Dual Tasking for the Differentiation between Depression and Mild Cognitive Impairment.

Florian G. Metzger,Tim Hahn,Sandra E. Hasmann,Walter Maetzler,Ann-Christine Ehlis,Gerhard W. Eschweiler,Andreas J. Fallgatter,Markus A. Hobert,Daniela Berg

doi:10.3389/fnagi.2016.00235

Abstract

Differentiation of mild cognitive impairment from depression in elderly adults is a clinically relevant issue which is not sufficiently solved. Gait and dual task (DT) parameters may have the potential to complement current diagnostic work-up, as both dementia and depression are associated with changes of gait and DT parameters. Methods: Seven hundred and four participants of the TREND study (Tübinger evaluation of Risk factors for Early detection of NeuroDegeneration) aged 50–80 years were assessed using the Consortium to Establish a Registry for Alzheimer's Disease Plus test battery for testing cognition and Beck's Depression Inventory for evaluation of depression. Based on these results, four groups were defined: acute depressed (N = 53), cognitively mildly impaired (N = 97), acute depressed, and cognitively mildly impaired (N = 15), and controls (N = 536). Participants underwent a 20 m walk and checking boxes task under single (ST) and DT conditions. ST and DT performance and dual task costs (DTC) were calculated. Due to the typical age of increasing incidence of depressive and also cognitive symptoms, the 7th decade was calculated separately. Results: ST speeds of gait and checking boxes, DT walking speed, and walking DTC were significantly different between groups. Healthy controls were the fastest in all paradigms and cognitively mildly impaired had higher DTC than depressed individuals. Additionally, we constructed a multivariate predictive model differentiating the groups on a single-subject level. Conclusion: DT parameters are simply and comfortably measureable, and DTC can easily be determined. The combination of these parameters allows a differentiation of depressed and cognitively mildly impaired elderly adults.

Highlights

During recent years, gait of elderly adults has been extensively studied
A significant main effect differencing the four groups healthy controls (HC), amnestic mild cognitive impairment (MCI) (aMCI), aMCI / depressed patients (aMCI-D), and D was found in four experimental parameters, i.e., Speed fast gait (ST) walking speed, ST checking boxes speed, dual tasking (DT) walking speed while checking boxes and DT costs (DTC) walking (Table 2)
In this study, speed of walking and checking boxes under ST and DT conditions, as well as DTC when performing both tasks simultaneously were used to test the potential of these parameters to differentiate between the most important psychiatric syndromes of older adults, MCI and depression

Summary

Introduction

Current understanding is that gait is a cognitively controlled task and that, as a result of aging, walking shows decreased automaticity and increased attentional control (YogevSeligmann et al, 2008; Boisgontier et al, 2013). This is reflected by reduction of, e.g., gait speed, cadence, stride length, and stride time in elderly compared to young adults (Al-Yahya et al, 2011; Hall et al, 2011). Since “walking while talking” was defined as a predictor of falling (Lundin-Olsson et al, 1997), DT was considered a marker for the interference between cognition and gait

Methods

Results

Conclusion