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Criterion-Referenced Sex-Specific Six-Minute Walk Distance Cut-Offs for Staging Alzheimer's Disease
Ines Ben Ayed1,2,3, Emna Makni1, Achraf Ammar4,5,6
1Research Laboratory, Exercise Physiology and Physiopathology: From Integrated to Molecular "Biology, Medicine and Health", LR19ES09, Faculty of Medicine of Sousse, Sousse University, Sousse 4000, Tunisia.
The six-minute walk distance (6MWD) can differentiate mild cognitive impairment (MCI) from moderate Alzheimer's disease (AD) dementia. Sex-specific thresholds for 6MWD show promise for functional staging in Alzheimer's disease patients.
Area of Science:
- Neurology
- Gerontology
- Clinical Diagnostics
Background:
- Functional decline is an early indicator in Alzheimer's disease (AD), potentially aiding clinical staging.
- Current diagnostic criteria lack specific thresholds for interpreting the six-minute walk distance (6MWD) across different AD stages.
- This study addresses the need for criterion-referenced 6MWD values to distinguish between mild cognitive impairment (MCI) and moderate AD dementia.
Purpose of the Study:
- To derive sex-specific cut-off values for the 6-minute walk distance (6MWD).
- To assess the 6MWD's ability to differentiate between mild cognitive impairment (MCI) and moderate Alzheimer's disease (AD) dementia.
- To establish diagnostic indices for the 6MWD in staging AD.
Main Methods:
- Cross-sectional study of 233 community-dwelling adults (128 women) diagnosed with MCI or moderate AD dementia using IWG-2 criteria.
- Standardized 6-minute walk test (6MWT) administered according to American Thoracic Society guidelines.
- Receiver operating characteristic (ROC) analyses performed overall and by sex to determine optimal thresholds and diagnostic accuracy (AUC, sensitivity, specificity, LR, OR).
Main Results:
- Participants with moderate AD dementia had significantly lower 6MWD (313.7 ± 46.5 m) compared to those with MCI (461.2 ± 60.1 m).
- The overall optimal 6MWD threshold was 390 m (AUC=0.97, sensitivity=98.0%, specificity=79.4%).
- Sex-specific thresholds identified were 389 m for men (AUC=0.96) and 367 m for women (AUC=0.98), with higher specificity in women.
Conclusions:
- The 6MWD is a robust measure for discriminating between MCI and moderate AD dementia.
- Derived sex-specific 6MWD thresholds may enhance functional staging and monitoring of AD progression.
- Further internal and external validation is necessary before widespread clinical adoption of these 6MWD thresholds.
