Reduced Gait Speed Research Articles

Predictors of post-hip fracture knee pain in hospitalized older adults with intertrochanteric femoral fracture.

Post-hip fracture knee pain (PHFKP) is an important issue that contributes to reduced gait speed and prolonged hospitalization. Femoral morphology has been reported to contribute to the development of PHFKP, but an independent association has not been confirmed and clinically applicable cutoffs for predicting the development of PHFKP remain unclear. To determine whether femoral morphology and knee extension range of motion limitation are independent factors in PHFKP and to determine cutoffs for predicting the development of PHFKP. Retrospective chart review study. Convalescent inpatient rehabilitation hospital. Patients in a convalescent ward after intertrochanteric femoral fracture surgery. PHFKP development, radiographic femoral morphology (leg length discrepancy and neck-shaft angle), and knee extension range of motion limitation. PHFKP developed in 36 (35%) of the 103 patients enrolled. The PHFKP group had a longer hospital stay (p=.029), greater weight (p=.031), greater knee extension range of motion limitation (p=.001), and more varus neck-shaft angle (p < .001) compared to the non-PHFKP group. Varus neck-shaft angle (odds ratio, 0.85; 95% confidence interval [CI], 0.78-0.92; p < .001) and knee extension range of motion limitation (odds ratio, 1.18; 95% CI, 1.07-1.30; p=.001) were significant factors for PHFKP development. Neck-shaft angle discrepancy and knee extension range of motion limitation demonstrated moderate accuracy in discriminating development of PHFKP according to receiver operating characteristic analysis, with cutoffs of 9.6° and 7.5°, respectively. Areas under the receiver operating characteristic curve were 0.77 (95% CI, 0.66-0.88; p < .001) for neck-shaft angle discrepancy and 0.67 (95% CI, 0.56-0.79; p=.004) for knee extension range of motion limitation. Varus neck-shaft angle and knee extension range of motion limitation were identified as independent predictors of PHFKP. The cutoff for neck-shaft angle may be useful for predicting PHFKP development and to define an acceptable angle of fracture reduction to prevent PHFKP.

A Prediction Model for Falls in Community-Dwelling Older Adults in Podiatry Practices

Introduction: Falls are a worldwide health problem among community-dwelling older adults. Emerging evidence suggests that foot problems increase the risk of falling, so the podiatrist may be crucial in detecting foot-related fall risk. However, there is no screening tool available which can be used in podiatry practice. The predictive value of existing tools is limited, and the implementation is poor. The development of risk models for specific clinical populations might increase the prediction accuracy and implementation. Therefore, the aim of this study was to develop and internally validate an easily applicable clinical prediction model (CPM) that can be used in podiatry practice to predict falls in community-dwelling older adults with foot (-related) problems. Methods: This was a prospective study including community-dwelling older adults (≥65 years) visiting podiatry practices. General fall-risk variables, and foot-related and function-related variables were considered as predictors for the occurrence of falls during the 12-month follow-up. Logistic regression analysis was used for model building, and internal validation was done by bootstrap resampling. Results: 407 participants were analyzed; the event rate was 33.4%. The final model included fall history in the previous year, unsteady while standing and walking, plantarflexor strength of the lesser toes, and gait speed. The area under the receiver operating characteristic curve was 0.71 (95% CI: 0.66–0.76) in the sample and estimated as 0.65 after shrinkage. Conclusion: A CPM based on fall history in the previous year, feeling unsteady while standing and walking, decreased plantarflexor strength of the lesser toes, and reduced gait speed has acceptable accuracy to predict falls in our sample of podiatry community-dwelling older adults and is easily applicable in this setting. The accuracy of the model in clinical practice should be demonstrated through external validation of the model in a next study.

Influence of Chronic Pain on Cardiovascular and Locomotor Components in Hispanic-Latinos Living with HIV

