Skip to main content Accessibility help

The Potential of Gait Analysis to Contribute to Differential Diagnosis of Early Stage Dementia: Current Research and Future Directions*

  • Debra Morgan (a1), Melanie Funk (a2), Margaret Crossley (a3), Jenny Basran (a3), Andrew Kirk (a3) and Vanina Dal Bello-Haas (a3)...


Early differential diagnosis of dementia is becoming increasingly important as new pharmacologic therapies are developed, as these treatments are not equally effective for all types of dementia. Early detection and differential diagnosis also facilitates informed family decision making and timely access to appropriate services. Information about gait characteristics is informative in the diagnostic process and may have important implications for discriminating among dementia subtypes. The aim of this review paper is to summarize existing research examining the relationships between gait and dementia, including gait classification systems and assessment tools, gait patterns characteristic of different dementias (Alzheimer's disease, vascular dementia, dementia with Lewy Bodies, and fronto-temporal dementia), and the utility of gait analysis in early-stage diagnosis. The paper concludes with implications for future research.

Le diagnostic différentiel précoce entre les formes de démence revêt de plus en plus d'importance au fil de l'émergence de nouveaux traitements médicamenteux qui sont efficaces dans certaines formes de démence et pas dans d'autres. La détection et le diagnostic différentiel précoces ont également pour avantages de permettre à la famille de prendre des décisions éclairées et de faciliter l'accès opportun aux services appropriés. Les caractéristiques de la démarche sont l'un des éléments essentiels du diagnostic et cette information serait utile dans la distinction entre les formes de démence. Le présent exposé de synthèse fait le point sur la recherche concernant le lien entre la démarche et la démence en présentant notamment des systèmes de classification et des méthodes d'évaluation de la démarche, les caractéristiques de la démarche selon le type de démences, dont la maladie d'Alzheimer, la démence vasculaire, la démence à corps de Lewy et la démence frontotemporale, et l'utilité de l'analyse de la démarche dans le diagnostic à un stade précoce. L'exposé se termine par les perspectives de la recherche à l'avenir.


Corresponding author

Requests for offprints should be sent to: / Les demandes de tirés-à-part doivent être adressées à: Debra Morgan, Ph.D., R.N., Canadian Centre for Health and Safety in Agriculture/Institute of Agricultural Rural and Environmental Health, Box 120, Royal University Hospital, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK S7N 0W8. (


Hide All

Thanks to Allison Cammer, Maxine Holmqvist, Lisa Lejbak, and Tasha Thornhill for their contributions to preparing this manuscript. The authors gratefully acknowledge the support of the Canadian Institutes of Health Research (Institute of Aging, Institute of Health Services and Policy Research, Rural and Northern Health Initiative), the Alzheimer Society of Saskatchewan, Saskatchewan Health Research Foundation, and the University of Saskatchewan.



