On average, people with dementia fall more often than their age-matched peers, with serious consequences, yet the underlying reasons remain poorly understood. This narrative review explores relevant psychological, physiological and neuroimaging studies to discuss whether diminished inhibitory control contributes to poor balance and falls in people with Alzheimer's Disease (AD), the most common form of dementia. Inhibitory control, a component of executive function, plays a vital role in suppressing dominant impulses or actions and regulating attention in favour of a desired outcome. Although objective tests of inhibitory control are not routinely used in clinical settings, research suggests inhibitory control declines early, and progressively, in AD. Postural tasks that require inhibitory control can improve the accuracy of distinguishing fallers from non-fallers beyond known factors. Neuroimaging studies link the prefrontal cortex to both inhibitory and postural control, and this region exhibits neuronal loss early in AD. Thus, emerging evidence suggests that accurately assessing inhibitory control could not only improve falls risk predictions but also aid AD detection.

Non-specific neck pain (NSNP) is increasingly common among students, often due to long hours of sitting and frequent use of electronic devices. This widespread issue underscores the importance of understanding how NSNP affects students' cognitive abilities and motor functions. This study aims to evaluate the effects of NSNP on dual-task performance by analyzing the gait parameters and cognitive performance during both single-task and dual-task conditions.

Forty-five participants with NSNP and forty-five age-matched controls were assessed using an optical motion-capture system. Participants underwent gait assessments during both single-task (without cognitive load) and dual-task conditions, in which the cognitive tasks involved simple mathematical computations.

Results revealed that under single-task conditions, differences in gait parameters between groups were not statistically significant. However, under dual-task conditions, participants with NSNP exhibited significant impairments in gait parameters and higher cognitive costs (p < 0.05). Correlation analysis indicated that pain intensity was significantly associated with cognitive cost and gait parameter alterations during dual-task conditions (p < 0.05).

These findings suggest that NSNP significantly elevates the cognitive effort required during the dual-task. These findings emphasize the need for interventions to alleviate neck pain and improve both physical and cognitive health.

The application of dual-task walking paradigms for gait assessment in stroke patients is critical, where varying concurrent tasks may elicit distinct gait patterns of dual-task interference. This study assessed the acute effects of different types of dual tasks on gait in stroke patients during task performance, informing occupational, and physical therapists about care recommendations to prevent patients from falling and improve their balance function in daily life.

A total of 19 stroke patients (52.7 ± 6.9 years old) performed the walking-only and dual-task walking (motor, arithmetic and speech) task test while a 3D motion capture system measured the gait parameters (the gait spatial-temporal parameters, sagittal angle of lower-limb joints, gait parameter variability and dual-task cost). One-way repeated measures ANOVA was used to test the effects of the above four walking conditions on gait parameters.

Arithmetic task and speech task interference can affect the gait of stroke patients (P < 0.05). Arithmetic task interference has the greatest impact on step speed, cadence, single support phase, hip joint range in support period and has the greatest dual-task cost, speech task interference has the greatest impact on cadence coefficient of variation (P < 0.05). The motor task was not significantly different from walking-only (P >0.05).

Both arithmetic and speech tasks have a great impact on gait in stroke patients. Faced with cognitive interference, stroke patients spontaneously adopted a "cautious gait" walking pattern. In future rehabilitation training, diversity of task types is critical for gait rehabilitation training based on the walking ability of the patients.

The aging global population is driving an increase in dementia, making the early identification of at-risk individuals crucial. Studies have shown that elderly people often exhibit a slowing gait before dementia diagnosis, which is linked to cognitive decline and predicts dementia risk. With 30% of those over 65 years of age experiencing falls annually, managing fall risk is essential. Motoric cognitive risk syndrome (MCR), characterized by subjective memory impairment and slow gait, is a pre-dementia condition that can identify high-risk individuals without extensive evaluation. The prevalence of MCR varies globally and is associated with an increased risk of falls, disability, and death. Early screening and intervention for MCR can delay dementia and improve fall regulation, offering a new perspective on elderly health management. This review synthesizes the current understanding of MCR-related falls, evaluates risk assessment methods, and discusses health strategies to provide a theoretical basis for fall prevention in community-dwelling older adults.

This study analyzes the effects of a 6-month multicomponent exercise program (MCT) followed by a 4-month detraining period on functional and cognitive status in pre-frail and frail older adults.

A total of 108 pre-frail and frail adults aged 65 and older participated in the study. They were assigned by convenience to either a control group (CG) or an intervention group (IG). The IG underwent a 6-month MCT followed by a 4-month detraining period. Assessments included a DT test, the Timed Up and Go (TUG) test, the Mini-Mental State Examination (MMSE), and evaluations of basic and instrumental activities of daily living. Data were analyzed using repeated-measures ANOVA.

Significant group-by-time interactions were observed for the DT test (p < 0.05). The IG showed improved DT performance after the 6-month MCT (4.0, 95% CI: 2.2 to 5.7 s), followed by a decline after the detraining period (-1.1, 95% CI: -2.1 to -0.2 s). However, performance after detraining remained higher than at baseline (2.9, 95% CI: 1.0 to 4.6 s, p < 0.05). No statistically significant changes were observed in the CG. Additionally, no significant effects were found for MMSE scores or daily activity questionnaires.

