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Abstract
Background
Older adults with mild cognitive impairment (OAwMCI) present subtle balance and gait deficits along with subjective memory decline. Although these presentations might not affect activities of daily living (ADLs), they attribute to a two-folded increase in falls. While changes occurring in volitional balance control during ADLs have been extensively examined among OAwMCI, reactive balance control, required to recover from external perturbations, has received little attention. Therefore, this study examined reactive balance control in OAwMCI compared to their healthy counterparts.
Methods
Fifteen older adults with mild cognitive impairment (OAwMCI), fifteen cognitively intact older adults (CIOA) (>55 years), and fifteen young adults (18–30 years) were exposed to stance perturbations at three different intensities. Behavioral outcomes postural COM state stability, step length, step initiation, and step execution were computed.
Results
Postural COM state stability was the lowest in OAwMCI compared to CIOA and young adults, and it deteriorated at higher perturbation intensities (P < 0.001). Step length was the lowest among OAwMCI and was significantly different from young adults (P < 0.001) but not from CIOA. Unlike OAwMCI, CIOA and young adults increased their step length at higher perturbation intensities (P < 0.001). OAwMCI showed longer recovery step initiation times and shorter execution times compared to CIOA and young adults at higher perturbation intensities (P < 0.001).
Conclusion
OAwMCI exhibit exacerbated reactive instability and are unable to modulate their responses as the threat to balance control altered. Thus, they are at a significantly higher risk of falls than their healthy counterparts.
-
1.
Petersen RC , Smith GE , Waring SC , Ivnik RJ , Kokmen E , Tangelos EG . Aging, memory, and mild cognitive impairment. Int Psychogeriatr 1997; 9(S1): 65–9.
-
2.
Plassman BL , Langa KM , Fisher GG , Heeringa SG , Weir DR , Ofstedal MB , et al. Prevalence of cognitive impairment without dementia in the United States. Ann Intern Med 2008; 148(6): 427–34.
-
3.
Villemagne VL , Burnham S , Bourgeat P , Brown B , Ellis KA , Salvado O , et al. Amyloid β deposition, neurodegeneration, and cognitive decline in sporadic Alzheimer's disease: a prospective cohort study. Lancet Neurol 2013; 12(4): 357–67.
-
4.
Kallin K , Gustafson Y , Sandman P-O , Karlsson S . Factors associated with falls among older, cognitively impaired people in geriatric care settings: a population-based study. Am J Geriatr Psychiatry 2005; 13(6): 501–9.
-
5.
Shaw FE . Falls in cognitive impairment and dementia. Clin Geriatr Med 2002; 18(2): 159–73.
-
6.
Bárrios H , Narciso S , Guerreiro M , Maroco J , Logsdon R , de Mendonça A . Quality of life in patients with mild cognitive impairment. Aging Ment Health 2013; 17(3): 287–92.
-
7.
Doi T , Shimada H , Makizako H , Tsutsumimoto K , Hotta R , Nakakubo S , et al. Mild cognitive impairment, slow gait, and risk of disability: a prospective study. J Am Med Directors Assoc 2015; 16(12): 1082–6.
-
8.
Petersen RC . Mild cognitive impairment as a diagnostic entity. J Intern Med 2004; 256(3): 183–94.
-
9.
Maki BE , McIlroy WE . The role of limb movements in maintaining upright stance: the “change-in-support” strategy. Phys Ther 1997; 77(5): 488–507.
-
10.
Pai Y-C , Bhatt TS . Repeated-slip training: an emerging paradigm for prevention of slip-related falls among older adults. Phys Ther 2007; 87(11): 1478–91.
-
11.
Pieruccini-Faria F , Sarquis-Adamson Y , Montero-Odasso M . Mild cognitive impairment affects obstacle negotiation in older adults: results from “Gait and Brain Study”. Gerontology 2019; 65(2): 164–73.
-
12.
Leandri M , Cammisuli S , Cammarata S , Baratto L , Campbell J , Simonini M , et al. Balance features in Alzheimer's disease and amnestic mild cognitive impairment. J Alzheimer's Dis 2009; 16(1): 113–20.
-
13.
Shin BM , Han SJ , Jung JH , Kim JE , Fregni F . Effect of mild cognitive impairment on balance. J Neurol Sci 2011; 305(1–2): 121–5.
-
14.
Mansfield A , Peters AL , Liu BA , Maki BE . Effect of a perturbation-based balance training program on compensatory stepping and grasping reactions in older adults: a randomized controlled trial. Phys Ther 2010; 90(4): 476–91.
-
15.
Tangen GG , Engedal K , Bergland A , Moger TA , Mengshoel AM . Relationships between balance and cognition in patients with subjective cognitive impairment, mild cognitive impairment, and Alzheimer disease. Phys Ther 2014; 94(8): 1123–34.
-
16.
Burleigh A , Horak F . Influence of instruction, prediction, and afferent sensory information on the postural organization of step initiation. J Neurophysiol 1996; 75(4): 1619–28.
-
17.
Timmann D , Horak F . Perturbed step initiation in cerebellar subjects 1. Modifications of postural responses. Exp Brain Res 1998; 119(1): 73–84.
-
18.
Timmann D , Horak F . Perturbed step initiation in cerebellar subjects: 2. Modification of anticipatory postural adjustments. Exp Brain Res 2001; 141(1): 110–20.
-
19.
