Association Between Performance on Timed Up and Go Subtasks and Mild Cognitive Impairment: Further Insights into the Links Between Cognitive and Motor Function

Mirelman, Anat; Weiss, Aner; Buchman, Aron S.; Bennett, David A.; Giladi, Nir; Hausdorff, J.M.

doi:10.1111/jgs.12734

Cited by 126 publications

(133 citation statements)

References 28 publications

(72 reference statements)

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“…This, too, is consistent with other studies, which also did not report any significant slowing in TUG times related to cognitive status [13,36]. Referring to Mirelman et al [13], one could suggest that the gait disturbances related to executive dysfunction are shown in subtasks of gait but do not impair gait speed. This may imply that a simple gait assessment (without sensors) for assessing MCI patients would not be predictive of impairments in executive functions.…”

Section: Discussionsupporting

confidence: 80%

“…As gait and cognitive function are closely related and gait disorders can be regarded as a predictor of future development of neurological diseases in older persons [11,12,13], recent progress has been made in the field of gait analysis using motor imagery, which is a mental process by which an individual rehearses or simulates a given action, for assessment of gait and executive function in older adults with cognitive decline. The influence of frontal and temporal lobe as well as executive function on gait in cognitively impaired persons has been recently examined in various studies [11,14,15].…”

Section: Introductionmentioning

confidence: 99%

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Cognitive Impairment Is Reflected by an Increased Difference between Real and Imagined Timed Up and Go Test Performance

Ruediger

Stuckenschneider

Vogt

et al. 2017

Dement Geriatr Cogn Disord

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Background: Recent research suggests using an imaginary version of the Timed Up and Go test (TUG) for a first assessment of cognitive impairment. By using the time difference between a real (TUGr) and an imagined (TUGi) TUG task, the objective of this study was to examine the effect of cognitive impairment on motor imagery ability. Methods: Fifty-two participants (mean age 69.3 ± 4.0 years) with mild cognitive impairment or subjective cognitive impairment were included in this study. The time difference between the TUGr and the TUGi was used as the main outcome. The Trail Making Test part B (TMT B), the ratio between TMT A and TMT B, and the Montreal Cognitive Assessment (MoCA) battery were the main independent variables. Results: The difference between TUGr and TUGi performance time and the TMT B performance time increased with decreasing cognitive function (p < 0.01). There was no relationship between TUGr and TUGi performance time and TMT B/A ratio. There were significant correlations between TUG time differences and the MoCA score (r = -0.489, p < 0.01), the TMT B (r = 0.364, p < 0.01), and the TMT B/A ratio (r = 0.377, p < 0.01). Conclusion: The combination of TUGr and TUGi may have added value in assessing cognitive impairment, which is a possible pre-stage of dementia.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Cognitive Impairment Is Reflected by an Increased Difference between Real and Imagined Timed Up and Go Test Performance

Ruediger

Stuckenschneider

Vogt

et al. 2017

Dement Geriatr Cogn Disord

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“…We used fNIRS during actual walking to examine frontal lobe activation before and during FOG. We focused on turns since they are one of the most common provokers of FOG and since turns are associated with increased executive function demands [14] and place greater demands on the coupling between posture, gait and perceptual processing and planning [17,27]. Accordingly, we hypothesized that frontal activation patterns would be altered during turns with FOG, compared to turns without FOG.…”

Section: Introductionmentioning

confidence: 98%

Changes in oxygenated hemoglobin link freezing of gait to frontal activation in patients with Parkinson disease: an fNIRS study of transient motor-cognitive failures

et al. 2015

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Recent studies have suggested that deficits in executive function contribute to freezing of gait (FOG), an episodic disturbance common among patients with Parkinson's disease (PD). To date, most findings provide only indirect evidence of this relationship. Here, we evaluated a more direct link between FOG and frontal lobe dysfunction. Functional, near infrared spectroscopy measured frontal activation, i.e., oxygenated hemoglobin (HbO2) levels in Brodmann area 10 before and during FOG. Eleven patients with PD and eleven healthy older adults were studied. Changes in frontal lobe activation before and during FOG that occurred during turns were determined. Altogether, 49 FOG episodes were observed-28 occurred during turns that were anticipated (i.e., the patient knew in advance that the turn was coming), 21 during unanticipated turns that were performed "abruptly", according to the examiner's request. During anticipated turns, HbO2 increased by 0.22 ± 0.08 µM (p = 0.004) before FOG and by an additional 0.19 ± 0.13 µM (p = 0.072) during FOG. In contrast, during unanticipated turns, HbO2 did not increase before or during FOG. HbO2 decreased by 0.32 ± 0.08 µM (p = 0.004) during turns without FOG; in healthy controls HbO2 did not change during turns. These findings support the existence of an association between FOG episodes and changes in frontal lobe HbO2. Increased activation in Brodmann area 10 before FOG, specifically during anticipated turns, highlights the connections between motor planning, information processing, and FOG. These results support the idea that alterations in executive control play a role in this debilitating motor disturbance.