MCT had beneficial effects on functional and cognitive performance in older adults, as assessed by the DT test. However, improvements in DT performance did not translate into better daily life activities. Although the 4-month detraining period negatively impacted DT performance, the results remained superior to baseline levels.

NCT03831841 and date of registration: 5th of November 2018.

Identifying and diagnosing cognitive impairment remains challenging. Some diagnostic procedures are invasive, expensive, and not always accurate. Meanwhile, evidence suggests that cognitive impairment is associated with changes in gait parameters. Certain gait parameters manifesting differences between people with and without cognitive impairment are more pronounced when adding a secondary task (dual-task scenario). In this systematic review, the capability of gait analysis to identify cognitive impairment is investigated. Twenty-three studies published between 2014 and 2024 met the inclusion criteria. A significantly lower gait speed and cadence as well as higher gait variability were found in people with mild cognitive impairment (MCI) and/or dementia, compared with the group with no cognitive impairment. While dual tasks appeared to amplify the differences between the two populations, the type of secondary tasks (e.g., calculations and recalling phone numbers) had an effect on gait changes. The activity and volume of different brain regions were also different between the two populations during walking. In conclusion, while this systematic review supported the potential of using gait analysis to identify cognitive impairment, there are a number of parameters researchers need to consider such as gait variables to be studied, types of dual tasks, and analysis of brain changes while performing the movement tasks.

Declining physical functionality is an indicator of cognitive impairment, distinguishing normal cognition (NC) from dementia. Whether this extends to pre-dementia stages is unclear.

Assess physical performance patterns, evaluate relationships with imaging biomarkers, and identify specific measures distinguishing NC, subjective cognitive decline (SCD) and mild cognitive impairment (MCI).

Group differences (78 NC, 35 SCD, and 41 MCI) in physical function (global function, balance, gait speed, step length, single leg support) were evaluated with logistic regression while distinguishing between MCI due-to-AD and MCI due-to-vascular etiology. Relationships with imaging biomarkers (cortical atrophy score, white matter hyperintensities volumes) were analyzed with ANCOVA.

Participants were 68.6 ± 9.3 years old, had 16.2 ± 3.0 years of education, and 23% were ethnoracial minorities. Physical performance distinguished MCI from NC and SCD. Greater performance on the Mini Physical Performance Test (mini PPT) and balance were associated with lower odds of being SCD versus NC (ORmini PPT = 0.73; 95% CI:0.56-0.97; ORbalance = 0.35, 95%CI:0.16-0.80). AD etiology accounted for most group differences in physical performance versus vascular etiology. Consistent associations between biomarkers, physical performance, and cognition were found.

Findings suggest that: 1) changes in mini PPT performance and balance may help detect cognitive impairments, as early as the SCD stage; 2) changes in gait speed, gait cycle parameters, and Timed Up-and-Go may indicate more significant cognitive impairment; 3) neuronal loss is linked to subtle changes in physical functionality as early as SCD. Physical performance may be a valuable tool in early dementia detection in clinical settings and could identify targets for early intervention.

Cognitive disorders (CD) are a common problem in the practice of various medical specialities. Among the most common causes of severe CD (dementia) are Alzheimer's disease (AD) and cerebrovascular diseases. The stage of non-dementia CD precedes dementia. Interventions at the non-dementia stage are believed to be more effective, prolonging the patient's quality of life at a higher functional level with a decrease in the need for nursing care. Currently, there is a pronounced underdiagnosis of CD, especially AD, which reduces the timely availability of specific drug therapy for patients and adversely affects the prognosis of the disease. The article presents basic information on the pathogenesis and methods of clinical and paraclinical diagnosis of AD and CD of vascular origin. The main markers helping to distinguish these diseases and diagnose them at the predementia stage have been identified.

Subjective cognitive decline (SCD) may represent a preclinical manifestation of objective cognitive impairment. This review consolidated existing findings to determine if dual-tasks objectively differentiate between individuals with SCD, motoric cognitive risk syndrome (MCR), mild cognitive impairment (MCI), and dementia. MEDLINE, Embase, PsycINFO, CENTRAL, AgeLine, and CINAHL were systematically searched for dual-task studies examining older adults with SCD and analyzed using random-effects meta-analyses. Thirteen studies met the inclusion criteria. Within the SCD group, faster gait speed (SMD, 1.35; 95% CI, 0.57-2.13; p = .0007) and longer step length (SMD, 0.85; 95% CI, 0.44-1.26; p < .0001) favored the single compared to dual-task condition. Faster gait speed was observed in the SCD group compared to MCI (SMD, 0.48; 95% CI, 0.28-0.67; p = .0001). A standardized dual-task approach is needed to track gait parameters longitudinally, beginning with changes occurring at the SCD stage as these may precede future cognitive impairments.

Evidence demonstrates that SCD may be a precursor to dementia.Faster dual-task gait speed was observed in the SCD group compared to MCI.Slower dual-task gait speed and shorter step length were observed within the SCD group.Dual-tasks may help differentiate between preclinical and clinical cognitive decline.Dual-tasks should be standardized and changes should be tracked longitudinally.