Background: Chronic pain is commonly reported in people living with the human immunodeficiency virus (HIV). Chronic pain has been linked to decreased quality of life, mobility impairments, and increased risk of cardiovascular complications in the general population. Therefore, the purpose of this study was to determine the relationship between chronic pain and cardiovascular and locomotor function in people living with HIV (PLWH). Subjects: A total of 291 participants were enrolled in this study, 251 without chronic pain (non-CP), and 40 participants with chronic pain (CP). Both groups were comparable in terms of age and years of diagnosis. Methods: Data was collected retrospectively from a community-based exercise program in San Juan, Puerto Rico from 2000-2020. The cardiovascular and motor components of this study were collected using the Ross submaximal cardiovascular test. The presence of chronic pain and Cd4 count was collected by interview and results from the participants’ most recent blood work. Results: For the cardiovascular component, the CP group demonstrated significantly reduced heart rate (p&lt;.05), systolic blood pressure (p&lt;.05), and time completed on the Ross test (p&lt;.001). The motor component portrayed by gait velocity and treadmill inclination was significantly reduced in the CP group (p&lt;.05). Conclusion: This study found that the presence of chronic pain in PLWH negatively affected locomotor and cardiovascular function. More research is needed to investigate the differences in lower extremity muscular activation and spatiotemporal parameters that could be associated with a reduction in gait speed and inclination in PLWH and chronic pain.

Gait Analysis Using the Physics Toolbox App

Sensors in new smartphones can be an excellent tool to measure different physical quantities and these can be useful to develop real experiments with application in human health. Therefore, in this research work, the design and construction of a gait analyser was carried out using the toolbox physics app for data acquisition and MATLAB was used for its analysis. This system analyses the behaviour of walking in people and its purpose is to diagnose any health problem caused by the human being&#x2019;s way of walking. For this, the g-force meter was used in <inline-formula> <tex-math notation="LaTeX">$x$ </tex-math></inline-formula>, <inline-formula> <tex-math notation="LaTeX">$y$ </tex-math></inline-formula>, and <inline-formula> <tex-math notation="LaTeX">$z$ </tex-math></inline-formula> components. This application uses inputs from the device&#x2019;s sensors to save and export the data in comma-separated values (CSV) format through a.csv extension. The results are very interesting because they can be used in medical diagnoses such as reduced gait speed and loss of regularity, symmetry, or synchronization of body movements. Since many organs are involved in gait, there are several types of gait disturbances that cause gait to be abnormal. With this system, it is possible to identify the hemiplegic gait, festinating gait, paraparhetic gait, waddling gait, among others. This analysis was carried out using the Pearson, Spearman, and Kendall correlation coefficients, which indicate the possible diagnoses in the patients.

Mildly Impaired Foot Control in Long-Term Treated Patients with Wilson's Disease.

Abnormal gait is a common initial symptom of Wilson’s disease, which responds well to therapy, but has not been analyzed in detail so far. In a pilot study, a mild gait disturbance could be detected in long-term treated Wilson patients. The question still is what the underlying functional deficit of this gait disturbance is and how this functional deficit correlates with further clinical and laboratory findings. In 30 long-term treated Wilson patients, the vertical component of foot ground reaction forces (GRF-curves) was analyzed during free walking without aid at the preferred gait speed over a distance of 40 m. An Infotronic® gait analysis system, consisting of soft tissue shoes with solid, but flexible plates containing eight force transducers, was used to record the pressure of the feet on the floor. Parameters of the GRF-curves were correlated with clinical scores as well as laboratory findings. The results of Wilson patients were compared to those of an age- and sex-matched control group. In 24 out of 30 Wilson patients and all controls, two peaks could be distinguished: the first “heel-on” and the second “push-off” peak. The heights of these peaks above the midstance valley were significantly reduced in the patients (p < 0.05). The time differences between peaks 1 or 2 and midstance valley were significantly negatively correlated with the total impairment score (p < 0.05). Gait speed was significantly correlated with the height of the “push-off” peak above the midstance valley (p < 0.045). The GRF-curves of free walking, long-term treated patients with Wilson’s disease showed a reduced “push-off” peak as an underlying deficit to push the center of mass of the body to the contralateral side with the forefoot, explaining the reduction in gait speed during walking.

Dual-Task Costs in Gait Speed Differs Across Age Groups

With age, there are simultaneous reductions in gait speed (GS). This decrease in GS has been associated with an increased fall risk and negatively impacts independence. Further, GS naturally declines with the addition of a secondary stimulus (i.e., cognitive requirements). Combined, these decrements can be additive in nature potentially leading to robust declines with advancing age. Therefore, the aim of this study was to examine age-related effects of dual-task cost (DTC) while walking. Adults (N = 145), over the age of 45 years, completed two walking trials for each GS condition: habitual (HAB) and fast (FST), with and without a DT (i.e., counting backwards by serials of three). Subjects were classified into four age groups: youngest-old (YG ≤ 64 years, n = 24), young-old (YO, 65-74 years, n = 46), middle-old (MO = 75-84 years, n = 54), and oldest-old (OO ≥ 85 years, n = 21). DTC was calculated and ANOVAs were used to assess differences between the groups. There was no difference in HAB DTC between the age groups (p=.61). However, there was a significant difference in FST DTC (p=.04) between the YO (M±SD: -14 ± -11%) and OO (M±SD: -24 ± -12%). These data indicate there was an age-related affect for fast dual-task cost, but not for habitual dual-task cost while walking. An increase in dual-task cost among the oldest-old may be associated with an inability to properly maintain a faster cadence while performing an arithmetic task which may be related to task prioritization.

