Abstract
Laboratory-based gait assessments are indicative of clinical outcomes (e.g., disease identification). Real-world gait may be more sensitive to clinical outcomes, as impairments may be exaggerated in complex environments. This study aims to investigate how different environments (e.g., lab, real world) impact gait. Different walking bout lengths in the real world will be considered proxy measures of context. Data collected in different dementia disease subtypes will be analysed as disease-specific gait impairments are reported between these groups. Thirty-two people with cognitive impairment due to Alzheimer’s disease (AD), 28 due to dementia with Lewy bodies (DLB) and 25 controls were recruited. Participants wore a tri-axial accelerometer for six 10 m walks in lab settings, and continuously for seven days in the real world. Fourteen gait characteristics across five domains were measured (i.e., pace, variability, rhythm, asymmetry, postural control). In the lab, the DLB group showed greater step length variability (p = 0.008) compared to AD. Both subtypes demonstrated significant gait impairments (p < 0.01) compared to controls. In the real world, only very short walking bouts (<10 s) demonstrated different gait impairments between subtypes. The context where walking occurs impacts signatures of gait impairment in dementia subtypes. To develop real-world gait assessment as a clinical tool, algorithms and metrics must accommodate for changes in context.
Highlights
Gait assessment may produce clinically meaningful outcomes, such as prediction and discrimination of neurological disorders from healthy controls [1,2,3,4,5], differentiation of dementia disease subtypes [3], monitoring progression of disease [6], reflecting cognitive impairments [7], identification of fall risk and freezing of gait [8,9,10,11], and assessment of treatment and rehabilitation efficacy [12,13]
This paper aims to investigate if gait assessments in both the lab and the real world can provide signatures of gait impairment that can discriminate between dementia disease subtypes and normal ageing, as assessed by wearable technology and if different walking bout lengths can affect these signatures of gait impairment
125 participants were recruited to the study; only Alzheimer’s disease (AD), dementia with Lewy bodies (DLB) and control participants with both lab-based and real-world gait assessment were included in this analysis (n = 85)
Summary
Gait assessment may produce clinically meaningful outcomes, such as prediction and discrimination of neurological disorders from healthy controls [1,2,3,4,5], differentiation of dementia disease subtypes [3], monitoring progression of disease [6], reflecting cognitive impairments [7], identification of fall risk and freezing of gait [8,9,10,11], and assessment of treatment and rehabilitation efficacy [12,13]. While the majority of gait assessment occurs in clinical or lab-based environments, the advent of wearable technology has led to growing interest in continuously assessing gait in the real world in neurological populations such as those with dementia and Parkinson’s disease (PD). Wearable technology refers to mobile devices incorporating sensors which can be worn on the body or embedded into clothing, watches or bracelets. They can be worn continuously for extended periods of time, offering a novel and realistic perspective of gait [12]. There has been a significant growth in research examining real-world gait using wearable technology, with many studies employing a single tri-axial accelerometer on the body for unobtrusive data collection [8,14,15]. Accelerometers are a useful method of real-world data collection due to their inexpensive nature, ability to collect spatiotemporal and macro gait information (e.g., physical activity measures) and their timely set-up
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