Forgetting what day it is. Misplacing the car keys. A little more confusion than normal.
Diagnosing dementia often starts with some telltale signs, but unfortunately these subtle symptoms are easy to ignore. And because no single diagnostic test exists for dementia, physicians are forced to rely on a mix of lab tests, physical examinations, a review of medical history and anecdotal evidence of things like lost car keys. However, some recent research hopes to change that, simply by watching how older adults walk.
A team of experts at Newcastle University in the United Kingdom report that simply by analyzing a person’s gait can help doctors diagnose dementia even sooner—and with more accuracy.
“By assessing someone’s walking, we could potentially detect and diagnose dementia earlier and more accurately,” wrote Ríona McArdle, research associate in Newcastle’s Brain and Movement Research Group, in The Conversation. “Evidence has shown that walking patterns change before memory and recognition problems become apparent.”
The team started with findings from a 2015 study that showed that a poor gait does in fact predict dementia—specifically non-Alzheimer’s dementia. But McArdle’s research sought to go beyond that—to use gait performance to not only predict dementia – which can be an umbrella term for many disease types – but to more accurately diagnose specific kinds of dementia, particularly Alzheimer’s disease and Lewy body dementia, both of which have different symptoms. Can walking patterns help doctors differentiate the two in the diagnostic phase?
Deciphering the ‘electronic footprint’
Dying brain cells, which is associated with dementia, impacts many activities of daily living—not just memory and cognitive skills (the most recognizable symptoms of the disease) but also walking. McArdle wanted to discover if Alzheimer’s and Lewy body dementia – which often exhibit similar symptoms – could be differentiated through how they affected a person’s walking ability. The two subtypes are often mistaken for each other through inaccurate diagnoses, which can lead to treatments that may not be the most effective.
McArdle used her research to examine specific aspects of a person’s gait, including the length of each step and how fast they walked, to better understand the walking patterns associated with each dementia subtype.
After dividing study participants into three groups – a control group, people with Alzheimer’s and people with Lewy body dementia – she had each participant walk across a sensor-filled floor mat that recorded walking patterns, step times, speed and more—basically an “electronic footprint” for each person. The results were clear, she said:
“I found that people with both types of dementia could be distinguished from the normal ageing group based on their walking pattern. They walked slower with shorter steps, were more variable and asymmetric, and spent longer with both feet on the ground compared to control subjects. This shows that people with dementia have significant walking problems, and that we need to look at this in people at risk of developing dementia to see if it can predict the onset of the condition.”
Even more important was the differences she found in the walking patterns between the two subtypes:
“I found that the people with Lewy body dementia had a unique walking pattern that distinguished them from those with Alzheimer’s disease,” she said. “Their steps were even more variable and asymmetric when they walked.”
Earlier diagnosis leads to better treatments
While current diagnostic tests are forced to rely on the presence of already-existing symptoms, this discovery could lead clinicians to earlier diagnoses—to spot warning signs sooner and begin preventive treatments when they can be more effective.
Previous research had already proven the connection between gait and dementia and how physicians can use the correlation to better serve patients:
“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,” William Thies, chief medical and scientific officer for the Alzheimer’s Association, told The New York Times. “If gait begins to deteriorate, we begin to have a conversation about how is your memory.”
McArdle’s research is shedding new light on decoding the complicated diagnosis of the various dementia subtypes, which will hopefully lead to more effective treatment and patient care.
“For people with dementia themselves, earlier diagnosis can give them and their families more time to understand their diagnosis and plan for the future,” she wrote. “As of yet, there is no cure for dementia, but an accurate diagnosis gives access to support and information, and treatments to help alleviate symptoms.”
