A new study published in the journal Neurology suggests that a simple test measuring how fast people walk and whether they have cognitive complaints can predict later problems with dementia. The study was conducted by researchers at Yeshiva University's Albert Einstein College of Medicine and Montefiore Medical Centre. Looking at nearly 27,000 older adults on five continents showed that one in ten met criteria for pre-dementia based on walking speed and cognitive complaints. Adults who tested positive for pre-dementia were twice as likely as control subjects to develop dementia over a twelve-year period.
According to Dr. Joe Verghese, a medical professor at the Albert Einstein College of Medicine and the senior author on the neurology paper, the new test diagnoses a condition known as motoric cognitive risk syndrome (MCR). The new syndrome can be easily diagnosed based on walking speed and answering a few simple questions. A slow gait is defined as a walking speed of about 2.2 miles per hour or about one meter per second. A "clearly abnormal" gait of less than .6 meters per second (about 1.3 miles per hour) is considered to indicate possible MCR. Of the nearly 27,000 adults over the age of 60 in the study, 9.7 met the criteria for MCR. Since early diagnosis of dementia is essential for providing proper treatment, using a simple test eliminates the need for medical imaging is often not available for many patients.
"In many clinical and community settings, people don't have access to the sophisticated tests --biomarker assays, cognitive tests or neuroimaging studies -- used to diagnose people at risk for developing dementia," Dr. Verghese noted in a press release describing the study findings. "Our assessment method could enable many more people to learn if they're at risk for dementia, since it avoids the need for complex testing and doesn't require that the test be administered by a neurologist. The potential payoff could be tremendous, not only for individuals and their families, but also in terms of healthcare savings for society. All that's needed to assess MCR is a stopwatch and a few questions, so primary care physicians could easily incorporate it into examinations of their older patients."
According to Center for Disease Control statistics, there are now more than five million Americans dealing with Alzheimer's disease alone -- about one out of every nine people over the age of 65. Taken worldwide, that number rises to forty million and new cases of dementia are expected to triple by 2050. Due to the lack of proper medical care, many of these dementia cases go undiagnosed and the responsibility for caring for them often rests on family members. Developing a simple and effective method of early diagnosis can help dementia patients receive treatment earlier and delay dementia symptoms for as long as possible.
"As a young researcher, I examined hundreds of patients and noticed that if an older person was walking slowly, there was a good chance that his cognitive tests were also abnormal," said Dr. Verghese.
"This gave me the idea that perhaps we could use this simple clinical sign, how fast someone walks, to predict who would develop dementia. In a 2002 New England Journal of Medicine study, we reported that abnormal gait patterns accurately predict whether people will go on to develop dementia. MCR improves on the slow gait concept by evaluating not only patients' gait speed but also whether they have cognitive complaints."
Dr. Verghese acknowledged that a slow gait alone was not enough for a diagnosis of MCR since other medical problems such as arthritis could also affect walking speed. For older adults reporting slow gait along with memory and attention problems however, the next step is to look at what may be causing their symptoms. Along with identifying potentially treatable problems such as diabetes, high cholesterol, and cardiovascular problems, older people with MCR can be encouraged to adopt healthier lifestyle habits including eating more sensibly, exercising more, and taking part in mentally stimulating activities such as crossword puzzles, board games, dancing, music, and interacting with friends.
"Our group has shown that cognitively stimulating activities can delay dementia's onset," Dr. Verghese stated. "Knowing they're at high risk for dementia can also help people and their families make arrangements for the future, which is an aspect of MCR testing that I've found is very important in my own clinical practice."
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