Download PDF
CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2016; 74(06): 450-455
DOI: 10.1590/0004-282X20160063
Article

Balance impairment does not necessarily coexist with gait apraxia in mild and moderate Alzheimer’s disease

Comprometimento do equilíbrio e apraxia da marcha não necessariamente coexistem na doença de Alzheimer leve e moderada
Fernando Vieira Pereira
Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil.
,
Fabricio Ferreira de Oliveira
Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil.
,
Rodrigo Rizek Schultz
Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil.
,
Paulo Henrique Ferreira Bertolucci
Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil.
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

ABSTRACT

Currently, there are no studies reporting how much balance impairment coexists with gait apraxia in mild and moderate Alzheimer’s disease (AD).

Objectives To assess correlations among gait apraxia, balance impairment and cognitive performance in mild (AD1, n = 30) and moderate (AD2, n = 30) AD.

Method The following evaluations were undertaken: gait apraxia (Assessment Walking Skills); balance performance (Berg Balance Scale); Clinical Dementia Rating and Mini-mental State Examination (MMSE).

Results While disregarding AD subgroups, Berg Balance Scale and the MMSE correlated significantly with Assessment Walking Skills and 23% of all subjects scored below its cut-off. After stratification, Berg Balance Scale correlated significantly with Assessment Walking Skills in both AD subgroups, and with the MMSE only in AD1.

Conclusions Balance impairment does not necessarily coexist with gait apraxia. Gait apraxia is more prevalent in moderate AD when compared with mild AD.

RESUMO

Apraxia da marcha e desequilíbrio são condições subinvestigadas na doença de Alzheimer (DA) leve e moderada.

Objetivo Verificar a correlação da apraxia da marcha com desequilíbrio e cognição em 30 idosos com DA leve (DA1) e 30 idosos com DA moderada (DA2).

Método Foram feitas as seguintes avaliações: apraxia da marcha (Assessment Walking Skills); equilíbrio (Berg Balance Scale); Clinical Dementia Rating e Mini-exame do estado mental – MEEM.

Resultados Desconsiderando-se os grupos, Berg Balance Scale e MEEM correlacionaram-se significativamente com a Assessment Walking Skills, enquanto 23% dos participantes pontuaram abaixo da note de corte da mesma. Considerando-se os grupos, Berg Balance Scale correlacionou-se significativamente com a Assessment Walking Skills em ambos os grupos, embora o MEEM o tenha feito apenas em DA1.

Conclusões Desequilíbrio e apraxia da marcha não necessariamente coexistem com apraxia da marcha. Prevalência de apraxia da marcha foi maior na DA moderada do que na DA leve.

Alzheimer disease - gait - apraxias - postural balance
doença de Alzheimer - marcha - apraxias - equilíbrio postural

Support:

Support: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).




