Journal List > Dement Neurocogn Disord > v.12(4) > 1120826

Dement Neurocogn Disord. 2013 Dec;12(4):94-99. Korean.
Published online Dec 31, 2013.
© 2013 Korean Dementia Association
The Association of Gait Disturbance and Cognitive Impairment
Jung-Hoon Han,* Sung-Woog Lee, M.D., and Kun-Woo Park, M.D.
*Korea University School of Medicine, Seoul, Korea.
Department of Neurology, Korea University Anam Hospital, Seoul, Korea.

Address for correspondence: Kun-Woo Park, M.D. Department of Neurology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 136-705, Korea. Tel: +82-2-920-5347, Fax: +82-2-925-2472, Email:
Received Sep 02, 2013; Revised Dec 30, 2013; Accepted Dec 30, 2013.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.



The incidence and prevalence of gait disturbance increases as age increases. The importance of cognitive aspects of gait disturbances has been studied in various types of dementia and MCI. This study was performed to identify relationship between cognitive impairment and change in gait, and investigate specific domains of cognitive function that may have affects in gait disturbance.


Three hundred eighty three participants over 60 years old volunteered for the study. Three stages evaluation were performed, dementia screening and timed up and go test (TUG), work up for cognitive impairment and dementia, and classifying cognitive impairment and dementia into subcategories by evaluating cause of the disease. To evaluate cognitive impairment, MMSE-KC (MMSE in the Korean version of the CERAD assessment packet) and Korean version of Consortium to Establish a Registry of Alzheimer's Disease (CERAD-K) assessment were used. One hundred forty one people were excluded from study and 242 people were analyzed. Timed Up and Go test (TUG) was performed for evaluation of gait disturbance. Relationship in every subcategory of CERAD-K and TUG was studied by correlation and multiple logistic analysis.


Of the 242 participants, 122 were without cognitive impairment, 51 had mild cognitive impairment, 56 had Alzheimer's disease and 13 had vascular dementia. These four groups showed different results in TUG. Normal group had the lowest values in TUG compare to other groups significantly. MMSE score also correlated with the value of TUG (r=-0.528, p<0.001). Every subcategory of CERAD-K score had significant correlation with the value of TUG. But there were no specific subcategory that had predominant effect in TUG. Only age was an independently significant factor influencing TUG (p<0.05).


This study shows that increase in age and impairment in cognitive function has an association with gait disturbance. Therefore clinician should be concerned about cognitive factors for evaluation of a patient who has gait disturbance.

Keywords: Gait disturbance; Cognitive impairment; Timed Up and Go test


Fig. 1
The value of 'timed up and go test' (seconds) according to groups.

*p value<0.01; **p value<0.05.

TUG, Timed Up & Go test; MCI, Mild Cognitive Impairment; AD, Alzheimer's Disease; VD, Vascular Dementia.

Click for larger image

Fig. 2
The correlation of the value of 'timed up and go test' and the score of MMSE. r=-0.528, p<0.001.
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Table 1
Participants' characteristics
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Table 2
Correlation analysis of CERAD-K subcategories and TUG results
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Table 3
Multiple regression analysis of CERAD-K subcategories, age, and years of educational history and TUG
Click for larger image

