Older women with dementia can perform fast alternating forearm movements and performance is correlated with tests of lower extremity function

Eva Bramell-Risberg,1 Gun-Britt Jarnlo,2 S lve Elmst hl11Division of Geriatric Medicine, 2Division of Physiotherapy, Department of Health Sciences, Lund University, Lund, SwedenBackground: The purpose of this work was to study the performance and reliability of a test of fast alternating forearm movements and its relationship with measures of lower extremity function in older women with dementia.Methods: Fast alternating movements was studied in 26 female patients (mean age 81.7 ± 5.9 years) with dementia and 34 controls (mean age 87.5 ± 4.7 years). Subgroup analyses for those aged 80–89 years were performed due to significant differences in the mean ages of the study groups. Test–retest reliability for alternating forearm movements was studied in 11 patients (mean age 80.3 ± 6.7 years) and 10 controls (mean age 87.4 ± 1.6 years). Pulses generated were transformed to an analog signal shown on a modified electrocardiogram. Numbers of cycles at 10 and 15 seconds were calculated for the right and left hand. Walking 2 × 15 m and the Get-Up-and Go (GUG) test were performed at self-selected and maximal speed. Associations between tests of upper and lower extremity function were sought in eight patients (mean age 85 ± 2.7 years) and 16 controls (mean age 85.1 ± 2.8 years) and also according to types of dementia in nine patients with probable Alzheimer's disease and 10 patients with other types of dementia.Results: Patients with dementia could perform the test and had significantly fewer cycles (P = 0.02–0.006) at both 10 and 15 seconds compared with controls after age adjustment. A higher number of cycles was associated with higher self-selected walking speeds in patients (r = -0.79). Test–retest reliability for alternating forearm movements was high for both patients (intraclass correlation 0.88–0.94) and controls (intraclass correlation 0.74–0.94).Conclusion: Alternating forearm movements at fast speed can be used as a reliable test in both patients with dementia and healthy older subjects. The test can be used as a measure of bradykinesia and might be useful as a proxy for lower extremity function in older persons with dementia when testing of the lower extremities is not applicable due to walking disability.Keywords: cognitive impairment, elderly, gait, upper extremity