Top

Published in:

01-09-2017 | Dementia (J Pillai, Section Editor)

Management of Gait Changes and Fall Risk in MCI and Dementia

Authors: Gilles Allali, MD PhD, Joe Verghese, MBBS

Published in: Current Treatment Options in Neurology | Issue 9/2017

Opinion statement

Gait disorders and falls are very prevalent in aging, especially in older adults with cognitive impairment: older adults with dementia are 2–3 times more likely to fall than their non-demented counterparts. The management of gait disorders and falls in older adults with mild cognitive impairment (MCI) or dementia begins by their identification with the use of specific screening tools, such as measuring gait speed, use of dual-task gait tests, or diagnosing motoric cognitive risk syndrome, a newly described pre-dementia syndrome. This clinical approach is useful to reveal subtle gait changes that may lead to an increased risk of falls in older adults. Various non-pharmacological interventions have been tested in older adults with MCI or dementia to reduce risk of falls. Physical activity interventions are feasible in older adults with cognitive impairments, and may improve gait, and thereby decrease risk of falls. Besides non-pharmacological interventions, identification and removal of potentially inappropriate medications (i.e., psychotropic drugs) is part of a comprehensive falls management strategy in older patients. The use of anti-dementia drugs, such as cholinesterase inhibitors or memantine, may help to improve gait in demented older adults. Adopting a multidisciplinary care strategy that integrates general practitioners, geriatricians, neurologists, cardiologists, physical therapists, and occupational therapists to identify older adults at increased risk of falling or with subtle gait changes, prior to applying individualized non-pharmacological and/or pharmacological interventions, is essential to reduce the burden of gait disorders and falls in older adults with cognitive impairment.

Verghese J, LeValley A, Hall CB, Katz MJ, Ambrose AF, Lipton RB. Epidemiology of gait disorders in community-residing older adults. J Am Geriatr Soc. 2006;54(2):255–61. doi:10.1111/j.1532-5415.2005.00580.x.PubMedPubMedCentralCrossRef

Verghese J, Robbins M, Holtzer R, Zimmerman M, Wang C, Xue X, et al. Gait dysfunction in mild cognitive impairment syndromes. J Am Geriatr Soc. 2008;56(7):1244–51. doi:10.1111/j.1532-5415.2008.01758.x.PubMedPubMedCentralCrossRef

Allan LM, Ballard CG, Burn DJ, Kenny RA. Prevalence and severity of gait disorders in Alzheimer’s and non-Alzheimer’s dementias. J Am Geriatr Soc. 2005;53(10):1681–7. doi:10.1111/j.1532-5415.2005.53552.x.PubMedCrossRef

• Del Campo N, Payoux P, Djilali A, Delrieu J, Hoogendijk EO, Rolland Y, et al. Relationship of regional brain beta-amyloid to gait speed. Neurology. 2016;86(1):36–43. doi:10.1212/WNL.0000000000002235. Cross-sectional study confirming the association between beta-amyloid deposition (assessed by PET) and gait speedPubMedPubMedCentralCrossRef

• Allali G, Annweiler C, Blumen HM, Callisaya ML, De Cock AM, Kressig RW, et al. Gait phenotype from mild cognitive impairment to moderate dementia: results from the GOOD initiative. Eur J Neurol. 2016;23(3):527–41. doi:10.1111/ene.12882. Multicenter cross-sectional study demonstrating that gait is more affected in non-Alzheimer dementia than Alzheimer dementia, and in the more advanced stages of dementiaPubMedCrossRef

Allali G, Verghese J, Mahoney JR. Contributions of mild parkinsonian signs to gait performance in the elderly. Age. 2014;36(4):9678. doi:10.1007/s11357-014-9678-4.PubMedPubMedCentralCrossRef

Boyle PA, Wilson RS, Aggarwal NT, Arvanitakis Z, Kelly J, Bienias JL, et al. Parkinsonian signs in subjects with mild cognitive impairment. Neurology. 2005;65(12):1901–6. doi:10.1212/01.wnl.0000188878.81385.73.PubMedCrossRef

Louis ED, Bennett DA. Mild Parkinsonian signs: an overview of an emerging concept. Mov Disord : Off J Mov Disord Soc. 2007;22(12):1681–8. doi:10.1002/mds.21433.CrossRef

Amboni M, Barone P, Hausdorff JM. Cognitive contributions to gait and falls: evidence and implications. Mov Disord : Off J Mov Disord Soc. 2013;28(11):1520–33. doi:10.1002/mds.25674.CrossRef

10.

Beauchet O, Launay CP, Fantino B, Annweiler C, Allali G. Episodic memory and executive function impairments in non-demented older adults: which are the respective and combined effects on gait performances? Age. 2015;37(4):9812. doi:10.1007/s11357-015-9812-y.PubMedCrossRef

11.

Montero-Odasso M, Verghese J, Beauchet O, Hausdorff JM. Gait and cognition: a complementary approach to understanding brain function and the risk of falling. J Am Geriatr Soc. 2012;60(11):2127–36. doi:10.1111/j.1532-5415.2012.04209.x.PubMedPubMedCentral

12.

