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"Research: Change in walking may indicate cognitive decline" By Janice Lloyd
Source
Subtle changes in the way a person walks can be an early warning sign of cognitive decline and a signal for advanced testing, according to research out at the Alzheimer's Association International Conference 2012.

The findings are the first to link a physical symptom to disease, which up until now, required doctors to begin a diagnosis by focusing on cognition and administering lengthy neurological exams. The evidence in the five studies is "robust," say experts, adding walking changes can occur even before cognition decline surfaces. The presentation on the opening day of the weeklong meetings follows a government plan announced in May to help train doctors to detect the disease earlier and to find a cure by 2025.

"Monitoring deterioration and other changes in a person's gait is ideal because it doesn't require any expensive technology or take a lot of time to assess,'' says Bill Thies, chief medical and scientific officer for the Alzheimer's Association.

The disease affects 5.4 million mostly older people in the USA, numbers expected to spike to 16 million in 2050 as the Baby Boomers age. Nearly 5,000 researchers are attending the meetings in Vancouver, where dozens of studies will address new treatments currently being tested in trials and how lifestyle influences the disease.

"Walking and movements require a perfect and simultaneous integration of multiple areas of the brain,'' says Rodolfo Savica, author of a study done at the Mayo Clinic in Rochester, Minn.

Walking changes occur because the disease interferes with the circuitry between these areas of brain. Savica ruled out other diseases (Parkinson's, arthritis) as possible causes of gait change.

In the Mayo Clinic study, researchers measured the stride length, cadence and velocity of more than 1,341 participants through a computerized gait instrument at two or more visits roughly 15 months apart. They found that study participants with lower cadence, velocity and length of stride experienced significantly larger declines in global cognition, memory and executive function.

"These changes support a possible role of gait changes as an early predictor of cognitive impairment,'' Savica says.

Another large study of 1,153 adults with a mean age of 78 done by researchers at the Basel Mobility Center in Basel Switzerland found gait became "slower and more variable as cognition decline progressed.''

Participants were divided into groups based on their cognitive diagnoses: cognitively healthy, mild cognitive impairment (MCI) or Alzheimer's dementia. Gait was measured using a walkway with nearly 30,000 integrated sensors.

"Those with Alzheimer's dementia walked slower than those with MCI, who in turn walked slower that those who were cognitively healthy,'' says Stephanie Bridenbaugh, lead researcher.

Bridenbaugh says analysis of walking could also be used to show if treatments to treat the disease are working.

"At the annual wellness visit required by Medicare, a physician could add a walking test to the checklist without adding a lot of extra time,'' says Thies.

Yet, one of the study's researchers said that one annual test wouldn't work with everyone.

"You'd be surprised how many people say to me 'He doesn't walk that well at home,' when I give them a gait test in the office,'' says physician Lisa Silbert.

Silbert conducted research on 19 dementia-free volunteers enrolled in the Intelligent Systems for Assessment of Aging Changes study at Oregon Health and Science University in Portland. They measured gait speed during MRIs and gait speeds at home. Participants walked faster when measured once in person than when walking in their home. Slower in-home walking speed was associated with smaller total brain size. Dementias cause brain shrinkage.

"Walking speed taken at a single time point may overestimate the walking abilities in the elderly,'' she says.

1. The word "robust" in paragraph 2 is closest in meaning to
A) durable
B) healthy
C) full-bodied
D) strong

2. According to paragraph 2, why is this new evidence about walking so important to Alzheimer's researchers?
A) It demonstrates that walking longer distances may improve your chances of developing disease
B) It could potentially be the earliest indication of potential Alzheimer's disease in patients who show no other outward symptom
C) It could help prevent doctor liability in diagnosing these cases
D) It is something that could be observed and logged by family and friends

3. Why is the statistic in paragraph 4 about the potential spike in Alzheimer's patients significant?
A) It shows that, because Alzheimer's primarily impacts older people, as largest generation (the Baby Boomers) ages, the number of cases will likely rise dramatically
B) It suggests that if the next generation wants to be healthy, they must have their gait tested now
C) It is of no real concern to the younger generation because Social Security will pay for medical care
D) The lifestyle of older generations is significantly poorer than that of younger generations

4. The statement made in paragraph 5 implies all of the following EXCEPT
A) Movements require many complex interactions within the brain
B) Our movements and cognitive state could very well be closely linked
C) Movement may become impaired if any one brain activity is somehow altered
D) Our brains have no control over our walking or movements

5. In paragraph 7, the word "cadence" is closest in meaning to
A) musical beat
B) rhythm of steps
C) intonation
D) sequence of movement

6. What is the most significant discovery of the Mayo Clinic study described in paragraph 7?
A) Cadence, velocity, and length of stride are all independent variables that impact cognitive function in different ways.
B) The slower the participant's walk, the greater their memory capacity
C) The pace of participant's walk demonstrated no correlation to brain activity
D) The ways in which the participants walked had a definitive relationship to cognitive functioning

7. Which of the following is NOT a population or group studied in the experiments the article discusses?
A) movement impaired
B) mild cognitive impairment (MCI)
C) cognitively health
D) Alzheimer's dementia

8. Throughout the article, "gait" is mostly often used to refer to
A) walking speed
B) the time it takes to transition from a walk to a run
C) a combination of cadence, length of stride, and velocity
D) the posture used while walking

9. What is the primary argument that the article makes AGAINST the link between gait and cognitive decline?
A) Areas of the brain that control movement are completely separate from those with cognitive function
B) Walking speed can change significantly depending upon the scenario and conditions
C) Dementia has no relationship to brain size
D) An annual test is too often to show significant changes over time

10. What best summarizes the overarching idea of the article?
A) The speed at which we walk and potential decline in cognitive function as we age is clearly proven by the studies presented in the article
B) Whatever your current walking speed is, the better shape you are in and the faster you become can both directly lower your chance of developing Alzheimer's
C) Annual gait tests are an expensive and ineffective test to add to Alzheimer's screenings
D) There is a definite probability that aspects of human gait and cognitive function are related, but the evidence is far from definitive



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