Cognition, gait disorders, and fall risk in healthy neurological older individuals

Abstract

Clinicians and researchers have commonly performed gait and cognitive assessments separately when evaluating older adults. Evidence from clinical practice, epidemiological studies, and clinical trials shows that gait and cognition are interrelated. Quantifiable alterations in gait among older adults are associated with falls, dementia, and disability. At the same time, emerging evidence indicates that early disturbances in cognitive processes such as attention, executive function, and working memory are associated with slower gait and gait instability and also with future mobility loss, falls, and progression to dementia. This chapter reviews the importance of the gait-cognition interrelationship in aging and presents evidence that gait performance mirrors cognitive function and provides insights about how brain and gait control contributes to fall risk in older people. To this end, the benefits of dual-task gait assessments (e.g., walking while performing a cognitive-demanding task) as a marker of fall risk are presented. Finally, evidence from an emerging therapeutic approach for reducing the risk of falls by improving certain aspects of cognition through both non-pharmacological and pharmacological treatments is reviewed. Disentangling the relationship between gait disturbances and cognitive changes at their earlier stages may be helpful for identifying older adults at higher risk of experiencing mobility decline and falls.