Background/Purpose

Gait instability which represents a common but non-specific complaint, mainly in the elderly, is of major interest in PubMed (6038 references). Gait Instability can be the first step towards risk of falling, exposure to dementia, and disability [1]. Despite the frequency of this symptom and its major devastating consequences, few dedicated out-patients consultations have been initiated, in order to provide a practical management approach. A two year study will highlight the interest and perspectives of such an out-patients consultation.

Methods

Patients were recommended either by their general practitioner for gait abnormalities, or following an out-patients memory consultation. The assessment included six steps: self-questionnaires (Dizziness Handicap Inventory, Hospital Anxiety and Depression Scale), nurse evaluation, balance tests (one leg balance, Timed Up and Go score, Timed chair rise test), Mini Mental Score, clinical examination, and ambulatory Gait Analysis under simple and dual task conditions (counting backwards). We measured, using a validated ambulatory gait analysis system (Locometrix^®), 3 main gait variables: walking speed, cadence, and stride regularity index. According to the results, additional specialized out-patients consultation and tests can be carried out (geriatrician, neurologist, otolaryngologist, brain magnetic resonance imaging…)

Results

– 80 patients were included (M=41, F=39, age: 68±14 y, BMI: 25±5 kg/m²)

– 3 main subgroups of patients with gait complaints were identified (gait instability and cautious gait (n=38), recurrent falls (n=24) and memory impairment (n=18),

– Gait analysis was found with no abnormality in thirteen patients under simple task, in these cases gait abnormalities occurred only during the dual task test

– A broad diversity of diagnosis and syndromes were identified as the main pathology (Mild Cognitive Impairment (n=23), dementia (n=9), leukoaraiosis (n=9),vestibular disease (n=7), frail people (n=9), musculoskeletal disorders including spinal stenosis (n=7), brain stroke attack sequel (n=6), hydrocephaly (n=2), peripheral neuropathy (n=1), Charcot Marie Tooth disease (n=1), myopathy (Facio-scapulo-humeral dystrophy) (n=1), brain haemosiderosis (n=1), and patients without any diagnosis (n=4).

Conclusion

The complaint of gait instability has to be taken into account by the clinician, and necessitates a multi-disciplinary network. Clinical examination remains a key point, but gait analysis provides a measurement of gait instability, which can sometimes occur only under dual task conditions. A decrease in gait variability under the dual task test may explain the mechanism of an unexplained fall. Moreover a large decrease in one or more of the gait variables highlights for the clinician about a decrease in the cognitive reserve of the patient. Thus this condition provides key information to the clinician who has to look for brain pathology in addition to musculoskeletal deterioration.

1 Montero-Odasso M et al. Gait and cognition: a complementary approach to understanding brain function and the risk of falling. JAGS 2012; 60: 2127-36.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/gait-instability-in-the-elderly-a-new-dedicated-out-patients-consultation/