Background and Purpose Studies have shown that adults with Alzheimer’s 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 if 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 thirteen age (72.6 ± 4.6 years old) and gender-matched (10 males, 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 the sharpened Romberg tests with eyes open (p<0.001) and with eyes closed (p=0.007) compared to participants in the control group. Those with AD also took longer to complete the Timed “Up & Go” Test (TUG), (p< 0.001). Gait deficits were found for those with AD as demonstrated by slower velocities in the 10-meter 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-meter walk at a fast pace. The gait velocity of participants in the control group was faster on the instrumented walkway than in the 10-meter 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-meter 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.

BackgroundThe visual system plays an important role in maintaining balance. As a person ages, gait becomes slower and stride becomes shorter, especially in dimly lighted environments. Falls risk has been associated with reduced speed and increased gait variability.MethodsTwenty-four older adults (half identified at risk for falls) experienced three lighting conditions: pathway illuminated by 1) general ceiling-mounted fixtures, 2) conventional plug-in night lights and 3) plug-in night lights supplemented by laser lines outlining the pathway. Gait measures were collected using the GAITRite© walkway system.ResultsParticipants performed best under the general ceiling-mounted light system and worst under the night light alone. The pathway plus night lights increased gait velocity and reduced step length variability compared to the night lights alone in those at greater risk of falling.ConclusionsPractically, when navigating in more challenging environments, such as in low-level ambient illumination, the addition of perceptual cues that define the horizontal walking plane can potentially reduce falls risks in older adults.

Injuries resulting from falls in seniors are a significant health concern. Visual information is important for postural control in seniors and postural control is affected by the light level. Moderate ambient illumination might be effective for postural control, but might compromise subsequent sleep efficiency and quality for seniors. In addition to safety concerns, a night lighting system must also be accepted by seniors. Researchers investigated if a self-luminous, night lighting system that provided horizontal and vertical cues could positively affect postural control in older subjects and evaluated its acceptance among seniors. The results showed that the night lighting system was effective for maintaining postural control in the critical, early phase of the sit-to-stand task and that it was preferred over conventional night lights.

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