Gait disorders in adults and the elderly : A clinical guide.
Gait disorders in adults and the elderly : A clinical guide.
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DOI：
10.1007/s00508-016-1096-4
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发表时间：
2017-02
影响因子：
2.6
通讯作者：
Katzenschlager R
中科院分区：
文献类型：
--
作者：
Pirker W;Katzenschlager R
人类的步态取决于神经、肌肉骨骼和心肺系统主要部分的复杂相互作用。个体的步态模式受年龄、个性、情绪和社会文化因素的影响。老年人首选的步行速度是衡量一般健康和生存的敏感标志。安全行走需要完整的认知和执行控制。步态障碍会导致个人自由丧失、摔倒和受伤，并导致生活质量显著下降。步态障碍的急性发作可能表明脑血管或神经系统的其他急性损害，但也可能是全身性疾病或药物的不良反应，特别是包括镇静剂在内的多药联用。步态障碍的患病率从60-69岁人群的10 %上升到80岁以上社区居民的60 %以上。多发性神经病引起的感觉共济失调、帕金森氏症和皮质下血管脑病引起的额部步态障碍或与痴呆症相关的疾病是最常见的神经系统原因。髋关节和膝骨性关节炎是步态障碍的常见非神经性原因。随着年龄的增长，患有多种原因或合并神经和非神经步态障碍的患者比例增加。对步态进行彻底的临床观察，重点了解患者的病史，并进行身体、神经和骨科检查，是步态障碍分类的基本步骤，并可作为辅助调查和治疗干预的重要指南。这篇面向临床的综述提供了步态障碍的表型谱、工作和治疗的概述。
Human gait depends on a complex interplay of major parts of the nervous, musculoskeletal and cardiorespiratory systems. The individual gait pattern is influenced by age, personality, mood and sociocultural factors. The preferred walking speed in older adults is a sensitive marker of general health and survival. Safe walking requires intact cognition and executive control. Gait disorders lead to a loss of personal freedom, falls and injuries and result in a marked reduction in the quality of life. Acute onset of a gait disorder may indicate a cerebrovascular or other acute lesion in the nervous system but also systemic diseases or adverse effects of medication, in particular polypharmacy including sedatives. The prevalence of gait disorders increases from 10 % in people aged 60–69 years to more than 60 % in community dwelling subjects aged over 80 years. Sensory ataxia due to polyneuropathy, parkinsonism and frontal gait disorders due to subcortical vascular encephalopathy or disorders associated with dementia are among the most common neurological causes. Hip and knee osteoarthritis are common non-neurological causes of gait disorders. With advancing age the proportion of patients with multiple causes or combinations of neurological and non-neurological gait disorders increases. Thorough clinical observation of gait, taking a focused patient history and physical, neurological and orthopedic examinations are basic steps in the categorization of gait disorders and serve as a guide for ancillary investigations and therapeutic interventions. This clinically oriented review provides an overview on the phenotypic spectrum, work-up and treatment of gait disorders.