Role of systematic cueing in 2-minute walk test, 6-minute walk test, and 10-meter walk test for older adults with dementia

Abstract

Background and Objectives: Decreased short-term memory, executive function and attention span reduce the ability of older adults living with dementia in following instructions and testing procedures of walk tests. Poor reliability and high drop-out rate have been frequently reported in studies on the walk tests for this population group. Systematic cueing has been shown effective in facilitating older adults with dementia in completing the walk tests. However, the role of systematic cueing in the walk tests for this population group has not been thoroughly investigated. This study aimed at examining the role of systematic cueing in the walk tests for older adults with dementia. Methods: Individuals who were aged 65 years or above, diagnosed with Alzheimer’s disease or dementia, and able to walk independently for at least 15 meters were recruited from residential care and day care facilities. All the participants completed 2-minute walk test (2MWT), 6-minute walk test (6MWT) and 10-meter walk test (10MeWT) on three separate testing occasions under two independent raters. A progressive cueing system was used to facilitate the participants to complete the walk tests. The raters provided cues to the participants when they deviated from the testing protocols. The cues were provided in the following escalating sequence: 0) no cue; 1) verbal prompt; 2) modelling/gesturing; 3) one-off physical prompt; 4) intermittent physical prompt; 5) intermittent physical guidance; and 6) complete physical guidance. Results: Thirty-nine participants (mean age = 87.1 ± 6.2) completed the walk tests. No significant difference in walking performance was found in the 2MWT (p = .18), 6MWT (p = .13) and 10MeWT (p = .23 - .37) among the participants with different levels of cognitive impairment. The cognitive function of the participants was independently and inversely associated with the level of cueing provided during the walk tests (p ≤ .007). The level of cueing provided during the 6MWT (p = .013) and 10MeWT (p ≤ .040) was independently and positively associated with the intra-rater and inter-rater differences in the walking performance of the participants. Conclusions: Older adults with more severe cognitive impairment required higher level of cueing from the raters to complete the walk tests. The participants who needed higher level of cueing during the walk tests had greater variations of walking performance as measured by the same rater and different raters. Systematic cueing should be implemented as an integral component in the walk tests for older adults with dementia, especially those with significant cognitive impairment, to facilitate the completion of the walk tests across multiple testing occasions. Systematic cueing may also be useful in monitoring the consistency of the walking performances measured on multiple testing occasions in this population group.