Consensus on Shared Measures of Mobility and Cognition: From the Canadian Consortium on Neurodegeneration in Aging (CCNA)

Manuel Montero-Odasso^{1

2

3}, Quincy J Almeida⁴, Louis Bherer^{5

6

7

8}, Amer M Burhan^{9

10}, Richard Camicioli¹¹, Julien Doyon¹², Sarah Fraser¹³, Susan Muir-Hunter^{1

14}, Karen Z H Li⁵, Teresa Liu-Ambrose^{15

16}, William McIlroy^{17

18

19}, Laura Middleton¹⁹, José A Morais²⁰, Ryota Sakurai³, Mark Speechley², Akshya Vasudev^{9

21}, Olivier Beauchet^{22

23

24}, Jeffrey M Hausdorff^{25

26

27}, Caterina Rosano²⁸, Stephanie Studenski²⁹, Joe Verghese³⁰; Canadian Gait and Cognition Network

Affiliations

¹ Department of Medicine, Division of Geriatric Medicine, University of Western Ontario, London, Canada.
² Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada.
³ Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada.
⁴ Department of Kinesiology and Physical Education, Sun Life Financial Movement Disorders Research Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada.
⁵ Department of Psychology and PERFORM Centre, Concordia University, Montréal, Quebec, Canada.
⁶ Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Quebec, Canada.
⁷ Department of Medicine, University of Montreal, Quebec, Canada.
⁸ Montreal Heart Institute, Research Centre, Quebec, Canada.
⁹ Department of Psychiatry, Geriatric Psychiatry, Schulich School of Medicine, University of Western Ontario, London, Canada.
¹⁰ Lawson Health Research Institute, London, Ontario, Canada.
¹¹ Department of Medicine, Geriatric and Cognitive Neurology, University of Alberta, Edmonton, Canada.
¹² Functional Neuroimaging Unit, University of Montreal, Quebec, Canada.
¹³ Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ontario, Canada.
¹⁴ Faculty of Health Sciences, School of Physical Therapy, University of Western Ontario, London, Canada.
¹⁵ Department of Physical Therapy, Centre for Hip Health and Mobility, University of British Columbia, Canada.
¹⁶ Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Research Institute, University of British Columbia, Canada.
¹⁷ Division of Neurology and Department of Medicine, University of Toronto, Ontario, Canada.
¹⁸ Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Ontario, Canada.
¹⁹ Department of Kinesiology, University of Waterloo, Ontario, Canada.
²⁰ Department of Medicine, Division of Geriatrics and Centre of Excellence in Aging and Chronic Disease, McGill University, Montréal, Quebec, Canada.
²¹ Department of Medicine, Division of Clinical Pharmacology, University of Western Ontario, London, Canada.
²² Department of Medicine, Division of Geriatric Medicine, McGill University, Montréal, Quebec, Canada.
²³ Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Quebec, Canada.
²⁴ RUIS McGill Centre of Excellence on Aging and Chronic Disease - CEViMaC, Montréal, Quebec, Canada.
²⁵ Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel.
²⁶ Department of Physical Therapy, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Israel.
²⁷ Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois.
²⁸ Department of Epidemiology, University of Pittsburgh, Pennsylvania.
²⁹ Division of Geriatric Medicine, School of Medicine, University of Pittsburgh, Pennsylvania.
³⁰ Department of Medicine, Albert Einstein College of Medicine, Bronx, New York.

PMID: 30101279
PMCID: PMC6521916
DOI: 10.1093/gerona/gly148

Consensus on Shared Measures of Mobility and Cognition: From the Canadian Consortium on Neurodegeneration in Aging (CCNA)

Manuel Montero-Odasso et al. J Gerontol A Biol Sci Med Sci. 2019.

. 2019 May 16;74(6):897-909.

doi: 10.1093/gerona/gly148.

Authors

Affiliations

¹ Department of Medicine, Division of Geriatric Medicine, University of Western Ontario, London, Canada.
² Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada.
³ Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada.
⁴ Department of Kinesiology and Physical Education, Sun Life Financial Movement Disorders Research Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada.
⁵ Department of Psychology and PERFORM Centre, Concordia University, Montréal, Quebec, Canada.
⁶ Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Quebec, Canada.
⁷ Department of Medicine, University of Montreal, Quebec, Canada.
⁸ Montreal Heart Institute, Research Centre, Quebec, Canada.
⁹ Department of Psychiatry, Geriatric Psychiatry, Schulich School of Medicine, University of Western Ontario, London, Canada.
¹⁰ Lawson Health Research Institute, London, Ontario, Canada.
¹¹ Department of Medicine, Geriatric and Cognitive Neurology, University of Alberta, Edmonton, Canada.
¹² Functional Neuroimaging Unit, University of Montreal, Quebec, Canada.
¹³ Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ontario, Canada.
¹⁴ Faculty of Health Sciences, School of Physical Therapy, University of Western Ontario, London, Canada.
¹⁵ Department of Physical Therapy, Centre for Hip Health and Mobility, University of British Columbia, Canada.
¹⁶ Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Research Institute, University of British Columbia, Canada.
¹⁷ Division of Neurology and Department of Medicine, University of Toronto, Ontario, Canada.
¹⁸ Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Ontario, Canada.
¹⁹ Department of Kinesiology, University of Waterloo, Ontario, Canada.
²⁰ Department of Medicine, Division of Geriatrics and Centre of Excellence in Aging and Chronic Disease, McGill University, Montréal, Quebec, Canada.
²¹ Department of Medicine, Division of Clinical Pharmacology, University of Western Ontario, London, Canada.
²² Department of Medicine, Division of Geriatric Medicine, McGill University, Montréal, Quebec, Canada.
²³ Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Quebec, Canada.
²⁴ RUIS McGill Centre of Excellence on Aging and Chronic Disease - CEViMaC, Montréal, Quebec, Canada.
²⁵ Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel.
²⁶ Department of Physical Therapy, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Israel.
²⁷ Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois.
²⁸ Department of Epidemiology, University of Pittsburgh, Pennsylvania.
²⁹ Division of Geriatric Medicine, School of Medicine, University of Pittsburgh, Pennsylvania.
³⁰ Department of Medicine, Albert Einstein College of Medicine, Bronx, New York.

