Table 3. Some neurological gait disturbances that are more common in the elderly.

Diagnosis	Clinical manifestations	Treatment options
Sensory deficits
Polyneuropathy	Unsteady gait, particularly with eyes closed Primarily distal sensory deficit Loss of ankle-jerk reflexes	Treatment of the underlying disease (e.g., diabetes mellitus) Avoidance of neurotoxic substances (e.g., alcohol) Physiotherapy
Bilateral vestibulopathy	Unsteady gait in the dark and on uneven ground Oscillopsia (unsteadiness of the visual image) Pathological head-impulse test	Treatment of the underlying disease (e.g., Ménière’s disease) Avoidance of ototoxic substances (e.g., aminoglycosides) Balance training
Visual impairment	Unsteady gait, mainly on uneven ground Ophthalmological abnormalities	Treatment of the underlying disease (e.g., cataract) Appropriate visual aids
Neurodegenerative disorders
Parkinsonism	Hypokinetic gait disturbance and accompanying manifestations (tremor, autonomic dysfunction, oculomotor and cerebellar disturbances, dementia) Lessened capacity for dual tasking	L-dopa therapy (or trial of L-dopa in atypical parkinsonism) Physiotherapy
Cerebellar ataxia	Ataxic gait Limb ataxia Oculomotor disturbance	Avoidance of toxic substances such as alcohol Physiotherapy
Dementing syndromes	Slow gait– Tendency to fall Impaired spatial orientation Lessened capacity for dual tasking	Treatment of the underlying disease Physical activity is correlated with cognitive performance, therefore also physiotherapy
Other
Vascular encephalopathy (MRI, Figure 1b)	“Frontal gait disturbance” (small-stepped, broad-based, but with good arm swing) Cognitive impairment (lessened capacity for dual tasking)	Treatment of vascular risk factors (hypertension) Physiotherapy
Normal-pressure hydrocephalus (MRI, Figure 1a)	Apraxic gait disturbance Clinical triad: gait disturbance, cognitive deficits, urinary incontinence Improvement after lumbar puncture for CSF removal	Repeated lumbar puncture or ventriculoperitoneal shunt (the gait disturbance improves more than the other manifestations)
Anxious gait disorder (fear of falling)	“Walking on ice” (broad-based gait, search for something to hold on to) Normal capacity for dual tasking Improvement with minimal help or distraction	Patient education Directed physical therapy Behavioral therapy, medical treatment of anxiety (SSRI), as indicated
Toxic (medications, alcohol)	Fluctuating gait disorder History Note: Alcohol exacerbates gait impairment in PNP and cerebellar ataxia	Avoidance or discontinuation of precipitating substance

PNP, polyneuropathy; SSRI, selective serotonin reuptake inhibitor