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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.

The New England Journal of Medicine, 347:1761-1768, Nov 28, 2002

Our comment

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)”.


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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.

The New England Journal of Medicine, 347:1761-1768, Nov 28, 2002



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.

Source Information. From the Department of Neurology (J.V., R.B.L., C.B.H., G.K., M.J.K., H.B.) and the Department of Epidemiology and Social Medicine (R.B.L., C.B.H.), Albert Einstein College of Medicine, Bronx, N.Y.; and Innovative Medical Research and the Center for Healthier Aging (Advanced PCS), Hunt Valley, Md. (R.B.L.). Address reprint requests to Dr. Verghese at the Einstein Aging Study, Albert Einstein College of Medicine, 1165 Morris Park Ave., Bronx, NY 10461, or at