无神经系统疾病的老年社区居民的定性神经步态异常、心血管危险因素和功能状态：健康大脑计划。
Qualitative neurological gait abnormalities, cardiovascular risk factors and functional status in older community-dwellers without neurological diseases: The Healthy Brain Project.
机构信息
Parc Sanitari Pere Virgili, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; RE-FiT Barcelona Research Group, Vall d'Hebrón Institute of Research (VHIR), Barcelona, Spain.
University of Pittsburgh, Pittsburgh, PA, USA.
出版信息
Exp Gerontol. 2019 Sep;124:110652. doi: 10.1016/j.exger.2019.110652. Epub 2019 Jul 6.
BACKGROUND
Neurologic gait abnormalities (NGA) increase risk for falls and dementia, but their pathophysiologic substrates or association with disability have been poorly investigated. We evaluated the association of NGA with clinical characteristics and functional status in older community-dwellers.
METHODS
Gait characteristics were measured in older community-dwellers without neurological or psychological diseases participating to the Health Aging Body Composition study. NGA were rated using standardized readings of video-recorded short walks, combined with standard neurological exam. We tested cross-sectional associations with demographics, vascular risk factors, comorbidities, cognitive function and disability.
RESULTS
Of 177 participants (median age [IQR] = 82 [4] years, 55% women, 58% Caucasian), 49 (27.7%) had NGA. The most prevalent sub-types were unsteady (10.7%), hemiparetic (4.5%) and parkinsonian (4%). In multivariable logistic regression models, diabetes was associated with higher risk (OR = 3.24, 95% CI = 1.38-7.59), whereas higher physical activity (OR = 0.89, 95% CI = 0.80-0.99) and gait speed (OR = 0.04, 95% CI = 0.005-0.27) with lower risk of NGA. Prevalence of NGA was associated with difficulty in at least 1 activity of daily living, adjusting for confounders (OR = 2.90, 95% CI = 1.11-7.58). After adjusting for gait speed, this association was attenuated to non-significance (OR = 2.13, 95% CI = 0.71-6.37).
CONCLUSIONS
In our sample of community-dwelling older adults without neurological diseases, NGA, detected with a standardized neurological exam, part of usual physicians' training, were common. The relationships with diabetes and reduced physical activity might suggest vascular dysfunction as an underlying contributor to NGA. These results, if confirmed by longitudinal studies, which should also disentangle the relationship between NGA, gait speed and disability, might add information for preventing and managing mobility disability.
背景
神经步态异常（NGA）会增加跌倒和痴呆的风险，但它们的病理生理基础或与残疾的关系尚未得到充分研究。我们评估了 NGA 与老年社区居民的临床特征和功能状态的关联。
方法
在没有神经或心理疾病的老年社区居民中参与健康老龄化身体成分研究，测量步态特征。使用视频记录的短距离行走的标准化读数以及标准神经检查来评估 NGA。我们测试了与人口统计学、血管危险因素、合并症、认知功能和残疾的横断面关联。
结果
在 177 名参与者中（中位数年龄[IQR] = 82 [4]岁，55%为女性，58%为白种人），49 名（27.7%）有 NGA。最常见的亚型是不稳定步态（10.7%）、偏瘫步态（4.5%）和帕金森步态（4%）。在多变量逻辑回归模型中，糖尿病与更高的风险相关（OR = 3.24，95%CI = 1.38-7.59），而较高的身体活动（OR = 0.89，95%CI = 0.80-0.99）和步态速度（OR = 0.04，95%CI = 0.005-0.27）与 NGA 的风险较低相关。调整混杂因素后，NGA 的患病率与至少 1 项日常生活活动困难相关（OR = 2.90，95%CI = 1.11-7.58）。调整步态速度后，这种关联不再具有统计学意义（OR = 2.13，95%CI = 0.71-6.37）。
结论
在我们的无神经疾病的社区居住的老年人群样本中，使用标准化神经检查检测到的 NGA 很常见，这是医生常规培训的一部分。与糖尿病和减少的身体活动的关系可能表明血管功能障碍是 NGA 的潜在原因。如果这些结果得到纵向研究的证实，并且还应阐明 NGA、步态速度和残疾之间的关系，它们可能会为预防和管理活动障碍提供信息。
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