Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
J Am Geriatr Soc. 2012 Nov;60(11):2127-36. doi: 10.1111/j.1532-5415.2012.04209.x. Epub 2012 Oct 30.
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.
直到最近，临床医生和研究人员在评估老年人时，分别进行步态评估和认知评估，但越来越多的临床实践、流行病学研究和临床试验证据表明，步态和认知在老年人中是相互关联的。老年人步态的可量化变化与跌倒、痴呆和残疾有关。与此同时，新出现的证据表明，认知过程（如注意力、执行功能和工作记忆）早期的障碍与单任务和双任务测试中较慢的步态和步态不稳定有关，这些认知障碍有助于预测未来的活动能力下降、跌倒和向痴呆发展。本文回顾了步态和认知在衰老过程中的相互关系的重要性，并提出了证据表明步态评估可以为理解认知功能和功能障碍以及老年人的跌倒风险提供一个窗口。为此，总结了双任务步态评估（例如，在执行注意力要求高的任务时行走）作为跌倒风险标志物的益处。还提出了一种潜在的互补方法，通过非药物和药物治疗改善某些认知方面来降低跌倒风险。理清早期步态障碍与早期认知变化之间的关系，可能有助于识别有发生活动能力下降、跌倒和向痴呆发展风险的老年人。
