Abstract
BackgroundOlder adults with mild cognitive impairment (MCI) have slower gait speed and poor gait performance under dual-task conditions. However, gait kinematic and kinetic characteristics in older adults with MCI or subjective cognitive decline (SCD) remain unknown. This study was designed to explore the difference in gait kinematics and kinetics during level walking among older people with MCI, SCD, and normal cognition (NC).MethodsThis cross-sectional study recruited 181 participants from July to December 2019; only 82 met the inclusion criteria and consented to participate and only 79 completed gait analysis. Kinematic and kinetic data were obtained using three-dimensional motion capture system during level walking, and joint movements of the lower limbs in the sagittal plane were analyzed by Visual 3D software. Differences in gait kinematics and kinetics among the groups were analyzed using multivariate analysis of covariance (MANCOVA) with Bonferroni post-hoc analysis. After adjusting for multiple comparisons, the significance level was p < 0.002 for MANCOVA and p < 0.0008 for post-hoc analysis.ResultsTwenty-two participants were MCI [mean ± standard deviation (SD) age, 71.23 ± 6.65 years], 33 were SCD (age, 72.73 ± 5.25 years), and 24 were NC (age, 71.96 ± 5.30 years). MANCOVA adjusted for age, gender, body mass index (BMI), gait speed, years of education, diabetes mellitus, and Geriatric Depression Scale (GDS) revealed a significant multivariate effect of group in knee peak extension angle (F = 8.77, p < 0.0001) and knee heel strike angle (F = 8.07, p = 0.001) on the right side. Post-hoc comparisons with Bonferroni correction showed a significant increase of 5.91° in knee peak extension angle (p < 0.0001) and a noticeable decrease of 6.21°in knee heel strike angle (p = 0.001) in MCI compared with NC on the right side. However, no significant intergroup difference was found in gait kinetics, including dorsiflexion, plantar flexion, knee flexion, knee extension, hip flexion, and hip extension(p > 0.002).ConclusionAn increase of right knee peak extension angle and a decrease of right knee heel strike angle during level walking were found among older adults with MCI compared to those with NC.
Highlights
Gait disturbance and cognitive decline increase with advancing age (Cohen et al, 2016), and both of these are considered prominent risk factors of fall in older people with dementia (Ambrose et al, 2013; Rinaldi and Moraes, 2016; Zhang et al, 2019)
The participants were assessed using the following neuropsychological tests, covering three cognitive domains: (1) episodic memory assessed by Auditory–Verbal Learning Test– Huashan version (AVLT-H) (Zhao et al, 2012), using the delayed recall and delayed recognition scores; (2) speed/executive function assessed by trail-making test (TMT) parts A and B (Perrochon and Kemoun, 2014), using the time spent for completing TMT A and TMT B; and (3) language function assessed by verbal fluency (McDonnell et al, 2020) and Boston Naming Test (Stålhammar et al, 2016), using the scores of both tests
Post-hoc analysis revealed increased knee peak extension and noticeable knee ROM and knee heel strike angle in mild cognitive impairment (MCI) compared with normal cognition (NC), while no difference was found in subjective cognitive decline (SCD) compared with NC. These findings indicated that knee kinematics were different significantly only in the MCI group; the SCD group had similar gait performance compared with NC
Summary
Gait disturbance and cognitive decline increase with advancing age (Cohen et al, 2016), and both of these are considered prominent risk factors of fall in older people with dementia (Ambrose et al, 2013; Rinaldi and Moraes, 2016; Zhang et al, 2019). Cognitive impairment is considered one of the risk factors associated with slow gait velocity, physical inactivity, muscle weakness, pain, impaired vision, prior history of falls, and obesity in older individuals (Verghese et al, 2016). Quantitative tests have revealed gait dysfunction in subjects with amnestic and non-amnestic mild cognitive impairment (MCI) subtypes compared with healthy controls (Verghese et al, 2008). Older adults with mild cognitive impairment (MCI) have slower gait speed and poor gait performance under dual-task conditions. Gait kinematic and kinetic characteristics in older adults with MCI or subjective cognitive decline (SCD) remain unknown. This study was designed to explore the difference in gait kinematics and kinetics during level walking among older people with MCI, SCD, and normal cognition (NC)
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