Balance and gait disorders in a memory clinic population: A prospective observational cross‐sectional study

Abstract

AbstractBackgroundBalance and gait disorders (B&GDs) increase with ageing, but often they are not adequately evaluated and largely go underdiagnosed. We have therefore investigated the prevalence of B&GDs and the underlying diagnosis among patients with memory impairment.Method410 consecutive patients enrolled between 2010 and 2014 from the Memory Disorders Clinic, Launceston, Tasmania. All patients had a detailed history of memory, balance and gait symptoms including features suggesting dementia. A full examination included the Mini‐Mental State Examination (MMSE) and balance/gait functions by observing the patients standing with their eyes closed, on their toes, and doing the tandem test. All patients had a brain CT scan.Result218 women and 192 men participated in the study, the median age was 76.5 years (range 32.6‐94.8) and the mean MMSE score was 23.3 (SD 4.9). 214 (52%) had B&GDs of whom, 85 (40%) had mild cognitive impairment (MCI), 25 (12%) had Alzheimer’s disease (AD), 62(29%) had idiopathic normal pressure hydrocephalus (INPH), 11 (5%) had mixed dementia (MD), 10 (5%) had vascular dementia (VD), 9 (4%) had Parkinson’s disease dementia, 2(1%) had Lewy body disease (LBD). 196(48%) didn’t have B&GIs, of whom, 97 (50%) had MCI, 66 (34%) had AD, 13(7%) had MD, 6(3%) had Gertsmann’s syndrome, 4 (2%) had hypogonadism, and 4 (2%) had frontal lobe dementia (FLD). After excluding patients with MCI, patients with B&GDs (n=129); 60 (48%) had INPH, 25 (20%) had AD, 11 (9%) had MD, 10 (8%) had VD, 2 (2%) had LBD. Patients without B&GDs (n=100), 66% had AD, 13% had MD, 1% had VD and 4% had FLD.ConclusionThe study shows that B&GDs are common among patients with memory impairment, and highlights the high prevalence of INPH, a condition that could be treated with shunt surgery resulting in improvement of cognitive, balance and gait functioning.