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065 GAIT VARIABILITY DURING CURVED PATH WALKING IN YOUNG AND OLD
Posters / Parkinsonism and Related Disorders 16S1 (2010) S11–S86
S19
063 A META-ANALYSIS-BASED STUDY ON RISK FACTORS FOR FALLS IN THE MEDICAL HISTORIES OF ELDERLY SUBJECTS: THE IMPORTANCE OF NEUROLOGICAL DISORDERS F. Bloch1,2 , M. Thibaud2,3,4 , C. Tournoux5 , A.-S. Rigaud1 , G. Kemoun2,3 . 1 Hˆ opital Broca (APHP), Paris, 2 EA 3813 – Universit´e de Poitiers, 3 Service de M´edecine Physique et de R´eadaptation, CHU de Poitiers, 4 UMR CNRS 6610, Universit´e de Poitiers, 5 Centre d’Investigation Clinique P-0802, CHU de Poitiers, Poitiers, France Introduction: Falls are the leading cause not only of morbimortality in elderly subjects, but also of increased dependency and institutionalization. Many authors have already shown that a fall is a multifactorial syndrome involving the patient and his overall medical history. Objective: Determine the link between falls in the elderly and their medical histories through a systematic review of the literature and meta-analysis, in the framework of the DRIFFT-PADCHUTE project. Method: We performed a search with the keywords ‘Accidental Falls’ and ‘Risk Factors’. We selected articles dealing with subjects aged >60 years, falls in everyday life. Articles on falls in the elderly not focusing on risk factors were not selected. Results: 3747 indexed articles published were identified. In the end, 179 studies with available data were included; there were 130 studies with meta-analysis of the medical history as risk factors. In these articles, 55 medical histories were isolated. History of falling (OR = 3.38 [2.77, 4.13]) and fear of falling (OR = 2.67 [2.19, 3.25]) appear to constitute the main risks of another fall. Parkinson’s disease (OR = 2.50 [1.87, 3.35]), cognitive impairment (OR = 2.28 [2.00, 2.61]) and neurological disorders (OR = 2.18 [1.69, 2.82]) all double the risk of falling. Conclusion: History of falls, fear of falling and neurological disorders are the most widespread predictors of falls or recurrent falls in elderly subjects. Effective fall prevention programmes aimed at diminishing these risk factors should be developed for these populations. The results of this study will help to create an algorithm taking into account the value assigned to each risk factor. 064 DETECTING FREEZING OF GAIT DURING TURNS IN PARKINSON’S DISEASE USING AN AMBULATORY MONITOR A. Speelman1 , W. Nanhoe-Mahabier1 , A. Weiss2 , J. Hausdorff2 , A. Snijders1 , B. Bloem1 , M. Munneke1 . 1 Department of Neurology, Radboud University Medical Centre Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; 2 Department of Neurology, Laboratory for Gait and Neurodynamics, Sourasky Medical Center, Tel Aviv, Israel Background and Aims: Freezing of gait (FOG) is a common and disabling feature of Parkinson’s disease (PD). There is no reliable method to measure FOG in patient’s own home environment. The aim of the study was to examine whether an ambulatory gait monitor (AGM) can detect FOG episodes during turns in PD patients. Methods: Twenty-one PD patients were tested in the ‘off’ state. Each subject was asked to complete eight turning tasks. Gait was videotaped, and used to identify FOG episodes by two clinicians. Subjects also wore an AGM (Dynaport Minimod [DM]) that could record linear trunk acceleration in three directions (anterioposterior, medio-lateral, and vertical). Episodes of FOG derived from the DM data were identified using the freeze index defined as the relation between high and low frequencies in the three directions. The ability to discriminate between turns with and without FOG was assessed using a ROC-curve. Results: Ten patients experienced forty-three turns with FOG episodes. Gait assessments in the anterio-posterior direction reached the highest sensitivity and specificity, with an area under the curve of 0.81 (Figure 1).
