Utility of the 4-meter backward walking speed test in older adults with neurodegenerative diseases

Abstract Background and aim Less is known about backward walking speed (BWS) in older adults. This study aims to establish a cutoff value for BWS to distinguish cognitively impaired individuals from healthy controls and to assess the association between backward walking slowing and risk of neurodegenerative diseases. Methods 389 older patients, grouped into cognitively healthy (CH), amnestic mild cognitive impairment (aMCI), Alzheimer’s disease (AD), Parkinson’s disease (PD), and non-AD groups. BWS was measured using a standardized 4-meter protocol. Cognitive and functional status were evaluated via the comprehensive geriatric assessment. ROC analysis was used to determine the diagnostic threshold for BWS, and multinomial logistic regression was used to assess the associations. Results A BWS cutoff of 0.395 m/s effectively distinguished CH individuals from those with neurodegenerative diseases (AUC=0.723). After adjusting for age, each 0.1 m/s decrease in BWS was associated with 22% increased odds of having aMCI, 37% increased odds of AD, 28% increased odds of PD, and 59% increased odds of having non-AD dementia. BWS showed a positive association with global cognitive scores in patients with CH and aMCI (p< 0.05) and with semantic verbal fluency scores in those with AD and aMCI ( p < 0.05). Conclusion BWS is associated with an increased risk of neurodegenerative diseases, which can cause cognitive impairment, and may help indicate individuals at risk of cognitive decline.