PMID- 15639397
OWN - NLM
STAT- MEDLINE
DCOM- 20050607
LR  - 20220318
IS  - 0966-6362 (Print)
IS  - 0966-6362 (Linking)
VI  - 21
IP  - 2
DP  - 2005 Feb
TI  - Gait instability and fractal dynamics of older adults with a "cautious" gait: why 
      do certain older adults walk fearfully?
PG  - 178-85
AB  - Many older adults walk with a cautious and impaired gait of unknown origin, 
      however, the relationship between fear of falling and the observed gait changes 
      is not well understood. To better understand the "cautious" gait of the elderly, 
      we tested the hypothesis that temporal gait variability, putatively a marker of 
      intrinsic walking unsteadiness, is increased among older adults with a cautious 
      gait and a higher-level gait disorder (HLGD), an altered gait that cannot be 
      attributed to a well-defined cause. Twenty-five older adults (mean age: 78 years) 
      with a HLGD were compared to healthy controls of similar age and sex (n=28). The 
      clinical characteristics (e.g., neurological status, fear of falling), the 
      magnitude of the stride-to-stride variations in gait cycle timing (a measure of 
      temporal gait variability), and a fractal index of gait (a measure of the stride 
      dynamics independent of the magnitude of the variability) were studied in both 
      groups. Gait variability was significantly increased (P<0.0001) in HLGD subjects 
      (52+/-26 ms) compared to controls (27+/-9 ms). Changes in frontal lobe and 
      extra-pyramidal function were also found in the patient group. Among HLGD 
      subjects, gait variability was not associated (P>0.05) with age, gender, MMSE 
      score, muscle strength, # of co-morbidities, balance, cerebellar signs, or 
      pyramidal signs, but was significantly associated with scores on the Geriatric 
      Depression Scale (r=0.46, P<0.02) and fear of falling (r=0.69, P<0.0001). Among 
      HLGD subjects, only a fractal index was significantly different in fallers and 
      non-fallers. These findings underscore the idea that the gait changes in older 
      adults who walk with fear may be an appropriate response to unsteadiness, are 
      likely a marker of underlying pathology, and are not simply a physiological or 
      psychological consequence of normal aging.
FAU - Herman, T
AU  - Herman T
AD  - Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical 
      Center, & Sackler School of Medicine, Tel-Aviv University, 6 Weizmann Street, Tel 
      Aviv 64239, Israel.
FAU - Giladi, N
AU  - Giladi N
FAU - Gurevich, T
AU  - Gurevich T
FAU - Hausdorff, J M
AU  - Hausdorff JM
LA  - eng
GR  - AG-08812/AG/NIA NIH HHS/United States
GR  - AG-14100/AG/NIA NIH HHS/United States
GR  - HD-39838/HD/NICHD NIH HHS/United States
GR  - RR-13622/RR/NCRR NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - England
TA  - Gait Posture
JT  - Gait & posture
JID - 9416830
SB  - IM
MH  - *Accidental Falls
MH  - Aged/*psychology
MH  - Case-Control Studies
MH  - Depression/psychology
MH  - Extrapyramidal Tracts/pathology/physiopathology
MH  - *Fear
MH  - Female
MH  - Frontal Lobe/pathology/physiopathology
MH  - Gait/*physiology
MH  - Humans
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Muscle, Skeletal/physiopathology
MH  - Psychiatric Status Rating Scales
MH  - Tomography, X-Ray Computed
EDAT- 2005/01/11 09:00
MHDA- 2005/06/09 09:00
CRDT- 2005/01/11 09:00
PHST- 2003/07/18 00:00 [received]
PHST- 2004/01/15 00:00 [accepted]
PHST- 2005/01/11 09:00 [pubmed]
PHST- 2005/06/09 09:00 [medline]
PHST- 2005/01/11 09:00 [entrez]
AID - S0966636204000438 [pii]
AID - 10.1016/j.gaitpost.2004.01.014 [doi]
PST - ppublish
SO  - Gait Posture. 2005 Feb;21(2):178-85. doi: 10.1016/j.gaitpost.2004.01.014.