Dual‐task gait and mild behavioral impairment: Findings on the interface between non‐cognitive dementia markers in the COMPASS‐ND study

AbstractBackgroundMild behavioral impairment (MBI) and poor dual‐task gait performance are non‐cognitive markers for dementia. Both MBI and dual‐task gait performance have been associated with an increased risk of cognitive decline, but to our knowledge the relationship between them has yet to be investigated.MethodCross‐sectional data from 193 non‐demented participants (10 cognitively normal, 48 subjective cognitive decline, 135 mild cognitive impairment; MCI) in the COMPASS‐ND study (February 2020 release) were analyzed. MBI was approximated using the Neuropsychiatric Inventory Questionnaire (NPI‐Q) using a published algorithm. Dual‐task gait cost (DTGC), operationalized as the percentage difference between dual‐task and preferred walking speeds, was assessed under three cognitive tasks: animal naming, counting backwards by one, and serial seven subtractions. Multivariable linear regression was used to determine the association between global MBI burden and DTGC, adjusting for age, sex, years of education, and Montreal Cognitive Assessment (MoCA) score, or diagnosis. Models were additionally fitted for the subgroup of participants with MCI alone. Mediation analyses were conducted using bootstrapping to determine if the association between MBI and DTGC was mediated by global cognition (MoCA), executive function (Trail Making B), verbal (Rey Auditory Verbal Learning Test) or working (Digit Span) memory.ResultParticipants on average were 72.4 years old (52.8% female) and had completed 15.8 years of education. MBI symptoms were observed in 46.6% of participants. Greater overall MBI burden was associated with reduced gait speed and higher DTGC for all three gait conditions in MCI, and in all participants without dementia when controlling for diagnosis or MoCA (Table 1), except for DTGC under animal naming conditions when controlling for MoCA. The associations between MBI and DTGC were mediated by executive function but not global cognition, verbal or working memory (Table 2).ConclusionIn this group of older adults at risk but without dementia (SCD and MCI spectrum), MBI is associated with DTGC, which in itself is a dementia risk marker. Our findings support the role of these non‐cognitive dementia markers in the detection of at‐risk individuals. Identification of older adults at risk of incident dementia may be enhanced by considering MBI and DTGC in conjunction.

Gait Analyses of Parkinson’s Disease Patients Using Multiscale Entropy

Parkinson’s disease (PD) is a type of neurodegenerative diseases. PD influences gait in many aspects: reduced gait speed and step length, increased axial rigidity, and impaired rhythmicity. Gait-related data used in this study are from PhysioNet. Twenty-one PD patients and five healthy controls (CO) were sorted into four groups: PD without task (PDw), PD with dual task (PDd), control without task (COw), and control with dual task (COd). Since dual task actions are attention demanding, either gait or cognitive function may be affected. To quantify the used walking data, eight pressure sensors installed in each insole are used to measure the vertical ground reaction force. Thus, quantitative measurement analysis is performed utilizing multiscale entropy (MSE) and complexity index (CI) to analyze and differentiate between the ground reaction force of the four different groups. Results show that the CI of patients with PD is higher than that of CO and 11 of the sensor signals are statistically significant (p &lt; 0.05). The COd group has larger CI values at the beginning (p = 0.021) but they get lower at the end of the test (p = 0.000) compared to that in the COw group. The end-of-test CI for the PDw group is lower in one of the feet sensor signals, and in the right total ground reaction force compared to the PDd group counterparts. In conclusion, when people start to adjust their gait due to pathology or stress, CI may increase first and reach a peak, but it decreases afterward when stress or pathology is further increased.

