Dementia, fall risk and routine clinical care: Opportunities to enhance care by incorporation of examiner‐independent analytics — Computerized cognitive evaluation and quantified digital gait analysis including dual tasking

Abstract

AbstractBackgroundDementia is an encompassing term referring to conditions characterized by progressive cognitive impairment (CI) that impairs ability to function independently and simultaneously results in increased risk of falling. Falls are common and their consequence costly in cognitively impaired individuals. Clinical reports suggest that falls and gait performance during dual tasking (DT) are particularly related to executive function. Additional reports propose that DT gait abilities predict future fall risk and that interventions designed to improve DT will decrease future fall risk. Analysis of DT gait function to non‐DT gait function has been shown to be superior in discerning those at higher fall risk, in comparison to previous measures. Clinically, CI varies in degree and combination of cognitive deficits and gait disturbance but clinician recognition of such varied types/degrees of CI is likely problematic.MethodsCross sectional analysis of PwDaD who underwent both validated computerized cognitive assessment battery (CAB) and digital gait analysis in the course of routine patient care and were screened for risk of falls.Results120 PwDaD, 57.5% female, average age 74+/‐ 10 years. T‐tests were performed between gait domains scored from PKMAS for PwDaD groups for step length, stride length, stride width, velocity and total double support. All individual gait domains showed a significant change in score for t‐tests performed between preferred walking speed (PWS) and DT gait function (p<0.01). Regression analysis of PwDaD cognitive profile against DT velocity was performed as well. CAB regressions of multiple cognitive domain scores against dual task velocity which were significant included: global summary score, executive function, visuo‐spatial and motor skills’ scores (p<0.05).ConclusionThe addition of a cognitive factor to gait, i.e. dual task, demonstrates a decrease in gait parameter functions in comparison to PwDaD gait at PWS. Earlier objective patient centric identification of increased fall risk provides clinicians an opportunity to effectively and pre‐emptively intervene to reduce such increased disability consequence and costs associated with this disease related impact.