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Neurologic gait disorders of elderly people

Author
Michael Ronthal, MD
Section Editors
Howard I Hurtig, MD
Kenneth E Schmader, MD
Deputy Editor
John F Dashe, MD, PhD

INTRODUCTION

Gait disorders are a major cause of functional impairment and morbidity in the elderly population. Most gait disorders in elderly people are multifactorial and have both neurologic and non-neurologic components. Furthermore, gait disturbances in the elderly are a risk factor for future cardiovascular disease and dementia [1].

This topic will review the physiologic and clinical aspects of age-related gait disorders, with an emphasis on neurologic causes.

Falling in the elderly is discussed separately. (See "Falls in older persons: Risk factors and patient evaluation" and "Falls: Prevention in community-dwelling older persons".)

PHYSIOLOGY OF GAIT

Walking is easy; we do it all the time. It may be a purely automatic movement, or we can take control and consciously direct our gait. The underlying mechanisms are complex, and only if we understand the physiology can we make sense of the pathophysiology [2].

Intimately associated with the propulsive movement that we call gait is the control of balance and posture, both at rest and with movement. The center of gravity must be kept within the vertical projections of a narrow base. In humans, two-thirds of the total body weight is centered in the upper body, which makes for inherent instability. The limits of stability have been defined as an inverted cone with the apex at the feet and the base defining a perimeter at the head. Sway outside of the perimeter results in instability. The dimensions of the base of the cone are roughly 12.5 degrees in the anteroposterior diameter and 16 degrees laterally [3].

                    

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Literature review current through: Nov 2016. | This topic last updated: Fri Mar 27 00:00:00 GMT+00:00 2015.
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