Inpatient knee pain after hip fracture surgery affects gait speed in older adults: A retrospective chart‐referenced study

Post-hip fracture knee pain (PHFKP) develops in 28-37.4% of patients with hip fracture and contributes to prolonged hospitalization. Although reduced balance and gait speed contribute to falls, the effects of PHFKP remain unclear. This study aimed to clarify whether PHFKP is a factor in balance and gait speed. We retrospectively reviewed the medical records of patients after hip fracture. Development of PHFKP, basic information, and physical function were examined. Berg balance scale (BBS) and maximum walking speed (MWS) were collected at discharge. These parameters were compared with the presence or absence of PHFKP. In addition, multiple analyses were conducted with BBS and MWS as dependent variables and PHFKP as one of the independent variables. Of the 146 patients enrolled, 43 (29.5%) developed PHFKP, and 37.2% of patients with PHFKP showed residual symptoms at discharge. Intensity of PHFKP was mostly mild to moderate. The PHFKP group showed an extended length of stay (+13.3 days) and a tendency toward more discharges to facilities compared with the control group. Knee extension range of motion limitation, knee extensor strength, and BBS did not differ between groups, while MWS was significantly lower in the PHFKP group (0.85 ± 0.32 m/s vs. 1.07 ± 0.39 m/s). Multiple analyses showed that development of PHFKP was not associated with BBS, but was associated with decreased MWS (standardized beta=-0.202, P=0.005). PHFKP was identified as an independent factor in gait speed decline. PHFKP patients should be monitored for reduced gait speed during rehabilitation. Geriatr Gerontol Int 2021; 21: 830-835.

SY2.5. Balance and gait assessment

Postural instability and walking difficulties are the most disabling symptoms in Parkinson disease (PD), leading to falls, physical injuries, functional decline and early institutionalization. Medical, surgical and rehabilitation are the mainstay of management for balance and gait disorders. Evaluation of balance and gait disorders is crucial to determine the problems of the patients so that targeted treatment can be given. Postural instability manifests as reductions in limits of stability, postural adjustment, and postural responses. Gait disorders comprise reduced gait speed, short stride length, freezing of gait, and dual-task deficits. Postural instability and gait disorders can be evaluated using reliable and validated clinical tests, measurement scales, questionnaires and technological equipment. Objective clinical tests and measurement scales require simple equipment and needs a short time to complete the tests. Questionnaires are useful to reflect patients’ perceived balance and gait ability. Technological equipment can be costly but they can increase the measurement sensitivity. The clinical tests used to evaluate postural instability include retropulsion tests, Functional reach test, and one-leg-stance test, whilst those for gait disorders include single or dual-task walk test, timed-up-and-go-test, and 6-minute walk test. Measurement scales including Berg’s balance scale, mini-Balance evaluation system test and Tinetti mobility test, are used to assess overall balance and gait limitations. Most of the measurement scales have cut-off scores for predicting fall risk. Validated questionnaires such as Activities-specific balance confidence scale and Fall efficacy scale evaluate one’s perceived level of balance confidence. Freezing-of-gait questionnaire subjectively assess the severity of freezing of gait. Most of the technological equipment are bulky, laboratory-based and may require a long time to complete the test and/or to analysis the data. Nowadays, body worn sensors is getting more popular because they allow measurement to be taken anywhere including patients’ home and in the community. Algorithm has been built in some systems to shorten the data analyzing time. There are many choices of outcome measures and clinicians/researchers can choose the evaluation methods that is best for their measurement purposes.

Quantitative Evaluation of Gait Changes Using APDM Inertial Sensors After the External Lumbar Drain in Patients With Idiopathic Normal Pressure Hydrocephalus.

Objectives: Gait and balance disturbances are common symptoms of idiopathic normal pressure hydrocephalus (iNPH). This study aimed to quantitatively evaluate gait and balance parameters after external lumbar drainage (ELD) using APDM inertial sensors.Methods: Two-minute walkway tests were performed in 36 patients with suspected iNPH and 20 healthy controls. A total of 36 patients underwent ELD. According to clinical outcomes, 20 patients were defined as responders, and the other 16 as non-responders. The gait parameters were documented, and the corresponding differences between responders and non-responders were calculated.Results: When compared with healthy controls, patients with suspected iNPH exhibited decreased cadence, reduced gait speed, a higher percentage of double support, decreased elevation at mid-swing, reduced foot strike angle, shorter stride length, difficulty in turning, and impaired balance functions. After the ELD, all these manifestations, except elevation at mid-swing and balance functions, were significantly improved in responders. The change of Z-score absolute value in the six parameters, except for foot strike angle, was >1. No significant improvement was observed in non-responders.Conclusion: APDM inertial sensors are useful for the quantitative assessment of gait impairment in patients with iNPH, which may be a valuable tool for identifying candidates that are suitable for shunting operations.

