Journal of Neurology

, Volume 252, Issue 3, pp 300–306 | Cite as

Clinical characteristics of elderly patients with a cautious gait of unknown origin

  • N. Giladi
  • T. Herman
  • I. I. Reider-Groswasser
  • T. Gurevich
  • J. M. Hausdorff



To evaluate and systematically characterize a group of older adults with disturbed gait of unknown origin.


Cross–sectional study.


Outpatient clinic in a movement disorders unit.


Twenty–five patients (mean age 78.4 years) with a disturbed gait of unknown origin were compared with twenty–eight age matched ”healthy” controls (mean age 78.2).


Detailed medical history, geriatric and neurological assessments.


Patients walked more slowly (P < 0.0001) and with shorter strides (P < 0.0001) compared with controls. Muscle strength was lower, and static and dynamic balance and gait performance were worse among the patients (P < 0.0001). The patients also tended to be more depressed (P < 0.0001),more anxious (P < 0.002), had a greater fear of falling (P < 0.0001) and had lower scores on the Mini–Mental State Examination (P < 0.005). There was no difference in the frequency of cerebellar or pyramidal signs in the two groups. However, neurological testing revealed that extrapyramidal (P < 0.0001) and frontal release signs (P < 0.0001) were more common among the patients. Neuroradiological findings were rare among the patients and they did not explain the changes in gait speed or fear of falling.


Older adults with a disturbed gait of unknown origin appear to share common characteristics. They walk more slowly than “healthy” controls with increased unsteadiness and with excessive fear of falling. The extrapyramidal, frontal lobe, and limbic systems apparently play an important role, to different degrees, in what can be viewed as a multisystem neurodegenerative syndrome clearly different from ”aging.”

