Curve walking may reveal cognitive decline in older adults

By Staff 10 Min Read

  • About 20% of the world’s population has mild cognitive impairment (MCI), 10%–15% of whom will develop dementia
  • There is currently no cure for MCI, but early diagnosis and intervention can help slow progression.
  • A new study has developed a way to use gait analysis to test for early cognitive decline.
  • The researchers found that difficulty walking a curved path was associated with early cognitive decline.

About 20% of the world’s population has mild cognitive impairment (MCI) — a condition affecting a person’s memory or thinking.

People with mild cognitive impairment are at an increased risk of developing Alzheimer’s disease (AD) or other types of dementia.

Researchers estimate that 10%–15% of people with mild cognitive impairment develop dementia. For this reason, scientists are working hard to develop new ways of diagnosing mild cognitive impairment.

Although there is currently no cure for mild cognitive impairment, early treatment can help manage symptoms and slow down its progression.

In a new study recently published in the Journal of Alzheimer’s Disease Reports, researchers from Florida Atlantic University analyzed gait — how a person stands and walks — to test for early cognitive decline.

For this study, researchers used gait analysis to look for differences between healthy older adults and older adults with mild cognitive impairment.

They recruited 55 older adults — 25 with mild cognitive impairment and 30 without.

Senior author Dr. Behnaz Ghoraani, associate professor in the Department of Electrical Engineering and Computer Science and co-director of the Center for SMART Health at Florida Atlantic University, said that gait analysis can significantly complement cognitive assessments in detecting and monitoring cognitive decline by providing an objective, noninvasive measure of an individual’s motor abilities that are often affected early in the course of cognitive impairment.

“Cognitive assessments focus on evaluating various aspects of cognitive function such as memory, attention, and problem-solving skills, which are crucial for diagnosing conditions like mild cognitive impairment and Alzheimer’s disease,” Dr. Ghoraani told Medical News Today.

“However, they may not capture all the early signs of cognitive decline, and their performance can be influenced by factors like test anxiety or the individual’s condition at the time of assessment.”

“Gait analysis, on the other hand, offers a unique window into the neurological health of an individual by quantifying changes in walking patterns, balance, and coordination,” Dr. Ghoraani detailed.

“These changes can precede noticeable cognitive symptoms, thereby providing an early indicator of cognitive decline.”

“By integrating gait analysis with traditional cognitive assessments, clinicians can gain a more comprehensive understanding of an individual’s cognitive and physical health, enabling earlier detection of cognitive decline, monitoring progression, and assessing the efficacy of interventions. This holistic approach enhances the ability to identify individuals at risk and develop personalized care plans, ultimately aiming to improve the quality of life for patients and their families.”

— Dr. Behnaz Ghoraani, senior study author

All participants in the study were asked to perform two different walking tests — one of straight walking and the other of walking on a curved path.

“Straight walking is a relatively simple, repetitive motion that primarily involves linear movement with minimal need for directional changes or complex spatial navigation,” Dr. Ghoraani explained.

“It’s a rhythmic activity that relies heavily on the established motor patterns and requires less cognitive input once initiated.”

“Curved walking, on the other hand, introduces a higher level of complexity due to the need for continuous adjustment of balance, direction, and speed,” Dr. Ghoraani continued.

“Navigating a curved path demands greater cognitive and motor coordination, as it involves changing the orientation of the body and adjusting gait parameters to maintain stability while turning. This requires the integration of visual, vestibular, and proprioceptive information to successfully negotiate the curve, placing a higher demand on cognitive resources and balance control mechanisms.”

Researchers used a depth camera to detect and track 25 joints of body movement during these tests, giving them a total of 50 gait markers for each test.

Upon analysis, the research team found that 31 of the 50 gait markers, or 62%, were increased for the mild cognitive impairment group when compared to the healthy controls when the walking test changed from straight walking to curved walking.

The scientists reported 13 of these markers showed significant differences between the two study participant groups.

“We found that individuals with mild cognitive impairment showed distinctive changes in their walking patterns compared to healthy controls,” Dr. Ghoraani detailed.

“Notably, during curved walking, those with mild cognitive impairment tended to have a shorter average step length and reduced walking speed. This suggests that navigating a curve was more challenging for them, likely due to the increased demand for balance and coordination that curved paths require.”

“Additionally, we observed that participants with mild cognitive impairment spent more time with both feet on the ground during curve walking, a phase known as ‘double support time’,” she continued.

“This increased time indicates a need for greater stability, reflecting potential difficulties in maintaining balance. We also noted increased variability in their gait parameters during curve walking. This variability — meaning their walking patterns were less consistent — points to challenges in executing the complex motor tasks needed for curved walking.”

Dr. Ghoraani explained the importance of developing new ways to detect cognitive decline.

Detecting cognitive impairment, particularly in its early stages, lies in the critical window it provides for timely intervention and management.

“Existing diagnostic methods for cognitive decline, including early Alzheimer’s disease and its precursor, mild cognitive impairment, often involve invasive procedures, are costly, and might not adequately detect early stages of cognitive decline,” Dr. Ghoraani said.

“These limitations pose significant challenges in the timely initiation of interventions that could potentially slow the progression of the disease and improve the quality of life for those affected.”

“Early detection is crucial because it opens the door to interventions that can delay or mitigate the progression towards more severe cognitive disorders,” she continued.

“Interventions might include pharmacological treatments, lifestyle changes, cognitive therapy, and planning for future care needs. Moreover, early detection can significantly impact the emotional well-being of patients and their families, allowing for better management of the condition and preparation for the changes it brings.”

After reviewing this study, Dr. Clifford Segil, a neurologist at Providence Saint John’s Health Center in Santa Monica, CA, told MNT he was surprised to see a study using gait impairment as a diagnostic tool for a memory loss disorder like mild cognitive impairment rather than as a diagnostic tool for a movement disorder like Parkinson’s disease.

“Common sense dictates older patients with a movement disorder are going to have more problems with gait than older patients with memory loss,” Dr. Segil explained.

“Gait abnormalities have never been used by clinicians to diagnose a memory loss disorder like Alzheimer’s dementia.”

MNT also spoke with Ryan Glatt, senior brain health coach and director of the FitBrain Program at Pacific Neuroscience Institute in Santa Monica, CA, who found this study to be a very interesting progression in the development of functional assessments that consider both physical mobility and cognitive abilities.

“There have been prior gait assessments that are correlated to cognition in those with mild cognitive impairment and dementia, such as the Groningen Meander Walking test and the Timed Up and Go Dual-Task assessment, and more research is needed to better understand the differences and values of these types of assessments.”

— Ryan Glatt, brain health coach

And after reviewing this research, Dr. Karen D. Sullivan, a board-certified neuropsychologist, owner of I CARE FOR YOUR BRAIN and Reid Healthcare Transformation Fellow at FirstHealth of the Carolinas in Pinehurst, NC, told MNT she liked the whole person approach of this study, as the authors stress that a gait assessment is an excellent compliment to a detailed neuropsychological evaluation.

“The subtypes of dementia are most commonly associated with cognitive change, but we need to be moving more towards a holistic understanding which includes physical, sensory, and mood/behavior changes,” Dr. Sullivan added.

“This diagnostic tool would be a great part of a multidisciplinary, whole-person assessment team for diagnosing dementia.”

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