Mild neurocognitive disorder (mNCD) is recognized as an early stage of dementia and is gaining attention as a significant healthcare problem due to current demographic changes and increasing numbers of patients. Timely detection of mNCD provides an opportunity for early interventions that can potentially slow down or prevent cognitive decline. Heart rate variability (HRV) may be a promising measure, as it has been shown to be sensitive to cognitive impairment. However, there is currently no evidence regarding the diagnostic accuracy of HRV measurements in the context of the mNCD population. This study aimed to evaluate the diagnostic accuracy of vagally-mediated HRV (vm-HRV) as a screening tool for mNCD and to investigate the relationship between vm-HRV with executive functioning and depression in older adults who have mNCD.

We retrospectively analyzed data from healthy older adults (HOA) and individuals with a clinical diagnosis of mNCD with a biomarker-supported characterization of the etiology of mNCD. Diagnostic accuracy was evaluated using receiver operating characteristic curve analysis based on the area under the curve. Sensitivity and specificity were calculated based on the optimal threshold provided by Youden's Index. Multiple linear regression analyses were conducted to investigate the relationship between vm-HRV and executive functioning and depression.

This analysis included 42 HOA and 29 individuals with mNCD. The relative power of high frequency was found to be increased in individuals with mNCD. The greatest AUC calculated was 0.68 (with 95% CI: 0.56, 0.81) for the relative power of high frequency. AUCs for other vm-HRV parameters were between 0.53 and 0.61. No consistent correlations were found between vm-HRV and executive functioning or depression.

It appears that vm-HRV parameters alone are insufficient to reliably distinguish between HOA and older adults with mNCD. Additionally, the relationship between vm-HRV and executive functioning remains unclear and requires further investigation. Prospective studies that encompass a broad range of neurocognitive disorders, HRV measurements, neuroimaging, and multimodal approaches that consider a variety of functional domains affected in mNCD are warranted to further investigate the potential of vm-HRV as part of a multimodal screening tool for mNCD. These multimodal measures have the potential to improve the early detection of mNCD in the future.

Complex walking tasks, including change of direction, patterns and rhythms, require more attentional resources than simple walking and significantly impact walking performance, especially among ageing and neurological populations. More studies have been focusing on complex walking situations, with or without the addition of cognitive tasks, creating a multitude of walking situations. Given the lack of a clear and extensive definition of complex walking, this narrative review aims to identify and more precisely characterize situations and related tests, improve understanding of behavioral adaptations in ageing and neurological populations, and report the clinical applications of complex walking. Based on the studies collected, we are proposing a framework that categorizes the different forms of complex walking, considering whether a cognitive task is added or not, as well as the number of distinct objectives within a given situation. We observed that combining complex walking tasks with a cognitive assignment places even greater strain on attentional resources, resulting in a more pronounced decline in walking and/or cognitive performance. This work highlights the relevance of complex walking as a simple tool for early detection of cognitive impairments and risk of falls, and its potential value in cognitive-motor rehabilitation. Future studies should explore various complex walking tasks in ageing and neurological populations, under varied conditions in real-life or in extended virtual environments.

The dynamical nature of gait increases fall risk for older adults as the Center of Mass (COM) is constantly displaced inside and outside the Base of Support (BOS). Foot placement and leg joint moments are the primary mechanisms controlling dynamic balance. The Margin of Stability (MOS) quantifies the distance between the COM dynamical state and the BOS. While research examined how aging affects the relationship between foot placement and MOS, the relationship to leg moments is unexamined. Examining this relationship would elucidate whether aging increases fall risk from changes in the joint moments controlling the COM. Fourteen older (66.9 ± 4.3 years) and sixteen young (26.3 ± 3.6 years) adults walked along a 12m path for three trials. The MOS, hip and ankle moments in sagittal and frontal planes were analyzed. For the knee, only the sagittal plane was analyzed. MOS was calculated as the distance between the extrapolated-COM and the Center of Pressure per step. Statistical Parametric Mapping independent t-tests assessed group differences. Cross-correlation quantified MOS and joint moment relationships per plane during single-stance. No group differences in walking speed were observed. A larger frontal plane MOS, hip abduction and ankle eversion moment occurred for older adults. Cross-correlation demonstrated moderate and strong relationships for the hip-MOS for both groups in the sagittal plane. Older adults had a larger sagittal plane hip-MOS correlation than young adults. The larger mediolateral MOS in older adults may indicate attempts to avoid lateral balance loss by shifting their COM away from their BOS lateral boundaries during single-stance. However, this strategy moves the COM toward the BOS medial borders potentially pre-maturely terminating the contralateral swing phase during medial destabilization. The stronger sagittal plane hip-MOS relationship in older adults may reflect increased coupling between hip moments and the COM to control dynamic balance.

