Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, PA, USA.
Department of Physical Therapy, School of Rehabilitation Sciences, University of Pittsburgh, PA, USA.
Gait Posture. 2023 Sep;106:34-41. doi: 10.1016/j.gaitpost.2023.08.010. Epub 2023 Aug 22.
BACKGROUND: Real-world mobility involves walking in challenging conditions. Assessing gait during simultaneous physical and cognitive challenges provides insights on cognitive health. RESEARCH QUESTION: How does uneven surface, cognitive task, and their combination affect gait quality and does this gait performance relate to cognitive functioning? METHODS: Community-dwelling older adults (N = 104, age=75 ± 6 years, 60 % females) performed dual-task walking paradigms (even and uneven surface; with and without alphabeting cognitive task (ABC)) to mimic real-world demands. Gait quality measures [speed(m/s), rhythmicity(steps/minute), stride time variability (%), adaptability (m/s), similarity, smoothness, power (Hz) and regularity] were calculated from an accelerometer worn on the lower back. Linear-mixed modelling and Tukey analysis were used to analyze independent effects of surface and cognitive task and their interaction on gait quality. Partial Spearman correlations compared gait quality with global cognition and executive function. RESULTS: No interaction effects between surface and cognitive task were found. Uneven surface reduced gait speed(m/s) (β = -0.07). Adjusted for speed, uneven surface reduced gait smoothness (β = -0.27) and increased regularity (β = 0.09), Tukey p < .05, for even vs uneven and even-ABC vs uneven-ABC. Cognitive task reduced gait speed(m/s) (β = -0.12). Adjusted for speed, cognitive task increased variability (β = 7.60), reduced rhythmicity (β = -6.68) and increased regularity (β = 0.05), Tukey p < .05, for even vs even-ABC and uneven vs uneven-ABC. With demographics as covariates, gait speed was not associated with cognition. Gait quality [lower variability during even-ABC (ρ =-.31) and uneven-ABC (ρ =-.28); greater rhythmicity (ρ between.22 and.29) and greater signal-adaptability AP (ρ between.22 and.26) during all walking tasks] was associated with better global cognition. Gait adaptability during even (ρ =-0.21, p = 0.03) and uneven(ρ =-0.19, p = 0.04) walking was associated with executive function. SIGNIFICANCE: Surface and cognitive walking tasks independently affected gait quality. Our study with high-functioning older adults suggests that task-related changes in gait quality are related to subtle changes in cognitive functioning.
背景：现实世界中的移动涉及在具有挑战性的条件下行走。评估身体和认知同时受到挑战时的步态，可以深入了解认知健康状况。
研究问题：不平坦的表面、认知任务以及它们的组合如何影响步态质量，这种步态表现与认知功能有何关系？
方法：104 名社区居住的老年人（年龄=75±6 岁，60%为女性）进行了双重任务行走范式（平坦和不平坦表面；有和没有字母认知任务（ABC）），以模拟现实世界的需求。步态质量测量值[速度（m/s）、节律性（每分钟步数）、步长时间变异性（%）、适应性（m/s）、相似性、平滑度、功率（Hz）和规律性]是从佩戴在腰部的加速度计上计算得出的。线性混合模型和 Tukey 分析用于分析表面和认知任务的独立影响及其对步态质量的相互作用。部分 Spearman 相关性比较了步态质量与整体认知和执行功能。
结果：表面和认知任务之间没有交互作用。不平坦的表面降低了行走速度（m/s）（β=-0.07）。在调整速度后，不平坦的表面降低了步态的平滑度（β=-0.27）并增加了规律性（β=0.09），Tukey p<.05，平坦对不平坦和平坦-ABC 对不平坦-ABC。认知任务降低了行走速度（m/s）（β=-0.12）。在调整速度后，认知任务增加了变异性（β=7.60），降低了节律性（β=-6.68）并增加了规律性（β=0.05），Tukey p<.05，平坦-ABC 对平坦和不平坦-ABC 对不平坦。将人口统计学因素作为协变量，步态速度与认知无关。步态质量[平坦-ABC（ρ=-.31）和不平坦-ABC（ρ=-.28）期间的变异性较低；平坦（ρ=.22 到.29）和不平坦（ρ=.22 到.29）期间的节律性更高；所有行走任务中信号适应性 AP 更高（ρ=.22 到.26）]与整体认知能力更好相关。在平坦（ρ=-0.21，p=0.03）和不平坦（ρ=-0.19，p=0.04）行走过程中，步态的适应性与执行功能有关。
意义：表面和认知步行任务独立影响步态质量。我们对高功能老年人的研究表明，与认知功能相关的步态质量变化与认知功能的细微变化有关。
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