Walking: What can it tell us about dementia?

Professor Lynn Rochester PhD

http://research.ncl.ac.uk/bam/@BAM_Research

• Links between gait & cognitive function

• Research illustrating the links

• Ongoing work in Newcastle

Improve existing management

Develop treatments to modify dementia/protect the brain

• Distinguish dementias • Early & predict risk• Track change

Diagnostic Markers

http://www.bsmp.co.uk/tests-and-results.aspx

http://nursingcrib.com/medical-laboratory-diagnostic-test/cerebrospinal-fluid-csf-analysis/

http://www.netdoctor.co.uk/procedures/examinations/a1161/mri-scan/

Walking speed: the 6th Vital Sign?

Fritz, et al.," J Geriatr Phys Ther, 32, 46-9, 2009

Age & speed predicts life expectancy

Studenski et al., 2011

Hickey et al., 2017

Walking in the real-world

Distracted walking

Non-motor substrates? 1,2,3

• Frontal cortex• Anterior cingulate• Hippocampus• Visual cortex• Association areas

1 Holtzer et al., 2014; 2 Annweiler et al., 2012; 3 Hamacher et al., 2015

Neural substrates

SMA/PMCDLPFC

Peripheral

Cortical

Subcortical

BrainstemSpinal Cord Bohnen NI, et al., 2011

Cognitive impairment & gait

Bahureska et al., 2017

Gait decline precedes & predicts cognitive decline, mild cognitive impairment & dementia

Cognition & gait share neurodegenerative mechanisms

• Robust relationship between gait & cognitive function

• Gait characteristics predict early changes in cognitive function in PD – marker of dementia risk?

What can gait analysis tell us about dementia & its subtypes? An integrated

study of brain & behaviour

Ríona Mc Ardle

Walking looks simple…

AsymmetryPostural Control

Rhythm VariabilityPace

Lord et al., 2013

Unique gait signatures?

The real world…

Gait assessment in the real-world

Habitual behaviours Gait analysisDel Din et al., 2015

Blondell et al., BMC Public Health, 2014 Norton et al., Lancet Neurology, 2014

• 7 modifiable risk factors for dementia (AD)

– diabetes, hypertension, obesity, inactivity, depression, smoking, low education

• Physical inactivity (increased risk of dementia)

Higher levels of PA associated with reduced risk of cog decline & dementia

Diagnostic Markers

http://www.bsmp.co.uk/tests-and-results.aspx

http://nursingcrib.com/medical-laboratory-diagnostic-test/cerebrospinal-fluid-csf-analysis/

http://www.netdoctor.co.uk/procedures/examinations/a1161/mri-scan/

http://blogs.plos.org/thestudentblog/author/rionamcardle/

http://research.ncl.ac.uk/bam/@BAM_Research

Acknowledgements

Brain & Movement Research:

Lynn Rochester

Brook Galna

Silvia Del-Din

Lisa Alcock

Annette Pantall

Carol Pringle

Sam Stuart

Rosie Morris

Riona McArdle

Heather Hunter

Philip Brown

Rodrigo Vitorio

Ellen Lirani

Michael Dunne-Willows

Sue LordAlan Godfrey