The aim of this study was to determine the effect of cognitive interference through a dual-task (DT) paradigm on gait parameters by sex or other predictive variables, such as physical fitness, health status, and cognition. A total of 125 older adults joined in this study (age, 72.42 ± 5.56 years old; 28 men and 97 women). The DT paradigm was evaluated through Comfortable Linear Gait (CLG) and Complex Gait Test (CGT). The gait parameters between single task (ST) vs. DT condition in men showed a significant reduction in speed (p < 0.001), cadence (p < 0.001), and step length (p = 0.049) and increased time to execute the CGT (p < 0.001), while women showed a decreased speed (p = 0.014), cadence (p < 0.001), and double support coefficient variation (CV) (p = 0.024) and increased single support time (p < 0.001) and CV step length (p < 0.05). In addition, women increased CGT time (p < 0.001). Furthermore, correlations between DT cost (DTC) cadence vs. Physical Activity for Elderly questionnaire (PASE) (r =  - 0.399; p = 0.008), DTC single support vs. 30 s Sit to Stand Test (r = - 0.356; 0.016), DTC single support vs. Rey Auditory Verbal Learning Test-Learning curve (r =  - 0.335; p = 0.023), DTC double support vs. 30 s Sit to Stand Test (r =  - 0.590; p < 0.001), DTC CV step length vs. 30 s Sit to Stand (r =  - 0.545; p = 0.003), and DTC CGT vs. 30 s Sit to Stand Test (r =  - 0.377; p = 0.048) were found. The results of our study indicate that the gait parameters within the DT condition decreased speed and cadence, while increasing CV step length and CGT time, causing slower gait with shortened steps in men and women.

Walking in complex environments increases the cognitive demand of locomotor control; however, our understanding of the neural mechanisms contributing to walking on uneven terrain is limited. We used a novel method for altering terrain unevenness on a treadmill to investigate the association between terrain unevenness and cortical activity in the prefrontal cortex, a region known to be involved in various cognitive functions.

Prefrontal cortical activity was measured with functional near infrared spectroscopy while participants walked on a novel custom-made terrain treadmill surface across four different terrains: flat, low, medium, and high levels of unevenness. The assessments were conducted in younger adults, older adults with better mobility function and older adults with worse mobility function. Mobility function was assessed using the Short Physical Performance Battery. The primary hypothesis was that increasing the unevenness of the terrain would result in greater prefrontal cortical activation in all groups. Secondary hypotheses were that heightened prefrontal cortical activation would be observed in the older groups relative to the younger group, and that prefrontal cortical activation would plateau at higher levels of terrain unevenness for the older adults with worse mobility function, as predicted by the Compensation Related Utilization of Neural Circuits Hypothesis.

The results revealed a significant main effect of terrain, indicating a significant increase in prefrontal cortical activation with increasing terrain unevenness during walking in all groups. A significant main effect of group revealed that prefrontal cortical activation was higher in older adults with better mobility function compared to younger adults and older adults with worse mobility function in all pooled terrains, but there was no significant difference in prefrontal cortical activation between older adults with worse mobility function and younger adults. Contrary to our hypothesis, the older group with better mobility function displayed a sustained increase in activation but the other groups did not, suggestive of neural compensation. Additional findings were that task-related increases in prefrontal cortical activation during walking were lateralized to the right hemisphere in older adults with better mobility function but were bilateral in older adults with worse mobility function and younger adults.

These findings support that compared to walking on a flat surface, walking on uneven terrain surfaces increases demand on cognitive control resources as measured by prefrontal cortical activation.

To address the lack of large-scale screening tools for mild cognitive impairment (MCI), this study aimed to assess the discriminatory ability of several gait tests for MCI and develop a screening tool based on gait test for MCI.

A diagnostic case-control test.

The general community.

We recruited 134 older adults (≥65 years) for the derivation sample, comprising -69 individuals in the cognitively normal group and -65 in the MCI group (N=134). An additional 70 participants were enrolled for the validation sample.

All participants completed gait tests consisting of a single task (ST) and 3 dual tasks (DTs): counting backwards, serial subtractions 7, and naming animals.

Binary logistic regression analyses were used to develop models, and the efficacy of each model was assessed using receiver operating characteristic (ROC) curve and area under the curve (AUC). The best effective model was the final diagnostic model and validated using ROC curve and calibration curve.

The DT gait test incorporating serial subtractions 7 as the cognitive task demonstrated the highest efficacy with the AUC of 0.906 and the accuracy of 0.831 in detecting MCI with "years of education" being adjusted. Furthermore, the model exhibited consistent performance across different age and sex groups. In external validation, the model displayed robust discrimination (AUC=0.913) and calibration (calibrated intercept=-0.062, slope=1.039).

The DT gait test incorporating serial subtractions 7 as the cognitive task demonstrated robust discriminate ability for MCI. This test holds the potential to serve as a large-scale screening tool for MCI, aids in the early detection and intervention of cognitive impairment in older adults.

Disorders associated with cognitive impairment impose a significant burden on both families and society. Previous studies have indicated that gait characteristics under dual-task as reliable markers of early cognitive impairment. Therefore, digital gait detection has great potential for future cognitive screening. However, research on digital biomarkers based on smart devices to identify cognitive impairment remains limited. The aim of this study is to explore digital gait biomarkers by utilizing intelligent wearable devices for discriminating mild cognitive impairment and dementia.