PMID: 30101279
PMCID: PMC6521916
DOI: 10.1093/gerona/gly148

Abstract

Background: A new paradigm is emerging in which mobility and cognitive impairments, previously studied, diagnosed, and managed separately in older adults, are in fact regulated by shared brain resources. Deterioration in these shared brain mechanisms by normal aging and neurodegeneration increases the risk of developing dementia, falls, and fractures. This new paradigm requires an integrated approach to measuring both domains. We aim to identify a complementary battery of existing tests of mobility and cognition in community-dwelling older adults that enable assessment of motor-cognitive interactions.

Methods: Experts on mobility and cognition in aging participated in a semistructured consensus based on the Delphi process. After performing a scoping review to select candidate tests, multiple rounds of consultations provided structured feedback on tests that captured shared characteristics of mobility and cognition. These tests needed to be sensitive to changes in both mobility and cognition, applicable across research studies and clinics, sensitive to interventions, feasible to perform in older adults, been previously validated, and have minimal ceiling/floor effects.

Results: From 17 tests appraised, 10 tests fulfilled prespecified criteria and were selected as part of the "Core-battery" of tests. The expert panel also recommended a "Minimum-battery" of tests that included gait speed, dual-task gait speed, the Montreal Cognitive Assessment and Trail Making Test A&B.

Conclusions: A standardized assessment battery that captures shared characteristics of mobility and cognition seen in aging and neurodegeneration may increase comparability across research studies, detection of subtle or common reversible factors, and accelerate research progress in dementia, falls, and aging-related disabilities.

Keywords: Aging; Cognition; Consensus; Falls; Gait; Mobility; Neurodegenerative diseases.

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Figures

**Figure 1.**
Concurrent decline of cognition and mobility in aging and neurodegeneration. Gray Arrows: cognitive impairment predicts dementia with Mild Cognitive Impairment (MCI) as an intermediate state. Gait impairments increase fall risk and slow gait mediates the association. White Arrows show that cognitive and gait impairments, as well as dementia and falls, are interrelated (arrow thickness represents the strength of associations). Dashed Arrows represent that gait abnormalities (slow gait, high dual-task cost) can predict dementia; similarly, executive and memory dysfunction can predict fall risk. *Note*: DTC = Dual-task gait cost. Adapted from Montero-Odasso et al. (1) and Amboni et al. (6).

**Figure 2.**
Decision tree showing the flow of the selection of tests by the consensus.

See this image and copyright information in PMC

References

1. Montero-Odasso M, Verghese J, Beauchet O, Hausdorff JM. Gait and cognition: a complementary approach to understanding brain function and the risk of falling. J Am Geriatr Soc. 2012;60:2127–2136. doi:10.1111/j.1532-5415.2012.04209.x - DOI - PMC - PubMed
1. Rosso AL, Studenski SA, Chen WG, et al. Aging, the central nervous system, and mobility. J Gerontol A Biol Sci Med Sci. 2013;68:1379–1386. doi:10.1093/gerona/glt089 - DOI - PMC - PubMed
1. Montero-Odasso MM, Barnes B, Speechley M, et al. Disentangling cognitive-frailty: results from the gait and brain study. J Gerontol A Biol Sci Med Sci. 2016;71:1476–1482. doi:10.1093/gerona/glw044 - DOI - PubMed
1. Verghese J, Wang C, Lipton RB, Holtzer R. Motoric cognitive risk syndrome and the risk of dementia. J Gerontol A Biol Sci Med Sci. 2013;68:412–418. doi:10.1093/gerona/gls191 - DOI - PMC - PubMed
1. Verghese J, Annweiler C, Ayers E, et al. Motoric cognitive risk syndrome: multicountry prevalence and dementia risk. Neurology. 2014;83:718–726. doi:10.1212/WNL.0000000000000717 - DOI - PMC - PubMed

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Consensus on Shared Measures of Mobility and Cognition: From the Canadian Consortium on Neurodegeneration in Aging (CCNA)

Affiliations

Consensus on Shared Measures of Mobility and Cognition: From the Canadian Consortium on Neurodegeneration in Aging (CCNA)

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical