Quantitative gait dysfunction and risk of cognitive decline and dementia

• Published in: Journal of neurology, neurosurgery and psychiatry neurosurgery and psychiatry, 2007-09, Vol.78 (9), p.929-935
• Main Authors: Verghese, Joe, Wang, Cuiling, Lipton, Richard B, Holtzer, Roee, Xue, Xiaonan
• Format: Article
• Language: English
• Subjects: Age; Aged; Aged, 80 and over; Aging; Alzheimer's disease; Biological and medical sciences; Case-Control Studies; Cognition & reasoning; Cognition Disorders - epidemiology; Cohort Studies; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Dementia; Dementia - epidemiology; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Family medical history; Female; Gait Disorders, Neurologic - psychology; hazard ratios; Heart attacks; Humans; Incidence; Male; Medical sciences; Nervous system (semeiology, syndromes); Neurology; Neuropsychological Tests; Older people; Parkinson's disease; Pathology; Physiology; Predictive Value of Tests; Severity of Illness Index; Standard deviation; Studies; Variables
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.2006.106914

Background: Identifying quantitative gait markers of preclinical dementia may lead to new insights into early disease stages, improve diagnostic assessments and identify new preventive strategies. Objective: To examine the relationship of quantitative gait parameters to decline in specific cognitive domains as well as the risk of developing dementia in older adults. Methods: We conducted a prospective cohort study nested within a community based ageing study. Of the 427 subjects aged 70 years and older with quantitative gait assessments, 399 were dementia-free at baseline. Results: Over 5 years of follow-up (median 2 years), 33 subjects developed dementia. Factor analysis was used to reduce eight baseline quantitative gait parameters to three independent factors representing pace, rhythm and variability. In linear models, a 1 point increase on the rhythm factor was associated with further memory decline (by 107%), whereas the pace factor was associated with decline on executive function measured by the digit symbol substitution (by 29%) and letter fluency (by 92%) tests. In Cox models adjusted for age, sex and education, a 1 point increase on baseline rhythm (hazard ratio (HR) 1.48; 95% CI 1.03 to 2.14) and variability factor scores (HR 1.37; 95% CI 1.05 to 1.78) was associated with increased risk of dementia. The pace factor predicted the risk of developing vascular dementia (HR 1.60; 95% CI 1.06 to 2.41). Conclusion: Our findings indicate that quantitative gait measures predict future risk of cognitive decline and dementia in initially non-demented older adults.