Jahn K, Heinze C, Selge C, Heßelbarth K, Schniepp R
Schön Klinik Bad Aibling, Deutsches Schwindel- und Gleichgewichtszentrum (DSGZ), Kolbermoorer Str. 72, 83043, Bad Aibling, Deutschland,
Nervenarzt. 2015 Apr;86(4):431-9. doi: 10.1007/s00115-014-4182-8.
Slow walking with reduced body dynamics is a characteristic feature of locomotion in the elderly. Impaired mobility and falls associated with gait disorders significantly contribute to a reduced quality of life in the elderly.
A gait disorder is not an inevitable consequence of aging. This article shows that it is worth recognizing specific deficits and differentiating specific aspects in multifactorial disorders because many causes can be well treated. Also provided are the bases for clinical classification and therapeutic principles.
Review of recent literature and clinical review based on own experience and own scientific results.
Common causes of disturbed gait in the elderly are neurological deficits, including sensory deficits (e.g. peripheral neuropathy and vestibulopathy), neurodegeneration (e.g. cerebellar ataxia and parkinsonian syndromes, cognitive impairment (e.g. degenerative dementia), degeneration of joints (e.g. coxarthrosis) and general loss of muscle mass (sarcopenia). Furthermore, a fear of falling also contributes to the gait disorder. Multimodal therapies are often necessary and the principles are presented.
Identification of deficits is a prerequisite for specific therapy. As physical activity protects against cognitive impairment, reduces the risk of falling and improves overall quality of life, a structured assessment of causes for gait impairment is crucial.
步速缓慢且身体动态变化减少是老年人运动的一个特征。与步态障碍相关的行动能力受损和跌倒显著降低了老年人的生活质量。
步态障碍并非衰老的必然结果。本文表明，认识到多因素疾病中的特定缺陷并区分特定方面是值得的，因为许多病因都可以得到有效治疗。本文还提供了临床分类和治疗原则的依据。
基于自身经验和科研成果对近期文献进行综述并开展临床回顾。
老年人步态紊乱的常见病因包括神经功能缺损，如感觉缺损（如周围神经病变和前庭病变）、神经退行性变（如小脑共济失调和帕金森综合征）、认知障碍（如退行性痴呆）、关节退变（如髋关节炎）以及肌肉量普遍减少（肌肉减少症）。此外，对跌倒的恐惧也会导致步态障碍。多模式治疗通常是必要的，并阐述了其原则。
识别缺陷是进行特定治疗的前提。由于体育活动可预防认知障碍、降低跌倒风险并改善整体生活质量，因此对步态受损原因进行结构化评估至关重要。
