Gait and balance measures and tools for early detection of dementias: A systematic review

Abstract

AbstractBackgroundBrain mechanisms supporting gait and balance are vulnerable to early neurodegenerative changes and identification of alterations in these behaviours has great potential for the detection of different dementia‐causing diseases. This systematic review aimed to identify the most promising gait and balance measures for early detection and technologies suitable for capturing these data and future deployment at scale in clinical practice.MethodWe performed literature searches following PRISMA guidelines across two databases (PubMed and Web of Science). Keywords were designed to capture literature on preclinical and prodromal stages of dementias and high‐risk populations that investigated gait and balance cross‐sectionally and longitudinally. We included studies written in English and published until August 2022. Exclusion criteria included case, intervention, and uncontrolled studies. Studies on established dementia were also excluded.ResultFrom 2086 titles, 182 were screened at full‐text stage, with 95 included in the systematic review. Most investigated gait and balance in association with preclinical or prodromal AD [n = 38], Parkinson’s [n = 18] or Lewy body [n = 17] dementias, with very few on FTD [n = 1] or vascular cognitive impairment [n = 2]. Twenty‐two studies utilised a term “dementia”. Fifty‐one unique metrics were used to characterise gait, with 12 balance metrics identified. The most common differentiative metric was gait speed (n = 44 studies), which declined across populations, and was often measured using a stopwatch. Twenty‐seven studies utilised pressure carpets, force platforms and body‐worn sensors, enabling quantification of finer‐grained metrics of gait and balance, e.g., variability, asymmetry, and movement jerkiness. These metrics were shown to be sensitive, especially under dual‐task conditions, and specific to different pre‐dementia states. Only three studies utilised smartphone‐based assessment, potentially the most scalable platform for at‐scale application.ConclusionGait and balance measures can detect early neurodegenerative diseases but measurement using scalable off‐the‐shelf technologies in real‐world settings is currently limited. These findings will guide the selection of gait‐measuring devices for the next generation EDoN (https://edon‐initiative.org) toolkit for early detection.