Sheridan PL, Solomont J, Kowall N, Hausdorff JM. Influence of executive function on locomotor function: divided attention increases gait variability in Alzheimer’s disease. J Am Geriatr Soc. 2003;51(11):1633–7.PubMedCrossRef

13.

Verghese J, Wang C, Lipton RB, Holtzer R, Xue X. Quantitative gait dysfunction and risk of cognitive decline and dementia. J Neurol Neurosurg Psychiatry. 2007;78(9):929–35. doi:10.1136/jnnp.2006.106914.PubMedPubMedCentralCrossRef

14.

Buchman AS, Boyle PA, Leurgans SE, Barnes LL, Bennett DA. Cognitive function is associated with the development of mobility impairments in community-dwelling elders. Am J Geriatr Psychiatry : Off J Am Assoc Geriatr Psychiatry. 2011;19(6):571–80. doi:10.1097/JGP.0b013e3181ef7a2e.CrossRef

15.

Taniguchi Y, Kitamura A, Seino S, Murayama H, Amano H, Nofuji Y, et al. Gait performance trajectories and incident disabling dementia among community-dwelling older Japanese. J Am Med Dir Assoc. 2017;18(2):192 e13–20. doi:10.1016/j.jamda.2016.10.015.CrossRef

16.

Verghese J, Derby C, Katz MJ, Lipton RB. High risk neurological gait syndrome and vascular dementia. J Neural Transm. 2007;114(10):1249–52. doi:10.1007/s00702-007-0762-0.PubMedCrossRef

17.

Waite LM, Grayson DA, Piguet O, Creasey H, Bennett HP, Broe GA. Gait slowing as a predictor of incident dementia: 6-year longitudinal data from the Sydney older persons study. J Neurol Sci. 2005;229-230:89–93. doi:10.1016/j.jns.2004.11.009.PubMedCrossRef

18.

Beauchet O, Annweiler C, Callisaya ML, De Cock AM, Helbostad JL, Kressig RW, et al. Poor gait performance and prediction of dementia: results from a meta-analysis. J Am Med Dir Assoc. 2016; doi:10.1016/j.jamda.2015.12.092.

19.

• Bullain SS, Corrada MM, Perry SM, Kawas CH. Sound body sound mind? Physical performance and the risk of dementia in the oldest-old: the 90+ study. J Am Geriatr Soc. 2016;64(7):1408–15. doi:10.1111/jgs.14224. Longitudinal study conducted on the oldest old showing that poor physical performance predicts dementia also in this populationPubMedCrossRef

20.

Verghese J, Lipton RB, Hall CB, Kuslansky G, Katz MJ, Buschke H. Abnormality of gait as a predictor of non-Alzheimer’s dementia. N Engl J Med. 2002;347(22):1761–8. doi:10.1056/NEJMoa020441.PubMedCrossRef

21.

Mielke MM, Roberts RO, Savica R, Cha R, Drubach DI, Christianson T, et al. Assessing the temporal relationship between cognition and gait: slow gait predicts cognitive decline in the Mayo Clinic study of aging. J Gerontol A Biol Sci Med Sci. 2013;68(8):929–37. doi:10.1093/gerona/gls256.PubMedCrossRef

22.

Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, et al. Gait speed and survival in older adults. JAMA. 2011;305(1):50–8. doi:10.1001/jama.2010.1923.PubMedPubMedCentralCrossRef

23.

Allali G, Ayers EI, Verghese J. Multiple modes of assessment of gait are better than one to predict incident falls. Arch Gerontol Geriatr. 2015;60(3):389–93. doi:10.1016/j.archger.2015.02.009.PubMedPubMedCentralCrossRef

24.

Verghese J, Ambrose AF, Lipton RB, Wang C. Neurological gait abnormalities and risk of falls in older adults. J Neurol. 2010;257(3):392–8. doi:10.1007/s00415-009-5332-y.PubMedCrossRef

25.

Verghese J, Holtzer R, Lipton RB, Wang C. Quantitative gait markers and incident fall risk in older adults. J Gerontol A Biol Sci Med Sci. 2009;64(8):896–901. doi:10.1093/gerona/glp033.PubMedCrossRef

26.

Deandrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C, Negri E. Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology. 2010;21(5):658–68. doi:10.1097/EDE.0b013e3181e89905.PubMedCrossRef

27.

Eriksson S, Strandberg S, Gustafson Y, Lundin-Olsson L. Circumstances surrounding falls in patients with dementia in a psychogeriatric ward. Arch Gerontol Geriatr. 2009;49(1):80–7. doi:10.1016/j.archger.2008.05.005.PubMedCrossRef

28.

•• Burns ER, Stevens JA, Lee R. The direct costs of fatal and non-fatal falls among older adults - United States. J Saf Res. 2016;58:99–103. doi:10.1016/j.jsr.2016.05.001. Estimation of the cost of fatal and non-fatal falls in 2012 among U.S. older adultsCrossRef

29.