Publication History

Received: 07 January 2016

Accepted: 22 March 2016

Article published online:
06 September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Leiguarda RC, Marsden CD. Limb apraxias: higher-order disorders of sensorimotor integration. Brain. 2000;123(5):860-79. doi:10.1093/brain/123.5.860
  • 2 Mink JW. The basal ganglia: focused selection and inhibition of competing motor programs. Prog Neurobiol. 2006;50(4):381-425. doi:10.1016/S0301-0082(96)00042-1
  • 3 Rossor MN, Tyrrell PJ, Warrington EK, Thompson PD, Marsden CD, Lantos P. Progressive frontal gait disturbance with atypical Alzheimer’s disease and corticobasal degeneration. J Neurol Neurosurg Psychiatry. 1999;67(3):345-52. doi:10.1136/jnnp.67.3.345
  • 4 Della Sala S, Francescani A, Spinnler H. Gait apraxia after bilateral supplementary motor area lesion. J Neurol Neurosurg Psychiatry. 2002;72(1):77-85. doi:10.1136/jnnp.72.1.77
  • 5 Nutt JG, Marsden CD, Thompson PD. Human walking and higher level gait disorders, particularly in the elderly. Neurology. 1993;43(2):269-79. doi:10.1212/WNL.43.2.268
  • 6 Elble RJ. Gait and dementia: moving beyond the notion of gait apraxia. J Neural Transm (Vienna). 2007;114(10):1253-8. doi:10.1007/s00702-007-0743-3
  • 7 Zadikoff C, Lang AE. Apraxia in movement disorders. Brain. 2005;128(7):1480-97. doi:10.1093/brain/awh560
  • 8 Della Sala S, Spinnler H, Venneri A. Walking difficulties in patientes with Alzheimer’s disease might originate from gait apraxia. J Neurol Neurosurg Psychiatry. 2004;75(2):196-201.
  • 9 Shumway-Cook A, Woollacott MH. Motor control: theory and practical applications. Philadelphia: Lippincott, Williams & Wilkins; 2001.
  • 10 Chong RK, Horak FB, Frank J, Kaye J. Sensory organization for balance: specific deficits in Alzheimer’s disease but not in Parkinson’s diasease. J Gerontol A Biol Sci Med Sci. 1999;54(3):122-8. doi:10.1093/gerona/54.3.M122
  • 11 O’Keeffe ST, Kazeem H, Philpott RM, Playfer JR, Gosney M, Lye M. Gait disturbance in Alzheimer’s disease: a clinical study. Age Ageing. 1996;25(4):313-6. doi:10.1093/ageing/25.4.31
  • 12 Kato-Narita EM, Nitrini R, Radanovic M. Assessment of balance in mild and moderate stages of Alzheimer’s disease: implications on falls and functional capacity. Arq Neuropsiquiatr. 2011;69(2A):202-7. doi:10.1590/S0004-282X2011000200012
  • 13 Morris JC, Heyman A, Mohs RC, Hughes JP, Belle G, Fillenbaum G et al. The consortium to establish a registry for Alzheimer’s disease (CERAD): Part I. Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology. 1989;39(9):1159-65. doi:10.1212/WNL.39.9.1159
  • 14 Folstein F, Folstein S, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-98. doi:10.1016/0022-3956(75)90026-6
  • 15 Chaves MLF, Camozzato AL, Godinho C, Kochhann R, Schuh A, Almeida VL et al. Validity of the Clinical dementia rating scale for the detection and staging of dementia in Brazilian patients. Alzheimer Dis Assoc Disord. 2007;21(3):210-7. doi:10.1097/WAD.0b013e31811ff2b4
  • 16 Perneczky R, Wagenpfeil S, Komossa K, Grimmer T, Diehl J, Kurz A. Mapping scores onto stages: mini-mental state examination and clinical dementia rating. Am J Geriatr Psychiatry. 2006;14(2):139-44. doi:10.1097/01.JGP.0000192478.82189.a8
  • 17 Maia ALG, Godinho C, Ferreira ED, Almeida V, Schuh A, Kaye J, Chaves MLF. [Application of the Brazilian version of the CDR scale in samples of dementia patients]. Arq Neuropsiquiatr. 2006;64(2B):485-9. Portuguese. doi:10.1590/S0004-282X2006000300025
  • 18 Berg K, Wood-Dauphinee S, Williams JI, et al. Measuring balance in the elderly: preliminary development of an instrument. Physiother Can. 1989;41(6):304-11. doi:10.3138/ptc.41.6.304
  • 19 Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Can J Public Health. 1992;83(Suppl 2):S7-11.
  • 20 Mancini M, Horak FB. The relevance of clinical balance assessment tools to differentiate balance deficits. Eur J Phys Rehabil Med. 2010;46(2):239-48.
  • 21 Shumway-Cook A, Baldwin M, Polissar NL, Gruber W. Predicting the probability for falls in community-dwelling older adults. Phys Ther. 1997;77(8):812-9.
  • 22 Vanbellingen T, Bohlhalter S. Apraxia in neurorehabilitation: classification, assessment and treatment. NeuroRehabilitation. 2011;28(2):91-8. doi:10.3233/NRE-2011-0637
  • 23 Holtzer R, Friedman R, Lipton RB, et al. The relationship between specific cognitive functions and falls in aging. Neuropsychology. 2007;21(5):540-8. doi:10.1037/0894-4105.21.5.540
  • 24 Camicioli R, Howieson D, Lehman S, Kaye J. Talking while walking: the effect of a dual task in aging and Alzheimer’s disease. Neurology. 1997;48(4):955-8. doi:10.1212/WNL.48.4.955
  • 25 Oliveira FF, Wajman JR, Bertolucci PHF, Chen ES, Smith MC. Correlations among cognitive and behavioural assessments in patients with dementia due to Alzheimer’s disease. Clin Neurol Neurosurg. 2015;135:27-33. doi:10.1016/j.clineuro.2015.05.010
  • 26 Decker L, Annweiler C, Yvain F, Leroux P, Lermite P, Berrut G et al. [How to manage gait and balance disorders among older adults aged 65 years and older with mild to moderate dementia in clinical practice?]. Geriatr Psychol Neuropsychiatr Vieil. 2011;9(3):269-76. French. doi:10.1684/pnv.2011.0291