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Mild Cognitive Impairment Is Associated With Reduced Dynamic Balance Performance and Altered Lower-Extremity

Meghan E Kazanski1, Clara E LaFollette2, Meredith D Wells1

  • 1Department of Medicine, Division of Geriatrics & Gerontology, Emory University School of Medicine, Atlanta, Georgia.

Journal of Geriatric Physical Therapy (2001)
|April 23, 2025
PubMed
Summary

Mild cognitive impairment (MCI) significantly slows dynamic balance performance on the Four Square Step Test (FSST). Individuals with MCI also show altered lower-extremity movement strategies, indicating challenges with complex stepping tasks.

Keywords:
Four Square Step Testdynamic balancemild cognitive impairmentmotor-cognition

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Area of Science:

  • Neurology
  • Biomechanics
  • Gerontology

Background:

  • Mild cognitive impairment (MCI) is associated with impaired balance control, particularly during dynamic activities.
  • The Four Square Step Test (FSST) assesses dynamic balance through obstacle navigation and multi-directional stepping.
  • Standard FSST completion time offers a limited view of underlying kinematic strategies.

Purpose of the Study:

  • To investigate the effects of aging and MCI on dynamic balance performance using an augmented FSST.
  • To characterize lower-extremity kinematic strategies during the FSST in younger adults, older adults, and individuals with MCI.

Main Methods:

  • An observational study involving younger adults (YA), older adults (OA), and individuals with MCI.
  • Comparison of FSST completion times to assess dynamic balance performance.
  • Analysis of lower-extremity joint angles to evaluate kinematic execution strategies.

Main Results:

  • Older adults were 31% slower than younger adults on the FSST; individuals with MCI were 18% slower than older adults.
  • Individuals with MCI exhibited reduced knee flexion during stepping compared to older adults.
  • Reduced knee flexion in MCI was linked to poorer FSST performance and difficulty with obstacle clearance.

Conclusions:

  • MCI deficits impact FSST performance, with altered kinematics suggesting challenges in complex tasks.
  • Kinematic analysis provides deeper insights into balance control deficits in MCI beyond simple performance measures.
  • Clinicians should assess both performance and kinematics to understand dynamic balance alterations in MCI.