Cerebrovascular disease and gait and balance impairment in mild to moderate Alzheimer's disease

Objectives: Gait and movement abnormalities are traditionally considered infrequent in patients with mild/moderate Alzheimer's disease (AD). However, an increased risk of falls and gait abnormalities has been detected, even in early stages of the disease. Whether these abnormalities are associated with cerebrovascular disease, which has a high prevalence in AD, remains unclear. Design: Cross-sectional study. Setting: Dementia outpatient clinics. Participants: 24 mild/moderate AD patients with (AD+CVD) and 20 without (AD-CVD) cerebrovascular disease without a history of stroke and antipsychotic medications. Measurements: Physical performance, measured with the Short Physical Performance Battery [SPPB], a summary measure combining 4-meter gait speed, balance and muscle strength, and with 8-meter gait speed with a turn was compared between the two groups. Results: AD+CVD patients showed a significant higher prevalence of 4-meter gait speed slower than 0,8 m/s (37.5% Vs 5%, p-value=0.01) and balance impairment (37.5% Vs 10%, p-value=0.038), as well as a slower 8-meter gait speed with a turn (mean+SD=0.6±0.2 Vs 0.8±0.2, p-value=0.024). These associations were confirmed in multivariable models. No differences were observed for muscle strength. Conclusion: In our sample, AD with cerebrovascular disease had worse gait and balance than AD without cerebrovascular disease. If confirmed, these results may have clinical implications, since cerebrovascular disease can be potentially prevented.