Figure 1. ROC curve. Conclusions: AGM can detect FOG during turns in patients with PD. Further research is needed to also detect FOG during actual everyday activities. 065 GAIT VARIABILITY DURING CURVED PATH WALKING IN YOUNG AND OLD J. Brach, J. Van Swearingen, D. Wert, S. Studenski. University of Pittsburgh, Pittsburgh, PA, USA Background and Aims: During straight walking gait is consistent with little variability and greater variability is related to falls and mobility disability. The ability to vary stepping may be necessary in curved walking. The purpose was to compare gait variability during straight and curved walking in young and older adults. Methods: 30 young (mean age = 25.3) and 30 old (mean age = 79.6) completed two passes of straight and curved walking on an instrumented walkway. Variability was calculated as standard deviation of all steps recorded over two trials. Results: During straight walking older were more variable than young (Step length SD = 0.03 and 0.02, p = 0.03; step width 0.03 and 0.02, p < 0.0001; stance time = 0.03 and 0.02, p = 0.0004). During curved walking older were more variable in step length (0.07 vs 0.06, p = 0.03) and stance time (0.08 and 0.03, p = 0.01) and less variable in step width (0.14 and 0.18, P < 0.0001) than young adults.
Straight Path Step length SD, m Step width SD, m Stance time SD, s Curved Path Step length SD, m Step width SD, m Stance time SD, s
Young
Old
p-value
0.02 (0.01) 0.02 (0.01) 0.02 (0.01)
0.03 (0.01) 0.03 (0.01) 0.03 (0.01)
0.03 <0.0001 0.0004
0.06 (0.02) 0.18 (0.04) 0.03 (0.02)
0.07 (0.02) 0.14 (0.04) 0.08 (0.10)
0.03 <0.0001 0.01
Conclusions: In young curved walking induces variability in step width allowing steps to be placed one in front of the other along a single track (Figure). Older kept a wider step width with little variability, a double track pattern, likely a more cautious gait pattern.
S20
Posters / Parkinsonism and Related Disorders 16S1 (2010) S11–S86
Curved path walking young & old
066 CHALLENGING GAIT CONDITIONS PREDICT 1-YEAR DECLINE IN GAIT SPEED IN OLDER ADULTS WITH APPARENTLY NORMAL GAIT J. Brach, E. Hile, D. Wert, S. Studenski. University of Pittsburgh, Pittsburgh, PA, USA Background and Aims: Mobility is often tested under a low challenge condition (i.e. straight, uncluttered path) which does not represent “real world” walking and often fails to distinguish early mobility difficulty. Testing walking during challenging conditions may uncover mobility difficulty not identified with usual gait testing. The objective was to determine if gait during challenging conditions predict decline in gait speed over 1 year in older persons with apparently normal gait (i.e. gait speed ≥1.0 m/s). Methods: 69 older adults (mean age = 75.9 years) with a usual gait speed ≥1.0 m/s participated. Gait was tested under 3 challenging conditions: narrow walk (15 cm wide), stepping over obstacles (6 cm and 30 cm), and walking while talking (reciting every other letter of the alphabet). Usual gait speed was recorded over a 4 meter course at baseline and 1 year later. Individuals who declined ≥0.10 m/s were considered to have declined in gait speed. Individual logistic regressions adjusting for baseline gait speed were used to examine the association between baseline challenging gait performance and decline in gait speed 1 year later. Results: Of the 69 individuals, 17 (25%) declined in gait speed over 1 year. After adjusting for baseline gait speed, poorer performance (i.e. greater time) on the narrow walk (OR 1.86, 95% CI 1.08, 3.22) and obstacle walk (OR 1.69, 95% CI 1.10, 2.60) were significant predictors of gait speed decline. Conclusions: The assessment of gait during challenging conditions may uncover mobility difficulty not identified with usual gait testing. 067 NON-AMNESTIC MCI AND INCIDENT FALLS T. Buracchio1,2 , N. Mattek1,3 , D. Howieson1 , T. Hayes3,4 , M. Pavel3,4 , J. Kaye1,2,3 . 1 Department of Neurology, Oregon Health & Science University, 2 Portland VA Medical Center, 3 Oregon Center for Aging & Technology (ORCATECH), 4 Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA Background: Little is known about the association of amnestic and non-amnestc mild cognitive impairment (MCI) with falls. We tested the hypothesis that subjects with non-amnestic MCI were at increased risk of incident falls because of increased likelihood of impairment in attention and executive function. Methods: Subjects were independently-living elderly enrolled in the ORCATECH-Biomedical Research Partnership cohort, a longitudinal study that uses in-home sensor technology to assess behavioral and cognitive changes with aging. Participants underwent baseline clinical evaluations and standardized neuropsychological testing. Those with vision impairment, Parkinson’s disease and dementia were excluded from analysis. Incident falls were determined prospectively using weekly on-
