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In PM News this morning, and later on MSNBC's "Morning Joe", people are talking about gait disturbances among the elderly are are potential early warning signs for cognitive decline, including Alzheimers.
I'm not in disagreement that a diseased brain probably affects ambulation, but there are so many other pathologies that affect gait that probably have no impact on mental health. Hallux rigidus, peripheral neuropathy, and a multitude of other pathologies affect gait, but I'm not sure they lead to cognitive decay. My father-in-law is in his late 80's. He has Meniere's disease. If spinal fluid builds up too much, it affects his gait, balance and cognitive abilities. Once the pressure is released, he is fine and very aware of his surroundings.
If gait disturbances can help identify early onset Alzheimer's disease, then I hope it is part of a multidisciplinary approach in getting an accurate diagnosis. I have seen way too many elderly people with disturbed gait that are sharp as they can be. I would hate to see them rounded up, evaluated and medicated if they have occasional "senior moments".
I'm not disputing the findings of the studies, they seem fairly obvious. The more diseased a brain becomes, the more it affects gait. I'm just concerned that poor gait, or changing gait patterns can lead people to drawing erroneous conclusions.
Regional Manager and Technical Consultant,
Novascarpa Group, LLC
Brands represented: Joya, Ryn, Terox
► We use 3 ways of combining data to assess reliability of gait variability in AD.
► Gait variability measures using strides of similar speed have highest reliability.
► The most reliable measure is stride length variability using 64 strides (ICC3,1=0.9).
► Velocity, cadence and stride width variability have high reliability (0.76–0.87).
Gait variability may be especially important to measure in people with Alzheimer's disease (AD) as it is related to risk of falling and may reflect the cognitive demand of walking. Its usefulness as an outcome measure in people with AD is currently limited by the lack of published evaluation of its reproducibility. Therefore measures of temporal and spatial gait variability were recorded using an instrumented mat on two occasions, one week apart in 16 community-dwelling people with mild to moderate probable AD. Data were combined in three ways for analysis: all available strides; all available strides from walks with mean velocity within 10cm/s of each other; and the first 12 strides from the second method. Measures of velocity, stride length and cadence variability were all found to have good reliability using an average of 64 strides from velocity-matched walks (ICC3,1 0.77–0.90) however only stride length variability reached acceptable reliability for a clinical test (ICC3,1 0.9). Estimates of the number of strides required to reach an ICC of 0.9 for velocity, cadence and stride width variability were between 169 and 212. Poor to moderate reliability of gait variability measures was obtained using 12 strides. Minimal detectable change values, calculated to reflect absolute agreement, appear to be feasible and may assist with evaluation of interventions to improve gait. Further research should examine the effects on reproducibility of gait variability measures, of systematic cueing aimed at producing consistent, optimal walking in larger groups with a range of dementia type and severity.