1. Snijders AH, Van De Warrenburg BP, Giladi N, Bloem BR. Neurological gait disorders in elderly people: clinical approach and classification. Lancet Neurol 2007;6:63–74.
2. Sudarsky L. Gait disorders: prevalence, morbidity, and etiology. Adv Neurol 2001;87:111–117.
3. Verghese J, Lipton RB, Hall CB, Kuslansky G, Katz MJ, Buschke H. Abnormality of gait as a predictor of non-Alzheimer's dementia. N Engl J Med 2002;347:1761–1768.
4. Bloem B, Gussekloo J, Lagaay A, Remarque E, Haan J, Westendorp R. Idiopathic senile gait disorders are signs of subclinical disease. J Am Geriatr Soc 2000;48:1098–1101.
5. Marquis S, Moore MM, Howieson DB, Sexton G, Payami H, Kaye JA, et al. Independent predictors of cognitive decline in healthy elderly persons. Arch Neurol 2002;59:601.
6. Yogev-Seligmann G, Hausdorff JM, Giladi N. The role of executive function and attention in gait. Mov Disord 2008;23:329–342.
7. Woollacott M, Shumway-Cook A. Attention and the control of posture and gait: a review of an emerging area of research. Gait Posture 2002;16:1–14.
8. Bland BH, Oddie SD. Theta band oscillation and synchrony in the hippocampal formation and associated structures: the case for its role in sensorimotor integration. Behav Brain Res 2001;127:119–136.
9. Nutt J, Marsden C, Thompson P. Human walking and higher-level gait disorders, particularly in the elderly. Neurology 1993;43:268.
10. Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39:142.
11. Herman T, Giladi N, Hausdorff JM. Properties of the 'timed up and go' test: more than meets the eye. Gerontology 2010;57:203–210.
12. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther 2000;80:896–903.
13. Ku BD, Kim SG, Lee JY, Park KH, Shin JH, Kim KK, et al. Clinical practice guideline for dementia by Clinical Research Center for Dementia of South Korea. J Korean Med Assoc 2011;54:861–875.
14. Woo JI. In: The Korean Version of CERAD neuropsychological assessment. 1st ed. Seoul: Seoul National University Press; 2010. pp. 3-46.
15. Jang JS, Kim SK. A Study on The Difference of Memory by the Types of Dementia and Utility of CERAD- K to Vascular Dementia Patients. J Soc Occup Ther Aged Dement 2012;6:31–38.
16. Jørstad EC, Hauer K, Becker C, Lamb SE. ProFaNE Group. Measuring the psychological outcomes of falling: a systematic review. J Am Geriatr Soc 2005;53:501–510.
17. Pahapill PA, Lozano AM. The pedunculopontine nucleus and Parkinson's disease. Brain 2000;123:1767–1783.
18. Nielsen JB. How we walk: central control of muscle activity during human walking. Neuroscientist 2003;9:195–204.
19. Morton SM, Bastian AJ. Cerebellar control of balance and locomotion. The Neuroscientist 2004;10:247–259.
20. Gunning-Dixon FM, Raz N. The cognitive correlates of white matter abnormalities in normal aging: a quantitative review. Neuropsychology 2000;14:224.
21. Giladi N, Herman T, Reider-Groswasser II, Gurevich T, Hausdorff JM. Clinical characteristics of elderly patients with a cautious gait of unknown origin. J Neurol 2005;252:300–306.
22. Malouin F, Richards CL, Jackson PL, Dumas F, Doyon J. Brain activations during motor imagery of locomotor-related tasks: A PET study. Hum Brain Mapp 2003;19:47–62.
23. Wiener SI, Berthoz A, Zugaro MB. Multisensory processing in the elaboration of place and head direction responses by limbic system neurons. Brain Res Cogn Brain Res 2002;14:75–90.
24. Scherder E, Eggermont L, Swaab D, van Heuvelen M, Kamsma Y, de Greef M, et al. Gait in ageing and associated dementias; its relationship with cognition. Neurosci Biobehav Rev 2007;31:485–497.
25. Erickson C, Barnes C. The neurobiology of memory changes in normal aging. Exp Gerontol 2003;38:61–69.
26. Pugh KG, Lipsitz LA. The microvascular frontal-subcortical syndrome of aging. Neurobiol Aging 2002;23:421–431.
27. Mungas D, Harvey D, Reed BR, Jagust WJ, DeCarli C, Beckett L, et al. Longitudinal volumetric MRI change and rate of cognitive decline. Neurology 2005;65:565–571.
28. Pettersson A, Olsson E, Wahlund L-O. Motor function in subjects with mild cognitive impairment and early Alzheimer's disease. Dement Geriatr Cogn Disord 2005;19:299–304.
29. Shin JH. Diagnosis of dementia: neuropsychological test. Korean J Fam Med 2010;31:253–266.
30. Lemke MR, Wendorff T, Mieth B, Buhl K, Linnemann M. Spatiotemporal gait patterns during over ground locomotion in major depression compared with healthy controls. J Psychiatr Res 2000;34:227–283.