In her thesis at Umeå University, Jenny Larsson showed that more than a third, 38 percent, of the elderly population in Umeå had walking problems.
Many can be treated
About half of these have a neurological cause for the problems, which can give them an overall unsteady gait. An unsteady gait is a condition that over time can develop into something called HLGD, “high-level gait disorder.”
The positive thing is that problems can be addressed in the case of this type of nervous walking disorder. For example, if the problems are caused by something called idiopathic normal pressure hydrocephalus, see below. The instability is then associated with an increase in the amount of cerebrospinal fluid in the head, causing enlargement of the brain’s ventricles, fluid-filled cavities.
Gait disturbance
A gait disorder is defined as a markedly deviated gait pattern in which steps become shorter and you walk more slowly than before. In the elderly, it can affect quality of life, lead to decreased independence and cause falls that can cause serious injuries.
HLGD, high walking disorder
Different methods can be used to classify gait disorders. One way is to segment neurological walking disorders based on which part of the nervous system is thought to be causing the problems. A gait disorder caused by damage to the higher parts of the brain results in a slow, unsteady gait and may be termed a “high-level gait disorder,” HLGD. The disease that can cause HLGD is idiopathic normal pressure hydrocephalus.
INPH, idiopathic normal pressure hydrocephalus
INPH is a disease characterized by three main symptoms: typical gait disturbance (HLGD), dementia, and enuresis. If any of the symptoms occur with an increased amount of cerebrospinal fluid in the cerebral cavity, and no other explanation for the symptoms can be found, then the diagnostic criteria for the disease are met.
Recent Swedish studies have shown that INPH is common among the elderly population. Up to 3.7 percent may be affected and gait disturbance is the most common symptom. It usually develops first in the course of the disease and is also the symptom that responds best to treatment: 70 percent improve over time. INPH is treated with a cerebrospinal fluid shunt which drains cerebrospinal fluid from the brain cavity, usually into the abdomen.
This disease is sometimes called “curable dementia” because about 40 percent experience cognitive improvement after treatment.
Source: Umeå University
Almost six percent of the elderly population in Umeå have HLGD and about four percent have HLGD with large cerebral ventricles, according to Jenny Larsson’s research.
Successful treatment
Idiopathic normal pressure hydrocephalus is often successfully treated by inserting a shunt that regulates the flow of cerebrospinal fluid. 70% of patients find walking easier.
It is possible that more people could receive such treatment, says Jenny Larson. But then the case must also be discovered.
– Since too much spinal fluid in the head is something that can often be treated, there is hope that you will be able to help people with HLGD and large brain ventricles. In the event of symptoms of HLGD, one should consider having a brain imaging scan to see if there are large cerebral ventricles.
hypothesis:
Population studies of high-level gait disturbances and hydrocephalus with a focus on measuring ventricular cerebral morphology and outcomes of shunt surgeryJenny Larsson, Umeå University
Contact:
Jenny Larsson, a physician and researcher at Umeå University
[email protected]
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