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Quantitative gait dysfunction and risk of cognitive decline and dementia

Joe Verghese¹, Cuiling Wang², Richard B Lipton¹, Roee Holtzer³, Xiaonan Xue²

¹ Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, USA
² Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, USA
³ Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA

Correspondence to:
Dr Joe Verghese
Einstein Ageing Study, Albert Einstein College of Medicine, 1165 Morris Park Avenue, Room 338, Bronx, New York 10461, USA; jverghes{at}aecom.yu.edu

Background: Identifying quantitative gait markers of preclinical dementia may lead to new insights into early disease stages, improve diagnostic assessments and identify new preventive strategies.

Objective: To examine the relationship of quantitative gait parameters to decline in specific cognitive domains as well as the risk of developing dementia in older adults.

Methods: We conducted a prospective cohort study nested within a community based ageing study. Of the 427 subjects aged 70 years and older with quantitative gait assessments, 399 were dementia-free at baseline.

Results: Over 5 years of follow-up (median 2 years), 33 subjects developed dementia. Factor analysis was used to reduce eight baseline quantitative gait parameters to three independent factors representing pace, rhythm and variability. In linear models, a 1 point increase on the rhythm factor was associated with further memory decline (by 107%), whereas the pace factor was associated with decline on executive function measured by the digit symbol substitution (by 29%) and letter fluency (by 92%) tests. In Cox models adjusted for age, sex and education, a 1 point increase on baseline rhythm (hazard ratio (HR) 1.48; 95% CI 1.03 to 2.14) and variability factor scores (HR 1.37; 95% CI 1.05 to 1.78) was associated with increased risk of dementia. The pace factor predicted the risk of developing vascular dementia (HR 1.60; 95% CI 1.06 to 2.41).

Conclusion: Our findings indicate that quantitative gait measures predict future risk of cognitive decline and dementia in initially non-demented older adults.

Abbreviations: HR, hazard ratios

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