Buchner DM, Larson EB. Falls and fractures in patients with Alzheimer-type dementia. JAMA. 1987;257(11):1492–5.PubMedCrossRef

30.

van Doorn C, Gruber-Baldini AL, Zimmerman S, Hebel JR, Port CL, Baumgarten M, et al. Dementia as a risk factor for falls and fall injuries among nursing home residents. J Am Geriatr Soc. 2003;51(9):1213–8.PubMedCrossRef

31.

Thurman DJ, Stevens JA, Rao JK. Quality standards Subcommittee of the American Academy of N. Practice parameter: assessing patients in a neurology practice for risk of falls (an evidence-based review): report of the quality standards Subcommittee of the American Academy of Neurology. Neurology. 2008;70(6):473–9. doi:10.1212/01.wnl.0000299085.18976.20.PubMedCrossRef

32.

Eshkoor SA, Hamid TA, Nudin SS, Mun CY. A research on functional status, environmental conditions, and risk of falls in dementia. Int J Alzheimers Dis. 2014;2014:769062. doi:10.1155/2014/769062.PubMedPubMedCentral

33.

Ogama N, Sakurai T, Shimizu A, Toba K. Regional white matter lesions predict falls in patients with amnestic mild cognitive impairment and Alzheimer’s disease. J Am Med Dir Assoc. 2014;15(1):36–41. doi:10.1016/j.jamda.2013.11.004.PubMedCrossRef

34.

Chen PY, Chiu HT, Chiu HY. Daytime sleepiness is independently associated with falls in older adults with dementia. Geriatr Gerontol Int. 2016;16(7):850–5. doi:10.1111/ggi.12567.PubMedCrossRef

35.

Allan LM, Ballard CG, Rowan EN, Kenny RA. Incidence and prediction of falls in dementia: a prospective study in older people. PLoS One. 2009;4(5):e5521. doi:10.1371/journal.pone.0005521.PubMedPubMedCentralCrossRef

36.

Kropelin TF, Neyens JC, Halfens RJ, Kempen GI, Hamers JP. Fall determinants in older long-term care residents with dementia: a systematic review. Int Psychogeriatr. 2013;25(4):549–63. doi:10.1017/S1041610212001937.PubMedCrossRef

37.

Allali G, Launay CP, Blumen HM, Callisaya ML, De Cock AM, Kressig RW, et al. Falls, cognitive impairment, and gait performance: results from the GOOD initiative. J Am Med Dir Assoc. 2016; doi:10.1016/j.jamda.2016.10.008.

38.

Imamura T, Hirono N, Hashimoto M, Kazui H, Tanimukai S, Hanihara T, et al. Fall-related injuries in dementia with Lewy bodies (DLB) and Alzheimer’s disease. Eur J Neurol. 2000;7(1):77–9.PubMedCrossRef

39.

Ballard CG, Shaw F, Lowery K, McKeith I, Kenny R. The prevalence, assessment and associations of falls in dementia with Lewy bodies and Alzheimer’s disease. Dement Geriatr Cogn Disord. 1999;10(2):97–103.PubMedCrossRef

40.

Srikanth V, Beare R, Blizzard L, Phan T, Stapleton J, Chen J, et al. Cerebral white matter lesions, gait, and the risk of incident falls: a prospective population-based study. Stroke. 2009;40(1):175–80. doi:10.1161/STROKEAHA.108.524355.PubMedCrossRef

41.

Callisaya ML, Beare R, Phan T, Blizzard L, Thrift AG, Chen J, et al. Progression of white matter hyperintensities of presumed vascular origin increases the risk of falls in older people. J Gerontol A Biol Sci Med Sci. 2015;70(3):360–6. doi:10.1093/gerona/glu148.PubMedCrossRef

42.

Delbaere K, Kochan NA, Close JC, Menant JC, Sturnieks DL, Brodaty H, et al. Mild cognitive impairment as a predictor of falls in community-dwelling older people. Am J Geriatr Psychiatry : Off J Am Assoc Geriatr Psychiatry. 2012;20(10):845–53. doi:10.1097/JGP.0b013e31824afbc4.CrossRef

43.

Mirelman A, Herman T, Brozgol M, Dorfman M, Sprecher E, Schweiger A, et al. Executive function and falls in older adults: new findings from a five-year prospective study link fall risk to cognition. PLoS One. 2012;7(6):e40297. doi:10.1371/journal.pone.0040297.PubMedPubMedCentralCrossRef

44.

Taylor ME, Lord SR, Delbaere K, Kurrle SE, Mikolaizak AS, Close JC. Reaction time and postural sway modify the effect of executive function on risk of falls in older people with mild to moderate cognitive impairment. Am J Geriatr Psychiatry : Off J Am Assoc for Geriatr Psychiatry. 2016; doi:10.1016/j.jagp.2016.10.010.

45.

Holtzer R, Friedman R, Lipton RB, Katz M, Xue X, Verghese J. The relationship between specific cognitive functions and falls in aging. Neuropsychology. 2007;21(5):540–8. doi:10.1037/0894-4105.21.5.540.PubMedPubMedCentralCrossRef

46.

