Clinical characteristics of elderly patients with a cautious gait of unknown origin

Objective: To evaluate and systematically characterize a group of older adults with disturbed gait of unknown origin. Design: Cross-sectional study. Setting: Outpatient clinic in a movement disorders unit. Participants: Twenty-five patients (mean age 78.4 years) with a disturbed gait of unknown origin were compared with twenty-eight age matched "healthy" controls (mean age 78.2). Measurement: Detailed medical history, geriatric and neurological assessments. Results: Patients walked more slowly (P < 0.0001) and with shorter strides (P < 0.0001) compared with controls. Muscle strength was lower, and static and dynamic balance and gait performance were worse among the patients (P < 0.0001). The patients also tended to be more depressed (P < 0.0001),more anxious (P < 0.002), had a greater fear of falling (P < 0.0001) and had lower scores on the Mini-Mental State Examination (P < 0.005). There was no difference in the frequency of cerebellar or pyramidal signs in the two groups. However, neurological testing revealed that extrapyramidal (P < 0.0001) and frontal release signs (P < 0.0001) were more common among the patients. Neuroradiological findings were rare among the patients and they did not explain the changes in gait speed or fear of falling. Conclusions: Older adults with a disturbed gait of unknown origin appear to share common characteristics. They walk more slowly than "healthy" controls with increased unsteadiness and with excessive fear of falling. The extrapyramidal, frontal lobe, and limbic systems apparently play an important role, to different degrees, in what can be viewed as a multisystem neurodegenerative syndrome clearly different from "aging.".