What is the initial workup for an elderly lady with weakness and rigid gait?

From the Guidelines

The initial workup for an elderly lady with weakness and rigid gait should prioritize a comprehensive assessment, including a detailed history, neurological examination, and selective use of laboratory tests and imaging studies, as outlined in the most recent guidelines 1. The assessment should begin with a thorough history, focusing on the onset and progression of symptoms, medication review, and associated symptoms like tremor, balance problems, or cognitive changes.

Key Components of the Initial Workup

• A detailed history, including age, location and cause of fall, difficulty with gait and/or balance, and specific comorbidities such as dementia, Parkinson’s, stroke, diabetes, hip fracture, and depression 1
• Medication assessment, with special attention to vasodilators, diuretics, antipsychotics, sedative/hypnotics, and other high-risk medications 1
• Orthostatic blood pressure assessment and neurologic assessment with special attention to presence/absence of neuropathies and proximal motor strength 1
• Laboratory tests, such as complete blood count, comprehensive metabolic panel, thyroid function tests, vitamin B12 and folate levels, and inflammatory markers, as well as brain imaging with MRI or CT to rule out structural lesions 1
• A "get up and go test" to assess gait and balance, and to evaluate the patient's ability to rise from the bed, turn, and steadily ambulate 1

Importance of Early Diagnosis and Treatment

Early diagnosis is crucial, as some conditions like Parkinson's disease respond well to medications, while others may require different interventions. The comprehensive approach helps differentiate between common causes such as Parkinson's disease, normal pressure hydrocephalus, vascular parkinsonism, and medication-induced parkinsonism, allowing for appropriate treatment planning. Gait and balance disorders can point to a group of disorders in which impaired cognition, behavior, and impaired motor function co-occur, and have predictive utility of future risk for developing dementia 1. Therefore, a thorough and timely workup is essential to improve outcomes and reduce the risk of falls and other complications in elderly patients with weakness and rigid gait.

From the Research

Initial Workup for Elderly Lady with Weakness and Rigid Gait

The initial workup for an elderly lady with weakness and rigid gait should involve a comprehensive assessment to identify the underlying causes of her symptoms.

• A focused physical examination and evaluation of functional performance are essential in determining the cause of gait disorders 2.
• The assessment should consider different sensorimotor levels and include a thorough clinical observation of gait, taking a focused patient history, and physical, neurological, and orthopedic examinations 3.
• The Timed Up and Go test is a fast and reliable diagnostic tool to assess gait and balance disorders in older adults 4.
• The workup should also consider common causes of gait disorders in older adults, such as arthritis, orthostatic hypotension, and neurological conditions like parkinsonism and frontal gait disorders 3, 4.
• A multifactorial evaluation followed by targeted interventions for identified contributing factors is the most effective strategy for managing gait disorders and preventing falls 4.

Key Components of the Initial Workup

• Medical history: to identify any underlying medical conditions that may be contributing to the gait disorder
• Physical examination: to assess muscle strength, range of motion, and balance
• Neurological examination: to assess cognitive function, coordination, and reflexes
• Orthopedic examination: to assess joint mobility and stability
• Functional assessment: to evaluate the patient's ability to perform daily activities and mobility tasks

Additional Considerations

• The patient's age, personality, mood, and sociocultural factors can influence her gait pattern 3.
• The presence of multiple causes or combinations of neurological and non-neurological gait disorders is common in older adults and should be considered in the workup 3.
• The patient's medication regimen should be reviewed to identify any potential contributors to the gait disorder, such as sedatives or other medications that can affect balance and mobility 3.