There is mounting evidence that gait disturbances can predict dementia in older adults. Gait observation is an important, but often overlooked, part of the neurological exam performed when assessing dementia. Existing and current research suggests that geriatrics physicians could someday use gait assessment strategies to predict dementia.
According to excerpts published by DementiaGuide, Kenneth Rockwood and Chris MacKnight identified the following gait disorders as being associated with dementia:
- Hemiplegic gait
- Parkinsonian gait
- Ataxic gait
- Apraxic gait
Circumduction at the hip, inhibited movement in the knee and dragging of the affected foot characterize the hemiplegic gait. Patients with a Parkinsonian gait walk with a stooped posture, shuffle their feet, take small steps, do not swing their arms, and walk with festination, which means they take short, accelerated steps.
An ataxic gait is unsteady and staggering. A patient with an ataxic gait due to cerebellar dysfunction will keep his legs further apart than normal, a stance sometimes known as a ‘broadened base.’ A patient with an apraxic gait can perform all of the motions of walking while laying down or standing with help but is unable to make those same walking motions standing unaided. An apraxic gait is consistent with both normal pressure hydrocephalus and vascular disease.
Studies continue into the association between dementia and gait
Rockwood and MacKnight published their findings in 2001, and scientists are still researching the connection between dementia and gait today.
Dr. Manuel Montero-Odasso, a geriatrician and director of the “Gait and Brain Lab,” is examining whether walking speed and variability could serve as predictors of dementia progression. This study may also shed light on whether gait alterations were associated with physical changes in the brain. The “Gait and Brain Study” is a longitudinal cohort study currently assessing up to 150 seniors with mild cognitive impairment (MCI) in hopes of detecting an early predictor of cognitive and mobility decline, and progression to dementia.
In a previous study, Dr. Montero-Odasso’s team asked MCI patients to walk on a specially-designed mat that was linked to a computer. The computer recorded the participants’ walking speed and gait variability then compared that information to the subjects walking gait while the participant was simultaneously performing a demanding cognitive task, such as walking backwards or carrying on a conversation. This previous study showed that some specific gait characteristics are associated with high variability, especially during “walking while talking” exercises. Individuals with MCI with the worst episodic memory and most marked executive dysfunction demonstrated the most significant gain abnormalities, suggesting a “motor signature” of cognitive impairment.
Future research could confirm these studies to determine whether gait changes are an effective predictor of cognitive decline. If confirmed, gait testing may eventually help behavioral health specialists diagnose dementia earlier.