title: [Gait disorders in the elderly: prospects for a symptomatic therapy].
abstract: Gait disorders are among the most common presenting symptoms in neurology. In the elderly, multiple causes of gait instability and dizziness may occur in the same subject. Relevant pathogenetic factors are sensory deficits (visual, vestibular, somatosensory), neurodegenerative processes (cortical, extrapyramidal, cerebellar), toxic factors (medication, alcohol) and anxiety (primary or as the result of falls). Reduced mobility reduces the quality of life; associated falls increase morbidity and mortality. The evaluation of aged people with the chief complaint "gait disorder" should focus on the identification of specific deficits. This is the prerequisite for reasoned therapy. Besides treatment of the underlying pathology there is a need for effective symptomatic therapy, in particular for degenerative disorders. Physical therapy with postural and locomotor training remains the basis of treatment; it can improve gait and prevent falls. So far, symptomatic drug treatment is unsatisfactory. Based on pathophysiology and uncontrolled studies, the most promising approaches are to support cholinergic neurotransmission in the midbrain and thalamus by central cholinesterase inhibitors and the regularisation of Purkinje cell function by potassium channel blockers. Brain stem nuclei which are target regions for deep brain stimulation (subthalamic and pedunculopontine nucleus) are known to be relevant for locomotor control (subthalamic and mesencephalic locomotor region). Accordingly, deep brain stimulation also affects posture and gait. The current literature on symptomatic therapy for gait disorders in the elderly is summarised.
authors.affiliation: Neurologische Klinik und Poliklinik, Klinikum der Universität München, München. klaus.jahn@med.uni-muenchen.de
authors.forename: K
authors.initials: K
authors.lastname: Jahn
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology; D002490:Central Nervous System / Q000254:growth & development / Q000503:physiopathology; D003071:Cognition / Q000502:physiology; D005260:Female; D020233:Gait Disorders, Neurologic / Q000188:drug therapy / Q000503:physiopathology / Q000534:rehabilitation / Q000628:therapy*; D006801:Humans; D008124:Locomotion / Q000502:physiology; D008297:Male; D019636:Neurodegenerative Diseases / Q000150:complications; D026741:Physical Therapy Modalities; D011788:Quality of Life; D012678:Sensation Disorders / Q000150:complications