，在随访中，ALS MCI+的跌倒发生率（p = 0.001）和跌倒次数（p < 0.001）更高。回归分析表明，MCI状态可预测未来跌倒的发生（β = 3.649；p = 0.01），并且与执行功能障碍一起，与跌倒次数相关（认知障碍：β = 0.63；p < 0.001；执行功能障碍：β = 0.39；p = 0.03），无论临床检查中的运动障碍情况如何。