Gait and posture impairment, parkinsonism and cognitive decline in older people Article First Online: 04 July 2007 Received: 24 May 2007 Accepted: 10 June 2007 DOI:
Cite this article as: Camicioli, R., Wang, Y., Powell, C. et al. J Neural Transm (2007) 114: 1355. doi:10.1007/s00702-007-0778-5 Summary
Our objective was to examine the frequency of gait and posture impairment and parkinsonism in 3 waves of the Canadians Study of Health and Aging (CSHA) and to determine their relationship to the development of cognitive impairment-not dementia (CIND) and dementia. A secondary analysis of a Canadian population-based cohort study was performed. People 65 years of age and older without cognitive impairment or dementia underwent examination for the presence of gait or posture impairment (GPI) or parkinsonism (based on the presence of 2/3 signs among resting tremor, rigidity or bradykinesia), both defined by a clinical examination. Risk for development of cognitive impairment or dementia was examined at 5 and 10 year follow up in pre-specified logistic regression models adjusted for age, sex, education and in separate models, frailty. The frequency of GPI ranged from 25 to 30% in cognitively unimpaired to 46–53% in CIND and demented subjects. Parkinsonism was more common with increasing cognitive impairment at each wave of the CSHA. Both GPI and parkinsonism predicted cognitive decline. Frailty reduced, but did not eliminate the impact of these motor measures and was itself a significant predictor of cognitive decline. In conclusion, motor impairment and frailty are common in older people and are associated with an increased risk of cognitive decline and dementia. GPI is common in CIND, while GPI and parkinsonism are both common in dementia.
Keywords: Parkinsonism; dementia; cognitive impairment; gait and posture impairment References Aarsland, D, Andersen, K, Larsen, JP, Lolk, A, Kragh-Sorensen, P 2003 Prevalence and characteristics of dementia in Parkinson disease: an 8-year prospective study Arch Neurol 60 387 392 CrossRef PubMed Google Scholar 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 CrossRef PubMed Google Scholar
American Psychiatric Association. (1987) Diagnostic and statistical manual of mental disorders: DSM-III-R. American Psychiatric Association, Washington, DC
Arvanitakis, Z, Wilson, RS, Schneider, JA, Bienias, JL, Evans, DA, Bennett, DA 2004 Diabetes mellitus and progression of rigidity and gait disturbance in older persons Neurology 63 996 1001 PubMed Google Scholar Bennett, DA, Beckett, LA, Murray, AM, Shannon, KM, Goetz, CG, Pilgrim, DM, Evans, DA 1996 Prevalence of parkinsonian signs and associated mortality in a community population of older people N Engl J Med 334 71 76 CrossRef PubMed Google Scholar Bennett, HP, Piguet, O, Grayson, DA, Creasey, H, Waite, LM, Lye, T, Corbett, AJ, Hayes, M, Broe, GA, Halliday, GM 2006 Cognitive, extrapyramidal, and magnetic resonance imaging predictors of functional impairment in nondemented older community dwellers: the Sydney older person Study J Am Geriatr Soc 54 3 10 CrossRef PubMed Google Scholar Bloem, BR, Gussekloo, J, Lagaay, AM, Remarque, EJ, Haan, J, Westendorp, RG 2000 Idiopathic senile gait disorders are signs of subclinical disease J Am Geriatr Soc 48 1098 1101 PubMed Google Scholar Boyle, PA, Wilson, RS, Aggarwal, NT, Arvanitakis, Z, Kelly, J, Bienias, JL, Bennett, DA 2005 Parkinsonian signs in subjects with mild cognitive impairment Neurology 65 1901 1906 CrossRef PubMed Google Scholar Camicioli, R, Moore, MM, Sexton, G, Howieson, DB, Kaye, JA 1999 Age-related brain changes associated with motor function in healthy older people J Am Geriatr Soc 47 330 334 PubMed Google Scholar Canadian Study of Health and Aging Working Group 1994 Canadian Study of Health and Aging: Study methods and prevalence of dementia CMAJ 150 899 913 Google Scholar