Miyake A, Friedman NP, Emerson MJ, Witzki AH, Howerter A, Wager TD. The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: a latent variable analysis. Cogn Psychol. 2000;41(1):49–100. doi:10.1006/cogp.1999.0734.PubMedCrossRef

47.

Shallice T, Burgess PW. Deficits in strategy application following frontal lobe damage in man. Brain : J Neurol. 1991;114(Pt 2):727–41.CrossRef

48.

Panel on Prevention of Falls in Older Persons AGS, British Geriatrics S. Summary of the updated American Geriatrics Society/British geriatrics society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011;59(1):148–57. doi:10.1111/j.1532-5415.2010.03234.x.CrossRef

49.

Covinsky KE, Kahana E, Kahana B, Kercher K, Schumacher JG, Justice AC. History and mobility exam index to identify community-dwelling elderly persons at risk of falling. J Gerontol A Biol Sci Med Sci. 2001;56(4):M253–9.PubMedCrossRef

50.

Leskinen R, Laatikainen T, Peltonen M, Levalahti E, Antikainen R. Prevalence, predictors and covariates of functional status impairment among Finnish second world war veterans during 1992-2004. Age Ageing. 2013;42(4):508–14. doi:10.1093/ageing/aft051.PubMedCrossRef

51.

Simonsick EM, Newman AB, Visser M, Goodpaster B, Kritchevsky SB, Rubin S, et al. Mobility limitation in self-described well-functioning older adults: importance of endurance walk testing. J Gerontol A Biol Sci Med Sci. 2008;63(8):841–7.PubMedCrossRef

52.

Swenor BK, Bandeen-Roche K, Munoz B, West SK. Does walking speed mediate the association between visual impairment and self-report of mobility disability? The Salisbury eye evaluation study. J Am Geriatr Soc. 2014;62(8):1540–5. doi:10.1111/jgs.12937.PubMedPubMedCentralCrossRef

53.

Abraham P, Ouedraogo N, Tew GA, Vielle B, Leftheriotis G, Mahe G. Aging reduces the accuracy of self-reported walking limitation in patients with vascular-type claudication. J Vasc Surg. 2012;56(4):1025–31. doi:10.1016/j.jvs.2012.03.258.PubMedCrossRef

54.

Verghese J. Person-centered fall risk awareness perspectives: clinical correlates and fall risk. J Am Geriatr Soc. 2016;64(12):2528–32. doi:10.1111/jgs.14375.PubMedCrossRef

55.

Mera TO, Filipkowski DE, Riley DE, Whitney CM, Walter BL, Gunzler SA, et al. Quantitative analysis of gait and balance response to deep brain stimulation in Parkinson’s disease. Gait Posture. 2013;38(1):109–14. doi:10.1016/j.gaitpost.2012.10.025.PubMedCrossRef

56.

Beauchet O, Fantino B, Allali G, Muir SW, Montero-Odasso M, Annweiler C. Timed up and go test and risk of falls in older adults: a systematic review. J Nutr Health Aging. 2011;15(10):933–8.PubMedCrossRef

57.

Podsiadlo D, Richardson S. The timed “up & go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142–8.PubMedCrossRef

58.

Muir SW, Berg K, Chesworth B, Speechley M. Use of the berg balance scale for predicting multiple falls in community-dwelling elderly people: a prospective study. Phys Ther. 2008;88(4):449–59. doi:10.2522/ptj.20070251.PubMedCrossRef

59.

Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P, Gottschalk M, et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med. 1994;331(13):821–7. doi:10.1056/NEJM199409293311301.PubMedCrossRef

60.

Beauchet O, Kressig RW, Najafi B, Aminian K, Dubost V, Mourey F. Age-related decline of gait control under a dual-task condition. J Am Geriatr Soc. 2003;51(8):1187–8.PubMedCrossRef

61.

Konig A, Klaming L, Pijl M, Demeurraux A, David R, Robert P. Objective measurement of gait parameters in healthy and cognitively impaired elderly using the dual-task paradigm. Aging Clin Exp Res. 2017; doi:10.1007/s40520-016-0703-6.

62.

Montero-Odasso M, Oteng-Amoako A, Speechley M, Gopaul K, Beauchet O, Annweiler C, et al. The motor signature of mild cognitive impairment: results from the gait and brain study. J Gerontol A Biol Sci Med Sci. 2014;69(11):1415–21. doi:10.1093/gerona/glu155.PubMedPubMedCentralCrossRef

63.

Allali G, Assal F, Kressig RW, Dubost V, Herrmann FR, Beauchet O. Impact of impaired executive function on gait stability. Dement Geriatr Cogn Disord. 2008;26(4):364–9. doi:10.1159/000162358.PubMedCrossRef

64.

Allali G, Dubois B, Assal F, Lallart E, de Souza LC, Bertoux M, et al. Frontotemporal dementia: pathology of gait? Mov Disord : Off J Mov Disord Soc. 2010;25(6):731–7. doi:10.1002/mds.22927.CrossRef

65.

