Upper-Extremity Dual-Task Function: An Innovative Method to Assess Cognitive Impairment in Older Adults
Upper-Extremity Dual-Task Function: An Innovative Method to Assess Cognitive Impairment in Older Adults
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DOI：
10.3389/fnagi.2016.00167
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发表时间：
2016-07-07
影响因子：
4.8
通讯作者：
Mohler, Jane
中科院分区：
文献类型：
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作者：
Toosizadeh, Nima;Najafi, Bijan;Mohler, Jane
背景：协调同时任务(即双重任务)的困难与老年人的认知障碍有关。步态测试通常被用作双重任务评估的运动任务组成部分；然而，许多老年人有行动障碍，或者在繁忙的临床环境中缺乏空间。我们评估了上肢功能(UEF)测试作为一种替代运动任务来研究老年人的双重任务运动表现。方法：招募65岁的老年人，使用蒙特利尔认知评估(MoCA)测量认知能力。参与者以他们的最大速度重复屈肘，一次是单一任务，一次是倒数一次(双重任务)。单任务和双任务步态测试也在正常速度下进行。使用可穿戴传感器测量上肢和下肢的三维运动学，以确定UEF和步态参数。在控制年龄、性别和体重指数(BMI)的同时，使用方差检验分析比较认知障碍组和健康组之间的参数。使用线性回归模型评估双任务和双任务成本下UEF与步态参数的相关性。结果：共招募了67名老年人(年龄=83+/-10岁)。根据MoCA评分，10例(15%)患者存在认知障碍。虽然在单任务条件下没有显著差异，但在双重任务条件下，当调整年龄、性别和体重指数时，认知障碍组与认知正常组相比，手臂屈曲速度(62%，d=1.51p=0.02)和活动范围(27%，d=0.93p=0.04)显著降低，速度变异性(88%，d=1.82p<；0.0001)显著增加。在双任务条件下，UEF速度参数与步态步速(r=0.55，p&t；0.0001)和双任务成本(r=0.28，p=0.03)之间存在显著的相关性。结论：我们提出了一种基于上肢功能的持续20天的老年人双任务绩效评估方法。我们的结果证实，在双重任务条件下，上肢速度、活动范围和速度变异性与MoCA评分和步态表现之间存在显著关联。
Background: Difficulties in orchestrating simultaneous tasks (i.e., dual-tasking) have been associated with cognitive impairments in older adults. Gait tests have been commonly used as the motor task component for dual-task assessments; however, many older adults have mobility impairments or there is a lack of space in busy clinical settings. We assessed an upper-extremity function (UEF) test as an alternative motor task to study the dual-task motor performance in older adults.Methods: Older adults (>= 65 years) were recruited, and cognitive ability was measured using the Montreal cognitive assessment (MoCA). Participants performed repetitive elbow flexion with their maximum pace, once single-task, and once while counting backward by one (dual-task). Single- and dual-task gait tests were also performed with normal speed. Three-dimensional kinematics was measured both from upper-extremity and lower-extremity using wearable sensors to determine UEF and gait parameters. Parameters were compared between the cognitively impaired and healthy groups using analysis of variance tests, while controlling for age, gender, and body mass index (BMI). Correlations between UEF and gait parameters for dual-task and dual-task cost were assessed using linear regression models.Results: Sixty-seven older adults were recruited (age = 83 +/- 10 years). Based on MoCA, 10 (15%) were cognitively impaired. While no significant differences were observed in the single-task condition, within the dual-task condition, the cognitively impaired group showed significantly less arm flexion speed (62%, d = 1.51, p = 0.02) and range of motion (27%, d = 0.93, p = 0.04), and higher speed variability (88%, d = 1.82, p < 0.0001) compared to the cognitively intact group, when adjusted with age, gender, and BMI. Significant correlations were observed between UEF speed parameters and gait stride velocity for dual-task condition (r = 0.55, p < 0.0001) and dual-task cost (r = 0.28, p = 0.03).Conclusion: We introduced a novel test for assessing dual-task performance in older adults that lasts 20 s and is based on upper-extremity function. Our results confirm significant associations between upper-extremity speed, range of motion, and speed variability with both the MoCA score and the gait performance within the dual-task condition.