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Shigeto Morimoto, MDMasayuki Matsumoto, MD
Department of Geriatric MedicineTakashi Takahashi, MD
Tsugiyasu Kanda, MDDepartment of General Medicine
Kanazawa Medical UniversityIshikawa, Japan
ACKNOWLEDGMENT
Financial Disclosure(s):Dr. Morimoto was supported by
agrant-in-aid for scientific research from the Ministry ofHealth,
Labour and Welfare of Japan. There is no conflict ofinterest
regarding the present study.
Author Contributions: Study concept and design:Shoshi Takamoto
and Shigeto Morimoto. Acquisition ofsubjects and data: Shuichi
Saeki, Yasuaki Yabumoto, Hide-ki Masaki, and Toshio Onishi.
Analysis and interpretationof data: Takashi Takahashi, Tsugiyasu
Kanda, and Ma-sayuki Matsumoto. Preparation of manuscript:
Shigeto
Morimoto and Takashi Takahashi.Sponsors Role:None.
REFERENCES
1. Kane RS, Goodwin JS. Spontaneous fractures of the longbones
in nursing home
patients. Am J Med 1991;90:263266.
2. Sherman FT. Transfer and turning fractures in nursing home
patients. Am
J Med 1991;91:668669.
3. Kane RS, Burns EA, Goodwin JS. Minimal trauma fractures in
older nursing
home residents. The interaction of functional status, trauma,
and site of frac-
ture. J Am Geriatr Soc 1995;43:156159.
4. Martin-Hunyadi C, Heitz D, Kaltenbach G et al. Spontaneous
insufficiency
fractures of long bones: A prospective epidemiological survey in
nursing home
subjects. Arch Gerontol Geriatr 2000;31:207214.
5. Takamoto S, Masuyama T, Nakajima M et al. Alterations of bone
mineraldensity of the femurs in hemiplegia. Calicif Tissue Int
1995;56:259262.
QUANTITATIVE GAIT ANALYSIS TO DETECT GAITDISORDERS IN GERIATRIC
PATIENTS WITHDEPRESSION
To the Editor:Gait disorders and depressive symptoms areboth
highly prevalent in elderly people and can have diverseand severe
consequences as an increased risk of falls andloss of
independence.1,2 Striking in the clinical observationof depressed
geriatric patients is their slowness of move-
ments and, during performance of a dual task, their in-creased
gait and balance problems. The shared etiologicalrole of cerebral
white matter lesions may explain the co-occurrence of mood and gait
disorders.3 Only three studieshave investigated quantitative
aspects of gait in patientswith depression and found a slower gait
velocity and short-er step length,46 but their population was young
(mean age44), they used methods of moderate quality, and they
didnot investigate gait variability, which is strongly
associatedwith increased fall frequency.7 It was hypothesized
thatnoninvasive quantitative gait analysis could be used in
de-pressed geriatric patients to detect and monitor decreasedgait
velocity and step length, increased double support time,
and an increase in their variability.
Therefore, an observational study was performed inpatients
consecutively admitted to an acute geriatric wardof an academic
hospital or an acute ward of old age psy-chiatry of a psychiatric
hospital. Patients were includedwhen they could walk 10 meters and
understand simpleinstructions and if they and their care givers had
giveninformed consent. The collected descriptive data about
theparticipants included age, sex, the cumulative illness
rating
scale in geriatrics (CIRS-G), a cognition test (Mini-MentalState
Examination, MMSE), functioning in daily life (Bar-thel Index),
number of drugs, and use of antidepressantsand walking aids. Two
groups of patients were comparedtwo different ways: with or without
depression and with orwithout mild to moderate depressive symptoms.
A psychi-atrist or geriatrician made the diagnosis of depression
basedonDiagnostic and Statistical Manual of Mental Disorders,Fourth
Edition (DSM-IV) criteria.8 For mild to moderatedepressive
symptoms, a cutoff score of 18 on the Mont-gomery Asberg Depression
Rating Scale (MADRS)9 wasused at the time of the measurements
(depressed: MADRSscore 18; not depressed: MADRS scoreo18). The
quan-titative gait variables (gait velocity, step length,
cadence,and percentage of double support phase) were measuredusing
the Gaitrite (CIR Systems, Inc., Havertown, PA), anelectronic
walkway.10 To measure these gait variables, thepatients walked
twice at comfortable speed over theGaitrite and twice while
counting backward from 45 asdual task. The independent samplettest
was used to com-pare gait variables between the two groups and the
coef-ficient of variation for calculation of gait variability.
Inaddition, the Pearson correlation coefficient was used toestimate
the correlation between MADRS score and gaitvelocity and step
length.
Twenty-eight patients with a mean age standard de-viation of
78.4 7.2 participated; 21 were women. Thir-
teen patients were diagnosed with depression (meanMADRS score
16.3). The distribution of covariables didnot differ significantly
between the two groups. In summa-ry, mean scores for the whole
group were CIRS-G, 9.8;MMSE, 22.6; and Barthel, 15.5. Patients used
6.7 drugs onaverage. Eight patients used an antidepressant, and
ninepatients used a walking aid during the measurements.
Significant differences were not found in gait variablesor their
variability between the group with and without adepression (DSM-IV
criteria). Geriatric patients who weredepressed according to their
MADRS score had a signifi-cantly shorter step length and greater
double support timeand a trend toward lower gait velocity. (Table
1). These
results were independent of the use of antidepressants.When
going from normal walking to walking while count-ing backward, the
increase in variability of gait velocity(15%) and double support
phase (16%) was larger in ger-iatric patients who were depressed
(MADRS score 18)than in those who were not (MADRS scoreo18)
(increasesof 2% and 3%, respectively) but not statistically
significant.There was no significant correlation between MADRSscore
and gait velocity and step length.
This study partially confirmed the hypothesis that de-pression
decreases gait velocity and step length, increasesdouble support
phase, and increases gait variability duringdual tasks in geriatric
patients. An explanation for the
absence of significant differences in gait when using the
LETTERS TO THE EDITOR 1441JAGS AUGUST 2005VOL. 53, NO. 8
