Can timed up and go subtasks predict functional decline in older adults with cognitive impairment?

Even in the early stages of cognitive impairment, older people can present important motor alterations. However, there are no studies that have investigated Timed Up and Go (TUG) and its subtasks in predicting impairment of functional capacity over time in this population. Objectives: The aim of this study was to verify if the TUG test and its subtasks can predict functional decline over 32 months in older adults with mild cognitive impairment (MCI) and mild Alzheimer's disease (AD). Methods: This is a prospective 32-month follow-up study, including at baseline 78 older adults (MCI: n=40; AD: n=38). The TUG and its subtasks (e.g., sit-to-stand, walking forward, turn, walking back, and turn-to-sit) were performed at baseline using the Qualisys Motion system. Functional capacity was assessed at baseline and after 32 months. Results: After follow-up, the sample had 45 older adults (MCI: n=25; AD: n=20). Of these, 28 declined functional capacity (MCI: n=13; AD: n=15). No TUG variable significantly predicted (p>0.05) functional decline in both groups, by univariate logistic regression analysis with the covariate gender. Conclusions: Although older adults with MCI and mild AD declined functional capacity, the TUG test and its subtasks could not predict this decline over 32 months.

Mesmo nos estágios iniciais do comprometimento cognitivo, os idosos podem apresentar alterações motoras importantes. No entanto, não há estudos que tenham investigado o timed up and go (TUG) e suas subtarefas como preditores do comprometimento da capacidade funcional ao longo do tempo nessa população. Objetivos: O objetivo deste estudo foi verificar se o teste timed up and go (TUG) e suas subtarefas podem predizer o declínio funcional ao longo de 32 meses em idosos com comprometimento cognitivo leve (CCL) e doença de Alzheimer leve (DA). Métodos: Este é um estudo prospectivo de acompanhamento de 32 meses, que incluiu no início do estudo 78 idosos (CCL: n=40; DA: n=38). O TUG e suas subtarefas (sentar para levantar, caminhar para frente, virar, caminhar para trás e girar para sentar) foram realizados na linha de base pelo sistema Qualisys Motion. A capacidade funcional foi avaliada no início e após 32 meses. Resultados: Depois do seguimento, a amostra foi composta de 45 idosos (CCL: n=25; DA: n=20). Destes, 28 tiveram a capacidade funcional diminuída (CCL: n=13; DA: n=15). Nenhuma variável do TUG previu declínio funcional significativamente estatístico (p>0,05) em nenhum dos grupos, por meio da análise de regressão logística univariada com a covariável sexo. Conclusões: Embora os idosos com CCL e DA leve tenham tido sua capacidade funcional diminuída, o teste TUG e suas subtarefas não puderam prever esse declínio em 32 meses.

Feasibility of improving strength and functioning and decreasing the risk of falls in older adults with Alzheimer's dementia: a randomized controlled home-based exercise trial.

PURPOSE: To determine the effects of a Home-based multimodal exercise program for older people with Alzheimer's disease (AD-HOMEX) on muscle strength, mobility, the risk of falls and functioning. MATERIALS AND METHODS: A trial with a blinded assessor was conducted involving 40 older people with mild to moderate AD randomized to an intervention group (IG) or control group (CG). The IG participated in a 16-week protocol with three 60-minute sessions per week. The sessions were performed at the participant's home by a physiotherapist and involved progressive individualized physical exercises. Muscle strength (5X Sit-to-Stand Test [5XSTS], 30-Second Chair Stand test, isokinetic and hand-grip dynamometer), functioning (DAFS-R and ADL-Q), mobility and the risk of falls (TUG) were assessed at baseline and after training. Intention-to-treat analysis was adopted. RESULTS: There was a significant group-evaluation time interaction for the 5XSTS (p = 0.011). The IG demonstrated an improved performance on the 5XSTS (p = 0.020) and a reduced risk of falls (p = 0.000), whereas the CG exhibited a worse functional limitation (p = 0.008) after 16 weeks. The CG had an increased risk of falls (p = 0.006) and worse performance on the ADL-Q (p = 0.047) at the follow-up evaluation. An improvement in the IG and worsening in the CG were found regarding transition patterns between severity levels of functional limitation based on the ADL-Q. CONCLUSIONS: Home-based physical exercise for older people with mild to moderate AD is an effective strategy that decreases the risk of falls and improves strength and functioning.

