Influence of executive function on locomotor function: Divided attention increases gait variability in Alzheimer's disease

OBJECTIVES:To evaluate how cognitive function and divided attention affect gait in Alzheimer's disease (AD). DESIGN: Cross-sectional intervention study with subjects serving as their own controls. SETTING: Inpatient unit and outpatient clinic for patients with dementia located at a Veterans Affairs Medical Center. PARTICIPANTS: Twenty-eight patients diagnosed with probable AD. INTERVENTION: Performance of a cognitive task (repeating random digits) while walking. MEASUREMENTS: Neuropsychological measures includ-ing clock drawing, verbal fluency, and digit span were obtained along with the Clinical Dementia Rating and Mini-Mental State Examination, the measures of dementia severity. Gait speed and stride-to-stride variability of gait rhythm were measured, once during normal walking and once during dual-task walking. RESULTS: During usual walking, subjects walked slowly and with greater gait variability than older adults without AD. Gait speed was significantly reduced (P<.012) and gait variability increased with dual-task walking (P<.007). The effect on gait variability was larger than the effect on gait speed (P<.015). Executive and neuropsychological function were significantly (P<.02) associated with the increased gait variability that occurred when walking with divided attention but not with gait speed or usual, single-task walking measures of gait. CONCLUSION: Divided attention markedly impairs the ability of patients with AD to regulate the stride-to-stride variations in gait timing. This susceptibility to distraction and its effect on stride time variability, a measure of gait unsteadiness, could partially explain the predilection to falling observed in patients with dementia. The results also support the concept that persons with AD have significant impairments in the cognitive domain of attention and that locomotor function relies upon cognitive, especially executive, function.