Balance Impairments as Differential Markers of Dementia Disease Subtype.

Ríona Mc Ardle,Lynn Rochester,Christopher Buckley,Silvia Del Din,Lisa Alcock,Alan Thomas,Brook Galna,Stephanie Pratt

doi:10.3389/fbioe.2021.639337

Abstract

BackgroundAccurately 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.MethodsNinety-seven participants were recruited, forming four groups: cognitive impairment due to Alzheimer’s disease (AD group; n = 31), dementia with Lewy bodies (DLB group; n = 26), Parkinson’s disease dementia (PDD group; n = 13), and normal aging controls (n = 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 U 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.ResultsThe PDD group demonstrated higher RMS [combined (p = 0.001), mediolateral (p = 0.005), and anterior–posterior (p = 0.001)] and ellipsis scores (p < 0.002) than the AD group (AUC = 0.71–0.82). The PDD group also demonstrated significantly impaired balance across all characteristics (p ≤ 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.DiscussionAlthough 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.

Highlights

Assessing motor performance, such as gait and balance, in the aging population may be a useful clinical tool for predicting a range of clinical outcomes, such as falls risk, neurological disorders, cognitive impairment, and mortality (Fritz and Lusardi, 2009; Schoneburg et al, 2013; Creaby and Cole, 2018; Buckley et al, 2019; Modarresi et al, 2019; Peel et al, 2019)
As the dementia disease groups included people with mild cognitive impairment (MCI) or dementia, we initially examined the differences in balance characteristics within each dementia disease group, comparing MCI and dementia
As there were no significant differences found between MCI and dementia within each subtype, it was deemed feasible to include both disease stages within each dementia disease group (i.e., Alzheimer’s disease (AD), dementia with Lewy bodies (DLB), and Parkinson’s disease dementia (PDD))

Summary

Introduction

Assessing motor performance, such as gait and balance, in the aging population may be a useful clinical tool for predicting a range of clinical outcomes, such as falls risk, neurological disorders, cognitive impairment, and mortality (Fritz and Lusardi, 2009; Schoneburg et al, 2013; Creaby and Cole, 2018; Buckley et al, 2019; Modarresi et al, 2019; Peel et al, 2019). Identifying supportive clinical tools to differentiate dementia subtypes, such as LBD [which includes dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD)], is of critical importance to ensure accurate and appropriate treatment and care provision for people with dementia (Palmqvist et al, 2009). This is apparent for people with DLB, as DLB is underdiagnosed and may be misdiagnosed as AD due to similarities in clinical presentation (Palmqvist et al, 2009; Kane et al, 2018). This study aimed to identify differences in balance impairments between different dementia disease subtypes and normal aging using a single triaxial accelerometer

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