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Erschienen in: Der Nervenarzt 6/2014

01.06.2014 | CME Zertifizierte Fortbildung

Gangstörungen im Alter

verfasst von: Dr. K. Amadori, R. Püllen, T. Steiner

Erschienen in: Der Nervenarzt | Ausgabe 6/2014

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Zusammenfassung

Gangstörungen sind eines der häufigsten gerontoneurologischen Symptome überhaupt. Stürze mit mitunter gravierenden Verletzungen sind hochrelevante Folgeerscheinungen. Im Zentrum des diagnostischen Prozesses stehen die klinisch-neurologische Untersuchung und die inspektorische Ganganalyse, welche Hypothesen bezüglich der gestörten Strukturen und eine gezielte Zusatzdiagnostik ermöglichen. Das ergänzende motorische Assessment quantifiziert die resultierende Mobilitätseinschränkung und Sturzgefahr mithilfe etablierter Instrumente. Charakteristisch für die Gangstörung im Alter ist ihre multifaktorielle Genese. Die Herausforderung besteht in der möglichst vollständigen Identifikation, korrekten Priorisierung und adäquaten Behandlung aller beitragenden Teilursachen. Das Therapiekonzept ist multiprofessionell und beinhaltet neben der möglichst kausalen Behandlung zugrunde liegender Erkrankungen u. a. physiotherapeutische Trainingsprogramme, Hilfsmittelverordnungen und ernährungstherapeutische Interventionen. Übergeordnete Bedeutung kommt der Identifikation und Beseitigung von – auch iatrogenen – Risikofaktoren für Gangstörungen und Stürze zu.
Literatur
1.
2.
Zurück zum Zitat Sudarsky L (2001) Gait disorders: prevalence, morbidity, and etiology. Adv Neurol 87:111–117PubMed Sudarsky L (2001) Gait disorders: prevalence, morbidity, and etiology. Adv Neurol 87:111–117PubMed
3.
Zurück zum Zitat Stolze H, Klebe S, Baecker C et al (2005) Prevalence of gait disorders in hospitalized neurological patients. Mov Disord 20:89–94PubMedCrossRef Stolze H, Klebe S, Baecker C et al (2005) Prevalence of gait disorders in hospitalized neurological patients. Mov Disord 20:89–94PubMedCrossRef
4.
5.
Zurück zum Zitat Nutt JG, Marsden CD, Thompson PD (1993) Human walking and higher-level gait disorders, particularly in the elderly. Neurology 43:268–279PubMedCrossRef Nutt JG, Marsden CD, Thompson PD (1993) Human walking and higher-level gait disorders, particularly in the elderly. Neurology 43:268–279PubMedCrossRef
6.
Zurück zum Zitat Camicioli R, Wang Y, Powell C et al (2007) Gait and posture impairment, parkinsonism and cognitive decline in older people. J Neural Transm 114:1355–1361PubMedCrossRef Camicioli R, Wang Y, Powell C et al (2007) Gait and posture impairment, parkinsonism and cognitive decline in older people. J Neural Transm 114:1355–1361PubMedCrossRef
7.
Zurück zum Zitat Bloem BR, Gussekloo J, Lagaay AM et al (2000) Idiopathic senile gait disorders are signs of subclinical disease. J Am Geriatr Soc 48:1098–1101PubMed Bloem BR, Gussekloo J, Lagaay AM et al (2000) Idiopathic senile gait disorders are signs of subclinical disease. J Am Geriatr Soc 48:1098–1101PubMed
8.
Zurück zum Zitat Cesari M, Kritchevsky SB, Penninx BW et al (2005) Prognostic value of usual gait speed in well-functioning older people – results from the health, aging and body composition study. J Am Geriatr Soc 53:1675–1680PubMedCrossRef Cesari M, Kritchevsky SB, Penninx BW et al (2005) Prognostic value of usual gait speed in well-functioning older people – results from the health, aging and body composition study. J Am Geriatr Soc 53:1675–1680PubMedCrossRef
9.
Zurück zum Zitat Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156PubMedCrossRef Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156PubMedCrossRef
