Digital Biomarkers of Cognitive Frailty: The Value of Detailed Gait Assessment Beyond Gait Speed.
Digital Biomarkers of Cognitive Frailty: The Value of Detailed Gait Assessment Beyond Gait Speed.
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作者：
Zhou H;Park C;Shahbazi M;York MK;Kunik ME;Naik AD;Najafi B
认知衰弱是指认知障碍和身体虚弱同时存在，是早期痴呆的一种临床症状，可用于评估痴呆的风险。本研究的目的是使用可穿戴设备来确定最敏感的数字步态生物标记物来识别CF。对121例老年人(年龄78.9±8.2岁，体重指数26.6±5.5 kg/m2)进行综合神经功能检查和Fry脆性评分，其中41例(34%)有CFs，80例(66%)无CFs。参与者的步态表现是使用经过验证的可穿戴平台在单任务(行走而不受认知干扰)和双重任务(行走时从随机数向后计数)下进行评估。参与者以习惯性的速度步行超过10米。一种有效的算法被用来确定稳态行走。感兴趣的步态参数包括稳态步态速度、步长、步态周期时间、双支撑和步态不稳定。此外，速度和步长按身高归一化。我们的研究结果表明，与无功能训练组相比，训练组在单任务和双任务行走中的步态表现都有所下降(Cohen‘s Effect Size d=0.42-0.97，p<；0.050)。归一化双任务步速的效应值最大(d=0.97p<；0.001)。使用双任务步态速度可以将曲线下面积(AUC)从单任务步态速度的0.73提高到0.76。同时增加单任务和双任务步态速度并没有显著改变AUC。然而，当模型中包括步态不稳定、步长和双支撑等步态参数时，AUC提高到0.87。这项研究表明，可穿戴传感器测量的步态表现可能是老年人CF的潜在数字生物标志物。双任务步态和其他详细的步态指标为单独识别高于步态速度的CF提供了价值。未来的研究需要检验步态表现对CF早期诊断和/或随时间推移追踪其严重性的潜在益处。
Cognitive-frailty (CF), defined as simultaneous presence of cognitive-impairment and physical-frailty, is a clinical symptom in early-stage dementia with promise in assessing the risk of dementia. The purpose of this study was to use wearables to determine the most sensitive digital gait biomarkers to identify CF. Of 121 older adults (age=78.9±8.2years, body mass index=26.6±5.5kg/m2) who were evaluated with a comprehensive neurological exam and the Fried Frailty Criteria, 41 participants (34%) were identified with CF and 80 participants (66%) were identified without CF. Gait performance of participants was assessed under single-task (walking without cognitive distraction) and dual-task (walking while counting backward from a random number) using a validated wearable platform. Participants walked at habitual speed over a distance of 10 meters. A validated algorithm was used to determine steady-state walking. Gait parameters of interest including steady-state gait speed, stride length, gait cycle time, double-support, and gait unsteadiness. In addition, speed and stride length were normalized by height. Our results suggest that compared to the group without CF, the CF group had deteriorated gait performances in both single-task and dual-task walking (Cohen’s effect size d=0.42–0.97, p<0.050). The largest effect size was observed in normalized dual-task gait speed (d=0.97, p<0.001). The use of dual-task gait speed improved the area-under-curve (AUC) to distinguish CF cases to 0.76 from 0.73 observed for the single-task gait speed. Adding both single-task and dual-task gait speeds did not noticeably change AUC. However, when additional gait parameters such as gait unsteadiness, stride length, and double-support were included in the model, AUC was improved to 0.87. This study suggests that gait performances measured by wearable sensors are potential digital biomarkers of CF among older adults. Dual-task gait and other detailed gait metrics provide value for identifying CF above gait speed alone. Future studies need to examine the potential benefits of gait performances for early diagnosis of CF and/or tracking its severity over time.
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