Walking speed, cognitive impairment, and what to do about it

I have previously reported on how gait and balance problems have been associated with white matter lesions, and walking speed and grip strength have been associated with dementia and stroke risk. Another recent study, involving 93 older adults (70+) has added to this evidence, with the finding that those with non-amnestic MCI were much more likely to be slow walkers.

The study involved 54 seniors with no cognitive impairment, 31 with non-amnestic MCI and eight with amnestic MCI. Passive infrared sensors fixed in series on the ceilings of participants’ homes enabled their walking speed to be monitored unobtrusively over a three-year period.

Those with non-amnestic MCI were nine times more likely to be slow walkers than moderate or fast walkers, and more likely to show greater variability in walking speed.

Unfortunately, I have not been able to read the full paper (which is why I’m not reporting this in news), so I can’t tell you any more details. I assume that the main reason for the failure to find a significant difference in the amnestic MCI group was because that group was so small, but I don’t know.

Nevertheless, the study does add to the growing evidence of an association between gait and balance problems and risk of cognitive impairment and dementia, which is why I was interested to read a recent paper on entraining walking using a metronomic beat.

The paper spoke about the use of sensory cues in neurological rehabilitation. Specifically, auditory cues have been shown to help various gait characteristics of patients with Parkinson's disease and stroke. In patients with Parkinson’s, visual cues also improved stride length, while auditory cues improved cadence.

So here’s the question: if you are having gait and/or balance problems, will improving them also reduce your risk of developing cognitive problems? Or are the physical problems merely the consequence of physical deterioration in the brain that also lead to cognitive problems?

I’ve raised the same question before in relation to sensory deterioration. My answer then is the same answer I give now: you shouldn’t ignore these physical problems as something that is simply inevitable with age and/or poor health. As with sensory impairment, there are two ways in which restricted physical movement might impact your cognition.

One is the physical damage in the brain I have spoken of. Whether or not you can reverse some of this damage (or at least counteract it by developing some other area of the brain) by improving gait, balance, or grip strength, is a question as yet unanswered. But it is possible, and for that reason should be tried.

The other way is through the effect of restricted physical movement on your activities, and your state of mind. Research suggests that restricting your environment is a risk factor in developing cognitive impairment. Similarly, social engagement and cognitively-stimulating activities are both important for preventing cognitive decline, and while physical frailty doesn’t necessarily limit these, it does make it much more likely that they will be restricted.

State of mind is associated with attitude, and I have spoken before (often!) about the effect of this on cognition. If you believe that life is ‘over’ for you, that you are sliding rapidly down the hill and there is nothing you can do about it, then your belief will make that true. Physical frailty is, understandably, going to make that belief more likely. Contrariwise, if you succeed in reducing your frailty, in being able once again to do some tasks that you thought you would never be able to do again, then you are much more likely to take action in fighting cognitive decline.

So, it’s worth tackling walking problems — and worth making your best efforts to ensure that they don’t happen, by keeping fit and active. The use of sensory cues to help gait problems probably requires some specialist assistance. Another approach is by practicing tai ch’i, which is generally recommended as an activity for improving balance.

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