Digital Theses Archive


Tesi etd-05282021-014222

Type of thesis
Study and Development of Innovative Bioengineering Approaches to Assess the Motor-Cognitive Interplay in Neurodegenerative Disorders.
Scientific disciplinary sector
Istituto di Biorobotica - BIOROBOTICS
relatore Prof. CAVALLO, FILIPPO
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Exam session start date
Worldwide, dementia represents one of the most important causes of disability and reduced autonomy in the elderly population. In particular, AD, the most common type of dementia, today afflicts approximately 47 million people. This number is expected to steadily increase over the next few years, reaching 74.7 million by 2030 and 100 million by 2050. Due to the aging population, the growth in dementia cases, the economic and social impacts, and the apparent lack of effective pharmacological treatments, AD and the other types of dementia constitute a dramatic challenge for public health services. Notably, among nosographic categories, Mild Cognitive Impairment (MCI) represents a 10-fold risk condition of progressing to dementia. It defines those who show cognitive depletion, which is the manifestation of an intermediate stage between healthy aging and dementia. However, their difficulties are not severe enough to compromise their autonomy in activities of daily living, and thanks to their sufficiently intact cognitive resources, they are an excellent candidate for early treatments to slow down or even prevent dementia development. Therefore, immediate identification and accurate characterization of these subjects are seminal to prevent dementia.<br>Interestingly, even if the clinical hallmark of MCI is primarily cognitive impairment, several studies found that also gait dysfunctions can occur in this type of subject. Human motor activity is the outcome of a widespread and complex network. It involves cortical and sub-cortical structures, and that requires the functioning of several cognitive domains, indeed. The MCIs&#39; motor abnormalities, barely detectable in single motor tasks, are exacerbated and unmasked using approaches that investigate the functioning of the motor-cognitive interplay, among which Motor and Cognitive Dual-Task (MCDT) protocols.<br>MCDT are &#34;brain-stress tests&#34;. These techniques provide for the simultaneous performance of a cognitive task (counting backward or verbal fluency) and a motor task (walking). The rationale behind this approach is that cognition is an embodied proprieties. Therefore, movements would require cognitive supplies for their functioning. For these reasons, MCDT can be considered as a window on the brain - and cognitive - processes.<br>The rationale behind this thesis is to combine the potentiality of information and communication technologies (ICT) and the internet of medical things (IoMT) with the scientific background of MCDT approaches. Our goal is to identify clinically valid, inexpensive, and non-invasive markers for the early detection of cognitive decline and at-risk subjects.<br>We aim at enlarging the standard MCDT framework. Our goal is to develop new protocols that include original motor exercises (both for the upper and lower limbs). Hence, we intend to study the effect of increasing cognitive and motor loads on subjects&#39; performances and, eventually, to identify customized protocols to distinguish among different types of subjects: healthy controls, MCI, and patients with Subjective Cognitive Impairment (SCI). Notably, we propose a larger concept compared to MCDT. We intend to draw the classic MCDT lesson. The idea is to generalize the MCDT concept, designing a broader group of protocols that aim to extract, through the adoption of bioengineering technologies, hidden information that human movement conveys, be they purely cognitive or related to the social sphere. <br>To achieve such goals, we designed and developed several protocols that combined motor exercises with cognitive and social tasks. We started from the more straightforward and immediate perspective to transpose pre-existent neuropsychological tests in a new version that engages the motor-cognitive interplay. These works \investigate respectively the episodic verbal memory and the sustained attention through motor responses (the first of upper limbs and the second of the lower limbs). The second and central group of work we conducted is related to the expansion of classic MCDT protocols. We design alternative MCDT tasks and tested their performances in distinguishing between MCI, SCI, and controls at different cognitive loads. In this framework, besides designing new protocols, we conceive new metrics and statistical-learning approaches to investigate the data. Eventually, a promising branch of work is represented by a brand-new approach to the motor-cognitive interplay: the social grasping protocol. This protocol combines motor exercises with different social tasks. Here we explore a particular sector of cognition, social cognition. We exploited the data gathered from this protocol to obtain information on the subjects&#39; cognitive status and the presence/absence of psychopathological symptoms, particularly apathy.<br>In conclusion, we combined significant clinical findings, cutting-edge bioengineering technologies, and robust data analysis to develop clinical tools which provide clinically valid, inexpensive, and non-invasive markers for the early detection of cognitive decline and at-risk subjects.