Screening older adults for amnestic mild cognitive impairment and early-stage Alzheimer’s disease using upper-extremity dual-tasking (original) (raw)

Abstract

The purpose of the current study was to develop an objective tool based on dual-task performance for screening early-stage Alzheimer's disease (AD) and mild cognitive impairment (MCI of the Alzheimer's type). Dual-task involved a simultaneous execution of a sensor-based upper-extremity function (UEF) motor task (normal or rapid speed) and a cognitive task of counting numbers backward (by ones or threes). Motor function speed and variability were recorded and compared between cognitive groups using ANOVAs, adjusted for age, gender, and body mass index. Cognitive indexes were developed using multivariable ordinal logistic models to predict the cognitive status using UEF parameters. Ninety-one participants were recruited; 35 cognitive normal (CN, age = 83.8 ± 6.9), 34 MCI (age = 83.9 ± 6.6), and 22 AD (age = 84.1 ± 6.1). Flexion number and sensor-based motion variability parameters, within the normal pace elbow flexion, showed significant between-group differences (maximum effect size of 1.10 for CN versus MCI and 1.39 for CN versus AD, p < 0.0001). Using these parameters, the cognitive status (both MCI and AD) was predicted with a receiver operating characteristic area under curve of 0.83 (sensitivity = 0.82 and specificity = 0.72). Findings suggest that measures of motor function speed and accuracy within a more practical upper-extremity test (instead of walking) may provide enough complexity for cognitive impairment assessment. Cognitive impairment is a critical health problem with an increasing prevalence because of the population aging 1. It is estimated that by 2040, the number of elders living with dementia will surpass nine million in the US, roughly 170% increase compared to 2001 2. Among different types of dementia, Alzheimer's disease (AD) is the most common type, which influences the lives of up to 7% of the elderly population in the US and globally 3. Early dementia screening provides an opportunity to begin secondary prevention, as well as planning for future care, safety concerns, and financial and legal arrangements, while decision-making capacity remains 4. Unfortunately, many providers are reluctant to screen for dementia resulting in less than half of patients with AD having ever received a formal diagnosis 5. The current research was founded based on the fact that simultaneous declines in motor and cognitive performance occur with aging 6-8. In many age-related neurodegenerative diseases, and more specifically in Alzheimer's disease, compensatory processes in cortical and subcortical brain regions allow maintenance of motor and cognitive performance 9. Assessing deficits in dual-tasking, therefore, can provide a powerful tool for screening cognitive impairments. Gait has been commonly used as the motor task component in dual-task assessments. Poor dual-task gait performance has been significantly correlated with decreased executive and neuropsychological function, and demonstrated to be associated with AD or even mild cognitive impairment (MCI) 10-12. However, many older adults have mobility impairments, and many clinics lack adequate space to safely perform gait measures.

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