Human gait depends on a complex interplay of major parts of the nervous, musculoskeletal and cardiorespiratory systems. The individual gait pattern is influenced by age, personality, mood and sociocultural factors. The preferred walking speed in older adults is a sensitive marker of general health and survival. Safe walking requires intact cognition and executive control. Gait disorders lead to a loss of personal freedom, falls and injuries and result in a marked reduction in the quality of life. Acute onset of a gait disorder may indicate a cerebrovascular or other acute lesion in the nervous system but also systemic diseases or adverse effects of medication, in particular polypharmacy including sedatives. The prevalence of gait disorders increases from 10 % in people aged 60–69 years to more than 60 % in community dwelling subjects aged over 80 years. Sensory ataxia due to polyneuropathy, parkinsonism and frontal gait disorders due to subcortical vascular encephalopathy or disorders associated with dementia are among the most common neurological causes. Hip and knee osteoarthritis are common non-neurological causes of gait disorders. With advancing age the proportion of patients with multiple causes or combinations of neurological and non-neurological gait disorders increases. Thorough clinical observation of gait, taking a focused patient history and physical, neurological and orthopedic examinations are basic steps in the categorization of gait disorders and serve as a guide for ancillary investigations and therapeutic interventions. This clinically oriented review provides an overview on the phenotypic spectrum, work-up and treatment of gait disorders.

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Gait disorders in adults and the elderly : A clinical guide.

Importance Gait performance is affected by neurodegeneration in aging and has the potential to be used as a clinical marker for progression from mild cognitive impairment (MCI) to dementia. A dual-task gait test evaluating the cognitive-motor interface may predict dementia progression in older adults with MCI. Objective To determine whether a dual-task gait test is associated with incident dementia in MCI. Design, Setting, and Participants The Gait and Brain Study is an ongoing prospective cohort study of community-dwelling older adults that enrolled 112 older adults with MCI. Participants were followed up for 6 years, with biannual visits including neurologic, cognitive, and gait assessments. Data were collected from July 2007 to March 2016. Main Outcomes and Measures Incident all-cause dementia was the main outcome measure, and single- and dual-task gait velocity and dual-task gait costs were the independent variables. A neuropsychological test battery was used to assess cognition. Gait velocity was recorded under single-task and 3 separate dual-task conditions using an electronic walkway. Dual-task gait cost was defined as the percentage change between single- and dual-task gait velocities: ([single-task gait velocity – dual-task gait velocity]/ single-task gait velocity) × 100. Cox proportional hazard models were used to estimate the association between risk of progression to dementia and the independent variables, adjusted for age, sex, education, comorbidities, and cognition. Results Among 112 study participants with MCI, mean (SD) age was 76.6 (6.9) years, 55 were women (49.1%), and 27 progressed to dementia (24.1%), with an incidence rate of 121 per 1000 person-years. Slow single-task gait velocity ( P  = .05) while high dual-task gait cost while counting backward (HR, 3.79; 95% CI, 1.57-9.15; P  = .003) and naming animals (HR, 2.41; 95% CI, 1.04-5.59; P  = .04) were associated with dementia progression (incidence rate, 155 per 1000 person-years). The models remained robust after adjusting by baseline cognition except for dual-task gait cost when dichotomized. Conclusions and Relevance Dual-task gait is associated with progression to dementia in patients with MCI. Dual-task gait testing is easy to administer and may be used by clinicians to decide further biomarker testing, preventive strategies, and follow-up planning in patients with MCI. Trial Registration clinicaltrials.gov:NCT03020381.

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Association of Dual-Task Gait With Incident Dementia in Mild Cognitive Impairment: Results From the Gait and Brain Study.

Poor Gait Performance and Prediction of Dementia: Results From a Meta-Analysis

Background and purpose Exercise interventions are effective at preventing falls in community-dwelling older adults, especially before disability is present Gait speed below 10 m/s is a strong predictor for falls in the elderly However, evidence is sparse for gait speed alone being sufficient to identify individuals at a high risk of falling This study aimed to describe the prevalence of fall risk factors among community-dwelling older adults in their late 70s and to investigate the associations between these risk factors and low gait speed in this population Methods This cross-sectional cohort study comprised 108 elderly living in a small Norwegian municipality, born between 1936 and 1938 Exclusion criteria were living in residential care, inability to walk 4 m, and severe cognitive impairment Measurements included gait speed, depressive symptoms, executive functions, fear of falling, vision function, fall history, body mass index, medications, and comorbidity Gait speed was dichotomized using a cut-off of 1 m/s, and associations between different risk factors and low gait speed was explored using logistic regression analysis Results Mean gait speed was 10 ± 03 m/s In 444% of the participants, gait speed was below 10 m/s, indicating increased fall risk Low gait speed was significantly associated with a history of multiple falls (odds ratio [OR] = 370, 95% CI [118, 1165]), low educational level (OR = 358, 95% CI [110, 1166]), higher number of medications (OR = 428, 95% CI [163, 112]), and higher number of depressive symptoms (OR = 131, 95% CI [109, 158]) We found no significant associations between gait speed and comorbidity, sex, vision, executive functions, or fear of falling Conclusion Our results indicate that gait speed with cut-off 10 m/s could represent a useful tool for identifying individuals who are vulnerable but not yet disabled and could benefit from fall-preventive exercise However, extended assessment is probably needed to personalize interventions

Associations between gait speed and well-known fall risk factors among community-dwelling older adults.

Objective: To report incidence and risk factors for motoric cognitive risk syndrome (MCR), a newly described predementia syndrome characterized by slow gait and cognitive complaints. Methods: We examined incidence rates of MCR in 3,128 adults aged 60 years and older, MCR- and dementia-free at baseline, participating in 4 US-based cohort studies. Hazard ratios (HRs) with 95% confidence intervals (CIs) for the association of modifiable risk factors with risk of MCR were computed using Cox models. Results: Over a median follow-up time of 3.2 years, 823 of the 3,128 participants met MCR criteria. The overall age- and sex-adjusted incidence of MCR was 65.2/1,000 person-years (95% CI: 53.3–77.1), and ranged from 50.8/1,000 person-years to 79.6/1,000 person-years in the individual cohorts. MCR incidence was higher with older age but there were no sex differences. In the pooled sample adjusted for age, sex, education, and cohort source, strokes (HR 1.42, 95% CI: 1.14–1.77), Parkinson disease (HR 2.52, 95% CI: 1.68–3.76), depressive symptoms (HR 1.65, 95% CI: 1.28–2.13), sedentariness (HR 1.76, 95% CI: 1.44–2.17), and obesity (HR 1.39, 95% CI: 1.17–1.65) predicted risk of incident MCR. Conclusions: The incidence of MCR is high in older adults. Identification of modifiable risk factors for MCR will improve identification of high-risk individuals and help develop interventions to prevent cognitive decline in aging.

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Motoric cognitive risk syndrome Multicenter incidence study

Objectives: Our objective is to report prevalence of motoric cognitive risk syndrome (MCR), a newly described predementia syndrome characterized by slow gait and cognitive complaints, in multiple countries, and its association with dementia risk. Methods: Pooled MCR prevalence analysis of individual data from 26,802 adults without dementia and disability aged 60 years and older from 22 cohorts from 17 countries. We also examined risk of incident cognitive impairment (Mini-Mental State Examination decline ≥4 points) and dementia associated with MCR in 4,812 individuals without dementia with baseline Mini-Mental State Examination scores ≥25 from 4 prospective cohort studies using Cox models adjusted for potential confounders. Results: At baseline, 2,808 of the 26,802 participants met MCR criteria. Pooled MCR prevalence was 9.7% (95% confidence interval [CI] 8.2%–11.2%). MCR prevalence was higher with older age but there were no sex differences. MCR predicted risk of developing incident cognitive impairment in the pooled sample (adjusted hazard ratio [aHR] 2.0, 95% CI 1.7–2.4); aHRs were 1.5 to 2.7 in the individual cohorts. MCR also predicted dementia in the pooled sample (aHR 1.9, 95% CI 1.5–2.3). The results persisted even after excluding participants with possible cognitive impairment, accounting for early dementia, and diagnostic overlap with other predementia syndromes. Conclusion: MCR is common in older adults, and is a strong and early risk factor for cognitive decline. This clinical approach can be easily applied to identify high-risk seniors in a wide variety of settings.

https://ir.lib.uwo.ca/cgi/viewcontent.cgi?article=1028&context=ptpub

Motoric cognitive risk syndrome: Multicountry prevalence and dementia risk

Gait and cognitive impairments in older adults can reﬂect the simultaneous existence of twosyndromes that affect certain brain substrates and pathologies Nutritional deﬁciencies,which areextremely common among elderly population worldwide, have potential to impactthe existence and rehabilitation of both syndromes Gait and cognition are controlled bybrain circuits which are vulnerable to multiple age-related pathologies such as vascular dis-eases, inﬂammation and dementias that may be caused or accentuated by poor nutrition ordeﬁciencies that lead to cognitive, gait or combined cognitive and gait impairments The fol-lowing review aims to link gait and cognitive classiﬁcations and provide an overview of thepotential impact of nutritional deﬁciencies on both neurological and gait dysfunctions Theidentiﬁcation of common modiﬁable risk factors, such as poor nutrition, may serve as animportant preventative strategy to reduce cognitive and mobility impairments and moderatethe growing burden of dementia and disability worldwideGait: Cognition: Nutrition: Ageing

Conference on Nutrition and Healthy Ageing Plenary Lecture IV Locomotion, cognition and influences of nutrition in ageing

Introduction: Cognitive impairment is associated with increased mortality. We examined the association between motoric cognitive risk (MCR) syndrome, a predementia syndrome characterized by slow gait and cognitive complaints, and survival. Methods: A total of 11,867 nondemented participants aged .65 years from three established cohort studies in the United States and Europe were screened for MCR. Mortality risk of MCR was assessed with Cox and logistic regression models. Results: At baseline, 836 (7.0%) participants had MCR. Over a median follow-up of 28 months, 1603 participants died (758 in first 2 years). MCR was associated with increased mortality overall (adjusted hazard ratio, 1.69; 95% confidence interval [CI], 1.46‐1.96) and 2-year mortality (adjusted odds ratio, 1.89; 95% CI, 1.50‐2.38). The association remained after accounting for established mortality risk factors as well as baseline gait speed and memory performance. Discussion: MCRisassociatedwithincreasedmortality.OlderadultsshouldbescreenedforMCRto identify at-risk individuals for dementia and death. 2015 Alzheimer’s Association. Published by Elsevier Inc. All rights reserved.

https://alzheimersanddementiajournal.com/article/S1552-5260(15)02911-8/pdf

Emmeline Ayers

Papers

Motoric cognitive risk syndrome: Multicountry prevalence and dementia risk

Conference on Nutrition and Healthy Ageing Plenary Lecture IV Locomotion, cognition and influences of nutrition in ageing

Featured Article Motoric cognitive risk syndrome and risk of mortality in older adults