To evaluate the relationship between multidomain gait assessment and fall risk in patients with probable Normal Pressure Hydrocephalus (NPH) and identify gait parameters that predict fall risk. 

Normal Pressure Hydrocephalus (NPH) is a condition that primarily affects older individuals, manifesting gait dysfunction, cognitive decline, and urinary incontinence. Gait disturbances have a significant impact on quality of life and increase fall risk in NPH patients.

A cohort of 322 probable NPH patients underwent gait assessments, including Timed Up and Go (TUG), 10 Meter Walk (10MW), 4 Stage Balance Test (4SBT), 30 Seconds Sit to Stand (S2S), and 2 Minute Walk (2MW) tests. Additionally, demographic data and neurological assessments such as Evan’s Index, Montreal Cognitive Assessment (MoCA), Fall Risk Questionnaire (FRQ), Functional Activities Questionnaire (FAQ), and number of falls in the past 6 months were collected.

Gait dysfunction was prevalent in the NPH cohort, with a high proportion exhibiting abnormalities in TUG (92.11%), 10MW (64.85%), 4SBT (92%), S2S (95%), and 2MW (95.26%). All three domains were affected in 92.95% of patients. Significant differences were found between fallers and non-fallers in TUG (P < 0.001), 2MW (P < 0.001), 10MW (P = 0.01),  S2S (P = 0.005), Semi-tandem (P = 0.009), and Tandem stance (P = 0.004). Fall history correlated with TUG (r = 0.42, P = 0.004), S2S (r = -0.51, P = 0.002), 2MW (r = -0.48, P = 0.003), FAQ (r = 0.56, P = 0.0001), and FRQ (r = 0.68, P = 0.0001). Logistic regression adjusted for age, sex, and BMI revealed that endurance-related measures were significant predictors of fall. The overall performance of the logistic regression model using raw gait measurements, age, sex, and BMI was 0.71 (AUC-ROC).

Gait disturbances, particularly endurance-related measures, are significantly associated with fall risk in patients with NPH.