The Gait That Spoke: How My Mom Walked Through Alzheimer's

My sweet daughter taking "Nana" through puzzles, circa 2017.

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The way that patients walk provides valuable insights into #mentalhealth and #cognitivestatus. Subtle changes in walking patterns may reflect emotional states such as #depression, #anxiety, and #cognitivedecline.

Gait and Cognitive Decline

In the rehabilitation world, gait changes are widely appreciated to be early indicators of cognitive decline (read my article on how #Bidens cognitive decline was belied by his gait). Subtle alterations in #walkingspeed, rhythm, and variability often precede a diagnosis of #Alzheimersdisease or other forms of #dementia. In fact, a 2020 study in Nature Reviews Neurology emphasized that dual-task gait testing walking while performing a cognitive task (something that I commonly do as part of therapy with people on my caseload) uncover early deficits in #executivefunction and #memory even before cognitive symptoms become obvious.¹ For many families, these changes are first noticed not in clinics, but in everyday life.

I saw this firsthand with my mom, who had Alzheimer’s Disease. Long before she struggled to find words or remember names her steps became closer together. Her posture grew more stooped. And, if you discussed topics that required thought or recall while she attempted to ambulate, her walking speed slowed. The above photo of her with my kids reminds me that #movement reflects more than function; it reflects presence and #neurological change.

The Connection Between Gait and Mood

Individuals with #depression also exhibit distinct #gait characteristics. These include reduced walking speed, less vertical movement, and a slouched posture. Such patterns have been observed both in controlled studies and everyday settings. One study in Cognitive Therapy and Research found that depressed individuals walked more slowly and with reduced vertical displacement compared to healthy controls.² These changes were strongly correlated with lower levels of positive affect.

Interestingly, this kind of gait analysis has moved beyond observation and into experimentation (ie, fooling with peoples walking to see how it affects depression). When participants were asked to deliberately change their gait (eg, walking in a more upright, energetic style), their recall of negative memories decreased. The findings suggest a bidirectional relationship between how we move and how we feel.

Gait as a Biomarker of Depression

Modern motion capture technology allows researchers to study gait features in fine detail. #Stridelength, #armswing, and trunk angle are all quantifiable and can now be interpreted using machine learning. A 2021 study in Frontiers in Psychiatry trained a computer model to recognize depression based on gait data.³ It achieved high accuracy, reinforcing the idea that mental states are deeply embodied.

Such technologies could be particularly powerful in clinical settings, where objective biomarkers for mental health conditions are limited. Compared to subjective mood scales or self-reported symptoms, gait analysis offers a noninvasive and continuous way to track emotional health.

Implications for Mental Health Interventions

Understanding the link between gait and mental state opens new possibilities for treatment. If certain movement patterns are associated with depression or anxiety, could changing the way we walk offer relief? The theory of embodied cognition suggests yes. In this view, emotions are not just felt in the mind, but expressed and reinforced through the body.

As I wrote above, moving differently may also help us think and feel differently. This discovery has inspired movement-based interventions such as dance therapy, somatic experiencing, and posture retraining. While these practices vary, they demonstrate that gait influences our mental state.

As A Clinician, You Should Be All About The Gait

It's often difficult to perform cognitive testing on people with neurodegenerative conditions, dementia, and other conditions affecting mental status. They may be understandably resistant to being tested, may become frustrated or even agitated during testing, or, on the other hand, there may be a Hawthorne effect (they perform better than usual, knowing that they're being tested).

Therefore, I routinely look at stance and gait, because these constructs offer a reliable, accurate reflection of patients' inner worlds that isn't always available given the shortfalls I mentioned above. Truly, I wish that #occupationaltherapy academic programs would teach gait essentials as part of their programs.

Concurrently, I lived in a gait lab for two years during my fellowship. Many (actually all) the researchers that came and went concerned themselves with the mechanics of gait, pooping out papers describing pathological gait patterns, or what this brace did to that gait pattern. Some still do. Recognizing gait as more than a mechanical process - and specifically as a potential biomarker of cognitive function, affective state, executive impairment, and/or neurological decline - allows for earlier and more comprehensive clinical assessment. That should interest a multitude of professions.

References

1. Montero-Odasso M, Ismail Z, Livingston G. One step at a time: Gait impairment as a mechanism of cognitive decline. Nat Rev Neurol. 2020;16(6):335-344. doi:10.1038/s41582-019-0280-2

2. Michalak J, Zimmermann J, Burg J, et al. Don't walk this way: How depressive gait styles affect memory and cognition. Cogn Ther Res. 2021;45(2):246-256. doi:10.1007/s10608-021-10215-7

3. Wang Y, Wang J, Liu X, Zhu T. Detecting depression through gait data: Examining the contribution of gait features in recognizing depression. Front Psychiatry. 2021;12:661213. doi:10.3389/fpsyt.2021.661213

4. Toosizadeh N, Mohler J, Lei H, et al. Motor performance assessment in Alzheimer’s disease: Gait and balance. Gait Posture. 2019;71:26-32. doi:10.1016/j.gaitpost.2019.04.015

5. Mubarok M, Yamamoto S, Koike S, et al. Gait characteristics in patients with major depressive disorder: A systematic review. J Affect Disord. 2020;274:199-206. doi:10.1016/j.jad.2020.05.048

6. Mirelman A, Bernad-Elazari H, Thaler A, et al. Gait as a clinical marker for prodromal Parkinson’s disease: Current evidence and future directions. J Neurol. 2022;269(1):179-189. doi:10.1007/s00415-021-10629-6