Abnormality of Gait as a Predictor of
Non-Alzheimer's Dementia
Source
Joe Verghese, M.D., Richard B. Lipton, M.D., Charles B.
Hall, Ph.D., Gail Kuslansky, Ph.D., Mindy J. Katz, M.P.H.,
and Herman Buschke,
M.D.
The New England Journal of Medicine, 347:1761-1768, Nov 28, 2002
We
appreciated the study of Verghese and Coll., and suggest of reading the full
article. It is of interest for general practitioners too. Nowadays, many
physicians and psychiatrists often neglect neurological examination with
immeasurable damage for the patient. There is an over reliance on the utility of
neuro-imaging (e.g. CT, MRI), these studies provide an evaluation of anatomy
but not function; Nuclear Medicine (e.g. PET, SPECT) provides functional
imaging only for some aspects, under particular conditions.
Among the
goals of the neurological examination there is a screening for the presence of
discrete abnormalities in patients at risk for the development of neurological
disorders. The major areas of the exam include:
q Cranial Nerves
q Gait
q Muscle strength, tone and
bulk
q Reflexes
q Cerebellar function
q Sensory function
Gait exam is simple and important
at the same time. We know that the elder who has
neurologic abnormalities with effects such as an unsteady gait or a
frontal gait, is at increased risk for dementia secondary to vascular
disease and many studies confirm as neurologic gait abnormalities such as an unsteady or
ataxic gait may be associated with several forms of non-Alzheimer's
dementia. An editors’ note well summarize the article: “In this prospective
study, investigators analysed gait abnormalities in 422 subjects who
were more than 75 years of age and had no evidence of dementia.
During follow-up, dementia developed in 125 subjects. The presence
of a gait abnormality at base line was a significant predictor of
dementia (hazard ratio, 1.96), but the association was primarily
with non-Alzheimer's dementia (hazard ratio, 3.51), rather than with
Alzheimer’s disease (hazard ratio, 1.07)”.
Abnormality of Gait as a Predictor of
Non-Alzheimer's Dementia
Joe Verghese, M.D., Richard B. Lipton, M.D., Charles B.
Hall, Ph.D., Gail Kuslansky, Ph.D., Mindy J. Katz, M.P.H., and Herman Buschke,
M.D.
ABSTRACT
Background Neurologic abnormalities affecting gait
occur early in several types of non-Alzheimer's dementias, but their
value in predicting the development of dementia is uncertain.
Methods We analyzed the relation between neurologic gait
status at base line and the development of dementia in a prospective
study involving 422 subjects older than 75 years of age who lived
in the community and did not have dementia at base line. Cox
proportional-hazards regression analysis was used to calculate hazard
ratios with adjustment for potential confounding demographic, medical,
and cognitive variables.
Results At enrollment, 85
subjects had neurologic gait
abnormalities of the following types: unsteady gait (in 31
subjects), frontal gait (in 12 subjects), hemiparetic gait (in 11
subjects), neuropathic gait (in 11 subjects), ataxic gait (in 10
subjects), parkinsonian gait (in 8 subjects), and spastic gait (in 2
subjects). During follow-up (median duration, 6.6 years), there were
125 newly diagnosed cases of dementia, 70 of them cases of
Alzheimer's disease and 55 cases of non-Alzheimer's dementia (47 of
which involved vascular dementia and 8 of which involved other types
of dementia). Subjects with neurologic gait abnormalities had a
greater risk of development of dementia (hazard ratio, 1.96 [95
percent confidence interval, 1.30 to 2.96]). These subjects had an
increased risk of non-Alzheimer's dementia (hazard ratio, 3.51 [95
percent confidence interval, 1.98 to 6.24]), but not of Alzheimer's
dementia (hazard ratio, 1.07 [95 percent confidence interval, 0.57
to 2.02]). Of non-Alzheimer's dementias, abnormal gait predicted the
development of vascular dementia (hazard ratio, 3.46 [95 percent
confidence interval, 1.86 to 6.42]). Among the types of abnormal
gait, unsteady gait predicted vascular dementia (hazard ratio,
2.61), as did frontal gait (hazard ratio, 4.32) and hemiparetic gait
(hazard ratio, 13.13).
Conclusions The presence of neurologic gait
abnormalities in elderly persons without dementia at base line is a
significant predictor of the risk of development of dementia,
especially non-Alzheimer's dementia.