The neural correlates of discrete gait characteristics in ageing: A structured review

Joanna Wilson, Liesl Allcock, Ríona Mc Ardle, John-Paul Taylor, Lynn Rochester, Joanna Wilson, Liesl Allcock, Ríona Mc Ardle, John-Paul Taylor, Lynn Rochester

Abstract

Gait is complex, described by diverse characteristics underpinned by widespread central nervous system networks including motor and cognitive functions. Despite this, neural substrates of discrete gait characteristics are poorly understood, limiting understanding of gait impairment in ageing and disease. This structured review aims to map gait characteristics, defined from a pre-specified model reflecting independent gait domains, to brain imaging parameters in older adults. Fifty-two studies of 38,029 yielded were reviewed. Studies showed inconsistent approaches when mapping gait assessment to neural substrates, limiting conclusions. Gait impairments typically associated with brain deterioration, specifically grey matter atrophy and white matter integrity loss. Gait velocity, a global measure of gait control, was most frequently associated with these imaging markers within frontal and basal ganglia regions, and its decline predicted from white matter volume and integrity measurements. Fewer studies assessed additional gait measures or functional imaging parameters. Future studies mapping regional neuroanatomical and functional correlates of gait are needed, including those which take a multi-process network perspective to better understand mobility in health and disease.

Keywords: Ageing; Gait; Neuroimaging; Older adults.

Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Figures

Fig. 1
Fig. 1
The model of gait developed by Lord et al. (Lord et al., 2013) for older adults. 16 gait characteristics map to 5 gait domains; Pace, Rhythm, Variability, Asymmetry and Postural Control.
Fig. 2
Fig. 2
A prisma diagram demonstrating the search yield for the structured review.
Fig. 3
Fig. 3
Heat map of the cross-sectional studies assessing each imaging and gait parameter.
Fig. 4
Fig. 4
Heat map of the longitudinal studies assessing each imaging and gait parameter.
Fig. 5
Fig. 5
Map of the regional associations between GM volume and gait characteristics; gait velocity (A), step length (B), step time variability (C), step width (D), cadence (E) and double support time (F). Areas which are darker in colour indicate regions that were associated with the characteristic in multiple studies. Panel A shows the entire brain in an orange colour, to indicate that the volume of most brain regions have been associated with gait velocity.
Fig. 6
Fig. 6
Key recommendations for future studies.

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