What Walking Patterns May Reveal About Cognitive Decline

Gait variability may predict certain types of cognitive decline in older adults.

Posted Feb 17, 2021 | Reviewed by Gary Drevitch

"Gait variability" is a term used to describe stride-to-stride fluctuations in timing and distance traversed as someone walks.
Source: Hamsterfreund/Pixabay

Key points: New research into the long-studied connection between changes in gait and the onset of cognitive decline and dementia found that stride-to-stride fluctuations were more specifically predictive of Alzheimer's disease than of age-related cognitive decline.

New research suggests that stride-to-stride fluctuations in someone's walking pattern may be a novel way to diagnose specific types of cognitive decline in older adults. "Our findings indicate that high gait variability is a marker of cognitive‐cortical dysfunction, which can help to identify Alzheimer's disease dementia," the authors state. These findings (Pieruccini‐Faria et al., 2021) were published on February 16 in Alzheimer's & Dementia.

This multiple-cohort "gait and brain" study investigated the link between mobility and cognition by comparing gait patterns across the cognitive spectrum in a wide range of older adults with Alzheimer's disease, Parkinson's disease, Lewy body dementia, frontotemporal dementia, mild cognitive impairment, subjective cognitive impairment, and a cognitively healthy control group.

After evaluating four independent gait patterns (pace, postural control, rhythm, and variability) among 500 clinical trial participants from the different "cognitive spectrum" cohorts listed above, the researchers found that "only high gait variability was associated with lower cognitive performance and it identified Alzheimer's disease with 70 percent accuracy."

"Gait impairment is common in neurodegenerative disorders. Specifically, gait variability—the stride‐to‐stride fluctuations in distance and time—has been associated with neurodegeneration and cognitive impairment," the authors explain in their paper's introduction. "However, quantitative comparisons of gait impairments across the cognitive spectrum of dementias have not been systematically investigated [until now]."

"This is the first strong evidence showing that gait variability is an important marker for processes happening in areas of the brain that are linked to both cognitive impairment and motor control," first author Frederico Perruccini-Faria of the University of Western Ontario's Lawson Health Research Institute said in a news release. "We've shown that high gait variability as a marker of this cognitive-cortical dysfunction can reliably identify Alzheimer's disease compared to other neurodegenerative disorders."

"We have longstanding evidence showing that cognitive problems, such as poor memory and executive dysfunction, can be predictors of dementia. Now, we're seeing that motor performance, specifically the way you walk, can help diagnose different types of neurodegenerative conditions," senior author Manuel Montero-Odasso, professor at the University of Western Ontario and director of the Gait and Brain Lab, added. "We see gait variability being similar to an arrhythmia. Health care providers could measure it with patients in the clinic, similar to how we assess heart rhythm with electrocardiograms."

Three Highlights from this "Gait and Brain" study (Pieruccini‐Faria et al., 2021)

  1. Gait and cognitive performance are strongly linked in neurodegenerative diseases.
  2. High gait variability (stride-to-stride changes) discriminates Alzheimer's disease from age‐related neurodegenerative disorders.
  3. High gait variability indicates cognitive‐cortical dysfunction in neurodegeneration.

"Increased gait variability may reflect the progression of cognitive impairment in neurodegenerative diseases, and potentially with specificity for Alzheimer's disease dementia, which is the archetypal cortical cognitive disorder," the authors conclude. "Our study, therefore, supports the notion that, compared with other gait parameters, gait variability may be a putative marker of cognitive‐cortical deterioration in neurodegenerative disorders. A future study using a validation cohort is required to confirm our findings."

In a follow-up post, I'll explore how dysfunctions of the cerebellum have historically been associated with high gait variability (Schniepp et al., 2011) and the often-overlooked link between cerebellar atrophy and Alzheimer's disease (Wegiel et al., 1999; Jacobs et al., 2017).


Frederico Pieruccini‐Faria, Sandra E. Black, Mario Masellis, Eric E. Smith, Quincy J. Almeida, Karen Z. H. Li, Louis Bherer, Richard Camicioli, Manuel Montero‐Odasso. "Gait Variability Across Neurodegenerative and Cognitive Disorders: Results from the Canadian Consortium of Neurodegeneration in Aging (CCNA) and the Gait and Brain Study." Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association (First published: February 16, 2021) DOI: 10.1002/alz.12298