Abnormality of Gait as a Predictor of Non-Alzheimer's Dementia (original) (raw)
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What can gait tell us about dementia? Review of epidemiological and neuropsychological evidence
Gait & Posture, 2017
Background: Cognitive impairment and gait disorders in people over the age of 65 represent major public health issues because of their high frequency, their link to poor outcomes and high costs. Research has demonstrated that these two geriatric syndromes are closely related. Methods and Results: We aim to review the evidence supporting the relationship between gait and cognitive impairment, particularly focusing on epidemiological and neuropsychological studies in patients with Mild cognitive impairment, Alzheimer's disease and Vascular dementia. The review demonstrates that gait and cognition are closely related, but our knowledge of their interrelationship is limited. Emerging evidence shows that gait analysis has the potential to contribute to diagnosis and prognosis of cognitive impairment. Conclusions: An integrated approach for evaluating these major geriatric syndromes, based on their close relationship, will not only increase our understanding of cognitive-motor interactions, but most importantly may be used to aid early diagnosis, prognosis and the development of new interventions.
High risk neurological gait syndrome and vascular dementia
Journal of Neural Transmission, 2007
We defined a 'high-risk neurological gait' (HRNG) syndrome based on presence of any one of hemiparetic, frontal, and unsteady gaits, and examined its validity to predict vascular dementia (VD) over 3 and 5 years in 399 nondemented older adults, age 75 and over. Cox analysis was used to estimate hazard ratios (HR) for VD adjusted for potential confounders. At baseline, 54 subjects had HRNG. 14 subjects developed VD over 3 years and 25 by 5 years. HRNG predicted risk of VD within the first three (HR 3.3, 95% CI 1.8-5.9) and five years (HR 2.7, 95% CI 1.7-4.2). Including executive dysfunction (Digit symbol scores <16) improved validity; subjects with HRNG and executive dysfunction (HR 12.5, 95% CI 5.5-28.4) or either (HR 5.9, 95% CI 3.6-9.7) had higher risk of VD over five years. Diagnosing HRNG is a clinically relevant approach to identifying older adults at high risk of VD over short intervals.
A Retrospective Study of Progressive Gait Impairment in Alzheimer’s Disease
OBM Geriatrics
Individuals with Alzheimer’s disease (AD) and Mild Cognitive Impairment (MCI) have increased gait disturbances throughout disease progression. However, an understanding of gait impairment and progression in early versus late AD is lacking. Further, the longitudinal progression of gait impairment in AD as well as in those with MCI that transition to AD is lacking. Understanding gait pathology and progression of gait impairment is critical for implementation of strategies that could limit the high prevalence of gait related falls, mobility disability and decreased overall function. Further, better understanding of the gait impairment progression may provide insight into disease processes. As such, this retrospective study aimed to evaluate, via cross sectional and longitudinal analyses, the relationship between MCI and AD diagnosis and gait parameters. Cross-sectional findings demonstrate significantly slower gait velocity and decreased step length as well as increased double limb sup...
Quantitative gait, cognitive decline, and incident dementia: The Rotterdam Study
Alzheimer's & Dementia
Introduction: Poor gait has recently emerged as a potential prodromal feature of cognitive decline and dementia. We assessed to what extent various aspects of poor gait are independently associated with cognitive decline and incident dementia. Methods: We leveraged detailed quantitative gait (GAITRiteÔ) and cognitive assessments in 4258 dementia-free participants (median age 67 years, 55% women) of the population-based Rotterdam Study (baseline 2009-2013). We summarized 30 gait parameters into seven mutually independent gait domains and a Global Gait score. Participants underwent follow-up cognitive assessments between 2014 and 2016 and were followed up for incident dementia until 2016 (median 4 years). Results: Three independent gait domains (Base of Support, Pace, and Rhythm) and Global Gait were associated with cognitive decline. Two independent gait domains (Pace and Variability) and Global Gait were associated with incident dementia. Associations of gait with cognitive decline and incident dementia were only present in individuals who had been cognitively unimpaired at baseline. Discussion: Poor performance on several independent gait domains precedes cognitive decline and incident dementia.
Gait in ageing and associated dementias; its relationship with cognition
Neuroscience & Biobehavioral Reviews, 2007
The focus of this review is on the close relationship between gait and cognition in ageing and associated dementias. This close relationship is supported by epidemiological studies, clinical studies of older people with and without dementia that focused on the intensity of the physical activity, clinical studies with older persons without dementia examining a relationship between gait and specific cognitive processes, and human and animal experimental studies examining a neural basis for such a relationship.
