Non-neurological factors are implicated in impairments in gait and mobility among patients in a clinical dementia referral population

Although gait abnormalities have been previously noted in dementia, their non-neurological correlates have not been examined. We used data on 900 consecutive outpatients assessed from 1994 to 1999 in the University of Nebraska Geriatric Assessment Clinic Data Base (UN-GAC) to examine the prevalence of gait disorders and the relationship of gait disorders to physical illness in Alzheimer's disease (AD) and non-AD dementia. Gait disorders were very prevalent at each level of cognitive function [58.7% for CDR = 0, 68.0% for CDR = 0.5, 57.9% for CDR = 1, 68.1% for CDR = 2 and 76.9% for CDR = 3, p = 0.02] and were more frequently observed in AD patients with poorer cognitive function. Among all demented patients, 45.0% of those without gait impairment were ADL independent compared to 11.8% of those with gait impairment. In adjusted logistic regression models, the presence of a gait disorder among AD patients was significantly associated with older age (Odds Ratio (OR) = 1.09, 95% Confidence Intervals (CI) = 1.04-1.15), special sensory (2.19, 1.17-4.12), and lower GI (3.57, 1.97-6.47) dysfunction. The prevalence of gait disorders is high in even mildly demented persons and associated with common and often treatable organ system dysfunction. Because gait disorders are also associated with a high prevalence of ambulatory disability, attention to co morbid illnesses implicated in gait impairment may reduce the burden of disability in this population.