October 29, 2019
Those who “step lively” are more likely to survive to an older age. In fact, scientists reporting in a special supplement to the Journal of Alzheimer’s Disease say that gait disorders, particularly slowing gait, should be considered a marker of future cognitive decline. They propose testing motor performance as well as cognitive performance in older adults with mild cognitive impairments.
“There is an emerging focus on the importance of assessing motor performance as well as cognitive performance to predict cognitive function loss,” explained guest editor Manuel Montero-Odasso, MD, PhD, Departments of Medicine (Geriatric Medicine), and Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, and Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, Ontario. “In the past two decades, large epidemiological studies have shown that gait disorders, particularly slowing gait, may be present at early stages of dementia or may even predict who will be at risk of progressing to dementia. Subtle impairments in gait are more prevalent in older adults with cognitive impairments and dementia—and are also associated with an increased risk of falls.”
He and his co-authors believe that gait testing may help to detect the subgroup of at-risk patients who may benefit the most from invasive diagnostic procedures or early interventions. “We believe simple gait testing should be part of routine clinical assessment for older adults with cognitive impairments. Implementing this in clinics may be a challenge, but we hope the evidence presented in this issue will lead to progress in this area,” said guest editor George Perry, PhD, editor-in-chief of JAD, Professor of Biology, Semmes Distinguished University Chair in Neurobiology, The University of Texas at San Antonio.
“Finding early dementia detection methods is vital,” added Dr. Montero-Odasso. “It is conceivable that in the future we will be able to make the diagnosis of AD and other dementias before people even have significant memory loss. In older adults with moderate cognitive impairment, slowing down their usual walking by more than 20% when they add a cognitive task is indicative of a seven-fold increased risk to develop AD in a five-year timeframe. We believe that gait, as a complex brain-motor task, provides a golden window of opportunity to detect individuals at higher risk of dementia who can benefit the most from more invasive testing or early interventions.”
Around 50 million people worldwide have dementia. Every year there are nearly 10 million new cases. AD is the most common form, accounting for around 60% to 70% of cases. Dementia is characterized by a progressive loss of cognitive function—affecting memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgment. Impairments in gait are more common in dementia than in normal aging and may be related to the severity of cognitive decline.
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