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Gait Variability and Fall Risk in Older Adults: The Role of Cognitive Function

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Falls and Cognition in Older Persons

Abstract

In this chapter, we will review the current literature assessing gait variability in older populations at higher risk of falls. Our primary goal is to discuss the role of assessing gait variability to monitor the risk of falls in older adults; the secondary goal is to highlight potential manageable risk factors known to affect gait stability and their relationship with cognition. Stride-to-stride fluctuations in walking are quantified to evaluate gait variability. While a complete understanding of the mechanisms affecting gait variability remains unclear, it is known that gait variability changes during an individual’s life course. High gait variability is considered an index of poor walking stability and has been associated with falls in older adults. Comorbidities, cognitive decline, frailty, fear of falling, cardiovascular problems, and brain pathology are often associated with high gait variability. Recently, it has been also shown that high gait variability is associated with neurodegenerative disorders including the mild cognitive impairment-Alzheimer’s disease spectrum, frontal-temporal dementias, and Parkinson’s disease. Therefore, variability may be viewed as a biomarker of organic integrity, falls risk, and even motor signature in dementia syndromes. Functional and morphological changes in cortical and subcortical brain areas have been correlated with abnormal gait variability in both cognitive healthy and cognitively impaired older adults, and these cerebral changes are also related to fall risk. In summary, this chapter describes putative mechanisms of dysfunctional gait variability in older populations and potential target for future treatments.

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Notes

  1. 1.

    Acetyl-CoA (acetyl coenzyme A) is a molecule that participates in many biochemical reactions involving energy production for cellular functioning including cholinergic transmission. It has a major role in cognitive functioning.

  2. 2.

    Apolipoprotein E (ApoE) is a class of proteins involved in the metabolism of fats in the body. Individuals expressing the allelic form ε4, particularly women, have up to fourfold higher risk to develop Alzheimer’s disease compared to allelic forms ε1, ε2, and ε3. Individuals with two allele ε4 have 20 times the risk of developing Alzheimer’s disease.

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Author information

Authors and Affiliations

  1. Department of Medicine, Division of Geriatric Medicine, University of Western Ontario, London, ON, Canada

    Frederico Pieruccini-Faria

  2. Gait and Brain Lab, Parkwood Institute and Lawson Health Research Institute, London, ON, Canada

    Frederico Pieruccini-Faria

  3. Departments of Medicine (Geriatric Medicine), and Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada

    Manuel Montero-Odasso

  4. Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada

    Manuel Montero-Odasso

  5. Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel

    Jeffrey M. Hausdorff

  6. Department of Physical Therapy, Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel

    Jeffrey M. Hausdorff

  7. Rush Alzheimer’s Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Jeffrey M. Hausdorff

Authors
  1. Frederico Pieruccini-Faria
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  2. Manuel Montero-Odasso
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  3. Jeffrey M. Hausdorff
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Correspondence to Frederico Pieruccini-Faria .

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Editors and Affiliations

  1. Division of Geriatric Medicine, University of Western Ontario, London, ON, Canada

    Manuel Montero-Odasso

  2. Division of Neurology, University of Alberta, Edmonton, AB, Canada

    Richard Camicioli

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Pieruccini-Faria, F., Montero-Odasso, M., Hausdorff, J.M. (2020). Gait Variability and Fall Risk in Older Adults: The Role of Cognitive Function. In: Montero-Odasso, M., Camicioli, R. (eds) Falls and Cognition in Older Persons. Springer, Cham. https://doi.org/10.1007/978-3-030-24233-6_7

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