Marche et démences

Abstract

Objectives The aim of this paper was to describe gait disorders and their consequences in primary dementias, and to prove the positive impact of their prevention and rehabilitation. Method The most relevant articles on gait and dementias available on Medline were analyzed. Results The prevalence of gait and balance disorders is between 9 and 52% in Alzheimer-type dementia in which frontal gait and apraxic gait are described. Gait disorders, appearing with a prevalence of over 71% in vascular dementia, seem to be an early indicator of this dementia in which hemiparetic gait, frontal gait and unsteady gait are commonly described. As clinical practice shows, gait disorders appear to be frequent in dementia with Lewy bodies and Parkinson's dementia, both being characterized by Parkinsonian gait; however, there are very few prevalence studies concerning gait disturbances in these two dementias. The balance and gait assessment in demented subjects is based on the analysis of sit-to-stand/back-to-sit and one-leg balance, the measurement of gait speed, the Timed-Up-and-Go and the dual task tests. Although there are few studies on the topic, the benefit of the motor rehabilitation on functional independency in demented subjects is now recognized. The programs used for motor rehabilitation of demented people must be individual with targeted objectives, and associate strength and balance exercises, attentional tasks, immediate and working memories and praxis, in the context of multidisciplinary intervention. However, there is no consensus on a standard rehabilitation program of demented subjects. Conclusion Future studies have to analyse gait disorders in demented subjects in order to clarify their pathophysiology. Besides, they may confirm the benefit of rehabilitation and suggest consensual programs.