line questionnaires. MCI was defined using Petersen criteria for amnestic and non-amnestic MCI. Statistical analysis compared incident falls in one year according to baseline cognitive status using Pearson’s chi-square tests. Results: Of 175 subjects (mean baseline age 84 years; 75% women), 66 (38%) reported at least one fall during one year of follow-up. Fallers did not differ from non-fallers in gender, age, or education. Non-amnestic MCI subjects (n = 39) were more likely to report at least one fall during the time period than cognitively intact subjects (n = 126) (54% vs. 33%; p < 0.02). There was no significant difference in incident falls rates between amnestic MCI (n = 10) and cognitively intact status. Cognitive status was not significantly associated with recurrent falls. Conclusions: Although the association of amnestic MCI with incident dementia has been recognized, non-amnestic MCI may also have a significant impact on additional impairments, such as risk of falling in the elderly. 068 A RELATIONSHIP BETWEEN POSTURAL AND COGNITIVE ABILITIES IN ADHD F. Carrick1 , G. Leisman1,2,3 , R. Melillo1,4 . 1 Neurology, FR Carrick Institute for Clinical Ergonomics, Rehabilitation and Applied Neuroscience, Cape Canaveral, FL, USA; 2 Faculty of Health, Leeds Metropolitan University, Leeds, UK; 3 Neurology, University of Haifa, Haifa, Israel; 4 Psychology, DeMontfort University, Leicester, UK Background and Aims: The majority of children and adolescents with attention deficit/hyperactivity disorder (ADHD) exhibit cerebellar signs with associated cognitive and motor abnormalities that include altered balance and gait. The cerebellum is thought to play an important role in cognition because of its dense connections to the prefrontal cortex and basal ganglia and is responsible for timing, fine-tuning and coordinating the motor system. Children with ADHD have been shown to have hypoactivation of the dorsal anterior cingulate cortex, the frontal cortex and the basal ganglia (striatum). We desired to see if there was a relationship between postural motor and cognitive abilities in ADHD children. Methods: This study compared postural and gait abilities in children diagnosed with ADHD according to DSM IV-TR diagnostic criteria with cognitive scores obtained from the Brown Attention Deficit Disorder Scale (BADDS) and Wechsler Individual Achievement Test, 2nd ed. (WIAT-II) tests. Results: Significant relationships were found between postural motor skills and performance on both the BADDS and WIAT-II tests. Poor postural motor skill performance was associated with poorer outcomes on cognitive testing when compared with subjects whose postural motor skills were superior. A better outcome on both the BADDS and WIAT-II tests was associated with greater postural motor skills. Conclusions: These findings support a relationship between postural motor and cognitive function in ADHD children. Further they suggest involvement of the frontostriatal-cerebellar networks in ADHD children and treatment directed to promote increase function in these systems. 069 ARE THERE COMMON PATTERNS BETWEEN PHYSICAL, COGNITIVE AND FUNCTIONAL STATUS IN ELDERLY OUTPATIENTS WITH GAIT DEFICITS? D. Champon, V. Azarian, S. Noyon. Unit´e Vivaldi, HGMS Plaisir, Plaisir, France Background and Aims: The objective is to determine if functional, general cognitive and physical status are correlated in elderly outpatients who have gait troubles. – A recent study suggests that “the variance of functional status attributed to cognition is modest . . . Executive and general screening measures explained significantly more variance . . . ”.
