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Original Investigation
May 15, 2017

Association of Dual-Task Gait With Incident Dementia in Mild Cognitive ImpairmentResults From the Gait and Brain Study

Author Affiliations
  • 1Gait and Brain Lab, Parkwood Institute and Lawson Health Research Institute, London, Ontario, Canada
  • 2Schulich School of Medicine, Division of Geriatric Medicine and Dentistry, Department of Medicine, University of Western Ontario, London, Ontario, Canada
  • 3Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
  • 4Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
  • 5Program of Geriatric Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
  • 6Department of Electrical and Computer Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 7Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
  • 8Robarts Research Institute and Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada
  • 9Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
  • 10Faculty of Health Sciences, School of Kinesiology, University of Western Ontario, London, Ontario, Canada
JAMA Neurol. Published online May 15, 2017. doi:10.1001/jamaneurol.2017.0643
Key Points

Question  Can dual-task gait testing (assessing gait while performing a challenging cognitive task) identify patients with mild cognitive impairment at risk of progression to dementia?

Findings  In this cohort study of 112 older adults with mild cognitive impairment with up to 6 years of follow-up, poor performance in dual-task gait testing was significantly associated with a 2- to 3-fold risk of dementia incidence independent of age, sex, education, comorbidities, and baseline cognition.

Meaning  Dual-task gait testing may serve clinicians to detect patients with mild cognitive impairment at higher risk of progression to dementia, allowing for optimization of further biomarker testing and initiation of early interventions.

Abstract

Importance  Gait performance is affected by neurodegeneration in aging and has the potential to be used as a clinical marker for progression from mild cognitive impairment (MCI) to dementia. A dual-task gait test evaluating the cognitive-motor interface may predict dementia progression in older adults with MCI.

Objective  To determine whether a dual-task gait test is associated with incident dementia in MCI.

Design, Setting, and Participants  The Gait and Brain Study is an ongoing prospective cohort study of community-dwelling older adults that enrolled 112 older adults with MCI. Participants were followed up for 6 years, with biannual visits including neurologic, cognitive, and gait assessments. Data were collected from July 2007 to March 2016.

Main Outcomes and Measures  Incident all-cause dementia was the main outcome measure, and single- and dual-task gait velocity and dual-task gait costs were the independent variables. A neuropsychological test battery was used to assess cognition. Gait velocity was recorded under single-task and 3 separate dual-task conditions using an electronic walkway. Dual-task gait cost was defined as the percentage change between single- and dual-task gait velocities: ([single-task gait velocity – dual-task gait velocity]/ single-task gait velocity) × 100. Cox proportional hazard models were used to estimate the association between risk of progression to dementia and the independent variables, adjusted for age, sex, education, comorbidities, and cognition.

Results  Among 112 study participants with MCI, mean (SD) age was 76.6 (6.9) years, 55 were women (49.1%), and 27 progressed to dementia (24.1%), with an incidence rate of 121 per 1000 person-years. Slow single-task gait velocity (<0.8 m/second) was not associated with progression to dementia (hazard ratio [HR], 3.41; 95% CI, 0.99-11.71; P = .05)while high dual-task gait cost while counting backward (HR, 3.79; 95% CI, 1.57-9.15; P = .003) and naming animals (HR, 2.41; 95% CI, 1.04-5.59; P = .04) were associated with dementia progression (incidence rate, 155 per 1000 person-years). The models remained robust after adjusting by baseline cognition except for dual-task gait cost when dichotomized.

Conclusions and Relevance  Dual-task gait is associated with progression to dementia in patients with MCI. Dual-task gait testing is easy to administer and may be used by clinicians to decide further biomarker testing, preventive strategies, and follow-up planning in patients with MCI.

Trial Registration  clinicaltrials.gov: NCT03020381.

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