Gait Parameters and Cognitive Impairment in the Geriatric Population

A recent study conducted at a tertiary care centre in India examined gait parameters across the spectrum of cognitive impairment in the geriatric population. With the rapidly aging demographic in India, major neurocognitive disorders (MNCDs) are becoming increasingly prevalent. This study aimed to assess whether simple gait measurements could serve as early indicators of cognitive decline, potentially offering a cost-effective screening tool in resource-constrained settings.

The researchers enrolled 112 patients aged 60 years and above from their memory clinic, categorising them into three groups based on the Clinical Dementia Rating (CDR) scale:

• 38 with subjective cognitive decline (SCD)
• 40 with mild cognitive impairment (MCI)
• 34 with MNCD

Gait assessment included usual gait speed over a 6-meter walkway and dynamic gait parameters using the Biodex Gait Trainer.

They found that the usual gait speed showed a progressive decline from SCD (0.79 ± 0.23 m/s) to MCI (0.64 ± 0.17 m/s) to MNCD (0.41 ± 0.14 m/s), with p < 0.001. Dynamic gait measurements also showed significant differences, with shorter step cycle time in SCD compared to MCI, and larger step and stride lengths in SCD compared to MNCD.

Interestingly, the researchers observed a significant increase in fall prevalence with cognitive decline:

• 23.68% in SCD
• 30% in MCI
• 67.65% in MNCD (p < 0.001)

This underscores the importance of fall prevention strategies in cognitively impaired patients.

After adjusting for age and gender, the study found that usual gait speed, total walking time and distance, dynamic gait speed, step cycle time, step length, and stride length were all significantly associated with cognitive decline.

These findings suggest that gait parameters, particularly gait speed, could potentially serve as early markers of cognitive decline. This is particularly relevant in the Indian setting, where advanced neuroimaging techniques may not be readily available or affordable for all patients.

While this study provides valuable insights, the researchers acknowledge its limitations. The cross-sectional design prevents assessment of the trajectory of gait parameters with cognitive outcomes over time. A longitudinal study would be beneficial to establish gait parameters as predictive markers of future cognitive decline.

Conclusion

In conclusion, the study demonstrates that gait parameters change across the spectrum of cognitive impairment in elderly patients. Simple gait assessments could potentially be used for early identification of individuals at risk of cognitive decline in clinical practice.

Early interventions focusing on gait training and fall prevention during the initial stages of cognitive impairment might help maintain independence and improve quality of life in the elderly population.

Reference

Gait Parameters Change can be an Early Marker of Cognitive Impairment Saini, Mamta; Subramanian, Manicka S.; Rao, Abhijith R.; Thakral, Meenal; Singh, Vishwajeet; Chakrawarty, Avinash; Chatterjee, Prasun; Dey, Aparajit B. Neurology India 72(3):p 603-609, May–Jun 2024. | DOI: 10.4103/ni.ni_148_22