Gait Disorders in Alzheimer’s Disease and Other Dementias: There is Something in the Way You Walk

Gait impairments are ubiquitous in Alzheimer’s disease (AD) and other dementias. Although the main clinical hallmark of dementia is cognitive impairment and decline, motor impairments, such as bradykinesia, extrapyramidal rigidity, and gait disorders, have been commonly described, mostly in late stages. However, during the last two decades, large epidemiological studies have shown that gait disorders, particularly slowing gait, may be present at early stages of dementia or may even predict who will be at risk of progressing to dementia.

Specifically, in older adults with mild cognitive impairment (MCI), a pre-dementia state, there is a coexistence of specific cognitive deficiencies and gait abnormalities which provides support to the theory that there is a transition period whereby cognitive loss occurs concurrently with gait slowing. These motor impairments are not benign. Older adults with MCI are also at higher risk of falling, with double the incidence of their cognitively healthy counterparts. This higher risk of falls has been related to poor attention and executive dysfunction affecting the brain’s gait control. Based on these gait-cognitive interactions, it has been postulated that early gait changes can be used as a motor biomarker to detect individuals who are at risk of progression to AD and non-AD dementias.