International Journal of Precision Engineering and Manufacturing, 2011
The purpose of this study was to compare gait pattern and cognitive function among elderly patients with Alzheimer's Disease (AD), elderly people with Mild Cognitive Impairment (MCI), and Healthy Controls (HC). Twenty three elderly patients participated: 10 AD (77.2±6.84 yrs), 7 MC I(72.9±6.28 yrs), and 6 HC (71.6±5.78 yrs). Gait and Cognitive function were collected using an accelerometer attached to the foot and the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease (CREAD-K), respectively. To compare differences in gait performance among groups, mean stride time, magnitude and structure of gait variability and ratio of low frequency and high frequency (LF/HF ratio) of stride time sequence were used in this study. Results showed that gait variables (mean stride time, LF/HF ratio of stride time) were useful for classification between MCI and HC. Cognitive function (T1, T3, T4, T6, and T8 of CREAD-K) represented the difference between AD and HC. This study may provide a foundation for future work on progression of dementia.
Journal of Aging and Physical Activity
Improving dementia screening procedures beyond simple assessment of current cognitive performance is timely given the ongoing phenomenon of population aging. A slow or declining gait speed (GS) is a potential early indicator of cognitive decline scarcely investigated in very old people. Here, we investigated the 5-year associations of baseline GS, change in GS, and cognitive function with subsequent dementia development in people aged 85 years and older (n = 296) without dementia at baseline. Declining and a slow baseline GS were associated with higher odds of dementia development after adjusting for confounders (e.g., age, sex, and dependency in activities of daily living) and missing GS values at follow-up. The GS decline was associated with cognitive decline in participants who developed dementia. The results support the potential of GS tests to predict future cognitive decline among community- and nursing home-dwelling very old people.
Balance and gait of adults with very mild Alzheimer disease
Journal of geriatric physical therapy (2001)
Studies have shown that adults with Alzheimer disease (AD) have gait and balance deficits; however, the focus has been on those with mild to severe disease. The purpose of this study was to determine whether balance and gait deficits are present in those with very mild AD. Thirteen adults (72.9±4.7 years old) with very mild AD and 13 age-matched (72.6±4.6 years old) and sex-matched (10 males and 3 females) participants in a control group without AD performed balance and gait tests. All participants were living in the community and independent in community ambulation. Participants with very mild AD had shorter times in tandem stance with eyes open (P<0.001) and with eyes closed (P=0.007) compared with participants in the control group. Those with AD also took longer to complete the Timed "Up & Go" Test (P<0.001). Gait deficits were found for those with AD as demonstrated by slower velocities in the 10-m walk at a comfortable pace (P=0.029) and on an instrumented walkw...
BMC Geriatrics, 2020
BackgroundPrevious evidence suggests that slower gait speed is longitudinally associated with cognitive impairment, dementia and falls in older adults. Despite this, the longitudinal relationship between gait speed, cognition and falls in those with a diagnosis of dementia remains poorly explored. We sought to assess this longitudinal relationship in a cohort of older adults with mild to-moderate Alzheimer Disease (AD).MethodsAnalysis of data from NILVAD, an 18-month randomised-controlled trial of Nilvadipine in mild to moderate AD. We examined: (i) the cross-sectional (baseline) association between slow gait speed and cognitive function, (ii) the relationship between baseline slow gait speed and cognitive function at 18 months (Alzheimer Disease Assessment Scale, Cognitive Subsection: ADAS-Cog), (iii) the relationship between baseline cognitive function and incident slow gait speed at 18 months and finally (iv) the relationship of baseline slow gait speed and incident falls over the study period.ResultsOverall, one-tenth (10.03%, N = 37/369) of participants with mild-to-moderate AD met criteria for slow gait speed at baseline and a further 14.09% (N = 52/369) developed incident slow gait speed at 18 months. At baseline, there was a significant association between poorer cognition and slow gait speed (OR 1.05, 95% CI 1.01–1.09, p = 0.025). Whilst there was no association between baseline slow gait speed and change in ADAS-Cog score at 18 months, a greater cognitive severity at baseline predicted incident slow gait speed over 18 months (OR 1.04, 1.01–1.08, p = 0.011). Further, slow gait speed at baseline was associated with a significant risk of incident falls over the study period, which persisted after covariate adjustment (IRR 3.48, 2.05–5.92, p < 0.001).ConclusionsPoorer baseline cognition was associated with both baseline and incident slow gait speed. Slow gait speed was associated with a significantly increased risk of falls over the study period. Our study adds further evidence to the complex relationship between gait and cognition in this vulnerable group and highlights increased falls risk in older adults with AD and slow gait speed.Trial registrationSecondary analysis of the NILVAD trial (Clincaltrials.gov {"type":"clinical-trial","attrs":{"text":"NCT02017340","term_id":"NCT02017340"}}NCT02017340; EudraCT number 2012–002764-27). First registered: 20/12/2013.