RESUMO
ABSTRACT Identifying gait and balance disorders in the earlier stages of Alzheimer's disease (AD) and Mild Cognitive Impairment (MCI) could reduce or prevent falls in older adults. This cross-sectional study aimed to determine which mobility tests best discriminate the risk of falls in MCI and mild AD. Functional mobility was assessed by the timed up and go test (TUG) and 10-meter walk test (10MWT). A calendar of falls was produced, with follow-up via telephone calls during 6 months. For the MCI Group (n=38), time spent on the 10MWT was the best variable for discriminating fallers, with a cut-off point of 10.69 seconds associated with the highest accuracy (76.3%). In the AD Group (n=37), 10MWT cadence was the best variable for discriminating fallers, with a cut-off point of 101.39 steps per minute associated with an accuracy of 81.1%. As a conclusion, 10MWT time and cadence were the most accurate variables for screening the risk of falls in MCI and mild AD, respectively. The 10MWT is a functional, simple and easy test and it should be widely used in clinical practice.
RESUMO A identificação de distúrbios da marcha e do equilíbrio em estágios iniciais da doença de Alzheimer (DA) e do comprometimento cognitivo leve (CCL) pode reduzir ou prevenir quedas na população idosa. Transversal, este estudo tem como objetivo determinar quais testes de mobilidade melhor discriminam o risco de quedas em idosos com CCL e DA leve. A mobilidade funcional foi avaliada pelo timed up and go test (TUG) e o teste de velocidade de marcha de 10 metros (10MWT). Foi produzido um calendário de quedas, com acompanhamento via contato telefônico durante 6 meses. Para o grupo CCL (n=38), o tempo gasto no 10MWT foi a melhor variável para discriminar caidores, com nota de corte de 10,69 segundos associada a maior precisão (76,3%). No grupo DA (n=37), a cadência do 10MWT foi a melhor variável para discriminar os caidores, com nota de corte de 101,39 passos por minuto associada a uma precisão de 81,1%. Como conclusão, o tempo e a cadência do 10MWT foram as variáveis mais precisas para rastrear o risco de quedas em idosos com CCL e DA leve, respectivamente. O 10MWT é um teste funcional, simples e fácil e pode ser amplamente utilizado na prática clínica.
RESUMEN La identificación de los trastornos de marcha y del equilibrio en las primeras etapas de la enfermedad de Alzheimer (EA) y del deterioro cognitivo leve (DCL) puede reducir o prevenir las caídas en la población anciana. Estudio transversal que tiene como objetivo determinar qué pruebas de movilidad discriminan mejor el riesgo de caídas en los ancianos con DCL y EA leve. La movilidad funcional se evaluó mediante el timed up and go test (TUG) y la prueba de velocidad de marcha de 10 metros (10MWT). Se elaboró un calendario de caídas, con seguimiento vía contacto telefónico durante 6 meses. En el grupo DCL (n=38), el tiempo empleado en el 10MWT fue la mejor variable para discriminar las caídas, con un puntaje de corte de 10,69 segundos asociado a una mayor precisión (76,3%). En el grupo de EA (n=37), la cadencia de 10MWT fue la mejor variable para discriminar las caídas, con un puntaje de corte de 101,39 pasos por minuto asociada a una precisión del 81,1%. Se concluye que el tiempo y la cadencia de 10MWT fueron las variables más precisas para detectar el riesgo de caídas en los ancianos con DCL y EA leve, respectivamente. El 10MWT es una prueba funcional, simple y fácil, y se puede utilizarla ampliamente en la práctica clínica.
