Association of dual-task gait with incident dementia in mild cognitive impairment: Results from the gait and brain study
Document Type
Article
Publication Date
7-1-2017
Journal
JAMA Neurology
Volume
74
Issue
7
First Page
857
Last Page
865
URL with Digital Object Identifier
10.1001/jamaneurol.2017.0643
Abstract
IMPORTANCE: Gait performance is affected by neurodegeneration in aging and has the potential to be used as a clinical marker for progression from mild cognitive impairment (MCI) to dementia. A dual-task gait test evaluating the cognitive-motor interface may predict dementia progression in older adults with MCI. OBJECTIVE: To determine whether a dual-task gait test is associated with incident dementia in MCI. DESIGN, SETTING, AND PARTICIPANTS: The Gait and Brain Study is an ongoing prospective cohort study of community-dwelling older adults that enrolled 112 older adults with MCI. Participants were followed up for 6 years, with biannual visits including neurologic, cognitive, and gait assessments. Data were collected from July 2007 to March 2016. MAIN OUTCOMES AND MEASURES: Incident all-cause dementiawas the main outcome measure, and single- and dual-task gait velocity and dual-task gait costs were the independent variables. A neuropsychological test battery was used to assess cognition. Gait velocity was recorded under single-task and 3 separate dual-task conditions using an electronic walkway. Dual-task gait cost was defined as the percentage change between single- and dual-task gait velocities: ([single-task gait velocity - dual-task gait velocity]/single-task gait velocity) × 100. Cox proportional hazard models were used to estimate the association between risk of progression to dementia and the independent variables, adjusted for age, sex, education, comorbidities, and cognition. RESULTS: Among 112 study participants with MCI, mean (SD) age was 76.6 (6.9) years, 55 were women (49.1%), and 27 progressed to dementia (24.1%), with an incidence rate of 121 per 1000 person-years. Slow single-task gait velocity (<0.8 m/second) was not associated with progression to dementia (hazard ratio [HR], 3.41; 95%CI, 0.99-11.71; P = .05) while high dual-task gait cost while counting backward (HR, 3.79; 95%CI, 1.57-9.15; P = .003) and naming animals (HR, 2.41; 95%CI, 1.04-5.59; P = .04) were associated with dementia progression (incidence rate, 155 per 1000 person-years). The models remained robust after adjusting by baseline cognition except for dual-task gait cost when dichotomized. CONCLUSIONS AND RELEVANCE: Dual-task gait is associated with progression to dementia in patients with MCI. Dual-task gait testing is easy to administer and may be used by clinicians to decide further biomarker testing, preventive strategies, and follow-up planning in patients with MCI.