Allali G, Kressig RW, Assal F, Herrmann FR, Dubost V, Beauchet O. Changes in gait while backward counting in demented older adults with frontal lobe dysfunction. Gait Posture. 2007;26(4):572–6. doi:10.1016/j.gaitpost.2006.12.011.PubMedCrossRef

66.

Camicioli R, Bouchard T, Licis L. Dual-tasks and walking fast: relationship to extra-pyramidal signs in advanced Alzheimer disease. J Neurol Sci. 2006;248(1–2):205–9. doi:10.1016/j.jns.2006.05.013.PubMedCrossRef

67.

Camicioli R, Howieson D, Lehman S, Kaye J. Talking while walking: the effect of a dual task in aging and Alzheimer's disease. Neurology. 1997;48(4):955–8.PubMedCrossRef

68.

Fritz NE, Kegelmeyer DA, Kloos AD, Linder S, Park A, Kataki M, et al. Motor performance differentiates individuals with Lewy body dementia, Parkinson’s and Alzheimer’s disease. Gait Posture. 2016;50:1–7. doi:10.1016/j.gaitpost.2016.08.009.PubMedCrossRef

69.

Allali G, Laidet M, Beauchet O, Herrmann FR, Assal F, Armand S. Dual-task related gait changes after CSF tapping: a new way to identify idiopathic normal pressure hydrocephalus. J Neuroeng Rehabil. 2013;10:117. doi:10.1186/1743-0003-10-117.PubMedPubMedCentralCrossRef

70.

Hausdorff JM, Yogev G, Springer S, Simon ES, Giladi N. Walking is more like catching than tapping: gait in the elderly as a complex cognitive task. Exp Brain Res. 2005;164(4):541–8. doi:10.1007/s00221-005-2280-3.PubMedCrossRef

71.

Holtzer R, Mahoney JR, Izzetoglu M, Izzetoglu K, Onaral B, Verghese J. fNIRS study of walking and walking while talking in young and old individuals. J Gerontol A Biol Sci Med Sci. 2011;66(8):879–87. doi:10.1093/gerona/glr068.PubMedCrossRef

72.

Holtzer R, Mahoney JR, Izzetoglu M, Wang C, England S, Verghese J. Online fronto-cortical control of simple and attention-demanding locomotion in humans. NeuroImage. 2015;112:152–9. doi:10.1016/j.neuroimage.2015.03.002.PubMedPubMedCentralCrossRef

73.

Doi T, Makizako H, Shimada H, Park H, Tsutsumimoto K, Uemura K, et al. Brain activation during dual-task walking and executive function among older adults with mild cognitive impairment: a fNIRS study. Aging Clin Exp Res. 2013;25(5):539–44. doi:10.1007/s40520-013-0119-5.PubMedCrossRef

74.

Allali G, Annweiler C, Predovan D, Bherer L, Beauchet O. Brain volume changes in gait control in patients with mild cognitive impairment compared to cognitively healthy individuals; GAIT study results. Exp Gerontol. 2016;76:72–9. doi:10.1016/j.exger.2015.12.007.PubMedCrossRef

75.

Beauchet O, Annweiler C, Assal F, Bridenbaugh S, Herrmann FR, Kressig RW, et al. Imagined timed up & go test: a new tool to assess higher-level gait and balance disorders in older adults? J Neurol Sci. 2010;294(1–2):102–6. doi:10.1016/j.jns.2010.03.021.PubMedCrossRef

76.

Beauchet O, Launay CP, Fantino B, Allali G, Annweiler C. Respective and combined effects of impairments in sensorimotor systems and cognition on gait performance: a population-based cross-sectional study. PLoS One. 2015;10(5):e0125102. doi:10.1371/journal.pone.0125102.PubMedPubMedCentralCrossRef

77.

Jeannerod M, Decety J. Mental motor imagery: a window into the representational stages of action. Curr Opin Neurobiol. 1995;5(6):727–32.PubMedCrossRef

78.

• Verghese J, Annweiler C, Ayers E, Barzilai N, Beauchet O, Bennett DA, et al. Motoric cognitive risk syndrome: multicountry prevalence and dementia risk. Neurology. 2014;83(8):718–26. doi:10.1212/WNL.0000000000000717. Worldwide prevalence of motoric cognitive risk (MCR) syndrome and establishment of the predicting value of MCR for dementiaPubMedPubMedCentralCrossRef

79.

Verghese J, Wang C, Lipton RB, Holtzer R. Motoric cognitive risk syndrome and the risk of dementia. J Gerontol A Biol Sci Med Sci. 2013;68(4):412–8. doi:10.1093/gerona/gls191.PubMedCrossRef

80.

Allali G, Laidet M, Armand S, Elsworth-Edelsten C, Assal F, Lalive PH. Stride time variability as a marker for higher level of gait control in multiple sclerosis: its association with fear of falling. J Neural Transm. 2016;123(6):595–9. doi:10.1007/s00702-016-1551-4.PubMedCrossRef

81.

