Gait and cognition: a complementary approach to understanding brain function and the risk of falling

Abstract

Until recently, clinicians and researchers have performed gait assessments and cognitive assessments separately when evaluating older adults, but increasing evidence from clinical practice, epidemiological studies, and clinical trials shows that gait and cognition are interrelated in older adults. Quantifiable alterations in gait in older adults are associated with falls, dementia, and disability. At the same time, emerging evidence indicates that early disturbances in cognitive processes such as attention, executive function, and working memory are associated with slower gait and gait instability during single- and dual-task testing and that these cognitive disturbances assist in the prediction of future mobility loss, falls, and progression to dementia. This article reviews the importance of the interrelationship between gait and cognition in aging and presents evidence that gait assessments can provide a window into the understanding of cognitive function and dysfunction and fall risk in older people in clinical practice. To this end, the benefits of dual-task gait assessments (e.g., walking while performing an attention-demanding task) as a marker of fall risk are summarized. A potential complementary approach for reducing the risk of falls by improving certain aspects of cognition through nonpharmacological and pharmacological treatments is also presented. Untangling the relationship between early gait disturbances and early cognitive changes may be helpful in identifying older adults at risk of experiencing mobility decline, falls, and progression to dementia.

Conflict of interest statement

Conflict of Interest

Dr. Montero Odasso’s program in “Gait and Brain” function is supported in part by grants from the Canadian Institutes for Health and Research - Institute of Aging (CIHR-IA), the Drummond Foundation, the Physician Services Incorporated Foundation of Canada (PSI) and the Ontario Ministry of Research and Innovation. He is the first recipient of the Schulich Clinician-Scientist Award and recipient of the CIHR New Investigator Award (2011–2016).

Dr. Verghese is supported in part by grants from the National Institute on Aging (RO1 AG025119 and POI AGO03949). Prof. Beauchet serves as a consultant for Ipsen Pharma, serves on a scientific advisory board for Groupe Korian, and serves as an editor for Annales de Gérontologie. He has no relevant financial interest in this manuscript. Dr. Hausdorff is supported in part by grants from the National Institute on Aging, the Israel Science Foundation, the Israel Ministry of Health, and the Michael J Fox Foundation for Parkinson Research.

© 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

Figures

Figure 1

Figure 1a and 1b. 1a Traditional view of the parallel decline of gait and cognitive function with aging. Gait performance and cognitive function deteriorate with aging yielding two geriatric entities: falls and dementia. 2b. Alternative, emerging view. Cognition predicts mobility decline and falls, on the one hand; and, on the other hand, mobility decline and slow gait predict cognitive deterioration. These phenomena occur in a concurrent manner.

Figure 2

Effects of a complex dual-task load (serials subtractions by sevens) on stride time variability in a participant with normal cognition (left) compared with a participant with mild cognitive impairment (right). From Montero-Odasso et al (2011).

Figure 3

Examples of the effects of four different forms of cognitive therapy on usual-walking gait velocity and dual-tasking gait velocity. Values shown are change with respect to baseline. Note: Note that 5 cm/s and 10 cm/s have been identified as the MCD and substantial difference (3a) Effects of 8 weeks of computerized cognitive training (while seated) in sedentary older adults, compared with wait list controls. Data from []. (3b) Effects of dual-task training during walking on gait speed in older adults with balance impairment, compared with subjects who only practiced walking. Data from []. (3c) Effects of 6 weeks of TT augmented with VR among patients with PD, compared with an active control comparison of 6 weeks of TT alone. Usual-walking gait speed increased in both the TT alone and TT + VR groups; however, DT gait speed only improved among the patients who participated in TT + VR. Data from [;]. (3d) Effects of 4 months of donepezil use on gait speed in patients with Alzheimer’s disease and compared with control patients with mild cognitive impairment. Data from []. Adapted with permission from Segev-Jacubovski et al []. AD: Alzheimer’s disease; DT: Dual-tasking; MCD: Minimal clinically significant difference; MCI: Mild cognitive impairment; PD: Parkinson’s disease; TT: Treadmill training; VR: Virtual reality