Stepping patterns detecting individuals with mild cognitive impairment

Abstract

Early detection of mild cognitive impairment (MCI) by family, community members, and older adults themselves, is important for identifying those who are at increased risk for dementia and need further evaluation. The author has developed a novel exercise form (Square-Stepping Exercise, SSE). SSE is a low-cost and easily administered exercise intervention that involves replicating a previously demonstrated stepping pattern in order to progress across a gridded floor mat. There are a total of 200 stepping patterns, ranging in difficulty from beginner (easy) to advanced (difficult) levels. A previous study found that those with low cognitive function could not accurately complete the difficult stepping patterns. The purpose of this study was to develop a protocol using SSE patterns to detect those with possible MCI. The Montreal Cognitive Assessment (MoCA) and four different SSE patterns [Pattern A (easy) to D (difficult)] were used to evaluate older adults (aged 65 years or older; n = 168) for possible MCI. Of the 168 participants, 25% were classified as having possible MCI (25 points or less on the MoCA). Success rates for all participants for Patterns A to D were 92.8%, 59.9%, 67.3%, and 16.2%, respectively. Those with MCI had significantly lower success rates than those without MCI. After applying the decision tree analysis involving age, sex, and information on success/failure for each pattern, a protocol was developed as follows: if an older adult fails to accurately complete the allocated stepping pattern (Pattern C for aged 75 years or younger; Pattern B for aged 76 years or older), he/she may be considered as possible MCI. The protocol showed high sensitivity (69.0%) and specificity (76.2%) and a low false positive rate (23.8%) when applying to all the participants. In conclusion, this new protocol was developed to detect possible MCI and may be useful in home and community settings. Specifically, if an older adult fails to accurately complete the designated stepping pattern then this would signal the need for further clinical evaluation and to take additional measures to improve cognitive function.