S19
063 A META-ANALYSIS-BASED STUDY ON RISK FACTORS FOR FALLS IN THE MEDICAL HISTORIES OF ELDERLY SUBJECTS: THE IMPORTANCE OF NEUROLOGICAL DISORDERS F. Bloch1,2 , M. Thibaud2,3,4 , C. Tournoux5 , A.-S. Rigaud1 , G. Kemoun2,3 . 1 Hˆ opital Broca (APHP), Paris, 2 EA 3813 – Universit´e de Poitiers, 3 Service de M´edecine Physique et de R´eadaptation, CHU de Poitiers, 4 UMR CNRS 6610, Universit´e de Poitiers, 5 Centre d’Investigation Clinique P-0802, CHU de Poitiers, Poitiers, France Introduction: Falls are the leading cause not only of morbimortality in elderly subjects, but also of increased dependency and institutionalization. Many authors have already shown that a fall is a multifactorial syndrome involving the patient and his overall medical history. Objective: Determine the link between falls in the elderly and their medical histories through a systematic review of the literature and meta-analysis, in the framework of the DRIFFT-PADCHUTE project. Method: We performed a search with the keywords ‘Accidental Falls’ and ‘Risk Factors’. We selected articles dealing with subjects aged >60 years, falls in everyday life. Articles on falls in the elderly not focusing on risk factors were not selected. Results: 3747 indexed articles published were identified. In the end, 179 studies with available data were included; there were 130 studies with meta-analysis of the medical history as risk factors. In these articles, 55 medical histories were isolated. History of falling (OR = 3.38 [2.77, 4.13]) and fear of falling (OR = 2.67 [2.19, 3.25]) appear to constitute the main risks of another fall. Parkinson’s disease (OR = 2.50 [1.87, 3.35]), cognitive impairment (OR = 2.28 [2.00, 2.61]) and neurological disorders (OR = 2.18 [1.69, 2.82]) all double the risk of falling. Conclusion: History of falls, fear of falling and neurological disorders are the most widespread predictors of falls or recurrent falls in elderly subjects. Effective fall prevention programmes aimed at diminishing these risk factors should be developed for these populations. The results of this study will help to create an algorithm taking into account the value assigned to each risk factor. 064 DETECTING FREEZING OF GAIT DURING TURNS IN PARKINSON’S DISEASE USING AN AMBULATORY MONITOR A. Speelman1 , W. Nanhoe-Mahabier1 , A. Weiss2 , J. Hausdorff2 , A. Snijders1 , B. Bloem1 , M. Munneke1 . 1 Department of Neurology, Radboud University Medical Centre Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; 2 Department of Neurology, Laboratory for Gait and Neurodynamics, Sourasky Medical Center, Tel Aviv, Israel Background and Aims: Freezing of gait (FOG) is a common and disabling feature of Parkinson’s disease (PD). There is no reliable method to measure FOG in patient’s own home environment. The aim of the study was to examine whether an ambulatory gait monitor (AGM) can detect FOG episodes during turns in PD patients. Methods: Twenty-one PD patients were tested in the ‘off’ state. Each subject was asked to complete eight turning tasks. Gait was videotaped, and used to identify FOG episodes by two clinicians. Subjects also wore an AGM (Dynaport Minimod [DM]) that could record linear trunk acceleration in three directions (anterioposterior, medio-lateral, and vertical). Episodes of FOG derived from the DM data were identified using the freeze index defined as the relation between high and low frequencies in the three directions. The ability to discriminate between turns with and without FOG was assessed using a ROC-curve. Results: Ten patients experienced forty-three turns with FOG episodes. Gait assessments in the anterio-posterior direction reached the highest sensitivity and specificity, with an area under the curve of 0.81 (Figure 1).