This study included 122 subjects (age: 74.7 ± 7.7 years) diagnosed with normal cognition (NC, n = 38), mild cognitive impairment (MCI, n = 42), or dementia (n = 42). All subjects underwent comprehensive neuropsychological assessments and cranial Magnetic Resonance Imaging (MRI). Gait parameters were collected using validated wearable devices in both single-task and dual-task (DT). We analyzed the ability of gait variables to predict MCI and dementia, and examined the correlations between specific DT-gait parameters and sub-cognitive functions as well as hippocampal atrophy.

Our results demonstrated that dual-task could significantly improve the ability to predict cognitive impairment based on gait parameters such as gait speed (GS) and stride length (SL). Additionally, we discovered that turn velocity (TV and DT-TV) can be a valuable novel digital marker for predicting MCI and dementia, for identifying MCI (DT-TV: AUC = 0.801, sensitivity 0.738, specificity 0.842), and dementia (DT-TV: AUC = 0.923, sensitivity 0.857, specificity 0.842). The correlation analysis and linear regression analysis revealed a robust association between DT-TV and memory function, as well as the hippocampus atrophy.

This study presents a novel finding that DT-TV could accurately identify varying degrees of cognitive impairment. DT-TV is strongly correlated with memory function and hippocampus shrinkage, suggests that it can accurately reflect changes in cognitive function. Therefore, DT-TV could serve as a novel and effective digital biomarker for discriminating cognitive impairment.

Falls are the leading cause of injury, disability, and injury-related mortality in the older adult population. Older adults with Alzheimer disease (AD) are over twice as likely to experience a fall compared to cognitively normal older adults. Intrinsic and extrinsic fall risk factors may influence falls during symptomatic AD; intrinsic factors include changes in cognition and impaired functional mobility, and extrinsic factors include polypharmacy and environmental fall hazards. Despite many known fall risk factors, the high prevalence of falls, and the presence of effective fall prevention interventions for older adults without cognitive impairment, effective fall prevention interventions for older adults with AD to date are limited and inconclusive. Falls may precede AD-related cognitive impairment during the preclinical phase of AD, though a narrow understanding of fall risk factors and fall prevention interventions for older adults with preclinical AD limits clinical treatment of falls among cognitively normal older adults with preclinical AD. This mini review explores fall risk factors in symptomatic AD, evidence for effective fall prevention interventions in symptomatic AD, and preclinical AD as an avenue for future falls research, including recommendations for future research directions to improve our understanding of falls and fall risk during preclinical AD. Early detection and tailored interventions to address these functional changes are needed to reduce the risk of falls for those at risk for developing AD. Concerted efforts should be dedicated to understanding falls to inform precision fall prevention strategies for this population.

Alzheimer's disease (AD) is a common cause of dementia, characterised by cerebral amyloid-β deposition, pathological tau and neurodegeneration. The prodromal stage of AD (pAD) refers to patients with mild cognitive impairment (MCI) and evidence of AD's pathology. At this stage, disease-modifying interventions should be used to prevent the progression to dementia. Given the inherent heterogeneity of MCI, more specific biomarkers are needed to elucidate the underlying AD's pathology. Although the uses of cerebrospinal fluid and positron emission tomography are widely accepted methods for detecting AD's pathology, their clinical applications are limited by their high costs and invasiveness, particularly in low-income areas in China. Therefore, to improve the early detection of Alzheimer's disease (AD) pathology through cost-effective screening methods, a panel of 45 neurologists, psychiatrists and gerontologists was invited to establish a formal consensus on the screening of pAD in China. The supportive evidence and grades of recommendations are based on a systematic literature review and focus group discussion. National meetings were held to allow participants to review, vote and provide their expert opinions to reach a consensus. A majority (two-thirds) decision was used for questions for which consensus could not be reached. Recommended screening methods are presented in this publication, including neuropsychological assessment, peripheral biomarkers and brain imaging. In addition, a general workflow for screening pAD in China is established, which will help clinicians identify individuals at high risk and determine therapeutic targets.

Early recognition of dementia like Alzheimer's disease is crucial for disease diagnosis and treatment, and existing objective tools for early screening of cognitive impairment are limited.

To investigate age-related behavioral indicators of dual-task cognitive performance and gait parameters and to explore potential objective markers of early cognitive decline.

The community-based cognitive screening data was analyzed. Hierarchical cluster analysis and Pearson correlation analysis were performed on the 9-item subjective cognitive decline (SCD-9) scores, walking-cognitive dual-task performance, walking speed, and gait parameters of 152 participants. The significant differences of indicators that may related to cognitive decline were statistically analyzed across six age groups. A mathematical model with age as the independent variable and motor cognition composite score as the dependent variable was established to observe the trend of motor cognition dual-task performance with age.

Strong correlation was found between motor cognitive scores and SCD and age. Gait parameters like the mean value of ankle angle, the left-right difference rate of ankle angle and knee angle and the coefficient of variation of gait cycle showed an excellent correlation with age. Motor cognition scores showed a decreasing trend with age. The slope of motor cognition scores with age after 50 years (k = -1.06) was six times higher than that before 50 years (k = -0.18).

Cognitive performance and gait parameters in the walking-cognitive dual-task state are promising objective markers that could characterize age-related cognitive decline.

