Association of gait, balance, and fall risk with dementia in Down syndrome: a systematic review of the literature

Conceição, Aline de Souza Gonçalves Gomes da; Fonseca, Luciana Mascarenhas; Forlenza, Orestes Vicente

doi:10.1590/1980-5764-DN-2025-0442

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View and Review • Dement. neuropsychol. 20 • 2026 • https://doi.org/10.1590/1980-5764-DN-2025-0442 linkcopy

Association of gait, balance, and fall risk with dementia in Down syndrome: a systematic review of the literature

Associação entre marcha, equilíbrio e risco de quedas com demência na síndrome de Down: uma revisão sistemática da literatura

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Advances in healthcare have led to increased life expectancy among individuals with Down syndrome, resulting in a growing population of older adults within this group. As a result, the prevalence of cognitive decline and dementia has increased, largely due to the genetic predisposition of Down syndrome to early and significant accumulation of brain amyloid and intensified formation of neurofibrillary tangles. Early detection of functional alterations, particularly those related to gait and balance, may serve as a valuable clinical marker of emerging neurocognitive impairment.

Objective: To synthesize the current evidence on the relationship between gait, cognitive decline, and dementia in adults and older adults with Down syndrome.

Methods: A systematic search was conducted in the PubMed database in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Original observational studies evaluating gait, balance, or fall risk in relation to cognitive decline or dementia in adults with Down syndrome were included. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools.

Results: Thirty-seven records were identified, of which five original studies met the inclusion criteria. Overall, the findings suggest an association between gait alterations, balance, and cognitive decline in individuals with Down syndrome. Commonly reported abnormalities included reduced gait speed, increased gait variability, inconsistency in gait parameters, and impaired balance. However, heterogeneity in study design, different measurement protocols, and small sample sizes limited the comparability and generalizability of the results.

Conclusion: Gait assessment holds promise as a non-invasive, accessible approach for early identification of cognitive decline in individuals with Down syndrome. Future research should prioritize longitudinal designs, standardized assessment protocols, and larger representative samples to inform targeted and evidence-based clinical interventions.

Keywords:
Trisomy 21; Intellectual Disability; Dementia; Gait; Postural Balance

Author	Country	Study design	Sample (n; age)	Gait/balance/fall assessment	Cognitive or dementia-related outcomes	Main findings relevant to the review question
Conceição et al.⁹	Brazil	Cross-sectional	n=66; 20–64 years	Performance-Oriented Mobility Assessment (POMA); Body Mass Index	CAMCOG-DS; clinical classification (stable cognition, prodromal dementia, dementia)	Poorer gait and balance performance were associated with prodromal dementia and dementia, supporting gait impairment as a functional marker of cognitive decline in adults with Down syndrome.
Van Pelt et al.¹⁰	USA	Cross-sectional	n=29; 25–59 years	Instrumented gait analysis under single- and dual-task conditions (GAITRite®)	Brief Praxis Test; Severe Impairment Battery; clinical consensus diagnosis	Dual-task gait paradigms revealed age-related slowing and associations with cognitive performance, suggesting cognitive–motor interference as an early marker of cognitive vulnerability.
Barry et al.¹³	USA	Longitudinal cohort (32 months)	n=218; 25–72 years	Tinetti Gait; motion capture and pressure-sensitive walkways	DSMSE; mCRT; NTG-EDSD; consensus diagnosis (stable, MCI-DS, dementia)	Baseline gait impairments and longitudinal gait decline were associated with incident dementia, supporting gait measures as prodromal indicators of Alzheimer's disease in adults with Down syndrome.
Leach et al.³⁰	USA	Longitudinal cohort	n=22; mean 37 ± 7.5 years	GAITRite® (step time variability); DTI–MRI	Vineland Adaptive Behavior Scales; Brief Praxis Test; Severe Impairment Battery	Increased gait variability was associated with reduced white matter integrity and poorer adaptive functioning, indicating early neurobiological changes related to dementia risk.
Washington et al.¹¹	USA	Cross-sectional	n=43; mean 30 ± 12 years	Timed Up and Go; Sit-to-Stand; grip strength	DSQIID; Waisman Activities of Daily Living Scale	Worse physical function and slower gait were associated with higher dementia risk symptoms and reduced independence, highlighting functional mobility as an early indicator of dementia risk.

Instrument/Name	Domain assessed	Description	Relevant findings/cut-offs	Specific for DS or ID
POMA – Performance-Oriented Mobility Assessment	Balance and gait	Clinical tool with two subscales (Balance: 9 items; Gait: 7 items); total score 28 points.	Scores <19 indicate high fall risk; applied in Down syndrome, showing an association with prodromal dementia.	No
TUG – Timed Up and Go	Mobility/Function	Functional mobility test: stand up, walk 3 meters, turn, sit. Timed in seconds.	>12s indicates impaired mobility/fall risk; in Down syndrome, associated with dementia risk symptoms.	No
STS – Sit-to-Stand Test	Lower limb strength	Measures the number of chair rises (usually 5x) or time to complete; an indicator of frailty.	Slower times are linked to frailty and dementia risk in Down syndrome.	Yes
GAITRite® System	Quantitative gait	Instrumented walkway; records spatiotemporal gait parameters.	Sensitive to dual-task effects and early Alzheimer's disease changes; feasible in Down syndrome.	No
Motion capture/pressure-sensitive walkways	Gait	Measures velocity, stride length, and variability using cameras or pressure mats.	Identified gait alterations predictive of Alzheimer's disease in aging Down syndrome.	No

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[TFN1] Abbreviations: CAMCOG-DS, Cambridge Cognitive Examination-Down Syndrome; DSMSE, Down Syndrome Mental Status Examination; mCRT, modified Cued Recall Test; NTG-EDSD, National Task Group – Early Detection Screen for Dementia; MCI-DS, Mild Cognitive Impairment in Down Syndrome; DTI-MRI, Diffusion Tensor Imaging – Magnetic Resonance Imaging; DSQIID, Dementia Screening Questionnaire for Individuals with Intellectual Disabilities.