Cerebrovascular disease and gait and balance impairment in mild to moderate Alzheimer’s disease

Abstract

Objectives

Gait and movement abnormalities are traditionally considered infrequent in patients with mild/moderate Alzheimer’s disease (AD). However, an increased risk of falls and gait abnormalities has been detected, even in early stages of the disease. Whether these abnormalities are associated with cerebrovascular disease, which has a high prevalence in AD, remains unclear.

Design

Cross-sectional study.

Setting

Dementia outpatient clinics.

Participants

24 mild/moderate AD patients with (AD+CVD) and 20 without (AD-CVD) cerebrovascular disease without a history of stroke and antipsychotic medications.

Measurements

Physical performance, measured with the Short Physical Performance Battery [SPPB], a summary measure combining 4-meter gait speed, balance and muscle strength, and with 8-meter gait speed with a turn was compared between the two groups.

Results

AD+CVD patients showed a significant higher prevalence of 4-meter gait speed slower than 0,8 m/s (37.5% Vs 5%, p-value=0.01) and balance impairment (37.5% Vs 10%, p-value=0.038), as well as a slower 8-meter gait speed with a turn (mean+SD=0.6±0.2 Vs 0.8±0.2, p-value=0.024). These associations were confirmed in multivariable models. No differences were observed for muscle strength.

Conclusion

In our sample, AD with cerebrovascular disease had worse gait and balance than AD without cerebrovascular disease. If confirmed, these results may have clinical implications, since cerebrovascular disease can be potentially prevented.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. 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 1984;34(7):939–944.

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Reisberg B, Ferris SH, de Leon MJ, Crook T. The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatry 1982;139(9):1136–1139.

    PubMed  CAS  Google Scholar 

  3. 3.

    Morris JC, Rubin EH, Morris EJ, Mandel SA. Senile dementia of the Alzheimer’s type: an important risk factor for serious falls. J Gerontol 1987;42(4):412–417.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Sheridan PL, Solomont J, Kowall N, Hausdorff JM. Influence of executive function on locomotor function: divided attention increases gait variability in Alzheimer’s disease. J Am Geriatr Soc 2003;51(11):1633–1637.

    PubMed  Article  Google Scholar 

  5. 5.

    Pettersson AF, Engardt M, Wahlund LO. Activity level and balance in subjects with mild Alzheimer’s disease. Dement Geriatr Cogn Disord 2002;13(4):213–216.

    PubMed  Article  Google Scholar 

  6. 6.

    Wang L, Larson EB, Bowen JD, van BG. Performance-based physical function and future dementia in older people. Arch Intern Med 2006 22;166(10):1115–1120.

    PubMed  Article  Google Scholar 

  7. 7.

    Donaldson C, Tarrier N, Burns A. Determinants of carer stress in Alzheimer’s disease. Int J Geriatr Psychiatry 1998;13(4):248–256.

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Scarmeas N, Albert M, Brandt J, Blacker D, Hadjigeorgiou G, Papadimitriou A, et al. Motor signs predict poor outcomes in Alzheimer disease. Neurology 2005 24;64(10):1696–1703.

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Baezner H, Blahak C, Poggesi A, Pantoni L, Inzitari D, Chabriat H, et al. Association of gait and balance disorders with age-related white matter changes: the LADIS study. Neurology 2008 18;70(12):935–942.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Zekry D, Hauw JJ, Gold G. Mixed dementia: epidemiology, diagnosis, and treatment. J Am Geriatr Soc 2002;50(8):1431–1438.

    PubMed  Article  Google Scholar 

  11. 11.

    Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 1993;43(2):250–260.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 1995;332(9):556–561.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Katula JA, Kritchevsky SB, Guralnik JM, Glynn NW, Pruitt L, Wallace K, et al. Lifestyle Interventions and Independence for Elders pilot study: recruitment and baseline characteristics. J Am Geriatr Soc 2007;55(5):674–683.

    PubMed  Article  Google Scholar 

  14. 14.

    Abellan van KG, Rolland Y, Andrieu S, Bauer J, Beauchet O, Bonnefoy M, et al. Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force. J Nutr Health Aging 2009;13(10):881–889.

    Article  Google Scholar 

  15. 15.

    Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12(3):189–198.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Esteban-Santillan C, Praditsuwan R, Ueda H, Geldmacher DS. Clock drawing test in very mild Alzheimer’s disease. J Am Geriatr Soc 1998;46(10):1266–1269.

    PubMed  CAS  Google Scholar 

  17. 17.

    Benito-Cuadrado MM, Esteba-Castillo S, Bohm P, Cejudo-Bolivar J, Pena-Casanova J. Semantic verbal fluency of animals: a normative and predictive study in a Spanish population. J Clin Exp Neuropsychol 2002;24(8):1117–1122.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Md State Med J 1965 Feb;14:61–65.: 61–5.

    PubMed  CAS  Google Scholar 

  19. 19.

    Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9(3):179–186.

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Jokinen H, Kalska H, Ylikoski R, Madureira S, Verdelho A, van der Flier WM, et al. Longitudinal cognitive decline in subcortical ischemic vascular disease—the LADIS Study. Cerebrovasc Dis 2009;27(4):384–391.

    PubMed  Article  Google Scholar 

  21. 21.

    Inzitari M, Baldereschi M, Di CA, Di BM, Marchionni N, Scafato E, et al. Impaired attention predicts motor performance decline in older community-dwellers with normal baseline mobility: results from the Italian Longitudinal Study on Aging (ILSA). J Gerontol A Biol Sci Med Sci 2007;62(8):837–843.

    PubMed  Article  Google Scholar 

  22. 22.

    Nadkarni NK, McIlroy WE, Mawji E, Black SE. Gait and subcortical hyperintensities in mild Alzheimer’s disease and aging. Dement Geriatr Cogn Disord 2009;28(4):295–301.

    PubMed  Article  Google Scholar 

  23. 23.

    Verghese J, Lipton RB, Hall CB, Kuslansky G, Katz MJ, Buschke H. Abnormality of gait as a predictor of non-Alzheimer’s dementia. N Engl J Med 2002;347(22):1761–1768.

    PubMed  Article  Google Scholar 

  24. 24.

    Littbrand H, Stenvall M, Rosendahl E. Applicability and effects of physical exercise on physical and cognitive functions and activities of daily living among people with dementia: a systematic review. Am J Phys Med Rehabil 2011;90(6):495–518.

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Marco Inzitari.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Inzitari, M., Gine-Garriga, M., Martinez, B. et al. Cerebrovascular disease and gait and balance impairment in mild to moderate Alzheimer’s disease. J Nutr Health Aging 17, 45–48 (2013). https://doi.org/10.1007/s12603-012-0091-3

Download citation

Key words

  • Alzheimer’s disease
  • physical function gait
  • falls
  • cerebrovascular