Zusammenfassung
Gangstörungen treten bei Demenz häufiger auf als im Rahmen des physiologischen Alterungsprozesses. Die Prävalenz dieser demenzassoziierten Gangstörungen hängt dabei vom Demenztyp und vom Schweregrad der kognitiven Beeinträchtigung ab. Während bei der vaskulären Demenz schon im Frühstadium klinisch manifeste Gangstörungen zu beobachten sind, zeigen sich diese bei der Alzheimer-Demenz meist erst im späteren Krankheitsverlauf. Mit modernen Methoden des „brain imaging“ wurde gezeigt, dass an Demenz erkrankte Personen vermehrt auf kortikale Aktivität angewiesen sind, um die Gangstabilität in komplexen Situationen aufrechtzuerhalten. Bei Dysfunktionen des Frontal- oder Temporallappens kann die Allokation dieser Ressourcen nicht mehr ausreichend sein. Klinisch lässt sich dies mithilfe von Dual-Task-Paradigmen überprüfen. Übersteigt die Aufmerksamkeitsanforderung die verfügbare Aufmerksamkeitskapazität, kommt es bei Alzheimer-Patienten auch schon im Frühstadium zu quantitativen Gangveränderungen, wie z. B. einer signifikanten Reduktion der Gehgeschwindigkeit und einer Zunahme der Schrittzeitvariabilität. Dies könnte die frühe Diagnose einer Alzheimer-Erkrankung erleichtern.
Abstract
Gait disorders are more common in dementia than in the context of the physiological aging process. Prevalence of dementia-associated gait disturbances depends on the type of dementia and the severity of cognitive impairment. While in vascular dementia gait abnormalities are often clinically apparent at early disease stages, Alzheimer’s disease patients usually have stable gait until late disease stages. With up-to-date ‘‘brain-imaging” methods, it has been demonstrated that people suffering from dementia are more dependent on cortical activity in order to maintain gait stability in complex situations. When dysfunction of the frontal or temporal lobes occurs, allocation of these resources may no longer be sufficient. Dual-task paradigms are useful to test such resources. It has been shown in early Alzheimer’s disease patients that, if the demand of attention exceeds available capacities, quantitative gait changes occur. Relevant parameters seem to be, e.g., walking speed and stride-time variability. Quantitative assessment of gait dysfunction in dementia may, thus, have the potential to serve as a trait marker.
Literatur
Al-Yahya E, Dawes H, Smith L et al (2011) Cognitive motor interference while walking: a systematic review and meta-analysis. Neurosci Biobehav Rev 35:715–728
Allali G, Dubois B, Assal F et al (2010) Frontotemporal dementia: pathology of gait? Mov Disord 25:731–737
Allali G, Kressig RW, Assal F et al (2007) Changes in gait while backward counting in demented older adults with frontal lobe dysfunction. Gait Posture 26:572–576
Allan LM, Ballard CG, Burn DJ, Kenny RA (2005) Prevalence and severity of gait disorders in Alzheimer’s and non-Alzheimer’s dementias. J Am Geriatr Soc 53:1681–1687
Beauchet O, Allali G, Berrut G et al (2008) Gait analysis in demented subjects: Interests and perspectives. Neuropsychiatr Dis Treat 4:155–160
Boustani M, Peterson B, Hanson L et al (2003) Screening for dementia in primary care: a summary of the evidence for the US Preventive Services Task Force. Ann Intern Med 138:927–937
Buchner DM, Larson EB (1987) Falls and fractures in patients with Alzheimer-type dementia. JAMA 257:1492–1495
Giladi N (2007) Gait and mental function: the interplay between walking, behavior and cognition. J Neural Transm 114:1241–1242
Harada T, Miyai I, Suzuki M, Kubota K (2009) Gait capacity affects cortical activation patterns related to speed control in the elderly. Exp Brain Res 193:445–454
Hausdorff JM, Schweiger A, Herman T et al (2008) Dual-task decrements in gait: contributing factors among healthy older adults. J Gerontol A Biol Sci Med Sci 63:1335–1343
Hausdorff JM, Yogev G, Springer S et al (2005) Walking is more like catching than tapping: gait in the elderly as a complex cognitive task. Exp Brain Res 164:541–548