Patel PJ , Bhatt T . Does aging with a cortical lesion increase fall-risk: examining effect of age versus stroke on intensity modulation of reactive balance responses from slip-like perturbations. Neuroscience 2016; 333: 252–63.
-
20.
Lin S-I , Woollacott MH . Postural muscle responses following changing balance threats in young, stable older, and unstable older adults. J Mot Behav 2002; 34(1): 37–44.
-
21.
Moreland JD , Richardson JA , Goldsmith CH , Clase CM . Muscle weakness and falls in older adults: a systematic review and meta‐analysis. J Am Geriatr Soc 2004; 52(7): 1121–9.
-
22.
Bastian AJ . Understanding sensorimotor adaptation and learning for rehabilitation. Curr Opin Neurol 2008; 21(6): 628.
-
23.
Wang Y , Wang S , Lee A , Pai Y-C , Bhatt T . Treadmill-gait slip training in community-dwelling older adults: mechanisms of immediate adaptation for a progressive ascending-mixed-intensity protocol. Exp Brain Res 2019; 237(9): 2305–17.
-
24.
Thompson JD , Plummer P , Franz JR . Age and falls history effects on antagonist leg muscle coactivation during walking with balance perturbations. Clin Biomech 2018; 59: 94–100.
-
25.
Dickerson B , Salat D , Greve D , Chua E , Rand-Giovannetti E , Rentz D , et al. Increased hippocampal activation in mild cognitive impairment compared to normal aging and AD. Neurology 2005; 65(3): 404–11.
-
26.
Wang L , Goldstein FC , Veledar E , Levey AI , Lah JJ , Meltzer CC , et al. Alterations in cortical thickness and white matter integrity in mild cognitive impairment measured by whole-brain cortical thickness mapping and diffusion tensor imaging. Am J Neuroradiology 2009; 30(5): 893–9.
-
27.
Zhang Y , Schuff N , Camacho M , Chao LL , Fletcher TP , Yaffe K , et al. MRI markers for mild cognitive impairment: comparisons between white matter integrity and gray matter volume measurements. PloS One 2013; 8(6): e66367.
-
28.
Nasreddine ZS , Phillips NA , Bédirian V , Charbonneau S , Whitehead V , Collin I , et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53(4): 695–9.
-
29.
Hans D , Schott A , Meunier P . Ultrasonic assessment of bone: a review. The Eur J Med 1993; 2(3): 157–63.
-
30.
Zagzebski JA , Rossman PJ , Mesina C , Mazess RB , Madsen EL . Ultrasound transmission measurements through the os calcis. Calcified Tissue Int 1991; 49(2): 107–11.
-
31.
Lajoie Y , Gallagher S . Predicting falls within the elderly community: comparison of postural sway, reaction time, the Berg balance scale and the Activities-specific Balance Confidence (ABC) scale for comparing fallers and non-fallers. Arch Gerontol Geriatr 2004; 38(1): 11–26.
-
32.
Yang F , Bhatt T , Pai Y-C . Role of stability and limb support in recovery against a fall following a novel slip induced in different daily activities. J Biomech 2009; 42(12): 1903–8.
-
33.
Pai Y-C , Iqbal K . Simulated movement termination for balance recovery: can movement strategies be sought to maintain stability in the presence of slipping or forced sliding? J Biomech 1999; 32(8): 779–86.
-
34.
McMahon TA . Muscles, reflexes, and locomotion. Princeton University Press; 1984.
-
35.
Smith JA , Fisher BE . Anticipatory postural adjustments and spatial organization of motor cortex: evidence of adaptive compensations in healthy older adults. J Neurophysiol 2018; 120(6): 2796–805.
-
36.
Hsiao-Wecksler ET . Biomechanical and age-related differences in balance recovery using the tether-release method. J Electromyogr Kinesiol 2008; 18(2): 179–87.
-
37.
Welch TD , Ting LH . A feedback model explains the differential scaling of human postural responses to perturbation acceleration and velocity. J Neurophysiol 2009; 101(6): 3294–309.
-
38.
Mahoney JR , Wang C , Dumas K , Holtzer R . Visual-somatosensory integration in aging: does stimulus location really matter? Vis Neurosci 2014; 31(3): 275.
-
39.
Mahoney JR , Verghese J . Does cognitive impairment influence visual-somatosensory integration and mobility in older adults? J Gerontol Ser A 2020; 75(3): 581–8.
-
40.
Jacobs J , Horak F . Cortical control of postural responses. J Neural Transm 2007; 114(10): 1339.
-
41.
Brandt T , Schautzer F , Hamilton DA , Brüning R , Markowitsch HJ , Kalla R , et al. Vestibular loss causes hippocampal atrophy and impaired spatial memory in humans. Brain 2005; 128(11): 2732–41.
-
42.
Hufner K , Stephan T , Hamilton D , Kalla R , Glasauer S , Strupp M , et al. Gray-matter atrophy after chronic complete unilateral vestibular deafferentation. Ann New York Acad Sci 2009; 1164(1): 383–5.
-
43.
Micarelli A , Viziano A , Della-Morte D , Augimeri I , Alessandrini M . Degree of functional impairment associated with vestibular hypofunction among older adults with cognitive decline. Otol Neurotol 2018; 39(5): e392–400.
-
44.
Ventre-Dominey J . Vestibular function in the temporal and parietal cortex: distinct velocity and inertial processing pathways. Front Integr Neurosci 2014; 8: 53.
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