Callisaya ML, Ayers E, Barzilai N, Ferrucci L, Guralnik JM, Lipton RB, et al. Motoric cognitive risk syndrome and falls risk: a multi-center study. J Alzheimers Dis : JAD. 2016;53(3):1043–52. doi:10.3233/JAD-160230.PubMedPubMedCentralCrossRef

82.

Australian commission on safety and quality in health care. Falls prevention. https://www.safetyandquality.gov.au/our-work/falls-prevention/. Accessed March 6th, 2017.

83.

National Institute for Clinical Excellence. Falls in older people: assessing risk and prevention. https://www.nice.org.uk/guidance/cg161. Accessed March 6th, 2017.

84.

Neyens JC, Dijcks BP, van Haastregt JC, de Witte LP, van den Heuvel WJ, Crebolder HF, et al. The development of a multidisciplinary fall risk evaluation tool for demented nursing home patients in the Netherlands. BMC Public Health. 2006;6:74. doi:10.1186/1471-2458-6-74.PubMedPubMedCentralCrossRef

85.

Allali G, Ayers EI, Holtzer R, Verghese J. The role of postural instability/gait difficulty and fear of falling in predicting falls in non-demented older adults. Arch Gerontol Geriatr. 2017;69:15–20. doi:10.1016/j.archger.2016.09.008.PubMedCrossRef

86.

Nazir A, Mueller C, Perkins A, Arling G. Falls and nursing home residents with cognitive impairment: new insights into quality measures and interventions. J Am Med Dir Assoc. 2012;13(9):819 e1–6. doi:10.1016/j.jamda.2012.07.018.CrossRef

87.

Fonad E, Emami A, Wahlin TB, Winblad B, Sandmark H. Falls in somatic and dementia wards at community care units. Scand J Caring Sci. 2009;23(1):2–10. doi:10.1111/j.1471-6712.2007.00574.x.PubMedCrossRef

88.

Hamers JP, Huizing AR. Why do we use physical restraints in the elderly? Z Gerontol Geriatr. 2005;38(1):19–25. doi:10.1007/s00391-005-0286-x.PubMedCrossRef

89.

Shorr RI, Guillen MK, Rosenblatt LC, Walker K, Caudle CE, Kritchevsky SB. Restraint use, restraint orders, and the risk of falls in hospitalized patients. J Am Geriatr Soc. 2002;50(3):526–9.PubMedCrossRef

90.

Montero-Odasso M, Levinson P, Gore B, Epid D, Tremblay L, Bergman H. A flowchart system to improve fall data documentation in a long-term care institution: a pilot study. J Am Med Dir Assoc. 2007;8(5):300–6. doi:10.1016/j.jamda.2006.12.031.PubMedCrossRef

91.

Gietzelt M, Feldwieser F, Govercin M, Steinhagen-Thiessen E, Marschollek M. A prospective field study for sensor-based identification of fall risk in older people with dementia. Inform Health Soc Care. 2014;39(3–4):249–61. doi:10.3109/17538157.2014.931851.PubMedCrossRef

92.

Spears GV, Roth CP, Miake-Lye IM, Saliba D, Shekelle PG, Ganz DA. Redesign of an electronic clinical reminder to prevent falls in older adults. Med Care. 2013;51(3 Suppl 1):S37–43. doi:10.1097/MLR.0b013e31827807f8.PubMedCrossRef

93.

Rose DJ, Hernandez D. The role of exercise in fall prevention for older adults. Clin Geriatr Med. 2010;26(4):607–31. doi:10.1016/j.cger.2010.07.003.PubMedCrossRef

94.

•• Stubbs B, Brefka S, Denkinger MD. What works to prevent falls in community-dwelling older adults? Umbrella review of meta-analyses of randomized controlled trials. Phys Ther. 2015;95(8):1095–110. doi:10.2522/ptj.20140461. This review of meta-analyses of randomized controlled trials for falls prevention confirmed that exercise and individually tailored interventions are effective in reducing fall in community-dwelling older adultsPubMedCrossRef

95.

Fernandez-Arguelles EL, Rodriguez-Mansilla J, Antunez LE, Garrido-Ardila EM, Munoz RP. Effects of dancing on the risk of falling related factors of healthy older adults: a systematic review. Arch Gerontol Geriatr. 2015;60(1):1–8. doi:10.1016/j.archger.2014.10.003.PubMedCrossRef

96.

•• Stubbs B, Eggermont L, Soundy A, Probst M, Vandenbulcke M, Vancampfort D. What are the factors associated with physical activity (PA) participation in community dwelling adults with dementia? A systematic review of PA correlates. Arch Gerontol Geriatr. 2014;59(2):195–203. doi:10.1016/j.archger.2014.06.006. This systematic review showed that poor cognition and increasing age does not influence physical activity participation in community dwelling adults with dementiaPubMedCrossRef

97.

Cott CA, Dawson P, Sidani S, Wells D. The effects of a walking/talking program on communication, ambulation, and functional status in residents with Alzheimer disease. Alzheimer Dis Assoc Disord. 2002;16(2):81–7.PubMedCrossRef

98.

