Verghese Joe, Lipton Richard B, Hall Charles B, Kuslansky Gail, Katz Mindy J, Buschke Herman
Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
N Engl J Med. 2002 Nov 28;347(22):1761-8. doi: 10.1056/NEJMoa020441.
Neurologic abnormalities affecting gait occur early in several types of non-Alzheimer's dementias, but their value in predicting the development of dementia is uncertain.
We analyzed the relation between neurologic gait status at base line and the development of dementia in a prospective study involving 422 subjects older than 75 years of age who lived in the community and did not have dementia at base line. Cox proportional-hazards regression analysis was used to calculate hazard ratios with adjustment for potential confounding demographic, medical, and cognitive variables.
At enrollment, 85 subjects had neurologic gait abnormalities of the following types: unsteady gait (in 31 subjects), frontal gait (in 12 subjects), hemiparetic gait (in 11 subjects), neuropathic gait (in 11 subjects), ataxic gait (in 10 subjects), parkinsonian gait (in 8 subjects), and spastic gait (in 2 subjects). During follow-up (median duration, 6.6 years), there were 125 newly diagnosed cases of dementia, 70 of them cases of Alzheimer's disease and 55 cases of non-Alzheimer's dementia (47 of which involved vascular dementia and 8 of which involved other types of dementia). Subjects with neurologic gait abnormalities had a greater risk of development of dementia (hazard ratio, 1.96 [95 percent confidence interval, 1.30 to 2.96]). These subjects had an increased risk of non-Alzheimer's dementia (hazard ratio, 3.51 [95 percent confidence interval, 1.98 to 6.24]), but not of Alzheimer's dementia (hazard ratio, 1.07 [95 percent confidence interval, 0.57 to 2.02]). Of non-Alzheimer's dementias, abnormal gait predicted the development of vascular dementia (hazard ratio, 3.46 [95 percent confidence interval, 1.86 to 6.42]). Among the types of abnormal gait, unsteady gait predicted vascular dementia (hazard ratio, 2.61), as did frontal gait (hazard ratio, 4.32) and hemiparetic gait (hazard ratio, 13.13).
The presence of neurologic gait abnormalities in elderly persons without dementia at base line is a significant predictor of the risk of development of dementia, especially non-Alzheimer's dementia.
影响步态的神经学异常在几种非阿尔茨海默病性痴呆中出现较早，但其在预测痴呆发生方面的价值尚不确定。
在一项前瞻性研究中，我们分析了基线时的神经学步态状态与痴呆发生之间的关系，该研究纳入了422名年龄大于75岁、居住在社区且基线时无痴呆的受试者。采用Cox比例风险回归分析来计算风险比，并对潜在的混杂人口统计学、医学和认知变量进行调整。
入组时，85名受试者存在以下类型的神经学步态异常：步态不稳（31名受试者）、额叶步态（12名受试者）、偏瘫步态（11名受试者）、神经病变性步态（11名受试者）、共济失调步态（10名受试者）、帕金森步态（8名受试者）和痉挛步态（2名受试者）。在随访期间（中位持续时间为6.6年），有125例新诊断的痴呆病例，其中70例为阿尔茨海默病，55例为非阿尔茨海默病性痴呆（其中47例为血管性痴呆，8例为其他类型痴呆）。有神经学步态异常的受试者发生痴呆的风险更高（风险比为1.96[95%置信区间为1.30至2.96]）。这些受试者发生非阿尔茨海默病性痴呆的风险增加（风险比为3.51[95%置信区间为1.98至6.24]），但发生阿尔茨海默病的风险未增加（风险比为1.07[95%置信区间为0.57至2.02]）。在非阿尔茨海默病性痴呆中，异常步态可预测血管性痴呆的发生（风险比为3.46[95%置信区间为1.86至6.42]）。在异常步态类型中，步态不稳可预测血管性痴呆（风险比为2.61），额叶步态（风险比为4.32）和偏瘫步态（风险比为13.13）也可预测。
基线时无痴呆的老年人存在神经学步态异常是痴呆发生风险的重要预测因素，尤其是非阿尔茨海默病性痴呆。
