Abstract
BackgroundReliability of quantitative gait assessment while dual-tasking (walking while doing a secondary task such as talking) in people with cognitive impairment is unknown. Dual-tasking gait assessment is becoming highly important for mobility research with older adults since better reflects their performance in the basic activities of daily living. Our purpose was to establish the test-retest reliability of assessing quantitative gait variables using an electronic walkway in older adults with mild cognitive impairment (MCI) under single and dual-task conditions.MethodsThe gait performance of 11 elderly individuals with MCI was evaluated using an electronic walkway (GAITRite® System) in two sessions, one week apart. Six gait parameters (gait velocity, step length, stride length, step time, stride time, and double support time) were assessed under two conditions: single-task (sG: usual walking) and dual-task (dG: counting backwards from 100 while walking). Test-retest reliability was determined using intra-class correlation coefficient (ICC). Gait variability was measured using coefficient of variation (CoV).ResultsEleven participants (average age = 76.6 years, SD = 7.3) were assessed. They were high functioning (Clinical Dementia Rating Score = 0.5) with a mean Mini-Mental Status Exam (MMSE) score of 28 (SD = 1.56), and a mean Montreal Cognitive Assessment (MoCA) score of 22.8 (SD = 1.23). Under dual-task conditions, mean gait velocity (GV) decreased significantly (sGV = 119.11 ± 20.20 cm/s; dGV = 110.88 ± 19.76 cm/s; p = 0.005). Additionally, under dual-task conditions, higher gait variability was found on stride time, step time, and double support time. Test-retest reliability was high (ICC>0.85) for the six parameters evaluated under both conditions.ConclusionIn older people with MCI, variability of time-related gait parameters increased with dual-tasking suggesting cognitive control of gait performance. Assessment of quantitative gait variables using an electronic walkway is highly reliable under single and dual-task conditions. The presence of cognitive impairment did not preclude performance of dual-tasking in our sample supporting that this methodology can be reliably used in cognitive impaired older individuals.
Highlights
Reliability of quantitative gait assessment while dual-tasking in people with cognitive impairment is unknown
Since a seminal study demonstrated that the inability to maintain a conversation while walking is a marker for future falls in older adults[8], walking while performing a secondary task has become a classic way to assess the relationship between cognition and gait Because the dual-task paradigm is a realistic proxy for daily living activities that seniors may perform at home, it is growing in interest and application in clinical research settings
Participants were diagnosed with mild cognitive impairment (MCI) if they[12]: did not have dementia.[13], had objective memory impairment, experienced subjective memory symptoms corroborated by an informant, and had preserved activities of daily living
Summary
Reliability of quantitative gait assessment while dual-tasking (walking while doing a secondary task such as talking) in people with cognitive impairment is unknown. Our purpose was to establish the test-retest reliability of assessing quantitative gait variables using an electronic walkway in older adults with mild cognitive impairment (MCI) under single and dual-task conditions. Previous studies have reported good test-retest reliability using electronic walkways while assessing gait in older people without performing a secondary task [911], the reliability of quantitative gait assessment under dual-task conditions among those with cognitive problems has not been established. Our objective was to determine the reliability of quantitative gait assessment under both single and dual-task conditions in people with mild cognitive impairment (MCI) using a one-week space between assessments. This timeframe is appropriate for research purposes in this population, since gait variables are stable over short intervals. Establishing the reliability of quantitative gait assessment under dual-task conditions among those with cognitive problems is an important first step in validating this methodology for future longitudinal studies
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