Falls and gait disorders in geriatric neurology

Gait disturbances are frequent in older patients and lead to immobility, falls, and increased mortality. In gerontoneurologic patients a higher prevalence of risk factors for gait disturbances and falls has to be attributed due to neurodegenerative diseases, dementia, delirium, or psychotropic medication. The potential of neurological expertise to contribute to the evaluation and treatment of falls and gait disorders in geriatric patients is still not fully exploited. Sometimes a fall can be an index event to the diagnosis of the underlying disorder. This review, therefore, focuses on the relationship between falls, gait, and neurological diagnosis. It helps to find the correct diagnosis of the underlying disease as one major step in the management of gait disorders and fall prevention. From a pragmatic point of view falls can be classified according to loss or preservation of consciousness. Gait disturbances should be differentiated into gait disorders with and without cognitive impairment. Although gait impairments are influenced by multifactorial parameters, this differentiation may help to find a diagnosis and also to initiate an appropriate, disease-specific therapy. In addition, every fall patient has to be analyzed individually according to his individual risk factors, which all can potentially be influenced to improve mobility and to reduce falls. (C) 2010 Elsevier B.V. All rights reserved.