Association between social frailty as well as early physical dysfunction and exercise intolerance among older patients receiving hemodialysis.

Recently, social frailty has been increasingly recognized as a factor associated with adverse health outcomes, including physical disability and mortality. However, there are no studies about the importance of this factor among hemodialysis patients. Therefore, we investigated the relationship between social frailty and early physical dysfunction in this group of patients. This was a two-center cross-sectional study. Older patients receiving hemodialysis were prospectively enrolled. Moreover, participants were evaluated for social frailty based on the definition of previous study and for physical function, peak oxygen uptake (peak VO2 ), ventilatory equivalent for carbon dioxide (VE/VCO2 ) slope and heart rate reserve. Then, they were divided into two groups based on the presence of physical frailty. Data collected from 158 individuals were statistically analyzed. The prevalence rate of social frailty was 59.5%. In the non-physical frailty group, social frailty was found to be independently associated with reduced gait speed (P= 0.007), leg strength (P= 0.040) and peak VO2 (P= 0.023), but not with hand grip strength (P= 0.36). In the physical frailty group, there was no association between social frailty and physical function. Moreover, in patients without physical and social frailty, physical function was maintained at above accepted threshold levels, whereas peak VO2 (14.1 ± 3.3 mL/kg/min), VE/VCO2 slope (32.3 ± 5.5) and heart rate reserve (50.8% ± 21.7%) were substantially impaired. Patients receiving hemodialysis can present with social frailty and exercise intolerance with cardiac dysfunction in the early phase, which may contribute to subsequent dysfunction. Geriatr Gerontol Int 2021; 21: 664-669.

Impact of Cognitive Reserve and Premorbid IQ on Cognitive and Functional Status in Older Outpatients.

The study aimed to investigate cross-sectionally the associations of cognitive reserve (CR) and premorbid IQ with cognitive and functional status in a cohort of older outpatients. Additionally, we evaluated the association of CR and premorbid IQ with the worsening of patients’ cognitive status at one-year follow-up. We originally included 141 outpatients (mean age 80.31 years); a telephone-based cognitive follow-up was carried out after one year, including 104 subjects (mean age 80.26 years). CR (β = 0.418), premorbid IQ (β = 0.271) and handgrip strength (β = 0.287) were significantly associated with the MMSE score. The cognitive worsening at follow-up was associated with lower CR, lower MMSE score, reduced gait speed and frailty exhibited at baseline. Univariate linear regressions showed that CR was associated with handgrip strength (β = 0.346), gait speed (β = 0.185), autonomy in basic (β = 0.221) and instrumental (β = 0.272) daily activities, and frailty (β = −0.290); premorbid IQ was significantly associated with autonomy in instrumental daily activities (β = 0.211). These findings highlight the need for integrating CR and premorbid IQ with physical and motor measures when appraising predictors of cognitive decline in the elderly population. The study also newly extends the link of CR and premorbid IQ to the functional status in older adults.

A Pediatric Knee Exoskeleton With Real-Time Adaptive Control for Overground Walking in Ambulatory Individuals With Cerebral Palsy.

Gait training via a wearable device in children with cerebral palsy (CP) offers the potential to increase therapy dosage and intensity compared to current approaches. Here, we report the design and characterization of a pediatric knee exoskeleton (P.REX) with a microcontroller based multi-layered closed loop control system to provide individualized control capability. Exoskeleton performance was evaluated through benchtop and human subject testing. Step response tests show the averaged 90% rise was 26 ± 0.2 ms for 5 Nm, 22 ± 0.2 ms for 10 Nm, 32 ± 0.4 ms for 15 Nm. Torque bandwidth of P.REX was 12 Hz and output impedance was less than 1.8 Nm with control on (Zero mode). Three different control strategies can be deployed to apply assistance to knee extension: state-based assistance, impedance-based trajectory tracking, and real-time adaptive control. One participant with typical development (TD) and one participant with crouch gait from CP were recruited to evaluate P.REX in overground walking tests. Data from the participant with TD were used to validate control system performance. Kinematic and kinetic data were collected by motion capture and compared to exoskeleton on-board sensors to evaluate control system performance with results demonstrating that the control system functioned as intended. The data from the participant with CP are part of a larger ongoing study. Results for this participant compare walking with P.REX in two control modes: a state-based approach that provided constant knee extension assistance during early stance, mid-stance and late swing (Est+Mst+Lsw mode) and an Adaptive mode providing knee extension assistance proportional to estimated knee moment during stance. Both were well tolerated and significantly improved knee extension compared to walking without extension assistance (Zero mode). There was less reduction in gait speed during use of the adaptive controller, suggesting that it may be more intuitive than state-based constant assistance for this individual. Future work will investigate the effects of exoskeleton assistance during overground gait training in children with neurological disorders and will aim to identify the optimal individualized control strategy for exoskeleton prescription.

