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Cognitive contributions to gait and falls: Evidence and implications

Authors

  • Marianna Amboni MD, PhD,

    1. Isituto di Diagnosi e Cura Hermitage-Capodimonte, Naples, Italy
    2. Neurodegenerative Diseases Center, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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  • Paolo Barone MD, PhD,

    1. Neurodegenerative Diseases Center, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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  • Jeffrey M. Hausdorff PhD

    Corresponding author
    1. Laboratory for Gait Analysis and Neurodynamics, Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
    2. Department of Physical Therapy, Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
    3. Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
    • Correspondence to: Dr. Jeffrey M. Hausdorff, Laboratory for Gait Analysis and Neurodynamics, Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel; jhausdor@tasmc.health.gov.il

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  • Relevant conflicts of interest/financial disclosures: Nothing to report.

  • Full financial disclosures and author roles may be found in the online version of this article.

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. © 2013 International Parkinson and Movement Disorder Society

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