Assuntos
Humanos , Feminino , Idoso , Idoso de 80 Anos ou mais , Acidentes por Quedas/prevenção & controle , Doença de Alzheimer , Disfunção Cognitiva , Desempenho Físico Funcional , Risco , Estudos Prospectivos , Reprodutibilidade dos Testes , Destreza MotoraRESUMO
BACKGROUND AND PURPOSE: Understanding fall risk factors in people with mild cognitive impairment (MCI) and Alzheimer disease (AD) can help to establish specific plans for prevention of falls. The purpose of this study was to identify fall risk factors in older adults with MCI and mild AD. METHODS: A prospective study was conducted with community-dwelling older adults (40 MCI; 38 mild AD). The assessments consisted of sociodemographic and health variables, caloric expenditure, functional status, functional mobility (10-m walk test, dual-task test, and transition Timed Up and Go phases), cognitive domains, and depressive symptoms. Falls were recorded for 6 months by a falls calendar and monthly telephone calls. RESULTS: Falls were reported in 52.6% and 51.4% of people with MCI and mild AD, respectively. Among people with MCI, lower functional status, higher time spent on walk and dual task tests, and higher depressive symptom scores were associated with falls. Higher time spent on the dual-task test was independently associated with falls. Among people with mild AD, falls were associated with lower time spent on the walk test and turn-to-sit phase, and a higher visuospatial domain score. Lower time spent on the turn-to-sit phase was identified as an independent predictor of falls. CONCLUSIONS: Careful attention should be given to dual-task and turn-to-sit activities when detecting risk of falls among older people with MCI and mild AD.
Assuntos
Acidentes por Quedas , Doença de Alzheimer/fisiopatologia , Doença de Alzheimer/psicologia , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/psicologia , Idoso , Idoso de 80 Anos ou mais , Metabolismo Energético , Feminino , Humanos , Vida Independente , Masculino , Estudos Prospectivos , Fatores de Risco , Análise e Desempenho de Tarefas , Fatores de Tempo , Teste de CaminhadaRESUMO
This work aimed to compare performances on the Timed Up and Go (TUG) test and its subtasks between faller and non-faller older adults with mild cognitive impairment (MCI) and mild Alzheimer's disease (AD). A prospective study was conducted, with 38 older adults with MCI and 37 with mild AD. Participants underwent an assessment at baseline (the TUG and its subtasks using the Qualisys ProReflex system) and the monitoring of falls at the six-month follow up. After six months, 52.6% participants with MCI and 51.3% with AD fell. In accordance with specific subtasks, total performance on the TUG distinguished fallers from non-fallers with AD, fallers from non-fallers with MCI and non-fallers with MCI from non-fallers with AD. Although no other difference was found in total performances, non-fallers with MCI and fallers with AD differed on the walking forward, turn and turn-to-sit subtasks; and fallers with MCI and non-fallers with AD differed on the turn-to-sit subtask.
Assuntos
Acidentes por Quedas/estatística & dados numéricos , Doença de Alzheimer/diagnóstico , Disfunção Cognitiva/diagnóstico , Teste de Esforço/métodos , Avaliação Geriátrica/métodos , Equilíbrio Postural/fisiologia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/complicações , Doença de Alzheimer/fisiopatologia , Disfunção Cognitiva/complicações , Disfunção Cognitiva/fisiopatologia , Feminino , Humanos , Masculino , Estudos Prospectivos , Escalas de Graduação PsiquiátricaRESUMO
ABSTRACT This work aimed to compare performances on the Timed Up and Go (TUG) test and its subtasks between faller and non-faller older adults with mild cognitive impairment (MCI) and mild Alzheimer's disease (AD). A prospective study was conducted, with 38 older adults with MCI and 37 with mild AD. Participants underwent an assessment at baseline (the TUG and its subtasks using the Qualisys ProReflex system) and the monitoring of falls at the six-month follow up. After six months, 52.6% participants with MCI and 51.3% with AD fell. In accordance with specific subtasks, total performance on the TUG distinguished fallers from non-fallers with AD, fallers from non-fallers with MCI and non-fallers with MCI from non-fallers with AD. Although no other difference was found in total performances, non-fallers with MCI and fallers with AD differed on the walking forward, turn and turn-to-sit subtasks; and fallers with MCI and non-fallers with AD differed on the turn-to-sit subtask.
