An older adult’s gait holds valuable clues about the likelihood that he or she will fall or develop a serious physical condition like Parkinson’s disease. But 3 new studies suggest that subtle changes in the way a person walks can also be an early sign of cognitive decline.
Researchers from Minnesota, Oregon, and Switzerland presented the 3 studies at this summer’s Alzheimer's Association International Conference in Vancouver, Canada. One study comes from CAST Member Oregon Health and Science University (OHSU) in Portland, OR.
Mayo Clinic: Gait as a Predictor of Impairment
A study conducted at the Mayo Clinic in Rochester, MN, used a computerized gait instrument to measure the stride length and walking speed of more than 1,341 older adults.
Researchers examined study participants at least twice, about 15 months apart.
Study participants who walked slower and took shorter strides experienced more serious declines in cognition and memory, according to a report on the research in USA Today.
“These changes support a possible role of gait changes as an early predictor of cognitive impairment,” said Rodolfo Savica, the study’s author.
Basel Mobility Center: Slower Gate as Dementia Progresses
A second study from the Basel Mobility Center in Basel, Switzerland found that gait becomes slower and more variable as cognition declines. Researchers observed that study participants with Alzheimer’s walked slower than those with mild cognitive impairment (MCI).
Older adults with MCI walked slower than those who were cognitively healthy.
The Swiss study involved 1,153 adults with a mean age of 78. Researchers divided study participants into groups based on whether they were cognitively healthy, had mild cognitive impairment or had already developed Alzheimer’s disease or another type of dementia.
They measured participants’ gait using a walkway with 30,000 integrated sensors.
Oregon Health and Science University: Need to Assess at Home
After studying 19 dementia-free volunteers, researchers at OHSU concluded that one annual test in a laboratory might not provide as much information as researchers need to predict early dementia.
Researchers reached this conclusion after discovering that older study participants actually walked faster in the lab than they did at home. This finding suggests that continuous monitoring at home could be a better predictor of early-onset dementia.
Lisa Silbert, a physician and assistant professor of neurology at OHSU, who led the study, found that slower in-home walking speed was associated with smaller total brain size, an indicator of dementia.
More Efficient Diagnosis
The Alzheimer’s Association expressed hope that gait measurements could become an efficient way to diagnose dementia early and introduce interventions that could delay the onset of dementia symptoms.
“Monitoring deterioration and other changes in a person’s gait is ideal because it doesn’t require any expensive technology or take a lot of time to assess,” says Bill Thies, chief medical and scientific officer for the Alzheimer's Association.
Gait Monitoring Options
CAST Executive Director Majd Alwan agrees that gait monitoring at home is extremely valuable and can be accomplished unobtrusively with a number of low-cost options including:
- A series of motion sensors in the ceilings.
- Vibration sensors on the floor.
- Pressure sensing floor mats.
- Force sensors and odometers embedded in walkers.
- Accelerometers embedded in ankle, arm, chest or waist bands.
- Pressure sensing in-sole inserts.
“Gait and sleep are important ‘vital signs’ that can convey important insights into health and wellness, especially for the elderly population,” says Alwan, who cited a recent study from Johns Hopkins University suggesting that older women with disturbed and fragmented sleep were 3 times more likely to be placed in a long-term care facility than elderly women with healthier sleep patterns. “We need clinicians to recognize the value of these signs and sensing modalities and to start using them to make diagnoses, detect change and prescribe timely interventions, including preventive ones.”