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It’s all in the walk: new findings on gait and dementia

Researchers at Monash University have discovered a potential link between the way individuals walk and their likelihood of developing dementia.

To put it more scientifically, the researchers were investigating “whether variability from one step to the next during walking, and slow gait speed, were related to cognitive decline over time”.

Associate Professor Michele Callisaya and Professor Velandai Srikanth led the study, supervising first author PhD student Oshadi Jayakody from the University of Tasmania.

The study concluded that higher step-to-step variability correlated with a decline in memory, and that slow gait (or walking) speed was a predictor of declines in spatial and visual awareness. The study also found that walking speed predicted decline in memory in individuals carrying the ApoE4 gene (associated with Alzheimer’s disease).

Co-author of the study Callisaya said researchers have known for some time that moderate to severe dementia was accompanied by changes in walking patterns. Examining this inspired the researchers to investigate whether someone’s walking style and speed could be an early indicator of the disease and possibly assist in early diagnosis.

The report’s authors have already identified a link between brain dysfunction and “walking dysfunction” from previous studies. Such studies found that loss of brain tissue in the hippocampus subcortical and prefrontal region was associated with both thinking and slow gait speed.

Despite previous research and the paper’s new findings, presently most dementia tests involve blood biomarkers testing, cognitive testing and different types of brains scans.

“Gait might be a good overall marker of ageing, pathology and the individual’s ability to cope with pathology,” Callisaya said.

“Gait measures, combined with the usual risk assessments, could be used to help better predict risk of future cognitive decline, potentially helping in planning future care, and gait could be objectively measured as a proxy to study the effectiveness of interventions to slow the progression of dementia.”

With roughly 415,000 people living with dementia in Australia and approximately 47 million worldwide, finding effective treatments for dementia is a top priority for researchers and health professionals. Dementia rates are expected to triple worldwide by 2050 and the disease is the leading cause of death for women in Australia and the second-leading cause for men. Detecting dementia earlier will hopefully help clinicians and scientists find appropriate treatments before “significant pathology … has built up in the brain”.

Callisaya, a physiotherapist, and Srikanth, a geriatrician in the Department of Medicine at Peninsula Health, are now planning to incorporate their research findings into cognitive disorder and memory clinics.

“We and others have begun to take the view that [gait and speed] may actually be a ‘super cognitive function’ itself. The simplicity with which we can measure gait and balance makes them easily applicable to a wide variety of settings as a future biomarker of dementia,” Srikanth said.

“Walking is usually taken for granted as a simple daily function – whereas we have demonstrated in our studies that it is dependent on several brain networks functioning effectively together,” he added.

“We think gait is a really good marker of somebody’s overall health status.

“It’s been shown to not only predict falls, but also hospitalisation, mortality, and now cognitive decline in specific domains.”

A full-text version of the study Gait Characteristics and Cognitive Decline: A Longitudinal Population-Based Study, published by IOS Press, can be accessed here.

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