Practice effect and cueing of 2-minute walk test, 6-minute walk test and 10-meter walk test in frail older adults with and without dementia - Recommendations to walk tests protocols

Objectives: 1) To determine if there was a practice effect associated with walk tests performed by frail older adults with and without dementia, 2) to examine the role of systematic cueing in the walk tests for those with dementia, and 3) to make recommendations to testing protocols of the walk tests for frail older adults with and without dementia. Setting: Residential and day care facilities. Participants: 44 frail older adults with normal cognition (NON-DEM) and 39 older adults with Alzheimer's disease or dementia (DEM) who were able to walk independently for at least 15 m. Methods: All the participants completed multiple trials of 2-minute walk test (2MWT), 6-minute walk test (6MWT) and 10-meter walk test (10MeWT) on three separate testing occasions. The DEM group was facilitated to complete the walk tests using a progressive cueing system. Results: Significant increases in the walking performance within the same testing occasion were found in the 2MWT (NON-DEM: p = .002; DEM: p <= .044) and 6MWT (NON-DEM: p <= .004; DEM: p <= .002) for both groups but only in the 10MeWT (p <= .023) for the DEM group. Significant increases in the walking performance across testing occasions were shown in the 2MWT (p <= .047), 6MWT (p <= .005) and 10MeWT (p < .039) for the NON-DEM group but not the DEM group (all p > .05). Multivariate regression analyses showed that the cognitive function of the DEM group was independently and inversely associated with the level of cueing provided during the walk tests (p <= .007). Conclusion: Practice effect associated with the walk tests was found within and across testing occasions for frail older adults with normal cognition, and only within the same testing occasion for those with dementia. Systematic cueing should be provided for those with dementia to complete the walk tests. Testing protocols of the walk tests have been recommended for these two population groups.