Gait impairment and falls in cognitively impaired older adults: an explanatory model of sensorimotor and neuropsychological mediators.

OBJECTIVES to explore the associations between spatiotemporal gait parameters and falls in cognitively impaired older people and to investigate whether sensorimotor and neuropsychological factors mediate the association between gait performance and falls. DESIGN prospective cohort study with a 1 year follow-up. SETTING community-dwelling sample. PARTICIPANTS sixty-four participants (62-96 years of age) with cognitive impairment. MEASUREMENTS gait analysis and sensorimotor and neuropsychological functions were assessed in all participants. Falls were identified prospectively for 1 year. RESULTS multiple fallers (≥2 falls) had significantly slower gait velocity, shorter stride length, greater double support time and increased step length variability in univariate analyses. Multivariate logistic regression indicated that the relationship between gait and falls was mediated primarily by sensorimotor function and to a lesser extent by neuropsychological performance. CONCLUSION the findings indicate that slow and variable gait patterns increase the risk of falls in cognitively impaired older adults. Further, the association between gait and falls seems to be mediated in large by reduced sensorimotor functioning. Further research is needed to investigate whether interventions aimed at improving gait and/or sensorimotor fall risk factors, such as strength and balance, can prevent falls in cognitively impaired older adults.