Abnormality of gait as a predictor of non-Alzheimer's dementia
Abnormality of gait as a predictor of non-Alzheimer's dementia
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DOI：
10.1056/nejmoa020441
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发表时间：
2002-11-28
影响因子：
158.5
通讯作者：
Buschke, H
中科院分区：
文献类型：
--
作者：
Verghese, J;Lipton, RB;Buschke, H
背景：影响步态的神经系统异常在几种类型的非阿尔茨海默病痴呆中出现较早，但其在预测痴呆发展中的价值尚不确定。方法：我们在一项前瞻性研究中分析了基线神经步态状态与痴呆发展之间的关系，该研究涉及422名年龄在75岁以上、居住在社区且基线时没有痴呆的受试者。采用Cox比例风险回归分析计算风险比，并校正潜在的混杂人口统计学、医学和认知变量。结果：入组时，85例受试者出现以下类型的神经系统步态异常：不稳定步态（31例）、正面步态（12例）、偏瘫步态（11例）、神经性步态（11例）、共济失调步态（10例）、帕金森步态（8例）和痉挛步态（2例）。在随访期间（中位持续时间为6.6年），有125例新诊断的痴呆病例，其中70例为阿尔茨海默病，55例为非阿尔茨海默病痴呆（其中47例涉及血管性痴呆，8例涉及其他类型的痴呆）。神经步态异常的受试者患痴呆的风险更高（风险比为1.96[95%置信区间为1.30 - 2.96]）。这些受试者患非阿尔茨海默氏痴呆的风险增加（风险比为3.51[95%可信区间，1.98至6.24]），但患阿尔茨海默氏痴呆的风险没有增加（风险比为1.07[95%可信区间，0.57至2.02]）。在非阿尔茨海默氏痴呆中，步态异常预测血管性痴呆的发展（风险比，3.46[95%置信区间，1.86 - 6.42]）。步态异常类型中，步态不稳预测血管性痴呆（风险比为2.61），正面步态预测血管性痴呆（风险比为4.32），偏瘫步态预测血管性痴呆（风险比为13.13）。结论：基线上无痴呆的老年人神经步态异常的存在是痴呆发展风险的重要预测因子，尤其是非阿尔茨海默氏痴呆。
Background: Neurologic abnormalities affecting gait occur early in several types of non-Alzheimer's dementias, but their value in predicting the development of dementia is uncertain.Methods: We analyzed the relation between neurologic gait status at base line and the development of dementia in a prospective study involving 422 subjects older than 75 years of age who lived in the community and did not have dementia at base line. Cox proportional-hazards regression analysis was used to calculate hazard ratios with adjustment for potential confounding demographic, medical, and cognitive variables.Results: At enrollment, 85 subjects had neurologic gait abnormalities of the following types: unsteady gait (in 31 subjects), frontal gait (in 12 subjects), hemiparetic gait (in 11 subjects), neuropathic gait (in 11 subjects), ataxic gait (in 10 subjects), parkinsonian gait (in 8 subjects), and spastic gait (in 2 subjects). During follow-up (median duration, 6.6 years), there were 125 newly diagnosed cases of dementia, 70 of them cases of Alzheimer's disease and 55 cases of non-Alzheimer's dementia (47 of which involved vascular dementia and 8 of which involved other types of dementia). Subjects with neurologic gait abnormalities had a greater risk of development of dementia (hazard ratio, 1.96 [95 percent confidence interval, 1.30 to 2.96]). These subjects had an increased risk of non-Alzheimer's dementia (hazard ratio, 3.51 [95 percent confidence interval, 1.98 to 6.24]), but not of Alzheimer's dementia (hazard ratio, 1.07 [95 percent confidence interval, 0.57 to 2.02]). Of non-Alzheimer's dementias, abnormal gait predicted the development of vascular dementia (hazard ratio, 3.46 [95 percent confidence interval, 1.86 to 6.42]). Among the types of abnormal gait, unsteady gait predicted vascular dementia (hazard ratio, 2.61), as did frontal gait (hazard ratio, 4.32) and hemiparetic gait (hazard ratio, 13.13).Conclusions: The presence of neurologic gait abnormalities in elderly persons without dementia at base line is a significant predictor of the risk of development of dementia, especially non-Alzheimer's dementia.