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“…This relationship can be explained by the idea that the TUG relies on the interplay between attention, executive function, and motor processing functions. 5,12,15 Moreover, dual-task during gait may be a marker of the efficiency of the central integration of multiple cognitive domains needed for this complex task.…”

Section: Strokementioning

confidence: 99%

Gait Measures as Predictors of Poststroke Cognitive Function

Assayag

Shenhar‐Tsarfaty

Korczyn

et al. 2015

Stroke

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Stroke considerably increases the risk of cognitive decline (CD) and dementia, with prevalence rates ranging from 24% to 33.3% within 5 years from stroke onset. In many cases, the cognitive decline develops abruptly, while in others, the decline develops insidiously over months or years at a rate which far exceeds the expected decline in this age group. 1,2After a stroke, patients frequently experience a spectrum of neuropsychological and motor deficits that can significantly interfere with their cognitive, communicative, and motor functions, resulting in impaired activities and function. Identifying those at higher risk of developing cognitive impairment has implications for the early initiation of treatment and for monitoring disease progression.Slowing of motor function is commonly observed with aging and is more pronounced in cognitively impaired individuals.3 Gait changes predict dementia as much as 6 to 10 years later 4 and may also precede the onset of even mild cognitive impairment, 4 which may occur as much as 12 years before the clinical presentation of cognitive changes. Moreover, the combination of motor and cognitive changes apparently is a stronger predictor of dementia than cognitive changes alone.6 Although the mechanisms of these motorcognitive interactions are not fully understood, subclinical pathological changes caused by cerebrovascular disease may Background and Purpose-Patients with stroke are at risk for developing cognitive impairment. We tested whether the assessment of balance and gait can enhance the prediction of long-term cognitive outcome in stroke survivors. Methods-Participants were patients with first-ever, mild-moderate ischemic stroke or transient ischemic attack from the Tel Aviv Brain Acute Stroke Cohort (TABASCO) study, a large prospective cohort study, who underwent 3-T MRI and were followed for ≥2 years using neurological, neuropsychological, and mobility examinations 6, 12, and 24 months after the index event. Results-Data were available for 298 patients (age: 66.7±9.6 years). Forty-six participants (15.4%) developed cognitive decline (CD) over the 2 years of follow-up. The CD group and cognitively intact group did not differ in their neurological deficits or in their infarct volume or location. Nonetheless, 6 months after stroke, the Timed Up and Go test took longer in those who later developed CD (P<0.001). Additionally, the CD group also had lower Berg Balance Scale scores (P<0.001), slower gait (P<0.001), and fewer correct answers during dual-task walking (P=0.006). Separate analyses of the patients with transient ischemic attack revealed similar results. Multivariate regression analysis showed that Timed Up and Go times >12 s at 6 months after stroke/transient ischemic attack was a significant independent risk marker of CD 24 months after stroke (odds ratio=6.07, 95% confidence interval: 1.36-27.15). Conclusions-These

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Association Between Performance on Timed Up and Go Subtasks and Mild Cognitive Impairment: Further Insights into the Links Between Cognitive and Motor Function

Cited by 126 publications

References 28 publications

Cognitive Impairment Is Reflected by an Increased Difference between Real and Imagined Timed Up and Go Test Performance

Cognitive Impairment Is Reflected by an Increased Difference between Real and Imagined Timed Up and Go Test Performance

Changes in oxygenated hemoglobin link freezing of gait to frontal activation in patients with Parkinson disease: an fNIRS study of transient motor-cognitive failures

Gait Measures as Predictors of Poststroke Cognitive Function

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