The Diagnostic and Prognostic Value of a Dual-Tasking Paradigm in a Memory Clinic

J Alzheimers Dis. 2018;61(3):1189-1199. doi: 10.3233/JAD-161310.

Abstract

Background: Daily living requires the ability to perform dual-tasking. As cognitive skills decrease in dementia, performing a cognitive and motor task simultaneously become increasingly challenging and subtle gait abnormalities may even be present in pre-dementia stages. Therefore, a dual-tasking paradigm, such as the Timed Up and Go-Dual Task (TUG-DT), may be useful in the diagnostic assessment of mild cognitive impairment (MCI).

Objective: To investigate the diagnostic and prognostic ability of a dual-tasking paradigm in patients with MCI or mild Alzheimer's disease (AD) and to evaluate the association between the dual-tasking paradigm and cerebrospinal fluid (CSF) AD biomarkers.

Methods: The study is a prospective cohort study conducted in a clinical setting in two memory clinics. Eighty-six patients were included (28 MCI, 17 AD, 41 healthy controls (HC)). The ability to perform dual-tasking was evaluated by the TUG-DT. Patients underwent a standardized diagnostic assessment and were evaluated to determine progression yearly.

Results: ROC curve analysis illustrated a high discriminative ability of the dual-tasking paradigm in separating MCI patients from HC (AUC: 0.78, AUC: 0.82) and a moderate discriminative ability in separating MCI from AD (AUC: 0.73, AUC: 0.55). Performance discriminated clearly between all groups (p < 0.01). Logistic regression analyses revealed a low prognostic value of the dual-tasking paradigm for progression and rate of cognitive decline. A moderately strong correlation between the dual-tasking paradigm and CSF AD biomarkers was observed.

Conclusion: In our study, we found that patients with MCI and mild AD have increasing difficulties in dual-tasking compared to healthy elderly. Hence, the dual-tasking paradigm may be a potential complement in the diagnostic assessment in a typical clinical setting.

Keywords: Alzheimer’s disease; cerebrospinal fluid; diagnosis; gait; mild cognitive impairment; motor control; prognosis.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Alzheimer Disease / diagnosis*
  • Biomarkers / cerebrospinal fluid*
  • Case-Control Studies
  • Cognitive Dysfunction / diagnosis*
  • Disease Progression
  • Female
  • Humans
  • Logistic Models
  • Male
  • Memory
  • Middle Aged
  • Neuropsychological Tests*
  • Prognosis
  • Prospective Studies
  • ROC Curve

Substances

  • Biomarkers