The results unexpectedly showed the opposite of our prediction: although frail elderly patients with dementia walked slowly, they still walked relatively too fast, given their overall degree of physical impairment that should have warranted a much slower gait. Two explanations seem most likely. First, the relatively fast gait velocity in frail patients with dementia may reflect frontal lobe disinhibition or recklessness. Another explanation can be a lack of insight, because of which patients may not have adapted their behaviour to their cognitive and physical impairments. Other studies that assessed gait in patients with dementia found a slower gait velocity in these patients than in patients without dementia.4,10
A reason for the difference with earlier findings may be that these studies investigated gait in relatively healthy patients with dementia, without or with poorly described comorbidity, whereas our patients with and without dementia were frail (used a high number of drugs, had a high Cumulative Illness Rating Scale—Geriatrics score, slow mean gait velocity and low handgrip strength). Further, all five previous studies, as discussed in the review,4,10
used a case–control design, creating the possibility of biased outcomes because of incorrect selection of controls.
The absolute gait velocity measured in our patients with dementia corresponds with values reported for patients with moderate to severe dementia,11,12
but is slower than the gait velocity of elderly people transitioning to frailty13
and much slower than gait velocity in healthy elderly people (range 0.97–1.4 m/s).14
A limitation of our study is that we only measured gait variables at preferred walking speed, although it is known that several gait variables can vary with gait velocity. Measuring gait at several gait velocities, however, was not feasible in this frail population. Nevertheless, we were able to pick up well‐known gait changes in this population, including both the reduced absolute velocity and the increased stride variability, which is an important marker of gait abnormalities.15,16
The inappropriately fast gait in patients with dementia, in the context of their frailty, may partially explain the excessive fall rate in frail elderly patients with dementia. This finding opens avenues to future intervention studies.