Association between cognition and gait in elderly people: The putamen as a shared substrate

Abstract

AbstractBackgroundCognitive impairment and gait disturbance are both prevalent in elderly people. However, few studies have focused on the underlying mechanisms in the relationship between cognition and gait. The aim of our study is to contrast the strength of correlations between each cognitive domain and gait parameters in a community‐dwelling population, as well as giving a new insight into the shared neuroimaging signature of cognitive impairment and gait disturbance.MethodIn the cross‐sectional population‐based Taizhou Imaging Study, 733 older adults with a mean (SD) age of 63.9 (3.1) years accepted brain MRI, neuropsychological tests and wearable gait tracking devices for quantitative gait analysis. Global cognitive function and individual cognitive domains (memory, executive function, language, visuospatial skill) were assessed using the Mini‐Mental State Examination, auditory verbal learning test (with>6 years of education), modified Fuld Object Memory Evaluation (with≤6 years of education), conflicting instructions task, clock drawing test and animal fluency test. Dementia and mild cognitive impairment (MCI) were diagnosed according to DSM‐5 criteria and the Petersen criteria. The volume of brain regions was analyzed by Freesurfer.ResultOf the 733 participants, 500 (68.2%) were cognitive normal, 182 (24.8%) were diagnosed as MCI, 51 (7.0%) were diagnosed as dementia. Gait parameters, including gait velocity, stride length and cadence, were significantly different among three cognition groups (P<0.001). In fully adjusted linear regression models, global cognitive function and each cognitive domain were significantly associated with gait parameters. Executive function demonstrated the strongest association with gait (β: 0.149‐0.206, P<0.001), which remained significant when adjusted for memory, language and visuospatial skill. The volume of putamen was the only region that was related to both executive function (β=0.103, P=0.007) and gait velocity (β=0.107, P=0.007). Mediation analysis confirmed a mediating role of putaminal atrophy in the association between executive function and gait velocity.ConclusionCognitive function is associated with gait performance in community‐dwelling elderly individuals. Executive function had the strongest association with gait among cognitive domains, which is supported by a shared substrate including putaminal atrophy. Future longitudinal studies with neuroimaging techniques are needed to further confirm our findings.