Doctoral student Mahmoud Seifallahi (L), the study's co-author, checks data with Behnaz Ghoraani, the study’s senior author and an associate professor in the Department of Electrical Engineering and Computer Science at Florida Atlantic University in Boca Raton, Photo courtesy of Florida Atlantic University
NEW YORK, March 29 (UPI) -- Tests to detect subtle gait impairment in older adults typically focus on straight walking -- a rhythmic and simple form of movement. But new research sheds light on "curve walking," which demands greater cognitive skills and could be an indicator of cognitive impairment.
Researchers at Florida Atlantic University in Boca Raton compared the performance of healthy older adults to older adults with mild cognitive impairment in straight and curve walking on a 10-meter oval path.
Mild cognitive impairment is the early stage of cognitive decline, and people with it have a much higher risk of transitioning to Alzheimer's disease, the researchers said.
"By focusing on walking patterns, specifically how people walk in curves or turns, we hoped to identify early warning signs that are easy to detect without needing invasive tests or expensive equipment," Behnaz Ghoraani, an associate professor in the Department of Electrical Engineering and Computer Science, told UPI via email.
"Walking is something most of us do every day, but how we walk can change subtly when our cognitive functions, such as thinking and memory, begin to decline," said Ghoraani, who received a National Science Foundation grant for her research.
To perform their study, researchers employed Kinect Camera -- the same type used for video games. Positioned on a tripod, the camera detected and tracked 25 joints of body movement and recorded participants' gait while they undertook the two different walking tests -- straight and curve.
Signals from the 25 body joints were processed to extract 50 gait markers for each test, and these markers were compared between the two groups.
The findings, published in the Journal of Alzheimer's Disease Reports, reveal that curve walking resulted in greater challenges for the mild cognitively impaired group and performed better than straight walking in detecting the condition.
In addition, several gait markers showed significant differences between healthy participants and mild cognitively impaired patients.
The study utilized 55 people -- 30 in good health and 25 with mild cognitive issues. The average age was about 68 years for the healthy group and about 70 years for those with cognitive issues.
The data for the research were gathered through collaborative efforts with the Iran Dementia and Alzheimer's Association.
"This research suggests a promising new way to help spot early signs of memory and thinking issues, highlighting the importance of paying attention to changes in how we walk as a clue to our brain health," said Ghoraani, the study's senior author.
She added that it's important to validate this screening method across diverse populations and settings to ensure that it's reliable and effective.
Health care professionals would require specialized training to interpret the data accurately and integrate it with other diagnostic tools for a comprehensive assessment, she said.
Hoping to make the tool more accessible and convenient, Ghoraani said the researchers are exploring ways to extend this method to use on everyday cameras, such as those found in cellphones, instead of relying solely on specialized equipment.
The research has promise, health professionals said.
"There is growing evidence over the past two decades that non-cognitive manifestations, such as abnormalities in walking patterns, occur early in dementia," said Dr. Joe Verghese, a professor of neurology and medicine at Albert Einstein College of Medicine in the Bronx, N.Y. He was not involved in the study.
"The current study adds to this literature using a novel curved walking paradigm to test patients," Verghese said. Assessment of walking difficulties "can be used to identify patients at high risk for dementia for further investigations and to institute preventive measures."
Many current cognitive screening tests are dependent on a variety of factors, such as individuals' education level and occupation, while curve walking may have the potential to reduce disparities in detection, Dr. Dylan Wint, a neurologist and director of Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas, told UPI via email.
"Curve walking may be more sensitive than straight walking for assessing subtle changes in brain function. The more challenging a task is, the more likely we are to detect mild changes in brain function," Wint said.
"Technologies that are able to detect, record and analyze more data than human senses and cognition can handle are increasingly important tools in clinical evaluation," he said.
Curve walking joins a series of novel gait tests that allow clinicians to learn more about a patient's progression of mild cognitive impairment. These tests evaluate skills such as walking backwards, walking and talking, or walking and carrying a glass of water, said Susy Stark, a professor of occupational therapy and neurology at Washington University School of Medicine in St. Louis.
"Alzheimer's disease has often been characterized as a disease impacting memory and thinking," Stark said. "This study recognizes the importance of understanding the role of the motor system in Alzheimer's disease."
The findings call attention to the multi-faceted nature of functional decline in people with mild cognitive impairment, who may have a higher risk of falls and fall-related injuries, said David Clark, associate chief of staff for research service at North Florida/South Georgia Veterans Health System.
This "can lead to a cycle of reduced physical activity and other problems that accelerate both cognitive decline and physical decline," said Clark, a professor in the department of neurology at the University of Florida College of Medicine in Gainesville.
But the study is too preliminary to know whether curve walking will ultimately become part of a comprehensive evaluation of cognitive status, said Dr. Michael Steinman, a professor of medicine in the division of geriatrics at the University of California-San Francisco and the San Francisco VA Medical Center.
For now, "people who are having some gait difficulty should not conclude that they are getting dementia just because their gait is changing," Steinman said.
