Cognitive impairment is associated with gait variability and fall risk in amyotrophic lateral sclerosis

Raffaele Dubbioso*, Myriam Spisto, Jeffrey M. Hausdorff, Gabriella Aceto, Valentina Virginia Iuzzolino, Gianmaria Senerchia, Stefania De Marco, Laura Marcuccio, Cinzia Femiano, Rosa Iodice, Elena Salvatore, Gabriella Santangelo, Luigi Trojano, Pasquale Moretta

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: In amyotrophic lateral sclerosis (ALS), gait abnormalities contribute to poor mobility and represent a relevant risk for falls. To date, gait studies in ALS patients have focused on the motor dimension of the disease, underestimating the cognitive aspects. Methods: Using a wearable gait analysis device, we compared gait patterns in ambulatory ALS patients with mild cognitive impairment (ALS MCI+; n = 18), and without MCI (ALS MCI−; n = 24), and healthy subjects (HS; n = 16) under two conditions: (1) normal gait (single task) and (2) walking while counting backward (dual task). Finally, we examined if the occurrence and number of falls in the 3 months following the baseline test were related to cognition. Results: In the single task condition, ALS patients, regardless of cognition, displayed higher gait variability than HS, especially for stance and swing time (p < 0.001). The dual task condition revealed additional differences in gait variability parameters between ALS MCI+ and ALS MCI− for cadence (p = 0.005), stance time (p = 0.04), swing time (p = 0.04) and stability index (p = 0.02). Moreover, ALS MCI+ showed a higher occurrence (p = 0.001) and number of falls (p < 0.001) at the follow-up. Regression analyses demonstrated that MCI condition predicted the occurrence of future falls (β = 3.649; p = 0.01) and, together with executive dysfunction, was associated with the number of falls (cognitive impairment: β = 0.63; p < 0.001; executive dysfunction: β = 0.39; p = 0.03), regardless of motor impairment at clinical examination. Conclusion: In ALS, MCI is associated with exaggerated gait variability and predicts the occurrence and number of short-term falls.

Original languageEnglish
Pages (from-to)3056-3067
Number of pages12
JournalEuropean Journal of Neurology
Issue number10
StatePublished - Oct 2023


FundersFunder number
National Recovery and Resilience Plan1553 11.10.2022, PE0000006
Ministero dell’Istruzione, dell’Università e della Ricerca


    • amyotrophic lateral sclerosis
    • cognition
    • falls
    • gait analysis
    • wearable sensors


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