Progressive nature of a higher level gait disorder: a 3-year prospective study.

The objective of the study was to characterize the natural history of patients with a higher level gait disorder (HLGD) of the cautious/disequilibrium type in a 3-year prospective study. Subjects were taken from an outpatient setting in a movement disorders clinic. Twenty-two mobile, community-living patients with a HLGD of the cautious/disequilibrium type and 26 age- and gender-matched healthy controls were evaluated at baseline and approximately 3 years later. Detailed medical history, a complete, structured geriatric and neurological examination, mental and affective state, gait and balance assessment were obtained. At follow-up, marked declines were observed in gait, mobility and functional independence in the patients, but not in the controls. For example, 23% of the patients could not complete the Timed Up and Go test, compared to only 4% of the control group, and among those who could complete the test, time to completion was almost three times longer (P < 0.0001) in the patients (23 s), compared to the controls (8 s). At follow-up, 50% of the patients required a personal live-in caregiver compared to only 4% of the controls (P < 0.0001). Although mild extra-pyramidal, pyramidal, cognitive and affective alterations were observed at baseline in the patients, those symptoms were stable over time. Unexpectedly, there was no association between the presence of HLGD or its progression and vascular risk factors. HLGD is a debilitating, rapidly progressive disease. The profound deterioration in functional independence in a relatively short period of time suggests that early multidisciplinary interventions may be the appropriate clinical approach to the treatment of these patients who are at risk for a rapid decline in functional abilities.

Freezing of gait in older adults with high level gait disorders: association with impaired executive function.

Freezing of gait (FOG) is frequently observed in high level gait disorders (HLGD), but its relationship to disease progression and cognitive function is unknown. To study this relationship, episodic gait disturbances, affect and cognitive function were assessed in twenty-five patients with HLGD (mean age: 78.2 +/- 5.0 yrs). After a mean of 32.2 +/- 4.2 months, twenty-two patients were reassessed. FOG was observed in 20% of the patients at baseline and in 40% at follow-up. The presence of FOG was associated with significant mobility disturbances, functional deterioration as well as poor performance on the frontal neuropsychological assessment battery (Dementia Rating Scale - initiation sub-score) at follow-up. Depression, anxiety and fear of falling were not correlated with the presence of FOG at baseline or follow-up. These results indicate that FOG is common in HLGD, and that it is associated with significant functional disability and a specific frontal cognitive disturbance of initiation.