Beyond frailty: Mild cognitive impairment linked to slower gait speed
· Medical Xpressedited by Sadie Harley, reviewed by Robert Egan
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Gait is a fundamental activity of daily living and can reflect multiple aspects of physical and cognitive function in older individuals. Slower gait speed is commonly associated with frailty, a condition in which the body has a reduced ability to withstand stressors. Mild cognitive impairment (MCI), which involves a decline in cognitive function without a major loss of independence in daily activities, is also associated with slower gait. However, because frailty and MCI often occur together, it has remained unclear whether the association between MCI and gait speed is independent of physical function.
To address this gap, a research team led by professor Yohei Otaka from the Department of Rehabilitation Medicine, School of Medicine, Fujita Health University, Japan, investigated whether MCI was associated with gait speed even after accounting for frailty. The study also examined whether MCI and frailty had an interactive effect on gait speed.
"Gait speed is simple to measure and is already widely used as an indicator of physical function in older individuals. This study further supported the evidence that not only physical function but also cognitive function per se influences gait speed," explains Otaka.
The research also included contributions from Dr. Koki Tan, professor Shigeo Tanabe, Dr. Hikaru Kondo, Dr. Taisei Sugiyama and professor Naoki Mori from Fujita Health University, Japan, along with other collaborators.
The findings are published in BMC Geriatrics.
Testing gait alongside frailty and cognition
To investigate this, the team conducted a cross-sectional study involving 421 individuals aged 60 and older who were recruited through Silver Human Resources Centers in Tokyo and Nagoya between June and November 2024. Participants completed a 10-m (33-foot) walking test under two conditions: walking at a comfortable, self-selected speed and walking as fast as possible.
Gait speed was calculated from the time taken to walk the central 6 m (20 feet) of the walkway, excluding the first and last 2 m (7 feet) used for acceleration and deceleration.
The researchers assessed frailty using the Japanese Kihon checklist and MCI using the Japanese version of the Montreal Cognitive Assessment. Based on these assessments, participants were classified into six groups according to their frailty and MCI status: frailty with MCI, frailty without MCI, pre-frailty with MCI, pre-frailty without MCI, non-frailty with MCI and non-frailty without MCI.
Cognitive impairment linked to gait independently
Using mediation analysis, the team found that frailty and MCI were independently associated with gait speed. Among the models examined, the model receiving the strongest support indicated that frailty and MCI were each directly associated with gait speed, with little evidence that either affected gait speed through the other. This suggests that the association between MCI and slower gait speed was largely independent of frailty.
This finding was further supported by an analysis that considered frailty and MCI simultaneously while accounting for age, sex and body mass index. Importantly, the researchers found no significant interaction between frailty and MCI, suggesting no evidence that frailty and MCI combine synergistically to affect gait speed. Together, the findings indicate that cognitive function may contribute to differences in gait speed alongside physical function.
Everyday walking as a potential screening tool
"These findings provide a foundation for assessing cognitive decline from walking, expanding the potential applications for gait screening in daily life," says Otaka.
In the longer term, the researchers suggest that further studies could explore whether changes in everyday walking can help distinguish physical impairment from cognitive impairment.
Wearable devices may eventually make it possible to incorporate gait assessment into routine health assessments, although further research is needed to determine how well gait measured in daily life can reflect these different aspects of health.
More information
Koki Tan et al, Mild cognitive impairment has a direct effect on gait speed even when accounting for frailty, BMC Geriatrics (2026). DOI: 10.1186/s12877-026-07609-1
Key medical concepts
Mild Cognitive ImpairmentWalking SpeedFrailty
Clinical categories
Healthy agingNeurologyAllied healthCommon illnesses & Prevention Provided by Fujita Health University Who's behind this story?
Sadie Harley
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