Hide All
Ala, T., & Frey, W. (1995). Validation of the NINCDS-ADRDA criteria regarding gait in the clinical diagnosis of Alzheimer disease. Alzheimer Disease and Associated Disorders, 9(3), 152159.
Allan, L., Ballard, C., Burn, D., & Kenny, R. (2005). Prevalence and severity of gait disorders in Alzheimer's and Non-Alzheimer's dementias. Journal of the American Geriatrics Society, 53, 16811687.
Alexander, N., Mollo, J., Giordani, B., Ashton-Miller, J., Schultz, A., Grunawalt, J., et al. (1995). Maintenance of balance, gait patterns, and obstacle clearance in Alzheimer's disease. Neurology, 45(5), 908914.
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (DSM-IV-TR). (4th ed.). Washington, DC: Author.
Bazner, H., Oster, M., Daffertshofer, M., & Hennerici, M. (2000). Assessment of gait in subcortical vascular encephalopathy by computerized analysis: A cross-sectional and longitudinal study. Journal of Neurology, 415, 841849.
Becker, J., Boller, F., Lopez, O., Saxton, J., & McGonigle, K. (1994). The natural history of Alzheimer's disease: Description of study cohort and accuracy of diagnosis. Archives of Neurology, 51(6), 585594.
Berg, K., Wood-Dauphinee, S., Williams, J., & Gayton, D. (1989). Measuring balance in the elderly: Preliminary development of an instrument. Physiotherapy Canada, 41, 304311.
Bohannon, R. (1997). Comfortable and maximum walking speed of adults aged 20–79 years: Reference values and determinants. Age and Ageing, 26, 1519.
Brill, P., Drimmer, A., Morgan, L., & Gordon, N. (1995). The feasibility of conducting strength and flexibility programs for elderly nursing home residents with dementia. Gerontologist, 35, 263266.
Canadian Study of Health and Aging Working Group (1994). Canadian Study of Health and Aging: Study methods and prevalence of dementia. Canadian Medical Association Journal, 150, 899913.
Canadian Study of Health and Aging Working Group (2000). The incidence of dementia in Canada. Neurology, 55, 6673.
Canadian Study of Health and Aging Working Group (2004). Clinical Examination. Retrieved 15 December 2004 from
Del Ser, T., McKeith, I., Anand, R., Cicin-Sain, A., Ferrara, R., & Spiegel, R. (2000). Dementia with Lewy Bodies: Findings from an international multicentre study. International Journal of Geriatric Psychiatry, 15, 10341045.
Duncan, P. (1989). Duke Mobility Skills Profile. Durham, NC: Duke University, Centre for Human Aging.
Ebersbach, G., Sojer, M., Valldeoriola, F., Wissel, J., Muller, J., Tolosa, E., et al. (1999). Comparative analysis of gait in Parkinson's disease, cerebellar ataxia and subcortical arteriosclerotic encephalopathy. Brain, 122, 13491355.
Ellis, R., Caligiuri, M., Galasko, D., & Thal, L. (1996). Extrapyramidal motor signs in clinically diagnosed Alzheimer disease. Alzheimer Disease and Associated Disorders, 10(2), 103114.
Fahn, S., Elton, R., Members of the UPDRS Development Committee. (1987). Unified Parkinson's Disease Rating Scale. In Fahn, S., Marsden, C., Caine, D., & Goldstein, M. (Eds.), Recent developments in Parkinson's disease (pp. 153163293304). Florham Park, NJ: Macmillan Health Care Information.
Fiatarone, M., & Evans, W. (1993). The etiology and reversibility of muscle dysfunction in the aged. Journal of Gerontology, 48, M77M83.
Franssen, E., Kluger, A., Torossian, C., & Reisberg, B. (1993). The neurologic syndrome of severe Alzheimer's disease: Relationship to functional decline. Archives of Neurology, 50, 10291039.
Franssen, E., Souren, L., Torossian, C., & Reisberg, B. (1999). Equilibrium and limb coordination in mild cognitive impairment and mild Alzheimer's disease. Journal of the American Geriatrics Society, 47(4), 463469.
Funkenstein, H., Albert, M., Cook, N., West, C., Scherr, P., Chown, M., et al. (1993). Extrapyramidal signs and other neurologic findings in clinically diagnosed Alzheimer's disease. Archives of Neurology, 50, 5156.
Galasko, D., Katzman, R., Salmon, D., & Hansen, L. (1996). Clinical and neuropathological findings in Lewy Body dementias. Brain and Cognition, 31, 166175.
Galasko, D., Kwo-on-Yuen, P., Klauber, B., & Thai, L. (1990). Neurological findings in Alzheimer's disease and normal aging. Archives of Neurology, 47, 625627.
Gnanalingham, K., Byrne, E., Thornton, A., Sambrook, M., & Bannister, P. (1997). Motor and cognitive function in Lewy Body dementia: Comparison with Alzheimer's and Parkinson's diseases. Journal of Neurosurgery and Psychiatry, 62, 243252.
Goldman, W., Baty, J., Buckles, V., Sahrmann, S., & Morris, J. (1999). Motor dysfunction in mildly demented AD individuals without extrapyramidal signs. Neurology, 53(5), 956962.
Hageman, P., & Thomas, V. (2002). Gait performance in dementia: The effects of a 6-week resistance training program in an adult day-care setting. International Journal of Geriatric Psychiatry, 17, 329334.
