Gait disorders can be characterized as follows:
- Anxious gait (e.g., due to fear of falling).
- Antalgic – limping gait
- Ataxic/ataxia – uncoordinated gait (may occur even if there is no paresis (paralysis), i.e. with normal muscle strength).
- Dyskinetic – gait with over-movements.
- Hypokinetic – small-step, slowed gait.
- Paretic – asymmetrical gait
- Psychogenic – with different, sometimes bizarre gait patterns.
- Sensory – variable, broad-based gait disorders.
- Spastic – non-fluid gait pattern
Associated symptoms
- Pain
- Sensory disturbance
- Increased muscle tone
- Reflex attenuation
- Positional sense disorder
- Tremor (shaking)
- Vertigo (dizziness)
- Cognitive impairment (memory impairment)
- Urinary and fecal incontinence – inability to hold stool and / or urine.
- Anxiety
Common causes of gait disorders in old age
| Diseases | Clinical presentation |
| Sensory deficits (visual acuity reduction, polyneuropathy/mostly diabetic polyneuropathy, bilateral vestibulopathy) | Complaints especially when walking, esp. in low light conditions (worsen in the dark) and on uneven ground |
| Neurodegenerative diseases (degenerative dementias, Parkinson’s syndromes, cerebellar ataxia, etc.) | Gait disorder with additional motor, coordination, and cognitive abnormalities |
| Normal pressure hydrocephalus and vascular encephalopathy. | Small-step gait disorder with subcortical dementia (memory impairment, urinary urgency, and possibly bladder incontinence; furthermore, dysarthria and dysphagia (in the case of: vascular encephalopathy) |
| Non-neurologic gait disorders (osteoarthritis, foot and toe deformities, peripheral arterial disease, pAVK) | Multifactorial gait disorder (see below of the respective disease). |
| Fear of falling and intoxications (alcohol, drugs, medications). | “Cautious gait” (English technical term: cautious gait); highly slowed walking with arm movements seeking support/stopping at walls, furniture, or companions; avoidance behavior (which at the same time maintains anxiety) |
Warning signs (red flags)
- Brief dizzy spells, transient sensory disturbances → think of: Apoplexy (stroke)
- Neurological symptoms such as optic neuritis; usually unilateral, paresthesias (sensory disturbances, numbness) → think of: Multiple Sclerosis (MS)
- Numbness in both legs (saddle-shaped) or flaccid paresis of legs, often with urinary bladder and rectal dysfunction → think of: Kauda syndrome
