Gait Change in Dual Task as a Behavioral Marker to Detect Mild Cognitive Impairment in Elderly Persons: A Systematic Review and Meta-analysis

Objectives To systematically summarize the evidence of gait tests as screening tools for mild cognitive impairment (MCI). Data Sources Electronic database searches were conducted in PubMed, EBSCO, Cochrane, Web of Science, Ovid, China National Knowledge Infrastructure, WanFang, and SinoMed, and studies published before November 30, 2018, were included. Study Selection Synonyms of MCI, gait, and cognitive-motor interference (CMI) were searched. Studies that analyzed gait change of people with MCI in single- or dual-task gait tests were included. Data Extraction The quality of the included studies was assessed with Downs and Black methodological quality appraisal tools. Study characteristics, participants’ characteristics, test descriptions, and results were extracted from the included studies. Data Synthesis Twenty-two studies involving 1928 participants were included. Meta-analysis showed that gait velocity difference in dual task (effect size [ES]=−0.89) were more obvious than in single task (ES=−0.74) between older adults with and without MCI, and the ES increased with the complexity of cognitive load (countdown by 1s, ES=−0.83; verbal fluency, ES=−0.96; serial reduction by 7s, ES=−1.26). The dual-task cost of gait velocity showed high sensitivity (ES=0.90) in detecting MCI. Meta-regression analysis demonstrated strong criterion-related validity between the CMI of gait velocity and the Montreal Cognitive Assessment score. Conclusions In comparison with the single-task gait test, gait change under cognitive load is more pronounced in older adults with MCI. CMI of gait velocity can be a potential screening tool for MCI in elderly persons.