10.
Zurück zum Zitat Jankovic J, Nutt JG, Sudarsky L (2001) Classification, diagnosis, and etiology of gait disorders. Adv Neurol 87:119–133PubMed Jankovic J, Nutt JG, Sudarsky L (2001) Classification, diagnosis, and etiology of gait disorders. Adv Neurol 87:119–133PubMed
11.
Zurück zum Zitat Podsiadlo D, Richardson S (1991) The timed „Up and Go“: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148PubMed Podsiadlo D, Richardson S (1991) The timed „Up and Go“: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148PubMed
12.
Zurück zum Zitat Guralnik JM, Ferrucci L, Pieper CF et al (2000) Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci 55:M221–M231PubMedCrossRef Guralnik JM, Ferrucci L, Pieper CF et al (2000) Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci 55:M221–M231PubMedCrossRef
13.
Zurück zum Zitat Alexander NB (1996) Gait disorders in older adults. J Am Geriatr Soc 44:434–451PubMed Alexander NB (1996) Gait disorders in older adults. J Am Geriatr Soc 44:434–451PubMed
14.
Zurück zum Zitat Bohannon RW, Williams Andrews A (2011) Normal walking speed: a descriptive meta-analysis. Physiotherapy 97:182–189PubMedCrossRef Bohannon RW, Williams Andrews A (2011) Normal walking speed: a descriptive meta-analysis. Physiotherapy 97:182–189PubMedCrossRef
15.
Zurück zum Zitat Guralnik JM, Ferrucci L, Simonsick EM et al (1995) Lower extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 332:556–561PubMedCrossRef Guralnik JM, Ferrucci L, Simonsick EM et al (1995) Lower extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 332:556–561PubMedCrossRef
16.
Zurück zum Zitat Guralnik JM, Simonsick EM, Ferrucci L et al (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49:M85–M94PubMedCrossRef Guralnik JM, Simonsick EM, Ferrucci L et al (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49:M85–M94PubMedCrossRef
17.
Zurück zum Zitat Lundin-Olsson L, Nyberg L, Gustafson Y (1997) „Stops walking when talking“ as a predictor of falls in elderly people. Lancet 349:617PubMedCrossRef Lundin-Olsson L, Nyberg L, Gustafson Y (1997) „Stops walking when talking“ as a predictor of falls in elderly people. Lancet 349:617PubMedCrossRef
18.
Zurück zum Zitat Yogev-Seligmann G, Hausdorff JM, Giladi N (2008) The role of executive function and attention in gait. Mov Disord 23:329–342PubMedCrossRef Yogev-Seligmann G, Hausdorff JM, Giladi N (2008) The role of executive function and attention in gait. Mov Disord 23:329–342PubMedCrossRef
19.
Zurück zum Zitat Stolze H, Kuhtz-Buschbeck JP, Drucke H et al (2001) Comparative analysis of the gait disorder of normal pressure hydrocephalus and Parkinson’s disease. J Neurol Neurosurg Psychiatry 70:289–297PubMedCentralPubMedCrossRef Stolze H, Kuhtz-Buschbeck JP, Drucke H et al (2001) Comparative analysis of the gait disorder of normal pressure hydrocephalus and Parkinson’s disease. J Neurol Neurosurg Psychiatry 70:289–297PubMedCentralPubMedCrossRef
20.
Zurück zum Zitat Iersel van MB, Hoefsloot W, Munneke M et al (2004) Systematic review of quantitative clinical gait analysis in patients with dementia. Z Gerontol Geriatr 37:27–32PubMedCrossRef Iersel van MB, Hoefsloot W, Munneke M et al (2004) Systematic review of quantitative clinical gait analysis in patients with dementia. Z Gerontol Geriatr 37:27–32PubMedCrossRef
21.
Zurück zum Zitat Calandre L, Conde I, Bermejo Pareja F (2005) Gait and stability disorders of the elderly. Clinical analysis of a series of 259 patients older than 70 years. Neurologia 20:232–239PubMed Calandre L, Conde I, Bermejo Pareja F (2005) Gait and stability disorders of the elderly. Clinical analysis of a series of 259 patients older than 70 years. Neurologia 20:232–239PubMed
