Researchers are trying to develop a gait-based dementia screening test. Because when our cognitive abilities diminish, we walk slower.
Return your patient
When Rebecca MacAulay sees a patient suspected of cognitive loss at the University of Maine, where she is a clinical researcher, she often takes the trouble to take him back to the waiting room after having subjected him to a few tests.
“Sometimes, the tests are inconclusive, either because the patient cooperates reluctantly, or because extensive education allows him to compensate for cognitive losses,” indicates the neuropsychologist. But by talking while walking, sometimes we discover things. »
I remember a patient who stopped in his tracks to think. His wife told me: “It’s exactly like that: it freezes.”
Rebecca MacAulay, clinical researcher at the University of Maine
These tricks of the trade pushed the Orono researcher to explore the possibility of tests combining gait and dementia.
These tests could be simpler than cognitive tests like those for dementia or for “mild cognitive impairment,” a risk factor for dementia. “We measure the walking speed [pendant qu’on pose des questions]indicates Mme MacAulay. One would not necessarily need a doctor to administer the test. This would facilitate screening and monitoring of patients. [Parce qu’]there is a major shortage of health personnel. »
At the Neuro of McGill University, Philippe Huot, a neurologist specializing in movement disorders, immediately thought of the maxim “walk and chew gum at the same time” when we asked him about M’s approach.me MacAulay.
PHOTO PROVIDED BY NEURO
The Dr Philippe Huot
Many patients [ayant des troubles du mouvement] also have cognitive problems. When I see a person in the street with a particular gait, sometimes I say to myself: “She has Parkinson’s. She had a stroke.”
The Dr Philippe Huot, neurologist specializing in movement disorders
“Studies show that medications that improve cognition in Parkinson’s improve gait,” explains Dr.r Huot. And since the approach, it partly affects executive functions [la partie du cerveau qui prend des décisions]it is plausible to think that there could be screening tests [de démence] which involve the process. »
Calibration
Before this research leads to clinical applications, we need to better understand how the average person responds to a test involving questions while walking. “We know that a person unable to walk faster than one meter per second risks falling and losing their independence,” recalls M.me MacAulay, who recommends, first and foremost, a calibration of the test.
Calibration of the test involves identifying questions that predict cognitive problems, as well as how they affect people’s gait on average, when asked while they are walking.
This operation is currently taking place in collaboration with several American hospitals. “We are in the process of standardizing data collection, based on two studies that I published,” emphasizes M.me MacAulay. I was just invited to review a meta-analysis on cognitive tests that involve gait, by a journal of the Alzheimer’s Association. »
This point was the first raised by the Dr Huot from Neuro during our interview. “I am not convinced that we are close to clinical application. There is a lot of variability in what tests are used, what type of movement, what type of reach. Same thing for cognitive tests. Clinimetric validation of these tests is required. »
It’s also possible that a gait test to detect dementia in people is infeasible, unlike tests for mild cognitive impairment or dementia tests. “There may be too much variability in the population,” says M.me MacAulay.
If people’s results vary too much, such a test could be useful for monitoring a patient throughout their life.
If gait slows down too quickly, especially when asking questions, it could indicate a cognitive problem.
Rebecca MacAulay, clinical researcher at the University of Maine
The ease of administering the test then becomes all the more important: it could be administered by a nurse at the same time as taking blood pressure and weight, before the interview with the doctor.
Comorbidities
Another factor that complicates the clinical use of gait tests to detect dementia: the influence of comorbidities on our gait. “Someone who has had a stroke walks slower because of it. The initial results of this person must be corrected to take the stroke into account, or in relation to population data. »
Tests to detect mild cognitive impairment or even dementia can also be affected by comorbidities, such as depression, underlines Mme MacAulay.
Phone
One promising avenue is the use of smartphones to perform this type of testing, with applications that would ask questions that people would answer with their headset.
“It’s interesting, we’re heading towards that,” underlines the Dr Huot.
We are increasingly using devices connected to smartphones in research. This bypasses the need to collect data.
Learn more
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- 2.6%
- Prevalence of dementia among women aged 65 to 79 in Canada, 2013-2014
Source: Canadian Institute for Health Information
- 2.4%
- Prevalence of dementia among men aged 65 to 79 in Canada, 2013-2014
Source: Canadian Institute for Health Information
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- 20.8%
- Prevalence of dementia among women aged 80 and over in Canada, 2013-2014
Source: Canadian Institute for Health Information
- 15.6%
- Prevalence of dementia among men aged 80 and over in Canada, 2013-2014
Source: Canadian Institute for Health Information