This study compares dual task (DT) gait speed between robust and frail older adults in the setting of a community-based frailty screening program.

A cross-sectional study was conducted involving older adults aged 50 years or older. Participants were categorized as robust, pre-frail or frail using the FRAIL phenotype. Gait speed was measured under single task (ST) and 2 DT conditions: arithmetic (DT1) and verbal fluency (DT2) tasks. For the arithmetic task, participants counted upwards in multiples of 2, starting from 16. For the verbal fluency task, they named different animals as they walked.

A total of 976 participants were recruited, of which 779 were robust, 181 were pre-frail and 16 were frail. Robust participants exhibited significantly faster DT gait speeds (DT1: 1.12 (0.25)m/s; DT2: 0.97 (0.27)m/s than pre-frail/frail (PFF) participants (DT1: 0.88 (0.30)m/s); DT2: 0.78 (0.30)m/s). Robust participants also demonstrated a significantly faster ST gait speed (1.31 (0.22)m/s) vs 1.05 (0.31)m/s).

DT gait assessment combines both physical and cognitive domains and may serve as a more holistic tool for early frailty detection in the community. The significant differences observed in DT gait speeds highlight the need for integrating cognitive assessments into frailty screening protocols, supporting timely interventions to improve health outcomes.

Dementia is a general term for several progressive neurodegenerative disorders including Alzheimer's disease. Timely and accurate detection is crucial for early intervention. Advancements in artificial intelligence present significant potential for using machine learning to aid in early detection.

Summarize the state-of-the-art machine learning-based approaches for dementia prediction, focusing on non-invasive methods, as the burden on the patients is lower. Specifically, the analysis of gait and speech performance can offer insights into cognitive health through clinically cost-effective screening methods.

A systematic literature review was conducted following the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The search was performed on three electronic databases (Scopus, Web of Science, and PubMed) to identify the relevant studies published between 2017 to 2022. A total of 40 papers were selected for review.

The most common machine learning methods employed were support vector machine followed by deep learning. Studies suggested the use of multimodal approaches as they can provide comprehensive and better prediction performance. Deep learning application in gait studies is still in the early stages as few studies have applied it. Moreover, including features of whole body movement contribute to better classification accuracy. Regarding speech studies, the combination of different parameters (acoustic, linguistic, cognitive testing) produced better results.

The review highlights the potential of machine learning, particularly non-invasive approaches, in the early prediction of dementia. The comparable prediction accuracies of manual and automatic speech analysis indicate an imminent fully automated approach for dementia detection.

Gait is a potential diagnostic tool for detecting mild cognitive impairment (MCI) and Alzheimer's disease (AD). Nevertheless, little attention has been paid to arm movements during walking, and there is currently no consensus on gait asymmetry. Therefore, in this study, we aimed to determine whether arm motion and gait asymmetry could be utilized for identifying MCI and AD.

In total, 102 middle-aged and elderly individuals were included in the final analysis and were assigned to the following three groups: AD (n = 27), MCI (n = 35), and a normal control group (n = 40). Gait and cognitive assessments were conducted for all participants. Gait detection included a single-task gait with free-speed walking and a dual-task gait with adding a cognitive task of successive minus seven to walking. Original gait parameters were collected using a wearable device featuring the MATRIX system 2.0. Gait parameters were shortened to several main gait domains through factor analysis using principal component extraction with varimax rotation. Subsequently, the extracted gait domains were used to differentiate the three groups, and the area under the receiver operating characteristic curve was calculated.

Factor analysis of single-task gait identified five independent gait domains: rhythm symmetry, rhythm, pace asymmetry, arm motion, and variability. Factor analysis of the dual-task gait identified four gait domains: rhythm, variability, symmetry, and arm motion. During single-task walking, pace asymmetry was negatively correlated with MoCA scores and could distinguish between the AD group and the other two groups. Arm motion was not associated with MoCA scores, and did not exhibit adequate discrimination in either task.

Currently, there is no reliable evidence suggesting that arm motion can be used to recognize AD or MCI. Gait asymmetry can serve as a potential gait marker for the auxiliary diagnosis of AD but not for MCI.

While assessment tools can increase the detection of cognitive impairment, there is currently insufficient evidence regarding clinical outcomes based on screening for cognitive impairment in older adults.

The study purpose was to investigate whether Timed Up and Go dual-task test (TUGdt) results, based on TUG combined with two different verbal tasks (name different animals, TUGdt-NA, and recite months in reverse order, TUGdt-MB), predicted dementia incidence over a period of five years among patients (N = 186, mean = 70.7 years; 45.7% female) diagnosed with Subjective Cognitive Impairment (SCI) and Mild Cognitive Impairment (MCI) following assessment at two memory clinics. Associations between TUG parameters and dementia incidence were examined in Cox regression models.

