Os parâmetros da marcha para a contribuição do diagnóstico diferencial, estadiamento da doença e análise da evolução do tratamento com exercício físico em idosos com doença de Alzheimer

Abstract

Alzheimer's disease (AD) is the most prevalent neurodegenerative disease in the elderly and is associated with cognitive and motor changes. One of the priorities in the advancement of knowledge about neurodegenerative diseases should be the identification and validation of biomarkers, which contribute to the improvement of the clinical and differential diagnosis, as well as to the monitoring of the evolution of the disease from the preclinical stages to the later phases diseases. The inclusion of motor biomarkers in clinical practice could contribute to cost reduction, increase in diagnostic accuracy and follow-up of clinical evolution after non-pharmacological treatments, such as physical exercise. In this sense, three studies were developed in this dissertation. Study 1: A systematic review and meta-analysis with the objective of identifying the tests used to differentiate healthy elderlies (HE), with mild cognitive impairment (MCI) and / or AD in the performance of simple motor tasks. A total of 2060 studies were found, including 10 articles. Through the analysis of the Timed up and go (TUG) test, the studies observed worse functional mobility in the elderly with CCL and AD compared to SC. Study 2: A cross-sectional study, aiming to compare gait parameters in different motor tasks. We evaluated 63 elderlies (17 HE, 23 MCI and 23 AD). The performance difference between the groups was higher in double task, showing worse results for the elderly with AD, compared to HE and MCI. Study 3: A randomized controlled pilot study to analyze mobility and cognitive functions, pre and post a multimodal physical exercise program (training with modalities: aerobic, strength, balance and flexibility). In addition to investigating the effect of exercise on the cognitive-motor variables of 27 elders with AD. These were randomized and allocated to a control group (CG) and an experimental group (EG). EG performed twice-weekly, one-hour training for 12 weeks. The effect size analysis showed a better response to the EG in the variables balance and executive function, with a correlation between cognitive and physical improvement. It is concluded that the mobility is compromised from the pre-dementia state, being able to differentiate HE elderly from MCI and AD, mainly through the performance of the double task speed. An exercise program can improve mobility by developing important physical and cognitive skills for independence in ADLs and in reducing the risk of falls in the elderly with AD. In this sense, the speed and time in the dual-task in functional mobility tests, as well as balance and mobility tests, should be better investigated as possible biomarkers of differential diagnosis and analysis of clinical evolution.