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BACKGROUND Although promising results concerning dual-task gait predicting dementia progression in older adults with Mild Cognitive Impairment have been established, the question remains whether this can also be applied to older adults who are not yet suffering from overt cognitive impairments. Spatiotemporal gait analysis has proven to be valuable and reliable in this context. Nevertheless, these instruments are not common in clinical environments. This study aims to investigate whether easy applicable, inexpensive instruments can be used in the detection of gait alterations associated with early cognitive decrements.METHODS Eighty-two healthy community-dwelling older adults (age 60-89) with a MMSE ≥27 were enrolled in this study. Gait analyses using 10-meter walk test (10MWT) and GAITRite-instrument were performed under single and dual-task conditions. Performance on MMSE, CDT, MoCA, TMT-A, TMT-B, Digit Span Forward and Digit Span Backward were registered. Based on the tertiles of dual-task costs (DTC), subjects were categorized as “poor walkers” or “good walkers”. Comparative and predictive statistical analyses were conducted.RESULTS During both types of dual-task 10MWT “poor walkers” performed significantly worse on CDT, MMSECDT, TMT-A and Digit Span Backward compared to “good walkers”. Spatiotemporal gait analysis revealed that temporal DTC resulted in poorer performance on MMSE, CDT, MMSECDT and MoCA orientation whereas spatial DTC showed significantly lower scores on MoCA language, TMT-B and ΔTMT for “poor walkers” compared to “good walkers”. The effort it took to perform either the verbal fluency or the arithmetic dual-task during 10MWT predicted TMT-A and Digit Span Backward outcome. Regarding spatiotemporal dual-task gait analysis, performance on MMSE could be predicted by DTC stride velocity and performance on MoCA language could be predicted by DTC step and stride length.CONCLUSIONS Poor walking abilities can be associated with early cognitive decrements, even in a very early stage when cognitive performance is still more or less intact. Poor walking performance might therefore be considered a clinical precursor or warning signal for beginning cognitive decline. The subtle cognitive and gait decrements can be identified using inexpensive tools, which are easy applicable in all clinical settings.Trial registration Not applicable

Objective: To describe a case of a simultaneous occurrence of an ossified stylohyoid ligament in a 56-year-old male cadaver and anomalies of the vertebral artery, and to consider the clinical implications for manipulative therapists. Intervention and Outcome: Dissection showed a simultaneous occurrence of complete developmental ossification of the left hyoid apparatus, variants of the vertebral artery, and a left superior vena cava in a 56-year-old male cadaver. Discussion: Developmental variants, posttraumatic and degenerative changes of the hyoid apparatus may result in variable degrees of ossification or calcification. Conclusion: This unusual disorder should be considered in the differential diagnosis of facial and neck pain especially within the scope of manipulation of the upper cervical spine. Cervical spine manipulation may exacerbate existing pathological conditions of the stylohyoid apparatus, thereby irritating neurovascular structures, and induce a fracture. Developmental ossification of this apparatus might be associated with anomalies in the atlantic section of the vertebral artery which make the patient more susceptible to vertebrobasilar insufficiency. We conclude that extreme care should be taken in the presence of such an ossification to avoid trauma to the stylohyoid apparatus and maybe even because of increased vertebrobasilar risk.

Background: Cervical spine manipulation is one of the many interventions practiced by health professionals to treat musculoskeletal disorders of the cervical spine. Although serious consequences of manipulation have been documented, the incidence is thought to be rare. More frequently, there may be minor transient side effects after manipulation of the cervical spine, such as headache, dizziness, and nausea. One of the hypothesis is that these side effects are caused by ischemia in the areas perfused by the vertebral arteries. Objective: The purpose of this study was to investigate whether manipulation of the cervical spine can influence blood flow in the brain. Methods: Single photon emission computed tomography was used to examine changes in regional cerebral blood flow caused by cervical spine manipulation (CSM) performed by a physiotherapist to 15 volunteers, using a 1-day split-dose Technetium 99m-ethyl cysteinate dimer single photon emission computed tomography activation paradigm. Results: One brain region was identified showing a decreased regional cerebral blood flow after manipulation. This region was situated in the anterior lobe of the left cerebellum (-42, -48, -24). Conclusions: These findings suggest that cerebellar hypoperfusion may occur after CSM. This could explain why certain people experience headache, dizziness, or nausea after CSM. Further investigation into patient symptoms in the presence of cerebellar hypoperfusion and the possible link of these findings with other adverse reactions are warranted.