During follow-up time (median (range) 3.7 (0.1-6.1) years) 98 participants converted to dementia. Novel findings indicated that the TUGdt parameter words/time, after adjustment for age, gender, and education, can be used for the prediction of conversion to dementia in participants with SCI or MCI over a period of five years. Among the TUG-related parameters investigated, words/time showed the best predictive capacity, while time scores of TUG and TUGdt as well as TUGdt cost did not produce significant predictive results. Results further showed that the step parameter step length during TUGdt predicts conversion to dementia before adjustment for age, gender, and education. Optimal TUGdt cutoffs for predicting dementia at 2- and 4-year follow-up based on words/time were calculated. The sensitivity of the TUGdt cutoffs was high at 2-year follow-up: TUGdt-NA words/time, 0.79; TUGdt-MB words/time, 0.71; reducing respectively to 0.64 and 0.65 at 4-year follow-up.

TUGdt words/time parameters have potential as cost-efficient tools for conversion-to-dementia risk assessment, useful for research and clinical purposes. These parameters may be able to bridge the gap of insufficient evidence for such clinical outcomes.

ClinicalTrials.gov Identifier: NCT05893524: https://www.

gov/study/NCT05893524?id=NCT05893524&rank=1 .

The use of dual-task model such as dual-task gait has been extensively studied to assess cognitive-motor performance among older adults. However, space restriction and safety factor limit its applications in remote assessment. To address the gap, we propose a video processing-based approach to remotely quantify cognitive-motor performance using a 20-s repetitive elbow flexion-extension test with dual-task condition, called video-based motoric-cognitive meter (MCM).

Eighteen older participants (age: 78.6 ± 6.5 years) who were clinically diagnosed as having either mild cognitive impairment or dementia were included in this study. Participants were asked to perform 20-s repetitive elbow flexion-extension exercise with a memory exercise by counting backward from a two-digit number. During the test, all movements of the forearm were recorded by a video camera. As a comparator, a validated wrist-worn sensor was used, which allowed quantifying upper extremity kinematics.

The results showed a good agreement (r ≥ 0.530 and ICC2,1 ≥ 0.681) between the derived dual-task upper extremity motor performance from the proposed video-based MCM and a clinically validated sensor-based MCM. We also observed moderate correlations (r ≥ 0.496) between some measures of video-based MCM (flexion time, extension time, and flexion-extension time) and clinical cognitive scale (Mini-Mental State Examination [MMSE]). Additionally, some measures of dual-task upper extremity motor performance (speed, flexion time, extension time, and flexion-extension time) were associated with dual-task gait speed (r ≥ 0.557), which has been found to be correlated with cognitive impairment. Lastly, the selected dual-task motor performance metric (flexion time) was sensitive to predict MMSE scores in linear regression analyses with statistical significance (adjusted R2 = 0.306, p = 0.025).

This study proposes a video processing-based approach to analyze dual-task upper extremity motor performance from a simple and convenient upper extremity function test. The results indicate concurrent validity of the proposed video-based MCM compared with the sensor-based MCM, and associations between dual-task upper extremity motor performance and clinically validated cognitive markers (MMSE scores and dual-task gait). Future studies are warranted to explore sensitivity of this solution to promote remote assessment of cognitive-motor performance among older adults in telehealth applications.

Subjective cognitive decline (SCD) refers to individuals who report persistent cognitive deficits but perform normally on neuropsychological tests. Performance may be facilitated by increased prefrontal cortex activation, known as neural compensation, and could be used to differentiate between older adults with and without SCD.

This cross-sectional pilot study measured changes in the hemodynamic response (ΔHbO2) using functional near-infrared spectroscopy (fNIRS) as well as cognitive and motor performance during fine and gross motor dual-tasks in older adults with and without SCD.

Twenty older adults over 60 years old with (n = 10) and without (n = 10) SCD were recruited. Two experiments were conducted using 1) gross motor walking and 2) fine motor finger tapping tasks that were paired with an n-back working memory task. Participants also completed neuropsychological assessments and questionnaires on everyday functioning.

Repeated measures ANOVAs demonstrated slower response times during dual-task gait compared to the single task (p = 0.032) and in the non-SCD group, slower gait speed was also observed in the dual compared to single task (p = 0.044). Response times during dual-task finger tapping were slower than the single task (p = 0.049) and greater ΔHbO2 was observed overall in the SCD compared to non-SCD group (p = 0.002).

Examining neural and performance outcomes revealed differences between SCD and non-SCD groups and single and dual-tasks. Greater brain activation during dual-task finger tapping may reflect neural compensation, which should be examined in a larger sample and longitudinally to better characterize SCD.

Cognitive and motor dysfunctions in older people become more evident while dual-tasking. Several dual-task paradigms have been used to identify older individuals at the risk of developing Alzheimer's disease and dementia. This study evaluated gait kinematic parameters for dual-task (DT) conditions in older adults with mild cognitive impairment (MCI), subjective cognitive decline (SCD), and normal cognition (NC).

This is a cross-sectional, clinical-based study carried out at the Zhongshan Rehabilitation Branch of First Affiliated Hospital of Nanjing Medical University, China.

We recruited 83 community-dwelling participants and sorted them into MCI (n = 24), SCD (n = 33), and NC (n = 26) groups based on neuropsychological tests. Their mean age was 72.0 (5.55) years, and male-female ratio was 42/41 (p = 0.112). Each participant performed one single-task walk and four DT walks: DT calculation with subtracting serial sevens; DT naming animals; DT story recall; and DT words recall.

