Geriatrics: gait disorders in the elderly

Article Abstract:

Many elderly people have problems with gait, or the manner of walking, that contribute to the incidence of falling. The mechanical, anatomical and physiological factors of normal gait is reviewed. The effects of aging on gait include the increase of sway while standing, slowed responses of postural support for balance, and change in the capacity to integrate sensory information. Studies have shown that people over the age of 65 use shorter, broader-based strides to compensate for the change in balance and walk more slowly. There are two general causes of gait disorders: those that affect the muscles and skeleton, such as myelopathy (diseases of the muscles), degenerative arthritis of the spine, spinal cord compression (causing bony protrusions of the spine), and vitamin B12 deficiency; and neurologic abnormalities, such as Parkinson's disease, sequelae from stroke, cerebellar degeneration, disorders of sensory afferent systems, and encephalopathy (abnormalities of the structure or function of the tissues of the brain) due to the toxicity of medications or adverse effects of medications on the body's metabolism. A number of other factors can also occasionally cause gait disorders. The evaluation of patients with gait disorders should include a history of the patient, a physical examination concentrating on musculoskeletal, visual, and neurologic abnormalities, observation of the patient's gait, assessment of balance, and other testing when appropriate, such as CT scanning or magnetic resonance imaging. The type of treatment depends on the cause of the gait disorder. Approximately one of four gait disorders is treatable, and physical therapy with gait training is recommended for all patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Causes of, Complications and side effects, Medical examination, Neuromuscular diseases, Gait disorders, Gait

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A 68-year-old woman with rapidly progressive dementia and a gait disorder

Article Abstract:

A 68-year-old woman was admitted to a hospital because she had become confused and disoriented over a three-month period and had difficulty walking. Because her symptoms developed so suddenly and she had no family history of dementia, her doctors suspected a brain disease called Creutzfeldt-Jakob disease. This disease belongs to a class of diseases called spongiform encephalopathies or prion diseases. They are caused by a defect in a normal brain protein called prion protein. The defective protein accumulates in the brain and damages nerve cells. An MRI scan of the brain and a brain biopsy confirmed the diagnosis.

Creutzfeldt-Jakob disease

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A 64-year-old man with progressive dementia, seizures, and unstable gait

Article Abstract:

A 64-year-old man presented with symptoms of dementia, slow movements, unstable gait, rigidity, and visual tracking abnormalities. His condition deteriorated over the ensuing months, and he died at age 68. Although his neurologic symptoms suggest several possible diagnoses, his rigidity without tremor and impairment of visual tracking are core symptoms of progressive supranuclear palsy, and dementia may be a feature of this disease. However, unusual presentations of certain other diseases cannot be ruled out. Analysis of brain tissue at autopsy confirmed the diagnosis of progressive supranuclear palsy.

Diagnosis, Dementia, Progressive supranuclear palsy

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