Taylor ME, Lord SR, Brodaty H, Kurrle SE, Hamilton S, Ramsay E, et al. A home-based, carer-enhanced exercise program improves balance and falls efficacy in community-dwelling older people with dementia. Int Psychogeriatr. 2017;29(1):81–91. doi:10.1017/S1041610216001629.PubMedCrossRef

99.

Smith-Ray RL, Irmiter C, Boulter K. Cognitive training among cognitively impaired older adults: a feasibility study assessing the potential improvement in balance. Front Public Health. 2016;4:219. doi:10.3389/fpubh.2016.00219.PubMedPubMedCentralCrossRef

100.

Ries JD, Hutson J, Maralit LA, Brown MB. Group balance training specifically designed for individuals with Alzheimer disease: impact on berg balance scale, timed up and go, gait speed, and mini-mental status examination. J Geriatr Phys Ther. 2015;38(4):183–93. doi:10.1519/JPT.0000000000000030.PubMedCrossRef

101.

Arcoverde C, Deslandes A, Moraes H, Almeida C, Araujo NB, Vasques PE, et al. Treadmill training as an augmentation treatment for Alzheimer’s disease: a pilot randomized controlled study. Arq Neuropsiquiatr. 2014;72(3):190–6.PubMedCrossRef

102.

Cadore EL, Moneo AB, Mensat MM, Munoz AR, Casas-Herrero A, Rodriguez-Manas L, et al. Positive effects of resistance training in frail elderly patients with dementia after long-term physical restraint. Age. 2014;36(2):801–11. doi:10.1007/s11357-013-9599-7.PubMedCrossRef

103.

Wesson J, Clemson L, Brodaty H, Lord S, Taylor M, Gitlin L, et al. A feasibility study and pilot randomised trial of a tailored prevention program to reduce falls in older people with mild dementia. BMC Geriatr. 2013;13:89. doi:10.1186/1471-2318-13-89.PubMedPubMedCentralCrossRef

104.

Pitkala KH, Poysti MM, Laakkonen ML, Tilvis RS, Savikko N, Kautiainen H, et al. Effects of the Finnish Alzheimer disease exercise trial (FINALEX): a randomized controlled trial. JAMA Intern Med. 2013;173(10):894–901. doi:10.1001/jamainternmed.2013.359.PubMedCrossRef

105.

Yoon JE, Lee SM, Lim HS, Kim TH, Jeon JK, Mun MH. The effects of cognitive activity combined with active extremity exercise on balance, walking activity, memory level and quality of life of an older adult sample with dementia. J Phys Ther Sci. 2013;25(12):1601–4. doi:10.1589/jpts.25.1601.PubMedCrossRef

106.

Vreugdenhil A, Cannell J, Davies A, Razay G. A community-based exercise programme to improve functional ability in people with Alzheimer’s disease: a randomized controlled trial. Scand J Caring Sci. 2012;26(1):12–9. doi:10.1111/j.1471-6712.2011.00895.x.PubMedCrossRef

107.

Suttanon P, Hill KD, Said CM, Williams SB, Byrne KN, LoGiudice D, et al. Feasibility, safety and preliminary evidence of the effectiveness of a home-based exercise programme for older people with Alzheimer’s disease: a pilot randomized controlled trial. Clin Rehabil. 2013;27(5):427–38. doi:10.1177/0269215512460877.PubMedCrossRef

108.

Ries JD, Drake JM, Marino C. A small-group functional balance intervention for individuals with Alzheimer disease: a pilot study. J Neurol Phys Ther : JNPT. 2010;34(1):3–10. doi:10.1097/NPT.0b013e3181d00f2e.PubMedCrossRef

109.

Santana-Sosa E, Barriopedro MI, Lopez-Mojares LM, Perez M, Lucia A. Exercise training is beneficial for Alzheimer’s patients. Int J Sports Med. 2008;29(10):845–50. doi:10.1055/s-2008-1038432.PubMedCrossRef

110.

Hageman PA, Thomas VS. Gait performance in dementia: the effects of a 6-week resistance training program in an adult day-care setting. Int J Geriatr Psychiatry. 2002;17(4):329–34. doi:10.1002/gps.597.PubMedCrossRef

111.

Rolland Y, Rival L, Pillard F, Lafont C, Rivere D, Albarede J, et al. Feasibility [corrected] of regular physical exercise for patients with moderate to severe Alzheimer disease. J Nutr Health Aging. 2000;4(2):109–13.PubMed

112.

Doi T, Makizako H, Shimada H, Yoshida D, Tsutsumimoto K, Sawa R, et al. Effects of multicomponent exercise on spatial-temporal gait parameters among the elderly with amnestic mild cognitive impairment (aMCI): preliminary results from a randomized controlled trial (RCT). Arch Gerontol Geriatr. 2013;56(1):104–8. doi:10.1016/j.archger.2012.09.003.PubMedCrossRef

113.

McCaffrey R, Park J, Newman D, Hagen D. The effect of chair yoga in older adults with moderate and severe Alzheimer’s disease. Res Gerontol Nurs. 2014;7(4):375–81. doi:10.3928/19404921-20140218-01.CrossRef

114.

Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc. 1999;47(1):30–9.PubMedCrossRef

115.

Woolcott JC, Richardson KJ, Wiens MO, Patel B, Marin J, Khan KM, et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med. 2009;169(21):1952–60. doi:10.1001/archinternmed.2009.357.PubMedCrossRef

116.

Ensrud KE, Blackwell TL, Mangione CM, Bowman PJ, Whooley MA, Bauer DC, et al. Central nervous system-active medications and risk for falls in older women. J Am Geriatr Soc. 2002;50(10):1629–37.PubMedCrossRef

117.

Vestergaard P, Rejnmark L, Mosekilde L. Fracture risk associated with parkinsonism and anti-Parkinson drugs. Calcif Tissue Int. 2007;81(3):153–61. doi:10.1007/s00223-007-9065-6.PubMedCrossRef

118.

Takkouche B, Montes-Martinez A, Gill SS, Etminan M. Psychotropic medications and the risk of fracture: a meta-analysis. Drug Saf. 2007;30(2):171–84.PubMedCrossRef

119.

Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs. J Am Geriatr Soc. 1999;47(1):40–50.PubMedCrossRef

120.

Sterke CS, Verhagen AP, van Beeck EF, van der Cammen TJ. The influence of drug use on fall incidents among nursing home residents: a systematic review. Int Psychogeriatr. 2008;20(5):890–910. doi:10.1017/S104161020800714X.PubMedCrossRef

121.

•• Berry SD, Placide SG, Mostofsky E, Zhang Y, Lipsitz LA, Mittleman MA, et al. Antipsychotic and benzodiazepine drug changes affect acute falls risk differently in the nursing home. J Gerontol A Biol Sci Med Sci. 2016;71(2):273–8. doi:10.1093/gerona/glv091. Case-crossover study showing that the risk of falls after benzodiazepine initiation increases immediately (in the 24 hours) in older adults with dementia residing in a nursing homePubMedCrossRef

122.

Kim DH, Brown RT, Ding EL, Kiel DP, Berry SD. Dementia medications and risk of falls, syncope, and related adverse events: meta-analysis of randomized controlled trials. J Am Geriatr Soc. 2011;59(6):1019–31. doi:10.1111/j.1532-5415.2011.03450.x.PubMedPubMedCentralCrossRef

123.

Beauchet O, Allali G, Launay C, Fantino B, Annweiler C. Does memantine improve the gait of individuals with Alzheimer’s disease? J Am Geriatr Soc. 2011;59(11):2181–2. doi:10.1111/j.1532-5415.2011.03648.x.PubMedCrossRef

124.

Beauchet O, Launay CP, Allali G, Annweiler C. Changes in gait variability with anti-dementia drugs: a systematic review and meta-analysis. CNS Drugs. 2014;28(6):513–8. doi:10.1007/s40263-014-0170-6.PubMedCrossRef

125.

Beauchet O, Launay CP, Allali G, Herrmann FR, Annweiler C. Gait changes with anti-dementia drugs: a prospective, open-label study combining single and dual task assessments in patients with Alzheimer’s disease. Drugs Aging. 2014;31(5):363–72. doi:10.1007/s40266-014-0175-3.PubMedCrossRef

126.

Beauchet O, Launay CP, Allali G, Watfa G, Gallouj K, Herrmann FR, et al. Anti-dementia drugs and changes in gait: a pre-post quasi-experimental pilot study. BMC Neurol. 2013;13:184. doi:10.1186/1471-2377-13-184.PubMedPubMedCentralCrossRef

127.

• Beauchet O, Launay CP, Montero-Odasso M, Annweiler C, Allali G. Anti-dementia drugs-related changes in gait performance while single and dual tasking in patients with Alzheimer disease: a meta-analysis. Curr Alzheimer Res. 2015;12(8):761–71. Meta-analysis showing that anti-dementia drugs (i.e. acetylcholinesterase inhibitors and memantine) improve gait in older adults with dementia with a specific class effectPubMedCrossRef

128.

Evans MD, Shinar R, Yaari R. Reversible dementia and gait disturbance after prolonged use of valproic acid. Seizure. 2011;20(6):509–11. doi:10.1016/j.seizure.2011.02.009.PubMedCrossRef

129.

Gallia GL, Rigamonti D, Williams MA. The diagnosis and treatment of idiopathic normal pressure hydrocephalus. Nat Clin Pract Neurol. 2006;2(7):375–81. doi:10.1038/ncpneuro0237.PubMedCrossRef

Title: Management of Gait Changes and Fall Risk in MCI and Dementia
Authors: Gilles Allali, MD PhD
Joe Verghese, MBBS
Publication date: 01-09-2017
Publisher: Springer US
Published in: Current Treatment Options in Neurology / Issue 9/2017
Print ISSN: 1092-8480
Electronic ISSN: 1534-3138
DOI: https://doi.org/10.1007/s11940-017-0466-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Management of Gait Changes and Fall Risk in MCI and Dementia

Opinion statement

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Opinion statement

Please log in to get access to this content