Anne Felicia Ambrose

Epidemiology of Gait Disorders in Community‐Residing Older Adults

OBJECTIVES: To study the epidemiology of gait disorders in community‐residing older adults and their association with death and institutionalization.

Picture-Based Memory Impairment Screen for Dementia

To develop and validate a picture‐based memory impairment screen (PMIS) for the detection of dementia.

Gait and cognition in older adults: Insights from the Bronx and Kerala

Background: Recent reports indicate that gait dysfunction can occur early in the course of cognitive decline suggesting that motor and cognitive functions in older adults may share common underlying brain substrates, pathological processes, and risk factors. Objective: This study was designed to report the association between gait and cognition in older adults in USA and the southern Indian state of Kerala. Materials and Methods: Literature review of gait and cognition studies conducted in Bronx County, USA as well as preliminary results from the Kerala-Einstein study (Kozhikode city, Kerala). Results: Review of published studies based in the Bronx shows that both clinical and quantitative gait dysfunction are common in older adults with cognitive impairment. Furthermore, clinical and quantitative gait dysfunction in cognitively normal older adults was a strong predictor of future cognitive decline and dementia. Our preliminary study in Kozhikode city shows that timed gait is slower in older adults diagnosed with dementia and mild cognitive impairment syndrome compared to healthy older controls. Conclusions: A strong association between gait and cognition is seen in seniors in USA as well as Kerala. A better understanding of the relationship between gait and cognition may help improve current diagnostic and therapeutic approaches globally.

A comparison of community-residing older adults with frontal and parkinsonian gaits

Frontal gaits (FG) and parkinsonian gaits (PG) are common neurological gait abnormalities in older adults. It may be difficult to distinguish these gaits as they share common clinical characteristics such as unsteadiness, slowing, and shuffling. Of 488 community-residing subjects in an aging study, 11 were diagnosed with FG and 9 with PG at baseline clinical evaluations. Subjects with FG were older than subjects with PG (84.5 vs. 77.7 years, p<0.001). As expected, parkinsonian signs such as tremor and rigidity were associated with PG and frontal release signs with FG. Subjects with PG had more falls (67% vs. 18%, p=0.02). They performed worse on a panel of executive function tests, although the scores were significantly different only on the verbal fluency test (17.0 vs. 28.3, p=0.009). Advancing age was associated with FG (OR=1.3, 95% CI=1.1-1.4) but not PG (OR=1, 95% CI=0.9-1.1). Medical illnesses were not significantly associated with FG. Diabetes (OR=4.1, 95% CI=1.1-15.5), strokes (OR=4.3, 95% CI=1.1-17.3), and depression (OR=5.1, 95% CI=1.2-20.8) were associated with PG. Despite similar gait characteristics, FG may be distinguished from PG by associated clinical signs, frequency of falls, and the neuropsychological profile. Vascular risk factors and depression were strongly associated with PG, and should be explored further.

Dementia Screening in Low Education Populations: Results from the Kerala-Einstein Study

memory were mildly impaired. Naming, comprehension, praxis, verbal memory and activities of daily living were preserved. Brain MRI showed isolated focal atrophy in the left parietal lobe. PET scan revealed left-sided parieto-temporal hypometabolism. CSF biomarkers (total tau, phospho-tau and A-beta) were in normal range. Conclusions: These findings are consistent with a pure clinical form of left parietal focal atrophy but the prediction of the underlying pathology is still challenging. Based on CSF biomarkers results a focal form of Alzheimer’s disease may be excluded. The other main hypotheses are TDP-43 and corticobasal degeneration pathologies. Subsequent clinical progression may favor one of them. This case report highlights the fact that clinicians are still facing major difficulties in predicting the underlying pathology of patients with primary progressive focal syndromes despite widespread use of biomarkers.