Management of Gait Changes and Fall Risk in MCI and Dementia

Gait disorders and falls are very prevalent in aging, especially in older adults with cognitive impairment: older adults with dementia are 2-3 times more likely to fall than their non-demented counterparts. The management of gait disorders and falls in older adults with mild cognitive impairment (MCI) or dementia begins by their identification with the use of specific screening tools, such as measuring gait speed, use of dual-task gait tests, or diagnosing motoric cognitive risk syndrome, a newly described pre-dementia syndrome. This clinical approach is useful to reveal subtle gait changes that may lead to an increased risk of falls in older adults. Various non-pharmacological interventions have been tested in older adults with MCI or dementia to reduce risk of falls. Physical activity interventions are feasible in older adults with cognitive impairments, and may improve gait, and thereby decrease risk of falls. Besides non-pharmacological interventions, identification and removal of potentially inappropriate medications (i.e., psychotropic drugs) is part of a comprehensive falls management strategy in older patients. The use of anti-dementia drugs, such as cholinesterase inhibitors or memantine, may help to improve gait in demented older adults. Adopting a multidisciplinary care strategy that integrates general practitioners, geriatricians, neurologists, cardiologists, physical therapists, and occupational therapists to identify older adults at increased risk of falling or with subtle gait changes, prior to applying individualized non-pharmacological and/or pharmacological interventions, is essential to reduce the burden of gait disorders and falls in older adults with cognitive impairment.