Signs of Cognitive Decline and Alzheimer's Are Seen in Gait The way people walk appears to speak volumes about the way they think, so much so that changes in an older person's gait appear to be an early indicator of cognitive impairment, including Alzheimer's disease. Five studies presented at the Alzheimer's Association International Conference in Vancouver this month provide striking evidence that when a person's walk gets slower or becomes more variable or less controlled, his cognitive function is also suffering. Thinking skills like memory, planning activities or processing information decline almost in parallel with the ability to walk fluidly, these studies show. In other words, the more trouble people have walking, the more trouble they have thinking. "Changes in walking may predate actually observable cognitive changes in people who are on their way to developing dementia," said Molly Wagster, chief of the National Institute on Aging's behavioral and systems neuroscience branch. Experts said the studies could lead to developing a relatively simple tool that doctors could use to forecast, if not diagnose, possible Alzheimer's disease. "You can probably just watch them walk down the hall in your office and look for people who are starting to show deterioration in their gait and have no other explanation for it," said William Thies, the chief medical and scientific officer for the Alzheimer's Association. If gait begins to deteriorate, we begin to have a conversation about how is your memory. While scientists have studied gait changes after a heart attack or stroke and in diseases like Parkinson's, they have only recently begun studying connections between walking and cognition. For decades, people thought slower walking was just part of getting old, but research shows some changes in gait signify problems that go beyond normal aging. "It's like driving a car - you need an engine, a chassis and steering," said Dr. Stephanie Studenski, an expert on walking who was not involved in the dementia studies. The engine of walking is the heart, lungs and blood, she said. The chassis is the muscles, joints and bones. And the steering is "the wiring - the nervous system," said Dr. Studenski, a geriatrician at the University of Pittsburgh and the Pittsburgh Veterans Administration. "People who are focused on cognition largely never watch people move," Dr. Studenski said. The tests are all done sitting down. But damage to the wiring is an important shared problem of difficulty with thinking and difficulty with moving. The new studies were larger and more detailed than previous research, and involved sophisticated measures of changes in gait. Some used an electronic walkway, a long mat outfitted with sensors that measure small differences in walking speed, cadence (the number of steps per minute), the width of the stride and variability (how often the person's stride changes). The studies screened out people with arthritis or other physical problems, and adjusted for height, age, weight and sex. One study involved more than 1,100 elderly people in Basel, Switzerland. About a quarter of them were cognitively healthy, while the others had mild cognitive impairment, considered a precursor to dementia, or were in various stages of Alzheimer's. The participants walked normally on the electronic walkway, and again while performing a cognitive task: counting backward by two's from 50, or naming animals. One 72-year-old woman's first walking test betrayed no problems. But when she walked while counting backward from 50, her gait worsened dramatically, said Dr. Stephanie Bridenbaugh, head of the Basel Mobility Center. "She teetered and wobbled on one foot," Dr. Bridenbaugh said. She almost tipped to the side. And "she didn't notice any of it," she added. She was mad that she didn't remember more numbers. Dr. Bridenbaugh referred her to the memory clinic, where cognitive testing showed the woman already had mild cognitive impairment. Asking people to simultaneously perform thinking and movement tasks revealed "deficits that you can't see with the naked eye," Dr. Bridenbaugh said. It may be that the brain is already so compromised that it cannot coordinate its circuits to efficiently manage such "dual tasks."