Dual Decline in Gait and Cognition Is Associated With Future Dementia: Evidence for a Phenotype

Abstract BACKGROUND: The concurrent decline in gait speed and cognition are associated with future dementia. However, the clinical profile of those who present with dual-decline has not yet been described. We aimed to describe the phenotype and risk for incident dementia of individuals who present a dual-decline in comparison with non dual-decliners. METHODS: Prospective cohort of community-dwelling older adults free of dementia at baseline. We evaluated participants’ gait speed, cognition, medical status, functionality, incidence of adverse events, and dementia biannually over 7 years. Gait speed was assessed with a 6-meter electronic-walkway, and global cognition was assessed using the MoCA test. We compared characteristics between dual-decliners and non dual-decliners using t-test, Chi-square, and hierarchical regression models. We estimated incident dementia using Cox models. RESULTS: Among 144 participants (mean age 74.23 ± 6.72 years, 54% women), 17% progressed to dementia. Dual-decliners had a three-fold risk (HR: 3.12, 95%CI:1.23-7.93, p=0.017) of progression to dementia compared with non dual-decliners. Dual-decliners were significantly older with a higher prevalence of hypertension and dyslipidemia (p=0.002). Hierarchical regression models show that age and sex alone explained 3% of the variation in the dual-decliners group, while adding hypertension and dyslipidemia increased the explained variation to 8% and 10 %, respectively. The risk of becoming a dual-decliner was 4-fold if hypertension was present. CONCLUSION: Older adults with concurrent decline in gait speed and cognition represent a group at the highest risk of progression to dementia. These dual-decliners have a distinct phenotype with a higher prevalence of hypertension, a potentially treatable condition.

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Dual decline in gait speed and cognition is associated with future dementia: evidence for a phenotype

Age and Ageing ◽

10.1093/ageing/afaa106 ◽

2020 ◽

Vol 49 (6) ◽

pp. 995-1002 ◽

Cited By ~ 4

Author(s):

Manuel Montero-Odasso ◽

Mark Speechley ◽

Susan W Muir-Hunter ◽

Frederico Pieruccini-Faria ◽

Yanina Sarquis-Adamson ◽

...

Keyword(s):

Older Adults ◽

Gait Speed ◽

Regression Models ◽

Community Dwelling ◽

Hierarchical Regression ◽

Chi Square ◽

Cox Models ◽

Incident Dementia ◽

Risk Of Progression ◽

Community Dwelling Older Adults

Abstract Background concurrent declines in gait speed and cognition have been associated with future dementia. However, the clinical profile of ‘dual decliners’, those with concomitant decline in both gait speed and cognition, has not been yet described. We aimed to describe the phenotype and the risk for incident dementia of those who present with dual decline in comparison with non-dual decliners. Methods prospective cohort of community-dwelling older adults free of dementia at baseline. We evaluated participants’ gait speed, cognition, medical status, functionality, incidence of adverse events and dementia, biannually over 7 years. Gait speed was assessed with a 6-m electronic walkway and global cognition using the MoCA test. We compared characteristics between dual decliners and non-dual decliners using t-test, chi-square and hierarchical regression models. We estimated incident dementia using Cox models. Results among 144 participants (mean age 74.23 ± 6.72 years, 54% women), 17% progressed to dementia. Dual decliners had a 3-fold risk (HR: 3.12, 95%CI: 1.23–7.93, P = 0.017) of progression to dementia compared with non-dual decliners. Dual decliners were significantly older with a higher prevalence of hypertension and dyslipidemia (P = 0.002). Hierarchical regression models show that age and sex alone explained 3% of the variation in the dual decliners group. Adding hypertension and dyslipidemia increased the explained variation by 8 and 10%, respectively. The risk of becoming a dual decliner was 4-fold higher if hypertension was present. Conclusion older adults with a concurrent decline in gait speed and cognition represent a group at the highest risk of progression to dementia. Older adults with dual decline have a distinct phenotype with a higher prevalence of hypertension, a treatable condition.

