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Title Neurology Collaboration
Year 2010
Contributor/Contact Mimi Kim
CTSA Einstein
Success Topic Collaboration, Manuscripts, Software development
Description of Success At the Albert Einstein College of Medicine, BERD statisticians, Xiaonan Xue and Tao Wang collaborated extensively with faculty in the Department of Neurology on a series of studies of the association of gait and subsequent development of dementia and disability in the elderly. Failure to diagnose disability and dementia early reduces the opportunity for early intervention. The Einstein studies showed that lack of performance in gait may reflect underlying subclinical disease and help shed light on the nature of functional reserve during the earlier stages of disablement. The BERD statisticians applied a variety of methodologic approaches to this research, including linear, logistic and Poisson regression models as well as principal components analysis. Four papers were published in 2010-2011 from these collaborations (Holtzer et al., 2010; Verghese and Xue, 2010; Oh-Park, et al., 2010; Verghese and Xue, 2011).
The first study was based on 824 community-dwelling adults over the age of 70. To use gait to predict the development of dementia and disability in the elderly, it is critical to develop a valid criterion to identify gait abnormality. Conventional cross-sectional norms underestimate gait performance in aging. Linear regression methods were used to assess the effect of disease on gait and the results led to a new longitudinal criterion for gait abnormalities that accounts for potential confounders.
In the second study, inter-session fluctuations on gait measures were studied using a repeated measurement design (six sessions within a 2-week period) in 71 nondisabled and nondemented older adults, 40 with pre-disability. Presence of performance inconsistency during repeated assessments of gait may reflect underlying subclinical disease. Various measures of variability were assessed and linear mixed effects models were used to account for correlations between repeated measurements. Subjects with pre-disability had slower gait velocity and shorter stride-length; however, there was no significant pattern of fluctuations across the six sessions. The findings support consistency of gait measurements during the earliest stages of disability.
The concept of ‘frailty’ has also been used to identify older adults at increased risk for disability. A major obstacle to developing primary prevention strategies for frailty is the lack of early clinical markers, especially among high functioning older adults. Slow gait has been shown to be the strongest predictor of disability but not of frailty. In the third study, the Physical Performance Battery (PPB) was evaluated in 539 nondisabled and nondemented older adults. Logistic and Poisson regression analyses were used to examine the association of PPB with frailty. The results show that PPB may detect early signs of frailty even before the occurrence of slow gait.
Finally, walking speed is associated with attention and executive control processes subserved by the prefrontal cortex. Because polymorphisms in catechol-O-methyltransferase (COMT) influence these cognitive processes the same polymorphisms may influence gait velocity. The associations between the Val Met polymorphism in COMT and gait velocity as well as attention and executive function were examined on 278 non-demented older adults using principal component factor analysis. The results revealed that methionine (Met)/valine (Val) was associated with faster gait velocity. In contrast, Met/Met was associated with better attention and executive function.
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Topic revision: r7 - 10 Apr 2012 - 15:52:45 - MaryBanach
 

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