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Quantitative Timed-Up-and-Go Parameters in Relation to Cognitive Parameters and Health-Related Quality of Life in Mild-to-Moderate Parkinson's Disease.

ABSTRACT: The instrumented-Timed-Up-and-Go test (iTUG) provides detailed information about the following movement patterns: sit-to-walk (siwa), straight walking, turning and walk-to-sit (wasi). We were interested in the relative contributions of respective iTUG sub-phases to specific clinical deficits most relevant for daily life in Parkinson's disease (PD). More specifically, we investigated which condition-fast speed (FS) or convenient speed (CS)-differentiates best between mild- to moderate-stage PD patients and controls, which parameters of the iTUG sub-phases are significantly different between PD patients and controls, and how the iTUG parameters associate with cognitive parameters (with particular focus on cognitive flexibility and working memory) and Health-Related-Quality of Life (HRQoL).Twenty-eight PD participants (65.1 ± 7.1 years, H&Y stage 1-3, medication OFF state) and 20 controls (66.1 ± 7.5 years) performed an iTUG (DynaPort®, McRoberts BV, The Netherlands) under CS and FS conditions. The PD Questionnaire 39 (PDQ-39) was employed to assess HRQoL. General cognitive and executive functions were assessed using the Montreal Cognitive Assessment and the Trail Making Test.The total iTUG duration and sub-phases durations under FS condition differentiated PD patients slightly better from controls, compared to the CS condition. The following sub-phases were responsible for the observed longer total duration PD patients needed to perform the iTUG: siwa, turn and wasi. None of the iTUG parameters correlated relevantly with general cognitive function. Turning duration and wasi maximum flexion velocity correlated strongest with executive function. Walking back duration correlated strongest with HRQoL.This study confirms that mild- to moderate-stage PD patients need more time to perform the iTUG than controls, and adds the following aspects to current literature: FS may be more powerful than CS to delineate subtle movement deficits in mild- to moderate-stage PD patients; correlation levels of intra-individual siwa and wasi parameters may be interesting surrogate markers for the level of automaticity of performed movements; and sub-phases and kinematic parameters of the iTUG may have the potential to reflect executive functioning and HRQoL aspects of PD patients.

SUBMITTER: Van Uem JM

PROVIDER: S-EPMC4824446 | biostudies-other | 2016

REPOSITORIES: biostudies-other

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Project description:The Timed Up and Go (TUG) test may be a useful tool to detect not only mobility impairment but also possible cognitive impairment. In this cross-sectional study, we used the TUG test to investigate the associations between trajectory-based spatial parameters measured by laser range sensor (LRS) and cognitive impairment in community-dwelling older adults.The participants were 63 community-dwelling older adults (mean age, 73.0 ± 6.3 years). The trajectory-based spatial parameters during the TUG test were measured using an LRS. In each forward and backward phase, we calculated the minimum distance from the marker, the maximum distance from the x-axis (center line), the length of the trajectories, and the area of region surrounded by the trajectory of the center of gravity and the x-axis (center line). We measured mild cognitive impairment using the Mini-Mental State Examination score (26/27 was the cut-off score for defining mild cognitive impairment).Compared with participants with normal cognitive function, those with mild cognitive impairment exhibited the following trajectory-based spatial parameters: short minimum distance from the marker (p = 0.044), narrow area of center of gravity in the forward phase (p = 0.012), and a large forward/whole phase ratio of the area of the center of gravity (p = 0.026) during the TUG test. In multivariate logistic regression analyses, a short minimum distance from the marker (odds ratio [OR]: 0.82, 95% confidence interval [CI]: 0.69-0.98), narrow area of the center of gravity in the forward phase (OR: 0.01, 95% CI: 0.00-0.36), and large forward/whole phase ratio of the area of the center of gravity (OR: 0.94, 95% CI: 0.88-0.99) were independently associated with mild cognitive impairment.In conclusion, our results indicate that some of the trajectory-based spatial parameters measured by LRS during the TUG test were independently associated with cognitive impairment in older adults. In particular, older adults with cognitive impairment exhibit shorter minimum distances from the marker and asymmetrical trajectories during the TUG test.

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Quantitative Timed-Up-and-Go Parameters in Relation to Cognitive Parameters and Health-Related Quality of Life in Mild-to-Moderate Parkinson's Disease.

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