RESUMO O objetivo deste trabalho foi comparar o desempenho do Timed up and go test (TUG) e suas subtarefas entre idosos caidores e não caidores com comprometimento cognitivo leve (CCL) e doença de Alzheimer (DA) leve. Um estudo prospectivo foi conduzido, com 38 idosos com CCL e 37 com DA leve. Foi realizada uma avaliação inicial (TUG e subtarefas por meio do sistema Qualisys Pro Reflex) e um monitoramento de quedas por 6 meses. Após 6 meses, 52.6% pessoas com CCL e 51.3% com DA caíram. Em concordância com subtarefas específicas, a performance total do TUG distinguiu caidores de não caidores com DA, caidores de não caidores com CCL e não caidores com CCL de não caidores com DA. Embora nenhuma outra diferença foi encontrada na performance total do TUG, não caidores com CCL e caidores com DA apresentaram diferenças nas performances das subtarefas marcha ida, retornar e virar-se para sentar; e caidores com CCL e não caidores com DA diferiram na subtarefa virar-se para sentar.
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Acidentes por Quedas/estatística & dados numéricos , Avaliação Geriátrica/métodos , Equilíbrio Postural/fisiologia , Teste de Esforço/métodos , Doença de Alzheimer/diagnóstico , Disfunção Cognitiva/diagnóstico , Escalas de Graduação Psiquiátrica , Estudos Prospectivos , Doença de Alzheimer/complicações , Doença de Alzheimer/fisiopatologia , Disfunção Cognitiva/complicações , Disfunção Cognitiva/fisiopatologiaRESUMO
The authors investigated whether impaired gait and dual-task performances are associated with specific cognitive domains among older people with preserved cognition (PC), mild cognitive impairment (MCI), and mild Alzheimer's disease (AD). The sample comprised 40 older adults with PC, 40 with MCI, and 38 with mild AD. The assessment consisted of gait (measured by 10-m walk test and Timed Up and Go Test [TUGT]), dual task (measured by TUGT associated with a cognitive-motor task of calling a phone number), and cognition (domains of the Addenbrooke Cognitive Examination-Revised and Frontal Assessment Battery [FAB]). For data analysis, the Pearson product-moment correlation and the backward stepwise linear regression were conducted. Language, fluency, and visuospatial domains predicted the 10-m walk test measure specifically in PC, MCI, and AD groups. Only the visuospatial domain was independently associated with the TUGT measure in the MCI and AD groups. FAB score, language domain, and FAB score and fluency domain were the strongest predictors for the isolated cognitive-motor task measure in the PC, MCI, and AD groups, respectively. The visuospatial domain was independently associated with the dual-task test measure in all 3 groups. The study findings demonstrate the influence of specific cognitive domains in daily mobility tasks in people with different cognitive profiles.
Assuntos
Transtornos Cognitivos/psicologia , Cognição , Marcha , Desempenho Psicomotor , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/psicologia , Fenômenos Biomecânicos , Disfunção Cognitiva/psicologia , Feminino , Humanos , Idioma , Masculino , Testes Neuropsicológicos , Percepção Espacial , CaminhadaRESUMO
BACKGROUND: The purpose of the study was to investigate the relationship between dual task walking, cognition, and depression in oldest old people living in the community. METHODS: We conducted an observational cross-sectional study at Federal University of São Carlos (Brazil). We assessed 67 community-dwelling older adults aged 80 years and over, who were able to walk alone and did not present with a risk of dementia (assessed by Mini-Mental State Examination, MMSE). The assessment consisted of anamnesis, dual task using the Timed Up and Go test associated with a motor task (TUGT-motor) and a cognitive task (TUGT-cognitive); cognitive measures using MMSE, Montreal Cognitive Assessment (MoCA), Clock Drawing test (CDT) and verbal fluency, and depressive measures by the Geriatric Depression Scale (GDS). RESULTS: There was a correlation with higher magnitude between cognitive tests and TUGT-cognitive, compared to TUGT-motor. For TUGT-motor, the highest correlations with cognitive tests were found between time and MMSE, MoCA (total score), and MoCA visuospatial/executive domain. For TUGT-cognitive, the highest correlations with cognitive tests were between number of steps and MMSE and between time and MMSE. GDS showed a significant weak correlation with number of steps taken in TUGT-motor, wrong words, and correct/time of TUGT-cognitive. CONCLUSIONS: Dual task performances are associated with cognition in oldest old. Furthermore, dual task tests have less influence of educational level, are functional, fast, and easily applicable in clinical practice. Future studies are needed to confirm if dual task test is useful for cognitive screening in oldest old.