de Lau, LM, Schipper, CM, Hofman, A, Koudstaal, PJ, Breteler, MM 2005 Prognosis of Parkinson disease: risk of dementia and mortality: the Rotterdam Study Arch Neurol 62 1265 1269 CrossRef PubMed Google Scholar Ebly, EM, Hogan, DB, Parhad, IM 1995 Cognitive impairment in the nondemented elderly. Results from the canadian study of health and aging Arch Neurol 52 612 619 PubMed Google Scholar Ferrucci, L, Guralnik, JM, Studenski, S, Fried, LP, Cutler, GB, Jr, Walston, JD 2004 Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report J Am Geriatr Soc 52 625 634 CrossRef PubMed Google Scholar Fried, LP, Tangen, CM, Walston, J, Newman, AB, Hirsch, C, Gottdiener, J, Seeman, T, Tracy, R, Kop, WJ, Burke, G, McBurnie, MA 2001 Frailty in older adults: evidence for a phenotype J Gerontol A Biol Sci Med Sci 56 M146 M156 PubMed Google Scholar Gill, TM, Allore, H, Holford, TR, Guo, Z 2004 The development of insidious disability in activities of daily living among community-living older persons Am J Med 117 484 491 CrossRef PubMed Google Scholar Goetz, CG, Stebbins, GT 2004 Assuring interrater reliability for the UPDRS motor section: utility of the UPDRS teaching tape Mov Disord 19 1453 1456 CrossRef PubMed Google Scholar Graham, JE, Rockwood, K, Beattie, BL, McDowell, I, Eastwood, R, Gauthier, S 1996 Standardization of the diagnosis of dementia in the Canadian Study of Health and Aging Neuroepidemiology 15 246 256 CrossRef PubMed Google Scholar Graham, JE, Rockwood, K, Beattie, BL, Eastwood, R, Gauthier, S, Tuokko, H, McDowell, I 1997 Prevalence and severity of cognitive impairment with and without dementia in an elderly population Lancet 349 1793 1796 CrossRef PubMed Google Scholar Guttmann, CR, Benson, R, Warfield, SK, Wei, X, Anderson, MC, Hall, CB, Abu-Hasaballah, K, Mugler, JP, 3rd, Wolfson, L 2000 White matter abnormalities in mobility-impaired older persons Neurology 54 1277 1283 PubMed Google Scholar Kluger, A, Gianutsos, JG, Golomb, J, Ferris, SH, George, AE, Franssen, E, Reisberg, B 1997 Patterns of motor impairement in normal aging, mild cognitive decline, and early Alzheimer’s disease J Gerontol B Psychol Sci Soc Sci 52 P28 P39 PubMed Google Scholar Kuo, HK, Lipsitz, LA 2004 Cerebral white matter changes and geri?atric syndromes: is there a link? J Gerontol A Biol Sci Med Sci 59 818 826 PubMed Google Scholar Louis, ED, Schupf, N, Manly, J, Marder, K, Tang, MX, Mayeux, R 2005 Association between mild parkinsonian signs and mild cognitive impairment in a community Neurology 64 1157 1161 PubMed Google Scholar Louis, ED, Tang, MX, Mayeux, R 2004 Parkinsonian signs in older people in a community-based study: risk of incident dementia Arch Neurol 61 1273 1276 CrossRef PubMed Google Scholar Marquis, S, Moore, MM, Howieson, DB, Sexton, G, Payami, H, Kaye, JA, Camicioli, R 2002 Independent predictors of cognitive decline in healthy elderly persons Arch Neurol 59 601 606 CrossRef PubMed Google Scholar McKhann, G, Drachman, D, Folstein, M, Katzman, R, Price, D, Stadlan, EM 1984 Clinical diagnosis of Alzheimer’s disease: Report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s disease Neurology 34 939 944 PubMed Google Scholar Meara, J, Bhowmick, BK, Hobson, P 1999 Accuracy of diagnosis in patients with presumed Parkinson’s disease Age Ageing 28 99 102 CrossRef PubMed Google Scholar Mitchell, SL, Rockwood, K 2000 The association between parkinsonism, Alzheimer’s disease, and mortality: a comprehensive approach J Am Geriatr Soc 48 422 425 PubMed Google Scholar Mitchell, SL, Rockwood, K 2001 Defining parkinsonism in the canadian study of health and aging Int Psychogeriatr 13 107 113 CrossRef PubMed Google Scholar Mitnitski, A, Song, X, Skoog, I, Broe, GA, Cox, JL, Grunfeld, E, Rockwood, K 2005 Relative fitness and frailty of elderly men and women in developed countries and their relationship with mortality J Am Geriatr