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February 15-16, 2019 Amsterdam| Netherlands
Vascular Dementia
11
th
International Conference on
Volume 09
Vascular Dementia 2019
Journal of Alzheimers Disease & Parkinsonism | ISSN : 2161-0460
Decoding dementia: At the intersection of vascular dementia and young stroke
Amy Edmunds
YoungStroke, USA
T
here is urgency among adults who live at the intersection of vascular dementia and young stroke. More than merely a medical
diagnosis, this intersection threatens every aspect of the social and professional roles they previously assumed. Further, too
few social supports are available for these premature stroke survivors and their untrained caregivers. Collectively, the voice of this
emerging population has largely been muted by lack of awareness and lack of interest in this research area. But discourse is rising,
and the opportunity abounds to explore this intersection on multiple dimensions to deliver quality patient-centered healthcare to
facilitate effective community reintegration.
Gait analysis under dual-task conditions: a biomarker for gait instability, falls, MCI and dementia
Bernard Auvinet
University of Rennes II, France
Background:
The dual-task test is unique as it reflects the motor cognitive interface, which is of great interest to detect deficits of
motor-gait control and fall risk, but also may precede cognitive decline linked to MCI and dementia. Very few studies have focused
on the relevance of gait analysis under dual-task conditions in elderly people on the basis of clinical approach.
Methods:
An observational study including 103 patients (mean age 76.3±7.2, women 56%) suffering from gait disorders, falls
or memory impairment was conducted. Gait analysis under dual-task conditions was carried out for all patients. Three main Gait
variables were measured: walking speed, stride frequency, and stride regularity. For each gait variable, the dual task cost was
computed, and a quartile analysis was obtained. Nonparametric tests were used for all the comparisons (Wilcoxon, Kruskal-Wallis,
Fisher or Chi² tests).
Results:
Four clinical subgroups were identified: gait instability (45%), recurrent falls (29%), memory impairment (18%), and
cautious gait (8%). The biomechanical severity of these subgroups was ordered according to walking speed and stride regularity
under both conditions (single and dual-task conditions), from least to most serious as follows: memory impairment, gait instability,
recurrent falls, cautious gait (p<0.01 for walking speed, p=0.05 for stride regularity). In a multivariate analysis of variance model
for dual-task cost, there is a strong variable effect (p<0.01), but no clinical subgroup effect was noted. According to the established
diagnoses of gait disorders, six main pathological subgroups were identified (musculoskeletal diseases (n=11), vestibular diseases
(n=6), mild cognitive impairment (n=24), dementia (n=27), other central nervous system pathologies (n=24), and without diagnosis
(n=8)). The subgroups mild cognitive impairment and dementia both showed a higher dual task cost for each variable compared
to the osteoarthrosis and vestibular diseases combined (p=0.01), other CNS pathologies represent an intermediate subgroup with
a potential cognitive impairment. According to the quartile analysis, we hypothesize that the fourth quartile value for each DTC
may represent an interesting cut off value in clinical setting (DTC walking speed: 20%; DTC stride frequency: 15%; DTC stride
regularity: 30%).
Conclusion:
In clinical setting, gait analysis under dual-task conditions in elderly people suffering from gait disorders or memory
impairment is of great value to assess the severity of gait disorders, to differentiate between peripheral pathologies and central nervous
system pathologies (mainly MCI and dementia), to understand unexplained falls, to highlight the prediction of MCI syndrome, to
inform about dementia progression. Change in gait performance while dual tasking may be used as a biomarker of pathologies with
cognition disorders.
J Alzheimers Dis Parkinsonism 2019, Volume 09
DOI: 10.4172/2161-0460-C1-061