Figure 1. ROC curve. Conclusions: AGM can detect FOG during turns in patients with PD. Further research is needed to also detect FOG during actual everyday activities. 065 GAIT VARIABILITY DURING CURVED PATH WALKING IN YOUNG AND OLD J. Brach, J. Van Swearingen, D. Wert, S. Studenski. University of Pittsburgh, Pittsburgh, PA, USA Background and Aims: During straight walking gait is consistent with little variability and greater variability is related to falls and mobility disability. The ability to vary stepping may be necessary in curved walking. The purpose was to compare gait variability during straight and curved walking in young and older adults. Methods: 30 young (mean age = 25.3) and 30 old (mean age = 79.6) completed two passes of straight and curved walking on an instrumented walkway. Variability was calculated as standard deviation of all steps recorded over two trials. Results: During straight walking older were more variable than young (Step length SD = 0.03 and 0.02, p = 0.03; step width 0.03 and 0.02, p < 0.0001; stance time = 0.03 and 0.02, p = 0.0004). During curved walking older were more variable in step length (0.07 vs 0.06, p = 0.03) and stance time (0.08 and 0.03, p = 0.01) and less variable in step width (0.14 and 0.18, P < 0.0001) than young adults.
Straight Path Step length SD, m Step width SD, m Stance time SD, s Curved Path Step length SD, m Step width SD, m Stance time SD, s
Young
Old
p-value
0.02 (0.01) 0.02 (0.01) 0.02 (0.01)
0.03 (0.01) 0.03 (0.01) 0.03 (0.01)
0.03 <0.0001 0.0004
0.06 (0.02) 0.18 (0.04) 0.03 (0.02)
0.07 (0.02) 0.14 (0.04) 0.08 (0.10)
0.03 <0.0001 0.01
Conclusions: In young curved walking induces variability in step width allowing steps to be placed one in front of the other along a single track (Figure). Older kept a wider step width with little variability, a double track pattern, likely a more cautious gait pattern.
S20
Posters / Parkinsonism and Related Disorders 16S1 (2010) S11–S86
Curved path walking young & old
066 CHALLENGING GAIT CONDITIONS PREDICT 1-YEAR DECLINE IN GAIT SPEED IN OLDER ADULTS WITH APPARENTLY NORMAL GAIT J. Brach, E. Hile, D. Wert, S. Studenski. University of Pittsburgh, Pittsburgh, PA, USA Background and Aims: Mobility is often tested under a low challenge condition (i.e. straight, uncluttered path) which does not represent “real world” walking and often fails to distinguish early mobility difficulty. Testing walking during challenging conditions may uncover mobility difficulty not identified with usual gait testing. The objective was to determine if gait during challenging conditions predict decline in gait speed over 1 year in older persons with apparently normal gait (i.e. gait speed ≥1.0 m/s). Methods: 69 older adults (mean age = 75.9 years) with a usual gait speed ≥1.0 m/s participated. Gait was tested under 3 challenging conditions: narrow walk (15 cm wide), stepping over obstacles (6 cm and 30 cm), and walking while talking (reciting every other letter of the alphabet). Usual gait speed was recorded over a 4 meter course at baseline and 1 year later. Individuals who declined ≥0.10 m/s were considered to have declined in gait speed. Individual logistic regressions adjusting for baseline gait speed were used to examine the association between baseline challenging gait performance and decline in gait speed 1 year later. Results: Of the 69 individuals, 17 (25%) declined in gait speed over 1 year. After adjusting for baseline gait speed, poorer performance (i.e. greater time) on the narrow walk (OR 1.86, 95% CI 1.08, 3.22) and obstacle walk (OR 1.69, 95% CI 1.10, 2.60) were significant predictors of gait speed decline. Conclusions: The assessment of gait during challenging conditions may uncover mobility difficulty not identified with usual gait testing. 067 NON-AMNESTIC MCI AND INCIDENT FALLS T. Buracchio1,2 , N. Mattek1,3 , D. Howieson1 , T. Hayes3,4 , M. Pavel3,4 , J. Kaye1,2,3 . 1 Department of Neurology, Oregon Health & Science University, 2 Portland VA Medical Center, 3 Oregon Center for Aging & Technology (ORCATECH), 4 Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA Background: Little is known about the association of amnestic and non-amnestc mild cognitive impairment (MCI) with falls. We tested the hypothesis that subjects with non-amnestic MCI were at increased risk of incident falls because of increased likelihood of impairment in attention and executive function. Methods: Subjects were independently-living elderly enrolled in the ORCATECH-Biomedical Research Partnership cohort, a longitudinal study that uses in-home sensor technology to assess behavioral and cognitive changes with aging. Participants underwent baseline clinical evaluations and standardized neuropsychological testing. Those with vision impairment, Parkinson’s disease and dementia were excluded from analysis. Incident falls were determined prospectively using weekly on-
