Preludes to brain failure: executive dysfunction and gait disturbances.

The progressive and insidious gait and cognitive decline seen in older individuals without overt disease may result from a combination of age-dependent neuronal changes that are often exacerbated by vascular pathomechanisms. Emerging evidence suggests that slow gait and executive dysfunction are early phenomena in this decline and may further evolve to the development of falls and dementia. These early manifestations can be seen as "brain failure" and their co-occurrence suggests that they may share a common underlying mechanism. The authors argue that brain cortical control of motor and gait performance; and high complex cognitive functions such as executive function, share the same brain networks. Due to its particular watershed vascularization, these brain networks are highly susceptible to microvascular damage and the effects of vascular risk factors. A unified approach for evaluating and treating these two features of aging will close the gap in our understanding of cognitive-motor interactions and ultimately alter the pathways to disability. Besides the standard treatment for cognitive and mobility decline, the authors suggest that treating reversible vascular risk factors and hypertension, especially when they represent early manifestations of brain damage, has the potential to be a complementary method to prevent loss of mobility and cognitive decline in older adults.