Herman T, Mirelman A, Giladi N et al (2010) Executive control deficits as a prodrome to falls in healthy older adults: a prospective study linking thinking, walking, and falling. J Gerontol A Biol Sci Med Sci 65:1086–1092
Imamura T, Hirono N, Hashimoto M et al (2000) Fall-related injuries in dementia with Lewy bodies (DLB) and Alzheimer’s disease. Eur J Neurol 7:77–79
Kelly AM, Hester R, Murphy K et al (2004) Prefrontal-subcortical dissociations underlying inhibitory control revealed by event-related fMRI. Eur J Neurosci 19:3105–3112
Lundin-Olsson L, Nyberg L, Gustafson Y (1997) Stops walking when talking as a predictor of falls in elderly people. Lancet 349:617
Malouin F, Richards CL, Jackson PL et al (2003) Brain activations during motor imagery of locomotor-related tasks: a PET study. Hum Brain Mapp 19:47–62
Morris JC, Rubin EH, Morris EJ, Mandel SA (1987) Senile dementia of the Alzheimer’s type: an important risk factor for serious falls. J Gerontol 42:412–417
Nakamura T, Meguro K, Sasaki H (1996) Relationship between falls and stride length variability in senile dementia of the Alzheimer type. Gerontology 42:108–113
O’Keeffe ST, Kazeem H, Philpott RM et al (1996) Gait disturbance in Alzheimer’s disease: a clinical study. Age Ageing 25:313–316
Pettersson AF, Olsson E, Wahlund LO (2007) Effect of divided attention on gait in subjects with and without cognitive impairment. J Geriatr Psychiatry Neurol 20:58–62
Rubenstein LZ, Josephson KR (2002) The epidemiology of falls and syncope. Clin Geriatr Med 18:141–158
Scherder E, Eggermont L, Swaab D et al (2007) Gait in ageing and associated dementias; its relationship with cognition. Neurosci Biobehav Rev 31:485–497
Scherder E, Eggermont L, Visscher C et al (2011) Understanding higher level gait disturbances in mild dementia in order to improve rehabilitation: ‚last in-first out’. Neurosci Biobehav Rev 35:699–714
Sheridan PL, Hausdorff JM (2007) The role of higher-level cognitive function in gait: executive dysfunction contributes to fall risk in Alzheimer’s disease. Dement Geriatr Cogn Disord 24:125–137
Sheridan PL, Solomont J, Kowall N, Hausdorff JM (2003) Influence of executive function on locomotor function: divided attention increases gait variability in Alzheimer’s disease. J Am Geriatr Soc 51:1633–1637
Springer S, Giladi N, Peretz C et al (2006) Dual-tasking effects on gait variability: the role of aging, falls, and executive function. Mov Disord 21:950–957
Stolze H, Vieregge P, Deuschl G (2008) Gait disturbances in neurology. Nervenarzt 79:485–499
Szameitat AJ, Schubert T, Muller K, Cramon DY von (2002) Localization of executive functions in dual-task performance with fMRI. J Cogn Neurosci 14:1184–1199
Tanaka A, Okuzumi H, Kobayashi I et al (1995) Gait disturbance of patients with vascular and Alzheimer-type dementias. Percept Mot Skills 80:735–738
Iersel MB van, Kessels RP, Bloem BR et al (2008) Executive functions are associated with gait and balance in community-living elderly people. J Gerontol A Biol Sci Med Sci 63:1344–1349
Verghese J, Lipton RB, Hall CB et al (2002) Abnormality of gait as a predictor of non-Alzheimer’s dementia. N Engl J Med 347:1761–1768
Verghese J, Wang C, Lipton RB et al (2007) Quantitative gait dysfunction and risk of cognitive decline and dementia. J Neurol Neurosurg Psychiatry 78:929–935
Visser H (1983) Gait and balance in senile dementia of Alzheimer’s type. Age Ageing 12:296–301
Weller I, Schatzker J (2004) Hip fractures and Alzheimer’s disease in elderly institutionalized Canadians. Ann Epidemiol 14:319–324
Yogev-Seligmann G, Hausdorff JM, Giladi N (2008) The role of executive function and attention in gait. Mov Disord 23:329–342
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Jamour, M., Becker, C., Synofzik, M. et al. Gangveränderungen als Frühindikator einer Demenz. Z Gerontol Geriat 45, 40–44 (2012). https://doi.org/10.1007/s00391-011-0260-8
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DOI: https://doi.org/10.1007/s00391-011-0260-8