Review articleCognition and gait in older people

- Cognition and gait decline with normal and pathological aging.
- Cognition and gait have shared anatomic substrates and brain control processes.
- Cognitive impairment can predict incident gait impairment.
- Changes in gait can predict incident cognitive impairment.
- Interventions may be able to mitigate gait and cognitive decline in aging.

Cognitive difficulties and gait abnormalities both increase with age. We review normal and pathologic changes in both gait and cognition in older adults. Gait performance in older individuals is linked to specific cognitive changes, in particular in executive function. Structural and functional assays highlight the shared anatomic control of cognitive and gait function, mostly in the prefrontal cortices. Cognitive impairment can be used to predict incident gait difficulties. Changes in gait, especially decreased gait velocity, may be a harbinger of impending cognitive decline. The combination of slow gait and cognitive complaints (the Motoric Cognitive Risk syndrome) is a powerful new clinical tool to identify those at high risk of developing dementia and therefore may be used to target interventions. Evidence is limited, but cognitive training and targeted physical activity may be useful to mitigate or prevent gait and cognitive decline with age.