High risk neurological gait syndrome and vascular dementia.
We defined a 'high-risk neurological gait' (HRNG) syndrome based on presence of any one of hemiparetic, frontal, and unsteady gaits, and examined its validity to predict vascular dementia (VD) over 3 and 5 years in 399 nondemented older adults, age 75 and over. Cox analysis was used to estimate hazard ratios (HR) for VD adjusted for potential confounders. At baseline, 54 subjects had HRNG. 14 subjects developed VD over 3 years and 25 by 5 years. HRNG predicted risk of VD within the first three (HR 3.3, 95% CI 1.8-5.9) and five years (HR 2.7, 95% CI 1.7-4.2). Including executive dysfunction (Digit symbol scores <16) improved validity; subjects with HRNG and executive dysfunction (HR 12.5, 95% CI 5.5-28.4) or either (HR 5.9, 95% CI 3.6-9.7) had higher risk of VD over five years. Diagnosing HRNG is a clinically relevant approach to identifying older adults at high risk of VD over short intervals.
Verghese
J
J
Einstein Aging Study, Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, U.S.A. jverghes@aecom.yu.edu
Derby
C
C
Katz
M J
MJ
Lipton
R B
RB
D000368:Aged; D000369:Aged, 80 and over; D015140:Dementia, Vascular / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D020233:Gait Disorders, Neurologic / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index