Assuntos
Envelhecimento/psicologia , Cognição , Depressão/diagnóstico , Análise e Desempenho de Tarefas , Caminhada , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos Transversais , Feminino , Marcha , Avaliação Geriátrica , Humanos , Masculino , Testes Neuropsicológicos , Escalas de Graduação PsiquiátricaRESUMO
AIM: To investigate the relationship between balance and dual task performance in adults aged over 80 years, and to analyze possible differences between fallers and non-fallers in dual task performance. METHODS: An observational cross-sectional study was carried out at the Federal University of São Carlos (Brazil). We assessed 67 community-dwelling older adults aged over 80 years who were able to walk. The volunteers were divided into groups of fallers and non-fallers. The one-leg standing and tandem tests were used to assess balance. Dual task was assessed by the Timed Up and Go test, associated with a motor task (TUGT-motor) and a cognitive task (TUGT-cognitive). Statistical analyses were carried out, and the significance level was set at α = 5%. RESULTS: Significant correlations were found between balance and dual task variables. Fallers took significantly more time and steps on both the TUGT-motor and the TUGT-cognitive, with no significant differences on balance tests between groups. CONCLUSIONS: Recognizing the influence of dual task walking on balance and fall risk could help health professionals to prevent falls in older adults, as well as optimize assessment and intervention planning.
Assuntos
Acidentes por Quedas , Equilíbrio Postural/fisiologia , Análise e Desempenho de Tarefas , Caminhada/fisiologia , Fatores Etários , Idoso de 80 Anos ou mais , Brasil , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Características de ResidênciaRESUMO
AIM: To compare the effects of 16-week multicomponent and resistance training, and 6-week detraining on physical variables related to a higher risk of falls in very old people. METHODS: A randomized, three-arm, controlled trial was carried out. A total of 69 community-dwelling older adults aged 80 years and older were allocated to three groups: control, multicomponent training and resistance training. They were assessed at baseline, after 16-week training and 6-week detraining. The control group did not perform any intervention. The multicomponent group performed protocol consisting of warm-up, aerobic, strength, balance and cool-down exercises. The resistance group underwent strength exercises using six adapted machines. The training sessions had progressive intensity, lasted 16 weeks and 12 included three 1-h sessions per week. The assessment consisted of anamneses, five-repetition sit-to-stand, one-leg standing, tandem and dual task tests. For statistical analysis, α = 0.05 was used. RESULTS: There were no significant differences between groups and assessments in any variable when analyzed by intention to treat. However, when analyzed, the older adults who adhered to the training, the multicomponent group, had a significant improvement in the sit-to-stand and the one-leg standing (right support) tests. There was a significant main effect between times on the one-leg standing (left support) test. CONCLUSION: In very old people, multicomponent training seems to be more beneficial and presents fewer adverse events when the adherence to protocol is higher.
Assuntos
Acidentes por Quedas/prevenção & controle , Pessoas com Deficiência/reabilitação , Terapia por Exercício/métodos , Exercício Físico/fisiologia , Marcha/fisiologia , Equilíbrio Postural/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologiaRESUMO
AIM: To compare the effect of multicomponent and resistance training and detraining on cognition and depressive symptoms in oldest-old community-dwelling people. METHODS: A total of 69 sedentary older adults aged older than 80 years were assessed and randomized into three groups (control, multicomponent and resistance training). The multicomponent group performed protocol consisting of aerobic, strength and balance exercises. The resistance group participated in strength exercises using six machines. The control group did not perform any intervention. The training sessions had progressive intensity, lasted 16 weeks and included three sessions per week. The volunteers were assessed at baseline, at the end of the 16-week training sessions and after the 6-week detraining period. The assessment consisted of anamneses, Geriatric Depression Scale and cognition (Montreal Cognitive Assessment, Clock Drawing Test, verbal fluency and dual task). RESULTS: There were no significant differences between groups and times in any of variables; however, the adherence to training was low, mainly in the multicomponent group. CONCLUSIONS: Randomized controlled trials using adherence strategies and longer times comparing training variations are required to verify which training protocols are more effective and consistent on cognition and depression in oldest-old people.