MO204CHRONIC KIDNEY DISEASE, SLEEPINESS, MILD COGNITIVE IMPAIRMENT AND FINE MOTOR CONTROL

Abstract Background and Aims Chronic kidney disease (CKD) is a systemic condition because it modifies all organs' function due to an imbalance in plasma volume, electrolytes, hormones, and proteins. Indeed, at the nervous system level, mild cognitive impairment (MCI), sleep disorders and depression often accompany CKD. MCI partially explains the low quality of life of CKD patients, comparable to that of metastatic cancer patients. Mild Cognitive Impairment (MCI) has a high prevalence in this cohort (27-62%). Nevertheless, scattered literature data suggest that CKD patients can also have poor motor control, evidenced by a higher risk of falls, postural instability, reduced gait speed. In this cohort, few data are available regarding the motor circuits called central pattern generators, which control physiological tremor. Specifically, uraemic encephalopathy accentuates physiological tremor, which is regulated by central and peripheral oscillators. Overall, subtle changes in motor control often accompany other forms of MCI. Therefore, this study aimed at evaluating the effects of chronic kidney disease on cognitive and motor functions using up-to-date technologies to record physiological tremor and innovative data analysis. Method This retrospective case-control study enrolled 313 patients (139 controls, 79 CKD patients stage III-IV, 35 kidney transplant (Tx), 60 dialysis (HD) patients). These groups were comparable for age and weight. Creatininemia, azotemia, LDL, HDL, hemoglobin, and proteinuria were used for correlative analyses. We evaluated the chronotype using the Morningness-Eveningness Questionnaire (MEQ) and the degree of sleepiness using the Epworth Sleepiness Scale (ESS). Cognitive impairment was assessed by the Montreal Cognitive Assessment test (MoCA). Cognitive domains of the MoCA score were projected onto brain regions using CerebroViz library in R and a new transformation matrix derived from fMRI literature data. UMAP algorithm was used to identify patients' subgroups. The physiological tremor was recorded on patients maintaining the dominant arm extended using the smartphone App Phyphox. The tremor frequency spectrum was extracted by Fourier analysis. Results The sleepiness score (ESS) was significantly increased in HD (ESS = 5±0.4) compared to the healthy controls (ESS= 4±0.41) whereas was not significantly modified in CKD patients (3.24± 0.32). The chronotype was also not significantly different among the various groups. The mean score of the MoCA test was significantly lower in CKD, Tx, and HD groups (CKD MoCA =24.5±0.3; Tx MoCA =25.4±0.6; HD MoCA =24.6±0.7) than controls (MoCA score=28±0.1). A different pattern of impairment in the cognitive domains of MoCA was evidenced in the various groups using the CerebroViz projection and UMAP tools. MoCA score was inversely correlated with proteinuria (Pearson coefficient=-0.47; p&amp;lt;0.05). The higher frequencies of the physiological tremor (11-13 Hz) were significantly more represented in Tx patients compared to controls (p&amp;lt;0.05). Conversely, the lower frequencies (1-4 Hz) were significantly less represented in the HD group compared to controls (p&amp;lt;0.05). The peak frequency was inversely correlated with age in all patients (Pearson coefficient= -0.45; p&amp;lt;0.05) and inversely associated with azotemia levels, particularly in HD patients (Pearson coefficient=0.43; p&amp;lt;0.05). Conclusion Our results suggest that CKD patients present altered cognitive and motor control patterns, linked in part to the proteinuria level, suggesting a pathogenetic role of endothelial dysfunction. The characteristic motor, sleepiness and cognitive patterns of HD patients might be due to the arteriovenous fistula or the other peculiarities of these patients. These results might help identify new early markers of brain dysfunction in these patients, with the possibility of delaying or reversing cognitive decay.