22.
Zurück zum Zitat Tideiksaar R (1997) Falling in old age: its prevention and management. Springer, New York Tideiksaar R (1997) Falling in old age: its prevention and management. Springer, New York
23.
Zurück zum Zitat Snijders AH, Warrenburg BP van de, Giladi N et al (2007) Neurological gait disorders in elderly people: clinical approach and classification. Lancet Neurol 6:63–74PubMedCrossRef Snijders AH, Warrenburg BP van de, Giladi N et al (2007) Neurological gait disorders in elderly people: clinical approach and classification. Lancet Neurol 6:63–74PubMedCrossRef
24.
Zurück zum Zitat Salzman B (2010) Gait and balance disorders in older adults. Am Fam Physician 82:61–68PubMed Salzman B (2010) Gait and balance disorders in older adults. Am Fam Physician 82:61–68PubMed
25.
Zurück zum Zitat Sherrington C, Whitney JC, Lord SR et al (2008) Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc 56:2234–2243PubMedCrossRef Sherrington C, Whitney JC, Lord SR et al (2008) Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc 56:2234–2243PubMedCrossRef
26.
Zurück zum Zitat Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB et al (2009) Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 339:b3692PubMedCentralPubMedCrossRef Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB et al (2009) Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 339:b3692PubMedCentralPubMedCrossRef
27.
Zurück zum Zitat American Geriatrics Society Workgroup on Vitamin D Supplementation for Older Adults (2014) Recommendations abstracted from the American Geriatrics Society consensus statement on vitamin D for prevention of falls and their consequences. J Am Geriatr Soc 62:147–152 American Geriatrics Society Workgroup on Vitamin D Supplementation for Older Adults (2014) Recommendations abstracted from the American Geriatrics Society consensus statement on vitamin D for prevention of falls and their consequences. J Am Geriatr Soc 62:147–152
28.
Zurück zum Zitat Holt S, Schmiedl S, Thürmann PA (2010) Potentially inappropriate medication in the elderly – PRISCUS list. Dtsch Arztebl Int 107:543–551PubMedCentralPubMed Holt S, Schmiedl S, Thürmann PA (2010) Potentially inappropriate medication in the elderly – PRISCUS list. Dtsch Arztebl Int 107:543–551PubMedCentralPubMed
29.
Zurück zum Zitat The American Geriatrics Society 2012 Beers Criteria Update Expert Panel (2012) American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 60:616–631 The American Geriatrics Society 2012 Beers Criteria Update Expert Panel (2012) American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 60:616–631
30.
Zurück zum Zitat Velde N van der, Stricker BH, Pols HA, Cammen TJ van der (2007) Risk of falls after withdrawal of fall-risk-increasing drugs: a prospective cohort study. Br J Clin Pharmacol 63:232–237PubMedCentralPubMedCrossRef Velde N van der, Stricker BH, Pols HA, Cammen TJ van der (2007) Risk of falls after withdrawal of fall-risk-increasing drugs: a prospective cohort study. Br J Clin Pharmacol 63:232–237PubMedCentralPubMedCrossRef
Metadaten
Titel
Gangstörungen im Alter
verfasst von
Dr. K. Amadori
R. Püllen
T. Steiner
Publikationsdatum
01.06.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
Der Nervenarzt / Ausgabe 6/2014
Print ISSN: 0028-2804
Elektronische ISSN: 1433-0407
DOI
https://doi.org/10.1007/s00115-014-4084-9

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