Department of Geriatric Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Consultant Geriatrician, Kauvery Hospital, Chennai.
Neurol India. 2024 May 1;72(3):603-609. doi: 10.4103/ni.ni_148_22. Epub 2024 Jun 30.
Gait impairment leads to increased dependence, morbidity, institutionalization, and mortality in older people. We intended to assess gait parameters with the continuum of cognitive impairment and observe variation with the severity of cognitive impairment.
This cross-sectional, observational study was conducted at the memory clinic of a tertiary care center. One hundred and twelve subjects were recruited, and cognition was assessed by the Clinical Dementia Rating scale. Usual gait was assessed by a 6-m walk test, and the dynamic gait was assessed using Biodex Gait Trainer™. Apart from crude analysis, adjusted linear regression was used to find the association of spatiotemporal gait parameters with cognitive decline.
Subjects were divided into subjective cognitive decline (SCD; n = 38), mild cognitive impairment (MCI; n = 40), and major neurocognitive disorder (MNCD; n = 34) groups. History of falls (23.7% vs. 30.0% vs. 67.7%, P < 0.001) and impaired activities of daily living (ADLs) (5.3% vs. 15.0% vs. 100%, P < 0.001) were significantly higher with cognitive decline. Age- and gender-adjusted regression analysis revealed that usual gait speed (0.8 vs. 0.6 vs. 0.5, P < 0.001) (m/s), total time (3.9 vs. 2.9 vs. 2.6, P = 0.022) (min), total distance (65.6 vs. 55.8 vs. 46.6, P = 0.025) (m), step cycle time (0.6 vs. 0.8 vs. 0.8, P = 0.020) (cycles/s), and step lengths were significant.
Gait speed and other parameters worsened with increasing cognitive impairment. Changes in gait parameters might be a useful marker of declining cognition, though a long-term follow-up study is required to establish this association. Early intervention could be beneficial in preserving autonomy in patients with cognitive impairment.
步态障碍可导致老年人依赖性增加、发病率上升、住院率和死亡率升高。本研究旨在评估认知障碍连续性与步态参数的相关性，并观察认知障碍严重程度对步态参数的影响。
这是一项在三级护理中心的记忆诊所进行的横断面观察性研究。共纳入 112 名受试者，采用临床痴呆评定量表评估认知功能。6 米步行试验评估日常步态，Biodex 步态训练器™评估动态步态。除了进行直观分析外，本研究还采用线性回归模型来分析步态参数与认知下降的相关性。
受试者分为主观认知下降（SCD）组（n = 38）、轻度认知障碍（MCI）组（n = 40）和重度神经认知障碍（MNCD）组（n = 34）。随着认知下降，跌倒史（23.7% vs. 30.0% vs. 67.7%，P < 0.001）和日常生活活动能力受损（5.3% vs. 15.0% vs. 100%，P < 0.001）的比例显著升高。经年龄和性别校正的回归分析显示，常规步态速度（0.8 vs. 0.6 vs. 0.5，P < 0.001）（m/s）、总时间（3.9 vs. 2.9 vs. 2.6，P = 0.022）（min）、总距离（65.6 vs. 55.8 vs. 46.6，P = 0.025）（m）、步周期时间（0.6 vs. 0.8 vs. 0.8，P = 0.020）（cycles/s）和步长显著降低。
随着认知障碍的加重，步态速度和其他参数逐渐恶化。步态参数的改变可能是认知能力下降的有用标志物，但需要进一步的长期随访研究来建立这种相关性。早期干预可能有助于保护认知障碍患者的独立性。