Feasibility of reducing frailty components in older adults with Alzheimer's dementia: a randomized controlled home-based exercise trial (AD-HOMEX).

OBJECTIVES: There is a need for interventions to reduce frailty in older people with Alzheimer's dementia (AD). The purpose of this study was to investigate the effect of a home-based multimodal exercise program for older adults with AD (AD-HOMEX) on frailty. DESIGN: A parallel single-blind randomized controlled trial comparing a home-based exercise program and usual care. SETTING AND PARTICIPANTS: A home-based program in Brazil. Forty individuals aged 65years or older with mild to moderate AD. METHODS: The intervention group (IG) participated in a 16-week protocol involving three 60-minute sessions per week of progressive individualized physical exercises supervised by a physical therapist. The participants in the control group (CG) maintained their usual care. Frailty was assessed using the FRAIL questionnaire, the Edmonton Frail Scale (EFS) and a subjective assessment by the evaluator (SAE) at baseline and follow-up. Per-protocol analysis was performed. RESULTS: Thirty-five participants completed the program (IG = 16; CG = 19). Frailty improved in the IG based on the EFS (P = .004) and FRAIL (P ≤ .001). An interaction between group and time (P = .008) and a significant difference between times (P = .047) were found for the SAE responsiveness domain. An improvement in the classification of frailty (EFS and FRAIL) was found between times in the IG (P = .003) and between groups at follow-up (P = .027). A significant difference in the SAE classification was found between groups at follow-up (P = .034), with a worsening between times in the CG (P = .032). Interestingly, a more favorable frailty transition pattern was found in the IG based on both the EFS and FRAIL. CONCLUSIONS AND IMPLICATIONS: AD-HOMEX seems to reduce frailty and improve frailty transition patterns. Our findings provide a further theoretical basis for designing home-based physical interventions as routine practice for older frail adults with AD.

Changes in executive function and gait in people with mild cognitive impairment and Alzheimer disease.

Changes in executive function and motor aspects can compromise the prognosis of older adults with mild cognitive impairment (MCI) and favor the evolution to dementia. OBJECTIVES: The aim of this study was to investigate the changes in executive function and gait and to determine the association between changes in these variables. METHODS: A 32-month longitudinal study was conducted with 40 volunteers: 19 with preserved cognition (PrC), 15 with MCI and 6 with Alzheimer disease (AD). Executive function and gait speed were assessed using the Frontal Assessment Battery, the Clock-Drawing test and the 10-meter walk test. For data analysis, the Pearson product-moment correlation, two-way repeated-measures ANOVA, and chi-square were conducted. RESULTS: After 32 months, an improvement in the executive function was found in all groups (p=0.003). At baseline, gait speed was slower in individuals with MCI and AD compared to those with PrC (p=0.044), that was maintained after the follow-up (p=0.001). There was significant increase in number of steps in all groups (p=0.001). No significant association was found between changes in gait speed and executive function. CONCLUSIONS: It should be taken into account that gait deteriorates prior to executive function to plan interventions and health strategies for this population.

Alterações na função executiva e nos aspectos motores podem comprometer o prognóstico de idosos com comprometimento cognitivo leve (CCL) e favorecer a evolução para demência. OBJETIVOS: O objetivo deste estudo foi investigar alterações na função executiva e na marcha e determinar a associação entre alterações nessas variáveis. MÉTODO: Foi realizado um estudo longitudinal de 32 meses com 40 voluntários: 19 com cognição preservada (PrC), 15 com CCL e 6 com doença de Alzheimer (DA). A função executiva e a velocidade da marcha foram avaliadas por meio de bateria de avaliação frontal, do teste de desenho do relógio e do teste de caminhada de 10 metros. Para a análise de dados, o coeficiente de correlação produto-momento de Pearson, ANOVA de medidas repetidas bidirecional e o qui-quadrado foram realizados. RESULTADOS: Após 32 meses, houve melhora na função executiva em todos os grupos (p=0,003). No início do estudo, a velocidade da marcha foi mais lenta nos indivíduos com CCL e DA em comparação com os PrC (p=0,044), que foi mantida após o acompanhamento (p=0,001). Houve aumento significativo no número de etapas em todos os grupos (p=0,001). Não foi encontrada associação significativa entre alterações na velocidade da marcha e função executiva. CONCLUSÕES: Deve-se levar em consideração que a marcha se deteriora antes da função executiva para planejar intervenções e estratégias de saúde para essa população.