Assessing the interplay between cognition and gait in the clinical setting.

In this review, we outline how the influence of cognitive processes on gait or balance can be appreciated in a clinical setting. Careful history taking of the patient or direct carer provides information about multiple task problems in daily life and the presence of cognitive impairment, depression or fear of falling. Physical examination may reveal abnormalities such as an inappropriately high walking speed or an inability to handle secondary tasks while walking. Assessment of frontal executive function helps to understand the nature of these multiple task problems and to detect "risky" behaviour caused by frontal disinhibition. Examples of clinically useable techniques include pressure-sensitive insoles or an electronic walkway (to record strides) or accelerometers (to measure body motion while walking). Combining these assessments may lead to a better appreciation of the fascinating but complex interplay between cognition and gait.