Neurologic gait disorders of elderly people
- Michael Ronthal, MD
Michael Ronthal, MD
- Professor of Neurology
- Harvard Medical School
- Section Editors
- Howard I Hurtig, MD
Howard I Hurtig, MD
- Section Editor — Movement Disorders
- Professor of Neurology
- University of Pennsylvania School of Medicine
- Kenneth E Schmader, MD
Kenneth E Schmader, MD
- Editor in Chief — Geriatric Medicine
- Section Editor — Geriatrics
- Chief, Division of Geriatrics
- Duke University
- Director, Geriatric Research Education and Clinical Center
- Durham VA Medical Centers
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 .
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 .
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 .
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- PHYSIOLOGY OF GAIT
- Spinal centers
- Higher centers
- EPIDEMIOLOGY AND IMPACT
- NEUROLOGIC CAUSES
- Extrapyramidal disorders
- Cerebellar ataxia
- Vestibular dysfunction
- Frontal lobe dysfunction
- Idiopathic gait disorder of old age
- Orthostatic myoclonus
- Functional gait disorder
- Confusional state
- NON-NEUROLOGIC CAUSES