Medial meniscus extrusion is a determinant factor for the gait speed among MRI-detected structural alterations of knee osteoarthritis

ObjectiveKnee osteoarthritis (OA) is one of the most common causes for reduction in gait speed. Research into the mechanism of underlying knee OA pain and other symptoms such as the reduction in the gait speed is essential to development of disease-modifying treatments for knee OA. We examined the magnetic resonance imaging (MRI)-detected structural alterations in knee joints those were associated with gait speed in knee OA patients. DesignIn this cross-sectional study, structural alterations in knee joints of 74 knee OA patients (51 females; mean 72.2 years old) were evaluated by MRI, and subjects’ gait speed was measured. ResultsThe mean self-selected gait speed of the subjects was 0.73 ​± ​0.21 ​m/s. A simple linear regression analysis revealed that MME was only correlated with the gait speed of the subjects with knee OA, while cartilage lesion, bone marrow lesion, subchondral bone cyst, subchondral cyst, osteophytes and meniscal pathology were not. A multiple regression analysis revealed that only MME was associated with gait speed (R2 ​= ​0.484, p ​< ​0.001). The area under the receiver operating characteristic curve for determining <0.8 ​m/s of gait speed as evaluated by MME were 0.72 (95% confidence interval: 0.60–0.84). The relative risks at a cut-off <0.8 ​m/s for gait speed as evaluated by MME at 6.2 ​mm were 2.19 (1.28–3.46, p ​= ​0.01). ConclusionsMME was associated with and the determinant for gait speed among MRI-detected structural alterations in patients with knee OA, suggesting the importance for elucidating the etiology of MME for developing a disease-modifying treatment for knee OA.

The Pandora"s box of frailty assessments, which is the best for clinical purpose? A critical review

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Assessment of frailty is recommended for patients undergoing elective transcatheter aortic valve implantation (TAVI) to appreciate post-interventional prognosis. Several studies investigated frailty in this population using single markers (e.g. gait speed), clinical judgment scales (e.g. Rockwood) or composite indexes (e.g. Fried). However, there is a lack of consensus on the most appropriate tool for assessment of frailty in clinical practice. Purpose To evaluate which frailty assessment is the most used and meaningful for post-interventional prognosis in older TAVI patients. Methods A systematic search was performed in PubMed (May 2020). We included randomized controlled trials or observational studies (prospective or retrospective) without time restrictions investigating the association of frailty and 1-year all-cause mortality in older (≥70 years) TAVI-patients. Results 60 studies (151,723 patients) were included. Studies heterogeneity (methods) was considerable. 40 different frailty assessments were identified. The most used single marker (Table) was gait speed (5-meter walk test), investigated in 16 observational studies (8/8 prospective/retrospective with 5,747/40,535 patients). 11 studies found mortality prediction by reduced gait speed, with hazard ratios (HR) between 1.36 (95% confidence interval (CI) 1.23-1.50) and 14.71 (95%CI 6.50-33.30) as well as an Odds Ratio (OR) of 2.34 (95%CI 1.03-5.32). Frailty in composite indexes (Table) predicted mortality in 10 of 11 observational studies 4-items index: HR 1.84 (95%CI 1.23-2.69) to 3.05 (95%CI 1.24-7.46), 5-items index: OR 1.63 (95 CI 1.12-2.37) to 2.75 (95%CI 1.55-4.87). Conclusion Predominantly, single markers, especially gait speed, are used to assess frailty in TAVI-patients. Composite indexes seem to be relieble as well and should be considered for prediction of 1-year mortality. Review results Single marker of frailty Total studies Predictive for 1-y mortality Gait speed (GS) 16 (46582) 11 (41376) Activities of Daily Living (ADL) 14 (6600) 6 (1405) Serum albumin (SA) 15 (49334) 13 (48729) Handgrip strength 10 (5912) 5 (1105) Composite indexes 4-items (GS, HG, SA, ADL) 6 (1957) 6 (1957) 5-items (GS, HG, exhaustion, low PA, weight loss) 5 (3014) 5 (3014) Clinical judgment scale Clinical Frailty Scale (CFS) 9 (6415) 5 (4316) Numbers indicate number of studies and (number of patients)

Changes to gait speed when romantic partners walk together: Effect of age and obstructed pathway