Kinematic gait parameters of speed, knee peak extension angle, and dual-task cost (DTC) were obtained using the Vicon Nexus motion capture system and calculated by Visual 3D software. A mixed-effect linear regression model was used to analyze the data.

The difference in gait speed under DT story recall and DT calculation was -0.099 m/s and - 0.119 m/s (p = 0.04, p = 0.013) between MCI and SCD, respectively. Knee peak extension angle under DT story recall, words recall, and single task was bigger in the MCI group compared to the NC group, respectively (p = 0.001, p = 0.001, p = 0.004). DTC was higher in the DT story recall test than all other DT conditions (p < 0.001).

Kinematic gait parameters of knee peak extension angle for the DT story recall were found to be sensitive enough to discriminate MCI individuals from NC group. DTC under DT story recall was higher than the other DT conditions.

It is already known the effectiveness of Pilates training on cognitive and functional abilities. It is also known that dual-task exercise and cognitive stimuli improve cognition and functional capacity. However, no previous report combined cognitive stimuli and Pilates in dual task and measured its effects on the cognitive and physical performances of postmenopausal women.

To apply an interventional dual-task (PILATES-COG) protocol and to evaluate its influence on memory, language, and functional physical performances on healthy, community-dwelling postmenopausal older women.

47 women with amenorrhea for at least 12 months participated in this study. Those allocated on the PILATES-COG group underwent a 12-week, twice a week regimen of 50 min sessions of simultaneous mat Pilates exercise program and cognitive tasks. Cognitive and physical functional performance were assessed. Two-way mixed ANOVA was used for data analysis, and Bonferroni post hoc tests were used for within- and between-group comparisons.

The PILATES-COG group showed significant improvement after the intervention in semantic verbal fluency (p < 0.001; ηρ² = 0.268), phonological verbal fluency (p < 0.019; ηρ² = 0.143), immediate memory (p < 0.001; ηρ² = 0.258), evocation memory (p < 0.001 ηρ² = 0.282), lower-limb muscle strength (p < 0.001; ηρ² = 0.447), balance (p < 0.001; ηρ² = 0.398), and dual-ask cost (p < 0.05; ηρ² = 0.111) assessments on healthy, community-dwelling postmenopausal older women.

This is the first report of a feasible and effective approach using Pilates and cognitive stimulation in dual task for the reduction of age-related cognitive decline and the improvement of physical functional performance in healthy postmenopausal women.

Aging affects the interplay between cognition and gait performance. Neuroimaging studies reported associations between gait performance and structural measures; however, functional connectivity (FC) analysis of imaging data can help to identify dynamic neural mechanisms underlying optimal performance. Here, we investigated the effects on divergent cognitive and inter-network FC patterns underlying gait performance during usual (UW) and dual-task (DT) walking.

A total of 115 community-dwelling, healthy participants between 20 and 80 years were enrolled. All participants underwent comprehensive cognitive and gait assessments in two conditions and resting state functional MRI (fMRI) scans. Inter-network FC from motor-related to 6 primary cognitive networks were estimated. Step-wise regression models tested the relationships between gait parameters, inter-network FC, neuropsychological scores, and demographic variables. A threshold of p < 0.05 was adopted for all statistical analyses.

UW was largely associated with FC levels between motor and sustained attention networks. DT performance was associated with inter-network FC between motor and divided attention, and processing speed in the overall group. In young adults, UW was associated with inter-network FC between motor and sustained attention networks. On the other hand, DT performance was associated with cognitive performance, as well as inter-network connectivity between motor and divided attention networks (VAN and SAL). In contrast, the older age group (> 65 years) showed increased integration between motor, dorsal, and ventral attention, as well as default-mode networks, which was negatively associated with UW gait performance. Inverse associations between motor and sustained attention inter-network connectivity and DT performance were observed.

While UW relies on inter-network FC between motor and sustained attention networks, DT performance relies on additional cognitive capacities, increased motor, and executive control network integration. FC analyses demonstrate that the decline in cognitive performance with aging leads to the reliance on additional neural resources to maintain routine walking tasks.

Performing multiple tasks in parallel is detrimental to performance, a phenomenon generically referred to as dual-task interference (DTi). Several variables can modulate DTi at the individual level, and increasing age is typically described as negatively affecting response costs. In this study, we investigated, in 252 healthy adults aged between 50 and 89 years, how age modulates the detrimental effect of DTi during the encoding of images. We combined a visual memory task and a sustained attention task (i.e., an auditory version of the continuous performance task, ACPT) in three separate blocks. In the first block, participants had to perform a four-alternative forced-choice recognition of previously memorized images without having attended to ACPT sounds during the encoding. In the second block, during memorization, participants had to press a response key when detecting the letter "X" within a stream of letters (Low Load). In the third block, they had to respond only when the letter "X" was preceded by the letter "A" (High Load). The results showed that overall performance linearly decreased with age. In contrast with our predictions, DTi was stable across different ages. Finally, using a cluster-based approach, we found that participants who paid the highest costs when dual-tasking also demonstrated, on a self-administered cognitive screening significantly lower scores than peers. These new types of tests, which ask for concurrent task performance, might become useful for detecting outlier performance that might anticipate or correlate with aging-related cognitive decline.