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Change in gait could be early sign of mental decline, Alzheimer's

Gait change could signal mental decline, dementia

Published: Monday, July 16 2012 12:58 p.m. MDT

Changes in a person's gait, from slowing down to walking differently, could be an early indicator of mental decline, according to a handful of studies reported Sunday at the Alzheimer's Association International Conference 2012 in Vancouver, British Columbia.

"With an aging baby boomer generation advancing into greater risk for Alzheimer's and dementia, it is important for physicians to be aware of the associations between gait and mental function. These studies suggest that observing and measuring gait changes could be a valuable tool for signaling the need for further cognitive evaluation," said William Thies, Alzheimer's Association chief medical and scientific officer, in a news release about the research.

"For busy doctors who have limited time with their patients, monitoring deterioration and other changes in a person's gait is ideal because it doesn't require any expensive technology or take a lot of time to assess. It is relatively simple and straightforward," he said.

Alzheimer's disease afflicts at least 5 million Americans and predictions say as many as 16 million will have the disease in 2050 as Baby Boomers age, according to an Alzheimer's Association fact sheet. Cost associated with disease, it said, was $200 billion in 2012, including Medicare, Medicaid, out-of-pocket and other expenses.

An article in USA Today said the multistudy research presentation at the beginning of the week-long conference "follows a plan the U.S. government announced in May to help train doctors in earlier detection and to find a cure by 2025."

For one study, Dr. Stephanie A. Bridenbaugh of the Basel Mobility Center in Basel, Switzerland, and her colleagues used quantitative gait analysis, following 1,153 subjects, both cognitively healthy and those being treated as outpatients at a memory clinic. The average age of the study participants was 77.

They were divided into three groups: cognitively healthy, those with mild cognitive impairment and individuals with Alzheimer's dementia. Those with Alzheimer's were divided into subgroups of mild, moderate or severe. Gait was measured with a special walkway that was 10 meters long and had nearly 30,000 integrated pressure sensors. Participants walked as they normally would, then walked again counting backwards out loud and then again naming animals while walking.

Researchers found the gait slowed and was less consistent as cognitive decline advanced. And for all groups, speeds slowed when the subjects walked and did something else, compared to just walking.

"Mobility impairments are often associated with dementia, and some gait changes may even appear before cognitive decline can be detected by traditional testing methods. Gait analysis can simply, quickly and objectively measured (while) walking. When problems emerge, this may provide early detection of fall risk and the earliest stages of cognitive impairment in older adults," Bridenbaugh said. "A gait analysis will not replace a comprehensive neuropsychological assessment to diagnose a patient's cognitive status. Gait analysis, however, may prove to be an important tool to aid diagnosis and record treatment effects or disease progression."

In another study, Dr. Mohammad Ikram and colleagues at Erasmus MC, Rotterdam, the Netherlands, examined cognition and gait in the elderly who live in a residential center. They used standardized neuropsychological tests to measure how fast each subject processed information, memory, fine motor speed and executive function. They also used an electronic walkway.

Each participant walked normally, then walked heel to toe, then turned. Researchers looked at gait variable using seven measures: rhythm, pace, phases, variability, step width and stride width, number of errors in a tandem walk and how long and how many steps it took each participant to turn around.

"Our results suggests that cognition and gait are tightly linked according to a specified pattern, in which certain cognitive domains only associate with corresponding aspects of gait," Ikram said.

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