Hennerici, J., Oster, J., Cohen, S., Schwartz, A., Motsch, L., & Daffertshofer, M. (1994). Are gait disturbances and white matter degeneration early indicators of vascular dementia? Dementia, 5, 197202.
Hogue, C., Studenski, S., Duncan, P.W. (1990). Assessing mobility: The first steps in preventing fall. In Funk, S.G., Tornquist, E.M., Champagne, M.T., Copp, L.A., & Wiese, R.A. (Eds.), Key aspects of recovery (pp. 275281). New York: Springer.
Hohl, U., Tiraboschi, P., Hansen, L., Thal, L., & Corey-Bloom, J. (2000). Diagnostic accuracy of dementia with Lewy Bodies. Archives of Neurology, 57, 347351.
Johansson, G., & Jarnloo, G.B. (1991). Balance training in 70-year-old women. Physiotherapy Theory and Practice, 7, 121125.
Krauss, J., Faist, M., Schubert, M., Borremans, J., Lücking, C., & Berger, W. (2001). Evaluation of gait in normal pressure hydrocephalus before and after shunting. Gait Disorders, Advances in Neurology, 87, 301310.
Kressig, R., Gregor, R., Oliver, A., Waddell, D., Smith, W., O'Grady, M., et al. (2004). Temporal and spatial features of gait in older adults transitioning into frailty. Gait and Posture, 20, 3035.
Kurlan, R., Richard, I., Papka, M., & Marshall, F. (2000). Movement disorders in Alzheimer's disease: More rigidity of definitions is needed. Movement Disorders, 15(1), 2429.
Larson, E., Shadlen, M., Wang, L., McCormick, W., Bopwen, J., Teri, L., et al. (2004). Survival after initial diagnosis of Alzheimer disease. Annals of Internal Medicine, 140, 501509.
Laufer, Y. (2005). Effect of age on characteristics of forward and backward gait at preferred and accelerated walking speed. Journal of Gerontology, 60A(5), 627632.
Louis, E., Goldman, J., Powers, J., & Fahn, S. (1995). Parkinsonian features of eight pathologically diagnosed cases of diffuse Lewy Body disease. Movement Disorders, 10, 188194.
Mbourou, G., Lajoie, Y., & Teasdale, N. (2003). Step length variability at gait initiation in elderly fallers and non-fallers, and young adults. Gerontology, 49, 2126.
McKeith, I. (2002). Dementia with Lewy Bodies. British Journal of Psychiatry, 180, 144147.
McKeith, I., Galasko, D., Kosaka, K., Perry, E., Dickson, D., Hansen, L., et al. (1996). Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy Bodies (DLB): Report of the consortium on DLB international workshop. Neurology, 47, 11131124.
McKeith, I., Perry, E., & Perry, R. (1999). Report of the second dementia with Lewy Body international workshop: Diagnosis and treatment. Neurology, 53(5), 902905.
McKeith, I., Perry, R., Fairbairn, A., Jabeen, S., & Perry, E. (1992). Operational criteria for senile dementia of Lewy Body type (SDLT). Psychological Medicine, 22, 911922.
McKhann, G., Albert, M., Grossman, M., Miller, B., Dickson, D., & Trojanowski, J. (2001). Clinical and pathological diagnosis of frontotemporal dementia: Report of the work group on frontotemporal dementia and Pick's disease. Archives of Neurology, 58, 18031809.
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., & Stadlan, E. (1984). Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939944.
Nakamura, T., Meguro, K., Yamazaki, H., Okuzumi, H., Tanaka, A., Horikawa, A., et al. (1997). Postural and gait disturbance correlated with decreased frontal cerebral blood flow in Alzheimer disease. Alzheimer Disease and Associated Disorders, 11(3), 132139.
Neary, D., Snowden, J., Gustafson, L., Passant, U., Stuss, D., Black, S., et al. (1998). Frontotemporal lobar degeneration: A consensus on clinical diagnostic criteria. Neurology, 51(6), 15461554.
Nutt, J., Marsden, C., & Thompson, P. (1993). Human walking and higher-level gait disorders, particularly in the elderly. Neurology, 43, 268279.
O'Keefe, S., Kazeem, H., Philpot, R., Playfer, J., Gosney, M., & Lye, M. (1996). Gait disturbance in Alzheimer's disease: A clinical study. Age and Ageing, 25(4), 313316.
Ott, B., Ellias, S., & Lannon, M. (1995). Quantitative assessment of movement in Alzheimer's disease. Journal of Geriatric Psychiatry and Neurology, 8(1), 7175.
Papka, M., Rubio, A., & Schiffer, R. (1998). A review of Lewy Body disease, an emerging concept of cortical dementia. Journal of Neuropsychiatry and Clinical Neurosciences, 10(3), 267279.
Papka, M., Rubio, A., Schiffer, R., & Cox, C. (1998). Lewy Body disease: Can we diagnose it? Journal of Neuropschiatry, 10(4), 405412.
Patterson, C., Gauthier, S., Bergman, H., Cohen, C., Feightner, J., Feldman, H., et al. (1999). The recognition, assessment and management of dementing disorders: Conclusions from the Canadian Consensus Conference on Dementia. Canadian Medical Association Journal, 160(Suppl. 12), S1S15.
Perry, J. (1992). Gait analysis: Normal and pathologic function. Thorofare, NJ: Slack.
Pettersson, A., Engardt, M., & Wahlund, L. (2002). Activity level and balance in subjects with mild Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 13(4), 213216.
