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Gait, balance, and physical performance as markers of early Alzheimer's disease and related dementia risk
Magdalena Ioana Tolea, Amie Rosenfeld, Sam Van Roy, Lilah M. Besser, Deirdre M. O’Shea, James E. Galvin. Journal of Alzheimer s Disease, 2025-01-26
Topic: Amyloid, tau and blood-test diagnosis
Background Declining physical functionality is an indicator of cognitive impairment, distinguishing normal cognition (NC) from dementia. Whether this extends to pre-dementia stages is unclear. Objective Assess physical performance patterns, evaluate relationships with imaging biomarkers, and identify specific measures distinguishing NC, subjective cognitive decline (SCD) and mild cognitive impairment (MCI). Methods Group differences (78 NC, 35 SCD, and 41 MCI) in physical function (global function, balance, gait speed, step length, single leg support) were evaluated with logistic regression while distinguishing between MCI due-to-AD and MCI due-to-vascular etiology. Relationships with imaging biomarkers (cortical atrophy score, white matter hyperintensities volumes) were analyzed with ANCOVA. Results Participants were 68.6 ± 9.3 years old, had 16.2 ± 3.0 years of education, and 23% were ethnoracial minorities. Physical performance distinguished MCI from NC and SCD. Greater performance on the Mini Physical Performance Test (mini PPT) and balance were associated with lower odds of being SCD versus NC (OR mini PPT = 0.73; 95% CI:0.56–0.97; OR balance = 0.35, 95%CI:0.16–0.80). AD etiology accounted for most group differences in physical performance versus vascular etiology. Consistent associations between biomarkers, physical performance, and cognition were found. Conclusions Findings suggest that: 1) changes in mini PPT performance and balance may help detect cognitive impairments, as early as the SCD stage; 2) changes in gait speed, gait cycle parameters, and Timed Up-and-Go may indicate more significant cognitive impairment; 3) neuronal loss is linked to subtle changes in physical functionality as early as SCD. Physical performance may be a valuable tool in early dementia detection in clinical settings and could identify targets for early intervention.
Key findings
- Results Participants were 68.6 ± 9.3 years old, had 16.2 ± 3.0 years of education, and 23% were ethnoracial minorities.
- Greater performance on the Mini Physical Performance Test (mini PPT) and balance were associated with lower odds of being SCD versus NC (OR mini PPT = 0.73; 95% CI:0.56–0.97; OR balance = 0.35, 95%CI:0.16–0.80).
- AD etiology accounted for most group differences in physical performance versus vascular etiology.
- Conclusions Findings suggest that: 1) changes in mini PPT performance and balance may help detect cognitive impairments, as early as the SCD stage; 2) changes in gait speed, gait cycle parameters, and Timed Up-and-Go may indicate more significant cognitive impairment; 3) neuronal loss is linked to subtle changes in physical functionality as early as SCD.
Why it matters
This study found that physical performance measures such as the Mini Physical Performance Test and balance distinguished mild cognitive impairment from normal cognition and subjective cognitive decline, with Alzheimer's etiology accounting for most group differences. The findings suggest physical performance could serve as an early marker of dementia risk, but no treatment, cure, or prevention was tested.
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Study details
- Evidence strengthLow
How this study scored 39/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of Alzheimer s Disease) |
| Journal's citation record | 2 / 4 | Journal of Alzheimer s Disease: journal h-index 218 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 8 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 2.7 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 3 / 6 | Cited 5.1× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 1 / 4 | Cited 8 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author James E. Galvin: h-index 56 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | University of Miami: institution h-index 998 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 39865686) |
| Free to read | 2 / 2 | Free to read |
| Total | 39 / 100 | — |
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Read the original
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Tolea, M. I., Rosenfeld, A., Van Roy, S., Besser, L. M., O’Shea, D. M., & Galvin, J. E. (2025). Gait, balance, and physical performance as markers of early Alzheimer's disease and related dementia risk. Journal of Alzheimer s Disease. https://doi.org/10.1177/13872877241313144
Vancouver
Tolea MI, Rosenfeld A, Van Roy S, Besser LM, O’Shea DM, Galvin JE. Gait, balance, and physical performance as markers of early Alzheimer's disease and related dementia risk. Journal of Alzheimer s Disease. 2025. doi:10.1177/13872877241313144. PMID: 39865686.
BibTeX
@article{tolea2025-39865686,
author = {Tolea, Magdalena Ioana and Rosenfeld, Amie and Van Roy, Sam and Besser, Lilah M. and O’Shea, Deirdre M. and Galvin, James E.},
title = {{Gait, balance, and physical performance as markers of early Alzheimer's disease and related dementia risk}},
journal = {Journal of Alzheimer s Disease},
year = {2025},
doi = {10.1177/13872877241313144},
pmid = {39865686},
url = {https://doi.org/10.1177/13872877241313144}
}
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