Changes in gait related to cognitive decline in elderly patients

Elderly patients who undergo at-home physical therapy show a strong relationship between cognition and gait performance with changes in gait related to cognitive decline, according to recently published data.

Researchers included all patients older than 65 years seen by a home-care agency between 2007 and 2008 with a history of fall in the previous 12 months or one or more modifiable fall risk factors. Overall, 10,953 patients met the criteria of being able to ambulate independently or with assistance and were indicated at referral to be at increased risk of falling. All patients attempted to perform the modified Clinical Test of Sensory Integration and Balance (mCTSIB), as well as either the Performance Oriented Measurement Assessment (POMA) or Dynamic Gait Index (DGI). Researchers scored mental function as part of the Outcome and Assessment Information Set.

After adjustment for age and sex, gait performance as measured by DGI was independently associated with the likelihood that a patient required cognitive prompting. Higher DGI scores were related with the cognitively independent group vs. the group requiring prompting or considerable assistance, while mean POMA scores showed significant differences between all cognitive function groups, except for patients who required some assistance and those requiring considerable assistance.

Functional limitations were associated with reduced gait performance on the DGI and mobility as measured by the POMA, according to results of the study. The likelihood of cognitive prompting relative to independence was reduced with each one-point increase in both DGI and POMA scores, after adjustment for age, sex and performance on the mCTSIB. Similarly, assistance or dependence with cognitive tasks relative to independence was associated with decreasing performance on the DGI and POMA.

For more information:

Whitney SL. J Rehabil Res Dev. 2013;50:1089-1098.

Disclosure: The researchers have no relevant financial disclosures.

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