Podsiadlo, D., & Richardson, S. (1991). The timed “Up & Go”: A test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39, 142148.
Reisberg, B., Ferris, S., DeLeon, M., & Crook, T. (1982). The Global Deterioration Scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 11361139.
Rockwood, K., Awalt, E., Carver, D., & MacKnight, C. (2000). Feasibility and measurement properties of the Functional Reach and the timed Up and Go tests in the Canadian Study of Health and Aging. Journal of Gerontology: Medical Sciences, 55A(2), M70M73.
Román, G., Tatemichi, M., Erkinjuntti, T., Cummings, M., Masdeu, J., Garcia, M., et al. (1993). Vascular dementia—Diagnostic criteria for research studies: Report of the NINDS-AIREN International Workshop. Neurology, 43, 250260.
Roth, M., Tym, E., & Mountjoy, C. (1986). CAMDEX: A standardized instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. British Journal of Psychiatry, 149, 698709.
Sheridan, P., Solomont, J., Kowall, N., & Hausdorff, J. (2003). Influence of executive function on locomotor function: Divided attention increases gait variability in Alzheimer's disease. Journal of the American Geriatrics Society, 51(11), 16331637.
Shkuratova, N., Morris, M., & Huxham, F. (2004). Effects of age on balance control while walking. Archives of Physical Medicine and Rehabilitation, 85, 582588.
Shumway-Cook, A., & Woollacott, M. (2001). Motor control: Theory and practical applications. Baltimore, MD: Lippincott Williams and Wilkins.
Stolze, H., Kuhtz-Buschbeck, J., Drucke, H., Johnk, K., Illert, M., & Deuschl, G. (2001). Comparative analysis of the gait disorder of normal pressure hydrocephalus and Parkinson's disease. Journal of Neurology, Neurosurgery and Psychiatry, 70(3), 289297.
Sudarsky, L. (2001). Gait disorders: Prevalence, morbidity, and etiology. Gait Disorders, Advances in Neurology, 87, 111119.
Tanaka, A., Okuzumi, H., Kobayashi, I., Murai, N., & Meguro, K. (1995). Gait disturbance of patients with vascular and Alzheimer-type dementias. Perceptual and Motor Skills, 80, 735738.
Tappen, R., Roach, K., Buchner, D., Barry, C., & Edelstein, J. (1997). Reliability of physical performance measures in nursing home residents with Alzheimer's disease. Journal of Gerontology Medical Science, 52A, M52M55.
Thajeb, P. (1993). Gait disorders of multi-infarct dementia. Acta Neurologica Scandinavica, 87, 239242.
Thomas, V.S., & Hageman, P.A. (2002). A preliminary study on the reliability of physical performance measures in older day-care center clients with dementia. International Psychogeriatrics, 14(1), 1723.
Thomas, V., & Hageman, P. (2003). Can neuromuscular strength and function in people with dementia be rehabilitated using resistance-exercise training? Results from a preliminary intervention study. Journal of Gerontology: Medical Sciences, 58A(8), 746751.
Thompson, P., & Marsden, C. (1987). Gait disorder of subcortical arteriosclerotic encephalopathy: Binswanger's disease. Movement Disorders, 2(1), 18.
Tinetti, M. (1986). Performance-oriented assessment of mobility problems in elderly patients. Journal of the American Geriatrics Society, 34, 119126.
Vale, M. (2000). What is Alzheimer's disease and who will be affected? Geriatrics and Aging, 3(7), 25.
van Iersel, M.B., Hoefsloot, W., Munneke, M., Bloem, B., & Olde Rikkert, M. (2004). Systemic review of quantitative clinical gait analysis in patients with dementia. Zeitschrift fur Gerontologie und Geriatrie, 37, 2732.
Verghese, J., Lipton, R., Hall, C., Kuslansky, G., Katz, M., & Busche, H. (2002). Abnormality of gait as a predictor of non-Alzheimer's dementia. New England Journal of Medicine, 347, 17611768.
Visser, H. (1983). Gait and balance in senile dementia of Alzheimer's type. Age and Ageing, 12, 296301.
Waite, L., Broe, G., Grayson, D., & Creasey, H. (2000). Motor function and disability in the dementias. International Journal of Geriatric Psychiatry, 15(10), 897903.
Weiner, M., Hynan, L., Parikh, B., Zaki, N., White, C., Bigio, M., et al. (2003). Can Alzheimer's disease and dementias with Lewy Bodies be distinguished clinically? Journal of Geriatric Psychiatry and Neurology, 16, 245250.
Wolfson, L., Whipple, R., Amerman, P., & Tobin, J.N. (1990). Gait assessment in the elderly: A gait abnormality rating scale and its relation to falls. Journal of Gerontology: Medical Sciences, 45(1), M1219.
Zijlmans, J., Poels, P., Duysens, J., van der Straaten, J., Thien, T., van't Hof, M., et al. (1996). Quantitative gait analysis in patients with vascular parkinsonism. Movement Disorders, 11(5), 501508.


The Potential of Gait Analysis to Contribute to Differential Diagnosis of Early Stage Dementia: Current Research and Future Directions*

  • Debra Morgan (a1), Melanie Funk (a2), Margaret Crossley (a3), Jenny Basran (a3), Andrew Kirk (a3) and Vanina Dal Bello-Haas (a3)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed