Assessing the Temporal Relationship Between Cognition and Gait: Slow Gait Predicts Cognitive Decline in the Mayo Clinic Study of Aging
01 Aug 2013-Journals of Gerontology Series A-biological Sciences and Medical Sciences (Oxford University Press)-Vol. 68, Iss: 8, pp 929-937
TL;DR: This study suggests that slow gait precedes cognitive decline and may be useful as a reliable, easily attainable, and noninvasive risk factor for cognitive decline.
Abstract: Gait control is a complex brain process that involves the integration of motor, perceptual, and cognitive processes, including memory, attention, and executive functions (1). Although several gait parameters can be assessed with sophisticated equipment or neurologic examination, the time to walk a short distance (eg, 25 feet) at usual pace is an inexpensive, easy, noninvasive, and highly reliable measure that has been successfully utilized in many epidemiological studies (2,3). Given the complex cognitive processes involved in gait speed, it has been hypothesized that slowing could be a sensitive, early indicator of subclinical cognitive deficits among cognitively normal individuals. Indeed, several studies have shown that slow gait predicts cognitive decline (4–7) and incident dementia (8–11). Alternatively, it has also been hypothesized that cognitive changes precede or co-occur with slowing gait because gait requires intact complex integrated cognitive processes (12–17).
Notably, few investigators have assessed the temporal relationship between gait slowing and cognitive decline within the same study population. Identifying which is affected first will provide important insight into the underlying pathophysiological mechanisms and the opportunity to identify individuals at greatest risk of cognitive or physical decline. Therefore, the aims of this study were to assess (i) whether baseline gait speed was associated with changes in global and/or domain-specific cognitive decline and (ii) whether global and/or domain-specific cognitive decline was associated with changes in gait speed among participants enrolled in the population-based Mayo Clinic Study of Aging.
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TL;DR: Progress and study findings over the past five years are summarized and new directions for how these studies can inform on aging and AD in the future are discussed.
Abstract: Background The Religious Orders Study and Rush Memory and Aging Project are both ongoing longitudinal clinical-pathologic cohort studies of aging and Alzheimer's disease (AD). Objectives To summarize progress over the past five years and its implications for understanding neurodegenerative diseases. Methods Participants in both studies are older adults who enroll without dementia and agree to detailed longitudinal clinical evaluations and organ donation. The last review summarized findings through the end of 2011. Here we summarize progress and study findings over the past five years and discuss new directions for how these studies can inform on aging and AD in the future. Results We summarize 1) findings on the relation of neurobiology to clinical AD; 2) neurobiologic pathways linking risk factors to clinical AD; 3) non-cognitive AD phenotypes including motor function and decision making; 4) the development of a novel drug discovery platform. Conclusion Complexity at multiple levels needs to be understood and overcome to develop effective treatments and preventions for cognitive decline and AD dementia.
634 citations
TL;DR: Evidence is summarized and synthesized that supports the role played by cognition in the control of gait and the implications deriving from the interplay between cognition and gait.
Abstract: Dementia and gait impairments often coexist in older adults and patients with neurodegenerative disease. Both conditions represent independent risk factors for falls. The relationship between cognitive function and gait has recently received increasing attention. Gait is no longer considered merely automated motor activity but rather an activity that requires executive function and attention as well as judgment of external and internal cues. In this review, we intend to: (1) summarize and synthesize the experimental, neuropsychological, and neuroimaging evidence that supports the role played by cognition in the control of gait; and (2) briefly discuss the implications deriving from the interplay between cognition and gait. In recent years, the dual task paradigm has been widely used as an experimental method to explore the interplay between gait and cognition. Several neuropsychological investigations have also demonstrated that walking relies on the use of several cognitive domains, including executive-attentional function, visuospatial abilities, and even memory resources. A number of morphological and functional neuroimaging studies have offered additional evidence supporting the relationship between gait and cognitive resources. Based on the findings from 3 lines of studies, it appears that a growing body of evidence indicates a pivotal role of cognition in gait control and fall prevention. The interplay between higher-order neural function and gait has a number of clinical implications, ranging from integrated assessment tools to possible innovative lines of interventions, including cognitive therapy for falls prevention on one hand and walking program for reducing dementia risk on the other. © 2013 International Parkinson and Movement Disorder Society. Language: en
402 citations
Cites background from "Assessing the Temporal Relationship..."
...More recently, a longitudinal population-based study concluded that slow gait speed precedes cognitive decline, whereas baseline cognition is not associated with later changes in gait speed.(102) Taken together, these findings support the idea that gait impairment antedates cognitive dysfunction and may even represent a reliable risk factor for cognitive decline....
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TL;DR: This clinically oriented review provides an overview on the phenotypic spectrum, work-up and treatment of gait disorders.
Abstract: 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.
375 citations
Cites background from "Assessing the Temporal Relationship..."
...closely with the future emergence of dementia than subjective cognitive impairment [5, 6]....
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...A psychometrist administered a neuropsychological battery that used nine tests to assess function in four domains: (i) memory (delayed free recall percent retention scores for Wechsler Memory Scale-Revised Logical Memory and Visual Reproduction tasks [26], and the Auditory Verbal Learning test [27]); (ii) language (Boston Naming test [28] and category fluency [29]); (iii) executive function (Trail Making test B [30] and Digit Symbol Substitution subtest from the Wechsler Adult Intelligence Scale-Revised [31]); and (iv) visuospatial skills (picture completion and block design [26])....
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