line questionnaires. MCI was defined using Petersen criteria for amnestic and non-amnestic MCI. Statistical analysis compared incident falls in one year according to baseline cognitive status using Pearson’s chi-square tests. Results: Of 175 subjects (mean baseline age 84 years; 75% women), 66 (38%) reported at least one fall during one year of follow-up. Fallers did not differ from non-fallers in gender, age, or education. Non-amnestic MCI subjects (n = 39) were more likely to report at least one fall during the time period than cognitively intact subjects (n = 126) (54% vs. 33%; p < 0.02). There was no significant difference in incident falls rates between amnestic MCI (n = 10) and cognitively intact status. Cognitive status was not significantly associated with recurrent falls. Conclusions: Although the association of amnestic MCI with incident dementia has been recognized, non-amnestic MCI may also have a significant impact on additional impairments, such as risk of falling in the elderly. 068 A RELATIONSHIP BETWEEN POSTURAL AND COGNITIVE ABILITIES IN ADHD F. Carrick1 , G. Leisman1,2,3 , R. Melillo1,4 . 1 Neurology, FR Carrick Institute for Clinical Ergonomics, Rehabilitation and Applied Neuroscience, Cape Canaveral, FL, USA; 2 Faculty of Health, Leeds Metropolitan University, Leeds, UK; 3 Neurology, University of Haifa, Haifa, Israel; 4 Psychology, DeMontfort University, Leicester, UK Background and Aims: The majority of children and adolescents with attention deficit/hyperactivity disorder (ADHD) exhibit cerebellar signs with associated cognitive and motor abnormalities that include altered balance and gait. The cerebellum is thought to play an important role in cognition because of its dense connections to the prefrontal cortex and basal ganglia and is responsible for timing, fine-tuning and coordinating the motor system. Children with ADHD have been shown to have hypoactivation of the dorsal anterior cingulate cortex, the frontal cortex and the basal ganglia (striatum). We desired to see if there was a relationship between postural motor and cognitive abilities in ADHD children. Methods: This study compared postural and gait abilities in children diagnosed with ADHD according to DSM IV-TR diagnostic criteria with cognitive scores obtained from the Brown Attention Deficit Disorder Scale (BADDS) and Wechsler Individual Achievement Test, 2nd ed. (WIAT-II) tests. Results: Significant relationships were found between postural motor skills and performance on both the BADDS and WIAT-II tests. Poor postural motor skill performance was associated with poorer outcomes on cognitive testing when compared with subjects whose postural motor skills were superior. A better outcome on both the BADDS and WIAT-II tests was associated with greater postural motor skills. Conclusions: These findings support a relationship between postural motor and cognitive function in ADHD children. Further they suggest involvement of the frontostriatal-cerebellar networks in ADHD children and treatment directed to promote increase function in these systems. 069 ARE THERE COMMON PATTERNS BETWEEN PHYSICAL, COGNITIVE AND FUNCTIONAL STATUS IN ELDERLY OUTPATIENTS WITH GAIT DEFICITS? D. Champon, V. Azarian, S. Noyon. Unit´e Vivaldi, HGMS Plaisir, Plaisir, France Background and Aims: The objective is to determine if functional, general cognitive and physical status are correlated in elderly outpatients who have gait troubles. – A recent study suggests that “the variance of functional status attributed to cognition is modest . . . Executive and general screening measures explained significantly more variance . . . ”.