Cognitive contributions to gait and falls: evidence and implications

Abstract

Dementia and gait impairments often coexist in older adults and patients with neurodegenerative disease. Both conditions represent independent risk factors for falls. The relationship between cognitive function and gait has recently received increasing attention. Gait is no longer considered merely automated motor activity but rather an activity that requires executive function and attention as well as judgment of external and internal cues. In this review, we intend to: (1) summarize and synthesize the experimental, neuropsychological, and neuroimaging evidence that supports the role played by cognition in the control of gait; and (2) briefly discuss the implications deriving from the interplay between cognition and gait. In recent years, the dual task paradigm has been widely used as an experimental method to explore the interplay between gait and cognition. Several neuropsychological investigations have also demonstrated that walking relies on the use of several cognitive domains, including executive-attentional function, visuospatial abilities, and even memory resources. A number of morphological and functional neuroimaging studies have offered additional evidence supporting the relationship between gait and cognitive resources. Based on the findings from 3 lines of studies, it appears that a growing body of evidence indicates a pivotal role of cognition in gait control and fall prevention. The interplay between higher-order neural function and gait has a number of clinical implications, ranging from integrated assessment tools to possible innovative lines of interventions, including cognitive therapy for falls prevention on one hand and walking program for reducing dementia risk on the other.

Keywords: aging; cognitive function; executive function; falls; gait; neuroimaging.

FIG. 1

Traditionally, cognitive impairment predicted dementia, whereas gait abnormalities increased the risk for falling (shaded arrows). A more complete understanding suggests that cognitive impairment and gait abnormalities, as well as dementia and falls, are associated with each other (white arrows). According to recent evidence, gait abnormalities predict dementia and cognitive impairment increases falls risk (gray arrows); based on the close relationship between cognition and gait, on one hand, integrated tools for risk estimation are needed (bracket), on the other hand, possible lines of intervention (black arrows) could rely on enhancing cognition for falls prevention and on walking training for lessening dementia risk. Adapted from Montero-Odasso et al.