Soc 53 2184 2189 CrossRef PubMed Google Scholar Moroney, JT, Bagiella, E, Desmond, DW, Hachinski, VC, Molsa, PK, Gustafson, L, Brun, A, Fischer, P, Erkinjuntti, T, Rosen, W, Paik, MC, Tatemichi, TK 1997 Meta-analysis of the Hachinski ischemic score in pathologically verified dementias Neurology 49 1096 1105 PubMed Google Scholar Parkkinen, L, Kauppinen, T, Pirttila, T, Autere, JM, Alafuzoff, I 2005 Alpha-synuclein pathology does not predict extrapyramidal symptoms or dementia Ann Neurol 57 82 91 CrossRef PubMed Google Scholar Petersen, RC, Smith, GE, Waring, SC, Ivnik, RJ, Tangalos, EG, Kokmen, E 1999 Mild cognitive impairment: clinical characterization and outcome Arch Neurol 56 303 308 CrossRef PubMed Google Scholar Rao, G, Fisch, L, Srinivasan, S, D’Amico, F, Okada, T, Eaton, C, Robbins, C 2003 Does this patient have Parkinson disease? JAMA 289 347 353 CrossRef PubMed Google Scholar Richards, M, Stern, Y, Mayeux, R 1995 Subtle extrapyramidal signs and incident dementia: a follow-up analysis Neurology 45 1942 PubMed Google Scholar Richards, M, Touchon, J, Ledesert, B, Ritchie, K 2002 Mild extrapyramidal signs and functional impairment in ageing Int J Geriatr Psychiatry 17 150 153 CrossRef PubMed Google Scholar Rockwood, K 2005 Frailty and its definition: a worthy challenge J Am Geriatr Soc 53 1069 1070 CrossRef PubMed Google Scholar Rockwood, K, Song, X, MacKnight, C, Bergman, H, Hogan, DB, McDowell, I, Mitnitski, A 2005 A global clinical measure of fitness and frailty in elderly people CMAJ 173 489 495 PubMed Google Scholar Rosano, C, Kuller, LH, Chung, H, Arnold, AM, Longstreth, WT, Jr, Newman, AB 2005 Subclinical brain magnetic resonance imaging abnormalities predict physical functional decline in high-functioning older adults J Am Geriatr Soc 53 649 654 CrossRef PubMed Google Scholar Ross, GW, Petrovitch, H, Abbott, RD, Nelson, J, Markesbery, W, Davis, D, Hardman, J, Launer, L, Masaki, K, Tanner, CM, White, LR 2004 Parkinsonian signs and substantia nigra neuron density in decendents elders without PD Ann Neurol 56 532 539 CrossRef PubMed Google Scholar Schneider, JA, Li, JL, Li, Y, Wilson, RS, Kordower, JH, Bennett, DA 2006 Substantia nigra tangles are related to gait impairment in older persons Ann Neurol 59 166 173 CrossRef PubMed Google Scholar Schrag, A, Ben-Shlomo, Y, Quinn, N 2002 How valid is the clinical diagnosis of Parkinson’s disease in the community? J Neurol Neurosurg Psychiatry 73 529 534 CrossRef PubMed Google Scholar Starr, JM, Leaper, SA, Murray, AD, Lemmon, HA, Staff, RT, Deary, IJ, Whalley, LJ 2003 Brain white matter lesions detected by magnetic resosnance imaging are associated with balance and gait speed J Neurol Neurosurg Psychiatry 74 94 98 CrossRef PubMed Google Scholar Teng, EL, Chui, HC 1987 The Modified mini-mental state (3MS) examination J Clin Psychiatry 48 314 318 PubMed Google Scholar Verghese, J, Levalley, A, Hall, CB, Katz, MJ, Ambrose, AF, Lipton, RB 2006 Epidemiology of gait disorders in community-residing older adults J Am Geriatr Soc 54 255 261 CrossRef PubMed Google Scholar Verghese, J, Lipton, RB, Hall, CB, Kuslansky, G, Katz, MJ, Buschke, H 2002 Abnormality of gait as a predictor of non-Alzheimer’s dementia N Engl J Med 347 1761 1768 CrossRef PubMed Google Scholar Waite, LM, Grayson, DA, Piguet, O, Creasey, H, Bennett, HP, Broe, GA 2005 Gait slowing as a predictor of incident dementia: 6-year longitudinal data from the Sydney Older Persons Study J Neurol Sci 229–230 89 93 CrossRef PubMed Google Scholar Wilson, RS, Schneider, JA, Bienias, JL, Evans, DA, Bennett, DA 2003 Parkinsonianlike signs and risk of incident Alzheimer disease in older persons Arch Neurol 60 539 544 CrossRef PubMed Google Scholar
World Health Organization (1992) International statistical classification of diseases and related health problems, 10th revision. World Health Organization, Geneva