Senior Citizens Who Walk Slowly Can Expect Dementia
to Catch Up with Them
Series of research reports in recent years have dire
predictions for slow walking seniors, including a shorter life
25, 2014 – If you are a senior citizen and you walk very slowly, you
have some things to worry about. The latest is a report from a study of
27,000 seniors age 60 or older that declares it can predict dementia in
the future of those who walk slowly and have cognitive complaints.
Another study early this year says slow walking seniors are less happy
and have shorter longevity. In fact, a study of seniors in 2011 says how
fast they walk is a better gage of how long they will live than trying
to do a more complicated analysis of their medical condition and
The new study involving older adults on five
continents found that nearly 1 in 10 met criteria for pre-dementia based
on a simple test that measures how fast people walk and whether they
have cognitive complaints.
People who tested positive for pre-dementia were
twice as likely as others to develop dementia within 12 years. The
study, led by scientists at
Albert Einstein College of Medicine
of Yeshiva University and
Montefiore Medical Center,
was published online on July 16, 2014 in Neurology®, the medical
journal of the American Academy of Neurology.
The new test diagnoses motoric cognitive risk
syndrome (MCR). Testing for the newly described syndrome relies on
measuring gait speed (our manner of walking) and asking a few simple
questions about a patient's cognitive abilities, both of which take just
The test is not reliant on the latest medical
technology and can be done in a clinical setting, diagnosing people in
the early stages of the dementia process. Early diagnosis is critical
because it allows time to identify and possibly treat the underlying
causes of the disease, which may delay or even prevent the onset of
dementia in some cases.
Large study of older Americans, published Jan. 5,
2011, says walking speed as predictor of longevity is most
accurate for those 75 and older; works for men and women
"In many clinical and community settings, people
don't have access to the sophisticated tests—biomarker assays, cognitive
tests or neuroimaging studies—used to diagnose people at risk for
developing dementia," said
Joe Verghese, M.B.B.S.,
professor in the
Saul R. Korey Department of
Neurology and of
medicine at Einstein,
geriatrics at Einstein
and Montefiore, and senior author of the Neurology paper.
"Our assessment method could enable many more
people to learn if they're at risk for dementia, since it avoids the
need for complex testing and doesn't require that the test be
administered by a neurologist.
"The potential payoff could be tremendous—not only
for individuals and their families, but also in terms of healthcare
savings for society. All that's needed to assess MCR is a stopwatch and
a few questions, so primary care physicians could easily incorporate it
into examinations of their older patients."
The U.S. Centers for Disease Control and Prevention
estimates that up to 5.3 million Americans - about 1 in 9 people age 65
and over - have Alzheimer's disease, the most common type of dementia.
That number is expected to more than double by 2050 due to population
"As a young researcher, I examined hundreds of
patients and noticed that if an older person was walking slowly, there
was a good chance that his cognitive tests were also abnormal," said Dr.
Verghese, who is also the Murray D. Gross Memorial Faculty Scholar in
Gerontology at Einstein.
"This gave me the idea that perhaps we could use
this simple clinical sign—how fast someone walks—to predict who would
develop dementia. In a 2002 New England Journal of Medicine
study, we reported that abnormal gait patterns accurately predict
whether people will go on to develop dementia. MCR improves on the slow
gait concept by evaluating not only patients' gait speed but also
whether they have cognitive complaints."
The Neurology paper reported on the
prevalence of MCR among 26,802 adults without dementia or disability
aged 60 years and older enrolled in 22 studies in 17 countries. A
significant number of adults - 9.7 percent - met the criteria for MCR
(i.e., abnormally slow gait and cognitive complaints).
While the syndrome was equally common in men and
women, highly educated people were less likely to test positive for MCR
compared with less-educated individuals. A slow gait, said Dr. Verghese,
is a walking speed slower than about one meter per second, which is
about 2.2 miles per hour (m.p.h.). Less than 0.6 meters per second (or
1.3 m.p.h.) is "clearly abnormal."
To test whether MCR predicts future dementia, the
researchers focused on four of the 22 studies that tested a total of
4,812 people for MCR and then evaluated them annually over an average
follow-up period of 12 years to see which ones developed dementia. Those
who met the criteria for MCR were nearly twice as likely to develop
dementia over the following 12 years compared with people who did not.
Dr. Verghese emphasized that a slow gait alone is
not sufficient for a diagnosis of MCR. "Walking slowly could be due to
conditions such as arthritis or an inner ear problem that affects
balance, which would not increase risk for dementia. To meet the
criteria for MCR requires having a slow gait and cognitive problems. An
example would be answering 'yes' to the question, 'Do you think you have
more memory problems than other people?'"
For patients meeting MCR criteria, said Dr.
Verghese, the next step is to look for the causes of their slow gait and
cognitive complaints. The search may reveal underlying - and
controllable - problems.
"Evidence increasingly suggests that brain health
is closely tied to cardiovascular health - meaning that treatable
conditions such as hypertension, smoking, high cholesterol, obesity and
diabetes can interfere with blood flow to the brain and thereby increase
a person's risk for developing Alzheimer's and other dementias," said
What about people who meet MCR criteria but no
treatable underlying problems can be found?
"Even in the absence of a specific cause, we know
that most healthy lifestyle factors, such as exercising and eating
healthier, have been shown to reduce the rate of cognitive decline,"
said Dr. Verghese. "In addition, our group has shown that cognitively
games, card games, reading, writing and also dancing—can delay
dementia's onset. Knowing they're at high risk for dementia can also
help people and their families make arrangements for the future, which
is an aspect of MCR testing that I've found is very important in my own
The Neurology paper is titled "Motoric
cognitive risk syndrome: Multi-country prevalence and dementia risk."
Other Einstein authors were Emmeline Ayers, M.P.H., Nir Barzilai, M.D.,
Roee Holtzer, Ph.D., and Cuiling Wang, Ph.D.
About Albert Einstein College of Medicine of
In 2013, Einstein received more than $155 million
in awards from the NIH. This includes the funding of
major research centers at
Einstein in diabetes, cancer, liver disease, and AIDS. Through its
extensive affiliation network involving Montefiore,
Jacobi Medical Center
-Einstein's founding hospital, and five other hospital systems in the
Bronx, Manhattan, Long Island and Brooklyn, Einstein runs one of the
largest residency and fellowship training programs in the medical and
dental professions in the United States. For more information, visit
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