BackgroundWalking at a brisk pace is widely recommended to promote health. When partners walk together, walking activity is increased and maintained due to enhanced social support and accountability, but at least one person must adjust their gait speed. Decreased gait speed could compromise health benefits, which may be especially relevant for the aging population. Research questionDo adults change gait speed when walking with their romantic partner, relative to walking alone, and is the change in speed affected by age or pathway conditions? MethodsParticipants were 141 individuals from 72 romantic couples; age range 25−79 years. The three couple conditions were walking alone, walking with their partner, and walking while holding hands with their partner. The two pathway conditions were clear pathway and pathway with obstacles. Gait speed was modeled as a function of the couple conditions, pathway conditions, and covariates (gender, age, relationship duration, and physical activity) using mixed-effects (3-level) regression. ResultsIn both pathway conditions, both partners reduced speed when walking together (p < 0.001), and reduced speed further while holding hands (p < 0.001), when compared to walking alone. These effects were unchanged when covariates were included in the model. Further, speed was slower on the obstructed pathway for all participants, but the magnitude of slowing was greater with increasing age (p < 0.001) and in females (p=0.03). SignificanceAcross the adult lifespan, when walking together, both partners decreased gait speed by a clinically meaningful amount (≥0.05 m/s). While walking with a partner may increase walking activity due to social support, reduced speed when walking together may unintentionally reduce health benefits and gait quality in both partners. Future research should identify how health is impacted by the trade-off between increased walking activity and reduced gait speed when romantic partners walk together.

Frailty and reduced gait speed are independently related to mortality of cirrhotic patients in long-term follow-up

Introduction and objectivesFrailty is characterized by a poor restoration of homeostasis after a stressor event. Although it is not usually diagnosed, it has been associated with decreased survival in cirrhotic patients. We aimed to evaluate the impact of frailty and decreased gait speed over survival in cirrhotic patients at long-term follow-up. Materials and methodsWe included stable cirrhotic patients Child–Pugh B-C or MELD ≥12, ≥50 years old. We performed a clinical evaluation, anthropometry, and laboratory tests. Frailty was diagnosed using Fried Frailty Index. We evaluated survival at a 4-year follow-up. ResultsWe included 126 patients; mean age 64±8.3 years, median MELD-Na 15[12–17], median follow-up was 881 [349–1277] days. The main etiology was MAFLD (31.4%). Frailty was diagnosed in 65.1% of patients. There were no significant differences in baseline characteristics per frailty condition. Mortality was higher in frail patients than non-frail patients (68.2% versus 20.6% at 48 months, respectively; p-value <0.001). The mean gait speed in frail and non-frail patients was 0.86±0.3m/s and 1.16±0.2m/s, respectively (p-value <0.001). Interestingly, 26.9% of patients presented a reduced gait speed (≤0.8m/s). Patients with decreased gait speed also had higher mortality than patients with normal gait speed (79.9% versus 40.8%, respectively; p-value <0.001). A multivariate-adjusted model showed that decreased gait speed (HR=3.27, 95%CI:1.74–6.14; p<0.001) and frailty (HR=4.24, 95%CI:1.89–9.51; p<0.001) were associated with mortality. ConclusionsFrailty is independently associated with decreased survival at long-term follow-up. Reduced gait speed is strongly associated with mortality and could be a surrogate marker of frailty in clinical practice.

Progression of Gait Changes in Older Adults With Mild Cognitive Impairment: A Systematic Review.

The identification of altered gait and its progression over time is important to gaining a better understanding of the clinical aspects of mild cognitive impairment (MCI) in older adults. The aim of the present systematic review was to determine changes in gait variables over time among older adults with MCI. The PubMed, Web of Science, Scopus, and Science Direct databases were searched for relevant articles using the following keywords and Medical Subject Headings: Aged AND "Mild cognitive impairment" AND (gait OR locomotion). A hand search was also performed of the reference lists of the selected articles in an attempt to find additional records. The following were the inclusion criteria: longitudinal studies and clinical trials involving a control group without intervention; samples of individuals 65 years or older; and characterization of gait using a single or dual task. The initial search led to the retrieval of 6979 studies, 9 of which met the inclusion criteria. The duration of follow-up among the studies ranged from 6 months to 2 years. Most trials investigated gait speed. Other gait variables were step length, time required to walk a given distance, and mean weekly gait speed. Altered gait progressed in older adults with MCI. The main alterations were gait speed and variability in daily number of steps in follow-up periods lasting more than 1 year. No significant changes in gait variables were found in shorter follow-up periods (up to 6 months). The progression of gait changes in older adults with MCI has been underinvestigated. MCI leads to reduced gait speed in longer follow-up periods. Such information can contribute to the determination of motor interventions for older adults with MCI, especially in the early stages.