Isituto di Diagnosi e Cura Hermitage-Capodimonte, Naples, Italy; Neurodegenerative Diseases Center, Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
Mov Disord. 2013 Sep 15;28(11):1520-33. doi: 10.1002/mds.25674.
Dementia and gait impairments often coexist in older adults and patients with neurodegenerative disease. Both conditions represent independent risk factors for falls. The relationship between cognitive function and gait has recently received increasing attention. Gait is no longer considered merely automated motor activity but rather an activity that requires executive function and attention as well as judgment of external and internal cues. In this review, we intend to: (1) summarize and synthesize the experimental, neuropsychological, and neuroimaging evidence that supports the role played by cognition in the control of gait; and (2) briefly discuss the implications deriving from the interplay between cognition and gait. In recent years, the dual task paradigm has been widely used as an experimental method to explore the interplay between gait and cognition. Several neuropsychological investigations have also demonstrated that walking relies on the use of several cognitive domains, including executive-attentional function, visuospatial abilities, and even memory resources. A number of morphological and functional neuroimaging studies have offered additional evidence supporting the relationship between gait and cognitive resources. Based on the findings from 3 lines of studies, it appears that a growing body of evidence indicates a pivotal role of cognition in gait control and fall prevention. The interplay between higher-order neural function and gait has a number of clinical implications, ranging from integrated assessment tools to possible innovative lines of interventions, including cognitive therapy for falls prevention on one hand and walking program for reducing dementia risk on the other.
痴呆症和步态障碍在老年人和神经退行性疾病患者中常常同时存在。这两种情况都是跌倒的独立危险因素。认知功能与步态之间的关系最近受到了越来越多的关注。步态不再被仅仅视为自动的运动活动，而是一种需要执行功能和注意力以及对外界和内部线索的判断的活动。在这篇综述中，我们旨在：(1)总结和综合实验、神经心理学和神经影像学证据，这些证据支持认知在步态控制中的作用；(2)简要讨论认知和步态之间相互作用所产生的影响。近年来，双重任务范式已被广泛用作探索步态和认知之间相互作用的实验方法。几项神经心理学研究也表明，行走依赖于几个认知领域的使用，包括执行注意功能、视空间能力，甚至记忆资源。一些形态和功能神经影像学研究提供了额外的证据，支持步态和认知资源之间的关系。基于 3 条研究线索的发现，越来越多的证据表明认知在步态控制和跌倒预防中起着关键作用。高级神经功能与步态之间的相互作用具有许多临床意义，从综合评估工具到可能的创新干预措施，包括认知疗法预防跌倒和步行计划降低痴呆风险。