Key words

gait disequilibrium fear of falling aging 


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  1. 1.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders. Washington DC, American Psychiatric Association, Washington, pp 393–400Google Scholar
  2. 2.
    Andrews AW, Thomas MW, Bohannon RW (1996) Normative values for isometric muscle force measurements obtained with hand-held dynamometers. Phys Ther 76:248–259Google Scholar
  3. 3.
    Baloh RW,Yue Q, Socotch TM, Jacobson KM (1995) White matter lesions and disequilibrium in older people. I. Case-control comparison. Arch Neurol 52:970–974Google Scholar
  4. 4.
    Benson RR, Guttmann CR, Wei X, Warfield SK, Hall C, Schmidt JA, Kikinis R, Wolfson LI (2002) Older people with impaired mobility have specific loci of periventricular abnormality on MRI. Neurology 58:48–55Google Scholar
  5. 5.
    Beversdorf DQ, Heilman KM (1998) Facilitory paratonia and frontal lobe functioning. Neurology 51:968–971Google Scholar
  6. 6.
    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 48:1098–1101Google Scholar
  7. 7.
    Bloem BR,Haan J, Lagaay AM, van Beek W, Wintzen AR, Roos RA (1992) Investigation of gait in elderly subjects over 88 years of age. J Geriatr Psychiatry Neurol 5:78–84Google Scholar
  8. 8.
    Bootsma-van der Wiel A, Gussekloo J, De Craen AJ, Van Exel E, Bloem BR, Westendorp RG (2002) Common chronic diseases and general impairments as determinants of walking disability in the oldest-old population. J Am Geriatr Soc 50:1405–1410Google Scholar
  9. 9.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefPubMedGoogle Scholar
  10. 10.
    Collin C, Wade DT, Davies S, Horne V (1988) The Barthel ADL Index: a reliability study. Int Disabil Stud 10:61–63Google Scholar
  11. 11.
    Demirkiran M, Bozdemir H, Sarica Y (2001) Vascular parkinsonism: a distinct, heterogeneous clinical entity. Acta Neurol Scand 104:63–67Google Scholar
  12. 12.
    Duncan PW, Weiner DK, Chandler J, Studenski S (1990) Functional reach: a new clinical measure of balance. J Gerontol 45:M192–M197Google Scholar
  13. 13.
    Factor SA, Jennings DL, Molho ES, Marek KL (2002) The natural history of the syndrome of primary progressive freezing gait. Arch Neurol 59:1778–1783Google Scholar
  14. 14.
    Fahn S, Elton RL, UPDRS development committee (1987) Unified Parkinson’s disease rating scale. In: Fahn S,Marsden CD, Calne DB,Goldstein M (eds) Recent developments in Parkinson’s disease. Florham Park: NJ, pp 153–163Google Scholar
  15. 15.
    Fife TD, Baloh RW (1993) Disequilibrium of unknown cause in older people. Ann Neurol 34:694–702Google Scholar
  16. 16.
    Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198Google Scholar
  17. 17.
    Guttmann CR, Benson R,Warfield SK, Wei X, Anderson MC, Hall CB, Abu- Hasaballah K, Mugler JP III, Wolfson L (2000) White matter abnormalities in mobility-impaired older persons. Neurology 54:1277–1283Google Scholar
  18. 18.
    Jankovic J, Nutt JG, Sudarsky L (2001) Classification, diagnosis, and etiology of gait disorders. Adv Neurol 87:119–133Google Scholar
  19. 19.
    Koller WC, Glatt SL, Fox JH (1985) Senile gait.A distinct neurologic entity. Clin Geriatr Med 1:661–669Google Scholar
  20. 20.
    Nutt JG (2001) Classification of gait and balance disorders. Adv Neurol 87:135–141Google Scholar
  21. 21.
    Nutt JG, Marsden CD, Thompson PD (1993) Human walking and higherlevel gait disorders, particularly in the elderly. Neurology 43:268–279Google Scholar
  22. 22.
    Oguro H, Okada K, Suyama N, Yamashita K, Yamaguchi S, Kobayashi S (2004) Decline of vertical gaze and convergence with aging. Gerontology 50:177–181Google Scholar
  23. 23.
    Podsiadlo D, Richardson S (1991) The timed “Up and Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148PubMedGoogle Scholar
  24. 24.
    Powell LE, Myers AM (1995) The Activities-specific Balance Confidence (ABC) Scale. J Gerontol A Biol Sci Med Sci 50A:M28–M34Google Scholar
  25. 25.
    Rajput A, Rajput AH (2001) Progressive supranuclear palsy: clinical features, pathophysiology and management. Drugs Aging 18:913–925Google Scholar
  26. 26.
    Spielberger CD, Gorsuch RL, Lushene RE (1983) State-Trait Anxiety Inventory. Self-evaluation questionnaire (form Y). In: Manual for the State-Trait Anxiety Inventory. Palo Alto, CAGoogle Scholar
  27. 27.
    Sudarsky L (1990) Geriatrics: gait disorders in the elderly. N Engl J Med 322:1441–1446Google Scholar
  28. 28.
    Sudarsky L (2001) Gait disorders: prevalence,morbidity, and etiology. Adv Neurol 87:111–117Google Scholar
  29. 29.
    Suzuki M, Ohyama N, Yamada K, Kanamori M (2002) The relationship between fear of falling, activities of daily living and quality of life among elderly individuals. Nurs Health Sci 4:155–161Google Scholar
  30. 30.
    Tinetti ME (1986) Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 34:119–126PubMedGoogle Scholar
  31. 31.
    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 347:1761–1768Google Scholar
  32. 32.
    Whitman GT, DiPatre PL, Lopez IA, Liu F, Noori NE, Vinters HV, Baloh RW (1999) Neuropathology in older people with disequilibrium of unknown cause. Neurology 53:375–382Google Scholar
  33. 33.
    Whitman GT, Tang Y, Lin A, Baloh RW, Tang T (2001) A prospective study of cerebral white matter abnormalities in older people with gait dysfunction. Neurology 57:990–994Google Scholar
  34. 34.
    Whittle M W (1996) Gait analysis – an introduction. Butterworth-Heinemann, Oxford OX2 8DP, pp 105–160Google Scholar
  35. 35.
    Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO (1982) Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 17:37–49Google Scholar
  36. 36.
    Zeilinger FS, Meier U (1998) Clinically suspected normal-pressure hydrocephalus diagnosis–current status of diagnosis and therapy. Z Arztl Fortbild Qualitatssich 92:495–501Google Scholar
  37. 37.
    Ziv I, Avraham M, Michaelov Y, Djaldetti R, Dressler R, Zoldan J, Melamed E (1998) Enhanced fatigue during motor performance in patients with Parkinson’s disease. Neurology 51:1583–1586Google Scholar

Copyright information

© Steinkopff Verlag 2005

Authors and Affiliations

  • N. Giladi
    • 2
    • 4
  • T. Herman
    • 2
    • 4
  • I. I. Reider-Groswasser
    • 1
    • 2
  • T. Gurevich
    • 2
    • 4
  • J. M. Hausdorff
    • 2
    • 3
    • 4
  1. 1.Section of Neuro-radiologyDept. of Imaging Tel-Aviv Sourasky Medical CenterTel-AvivIsrael
  2. 2.Depts. of Physical Therapy, Neurology and Diagnostic Imaging Sackler Faculty of Medicine Tel-Aviv UniversityTel-AvivIsrael
  3. 3.Division on AgingHarvard Medical SchoolBoston (MA)USA
  4. 4.Movement Disorders UnitTel-Aviv Sourasky Medical CenterTel-AvivIsrael

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