Older People with Dementia Have Reduced Daily-Life Activity and Impaired Daily-Life Gait When Compared to Age-Sex Matched Controls

Issue title: Gait Disorders in Alzheimer’s Disease and Other Dementias

Guest editors: Manuel Montero-Odasso and George Perry

Article type: Research Article

Authors: Taylor, Morag E.^{a; b; c; *} | Brodie, Matthew A.^{a; d} | van Schooten, Kimberley S.^{a; e} | Delbaere, Kim^{a; e} | Close, Jacqueline C.T.^{a; c} | Payne, Narelle^a | Webster, Lyndell^a | Chow, Jessica^a | McInerney, Garth^a | Kurrle, Susan E.^b | Lord, Stephen R.^{a; e}

Affiliations: [a] Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia | [b] Cognitive Decline Partnership Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia | [c] Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia | [d] Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, NSW, Australia | [e] School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia

Correspondence: [*] Correspondence to: Morag Taylor, Neuroscience Research Australia, Barker Street, Randwick, NSW, 2031, Australia. Tel.: +61 293991885; Fax: +61 293 991 120; E-mail: m.taylor@neura.edu.au.

Abstract: Understanding the characteristics of physical activity and daily-life gait in older people with dementia may help identify those at risk of negative health outcomes and inform targeted interventions. Questionnaires are often used to assess physical activity but may be more affected by recall bias in people with dementia and provide little information about daily-life gait characteristics. The aim of the study was to assess differences in daily-life activity levels and gait characteristics between community-dwelling older people with mild to moderate dementia (n = 45; mean age 81±6 years, 42% female) and age-sex matched (1:2) cognitively-healthy controls (n = 90). Participants wore a tri-axial accelerometer (DynaPort MoveMonitor, McRoberts) on their lower back for 7 days and were assessed on neuropsychological and physical performance. Compared to age-sex matched controls, participants with dementia demonstrated reduced daily-life activity (fewer steps per day, fewer and shorter walking bouts, and lower daily walk time) and walking intensity (reduced speed, stride length and cadence). Participants with dementia also had significantly increased within-walk variability (stride time) and less regular gait (higher sample entropy). Within the group of participants with dementia, higher daily-life activity levels were associated with greater self-reported physical activity and better executive function. Fallers (1+ falls past year) with dementia had significantly reduced daily-life activity and walking speed when compared to non-fallers with dementia. In conclusion, people with dementia are less active in daily-life and present with significant impairments across multiple gait domains when compared to age-sex matched controls. These findings highlight opportunities for targeted interventions and support further research to examine interventions aimed at addressing these deficits.

Keywords: Accidental falls, daily-life gait, dementia, executive function, neurocognitive disorders, physical activity, walking speed

DOI: 10.3233/JAD-181174

Journal: Journal of Alzheimer's Disease, vol. 71, no. s1, pp. S125-S135, 2019