Do frailty and cognitive impairment affect dual-task cost during walking in the oldest old institutionalized patients?

Abstract

The objective of this study was to investigate dual-task costs in several elderly populations, including robust oldest old, frail oldest old with MCI, frail oldest old without MCI, and frail elderly with dementia. Sixty-four elderly men and women categorized into frail without MCI (age 93.4 ± 3.2 years, n = 20), frail with MCI (age 92.4 ± 4.2 years, n = 13), robust (age 88.2 ± 4.1 years, n = 10), and patients with dementia (age 88.1 ± 5.1 years, n = 21). Five-meter gait ability and timed-up-and-go (TUG) tests with single and dual-task performance were assessed in the groups. Dual-task cost in both 5-m habitual gait velocity test and TUG test was calculated by the time differences between single and dual-task performance. The robust group exhibited better 5-m gait and TUG test performances in the single and dual-task conditions compared with the other three groups (P < 0.001), and the frail and frail + MCI groups exhibited better performances than the dementia group (P < 0.001). No significant differences were observed between the frail and frail + MCI groups. However, all groups exhibited lower gait velocities in the verbal and arithmetic task conditions, but the dual-task cost of the groups were similar. Robust individuals exhibited superior single and dual-task walking performances than the other three groups, and the frail and frail + MCI individuals exhibited performances that were superior to those of the patients with dementia. However, the dual-task costs, i.e., the changes in gait performance when elderly participants switch from a single to a dual task, were similar among all four of the investigated groups. Therefore, these results demonstrated that the magnitude of the impairment in gait pattern is independent of frailty and cognitive impairment status.

Keywords: Cognitive impairment; Dementia; Dual-task walking; Frailty; Oldest old.

Fig. 1

Flowchart for screening, recruitment, allocation, and assessment

Fig 2

5-m gait velocity test (m.s⁻¹) (mean ± SD) in frail + mild cognitive impairment (MCI), frail, robust, and dementia groups. Different letters (a, b, and c) denote differences between groups in each condition (P < 0.001). *Significant difference from dual task conditions (P < 0.001)

Fig 3

Timed-up-and-go test (s) (mean ± SD) in frail + cognitive impairment (MCI), frail, and robust groups. Different letters (a and b) denote differences between groups in each condition (P < 0.001). *Significant difference from dual task conditions (P < 0.001)