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Balance and Gait of Adults With Very Mild Alzheimer Disease

Gras, Laura Z. PT, DPT, DSc, GCS1; Kanaan, Saddam F. PT, PhD2; McDowd, Joan M. PhD3; Colgrove, Yvonne M. PT, PhD4; Burns, Jeffrey MD5; Pohl, Patricia S. PT, PhD1

Journal of Geriatric Physical Therapy: January/March 2015 - Volume 38 - Issue 1 - p 1–7
doi: 10.1519/JPT.0000000000000020
Research Reports

Background and Purpose: Studies have shown that adults with Alzheimer disease (AD) have gait and balance deficits; however, the focus has been on those with mild to severe disease. The purpose of this study was to determine whether balance and gait deficits are present in those with very mild AD.

Methods: Thirteen adults (72.9 ± 4.7 years old) with very mild AD and 13 age-matched (72.6 ± 4.6 years old) and sex-matched (10 males and 3 females) participants in a control group without AD performed balance and gait tests. All participants were living in the community and independent in community ambulation.

Results: Participants with very mild AD had shorter times in tandem stance with eyes open (P < 0.001) and with eyes closed (P = 0.007) compared with participants in the control group. Those with AD also took longer to complete the Timed “Up & Go” Test (P < 0.001). Gait deficits were found for those with AD as demonstrated by slower velocities in the 10-m walk at a comfortable pace (P = 0.029) and on an instrumented walkway (P < 0.001). Stance times were longer for those with AD (P < 0.001) and step length was shorter (P = 0.001). There were no group differences in the 10-m walk at a fast pace. The gait velocity of participants in the control group was faster on the instrumented walkway than in the 10-m walk at a comfortable pace (P = 0.031). In contrast, the gait velocity of those with AD was significantly slower on the instrumented walkway than in the 10-m walk at a comfortable pace (P = 0.024).

Discussion: Balance and gait deficits may be present in those in the very early stages of AD. Novel surfaces may affect gait speed in those with very mild AD. Identifying mobility deficits early in the progression of AD may provide an opportunity for early physical therapy intervention, thus promoting continued functional independence.

Conclusions: Adults in the very early stages of AD may show signs of balance and gait deficits. Recognition of these problems early with subsequent physical therapy may slow the progression of further balance and gait dysfunction.

1Department of Physical Therapy, Ithaca College, Ithaca, New York.

2Department of Rehabilitation, Jordan University of Science and Technology, Irbid, Jordan.

3Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri.

4Department of Physical Therapy and Rehabilitation Science, The University of Kansas, Kansas City, Kansas.

5Department of Neurology and Alzheimer and Memory Program, The University of Kansas, Kansas City, Kansas.

Address correspondence to: Laura Z. Gras, PT, DPT, DSc, GSC, Associate Professor, Department of Physical Therapy, Ithaca College, Ithaca, NY (

This work was supported by an Investigator-Initiated Research Grant from the Alzheimer's Association [IIRG-07-57789] awarded to PSP; identifier: NCP00611312 and a Schacht Grant through The Sage Colleges awarded to LG and PSP.

This research has been presented at the New York Physical Therapy Association's Annual Conference, October 2013, and at APTA's Combined Sections Meeting in February 2014.

The authors declare no conflicts of interest.

Robert Wellmon was the Decision Editor.

Copyright © 2015 the Section on Geriatrics of the American Physical Therapy Association
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