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Screening prefrailty in Japanese community-dwelling older adults with daily gait speed and number of steps via tri-axial accelerometers

Scientific Reports ◽

10.1038/s41598-021-98286-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Naoto Takayanagi ◽

Motoki Sudo ◽

Yukari Yamashiro ◽

Ippei Chiba ◽

Sangyoon Lee ◽

...

Keyword(s):

Older Adults ◽

Gait Speed ◽

Early Stage ◽

Intermediate Stage ◽

Community Dwelling ◽

Increased Risk ◽

Risk Of Progression ◽

Care Assistance ◽

Community Dwelling Older Adults ◽

Self Administered Questionnaire

AbstractPrefrailty is an intermediate stage between non-frailty and frailty. It is associated with an increased risk of progression to frailty, which makes it important to screen older adults for prefrailty at an early stage. This study verified whether daily gait speed and number of steps measured using a tri-axial accelerometer could be used to identify prefrailty. In total, 1692 Japanese community-dwelling older adults were divided into robust (n = 1032) and prefrail (n = 660) groups based on the Kihon Checklist, which is a self-administered questionnaire. Both daily gait speed and number of steps were measured for two weeks using tri-axial accelerometers. We also calculated the area under the ROC curve and the cut-off values for these parameters. Our results showed that the cut-off value for daily gait speed was 106.3 cm/s, while that for number of steps was 6342.2. In addition, we found that the combined assessment of both cut-off values was a more effective way to screen older adults with prefrailty status compared to either parameter alone. This is also considered an effective way to reduce national expenditures for daily care assistance.

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Association between Physical Frailty Subdomains and Oral Frailty in Community-Dwelling Older Adults

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18062931 ◽

2021 ◽

Vol 18 (6) ◽

pp. 2931

Author(s):

Ryo Komatsu ◽

Koutatsu Nagai ◽

Yoko Hasegawa ◽

Kazuki Okuda ◽

Yuto Okinaka ◽

...

Keyword(s):

Older Adults ◽

Gait Speed ◽

Community Dwelling ◽

Health Study ◽

Cardiovascular Health Study ◽

Physical Frailty ◽

Cross Sectional ◽

Important Indicator ◽

Community Dwelling Older Adults ◽

Oral Frailty

This cross-sectional study aimed to demonstrate the association between physical frailty subdomains and oral frailty. This study involved community-dwelling older adults (aged ≥65 years). Physical frailty was assessed with the Japanese version of the Cardiovascular Health Study criteria. Oral frailty was defined as limitations in at least three of six domains. Logistic regression analysis was used to analyze the association between physical frailty risk and oral frailty. In addition, we examined the association between physical frailty subdomains (gait speed, grip strength, exhaustion, low physical activity, and weight loss) and oral frailty. A total of 380 participants were recruited for this study. Overall, 18% and 14% of the participants were at risk of physical frailty and had oral frailty, respectively. Physical frailty risk (odds ratio (OR) = 2.40, 95% confidence interval (CI): 1.22–4.75, p = 0.012) was associated with oral frailty in multivariate analysis. In secondary analysis, among physical frailty subdomains, gait speed (OR = 0.85, 95% CI: 0.73–0.97, p = 0.019) was associated with oral frailty. The present findings suggest that physical frailty is closely related to oral frailty. Among physical frailty subdomains, decreased gait speed in particular is an important indicator related to the development of oral frailty.

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How wearable sensors have been utilised to evaluate frailty in older adults: a systematic review

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-021-00909-0 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Grainne Vavasour ◽

Oonagh M. Giggins ◽

Julie Doyle ◽

Daniel Kelly

Keyword(s):

Systematic Review ◽

Older Adults ◽

Gait Speed ◽

Outcome Measurement ◽

Wearable Sensors ◽

Adverse Outcomes ◽

Community Dwelling ◽

Ageing Population ◽

Application Development ◽

Community Dwelling Older Adults

Abstract Background Globally the population of older adults is increasing. It is estimated that by 2050 the number of adults over the age of 60 will represent over 21% of the world’s population. Frailty is a clinical condition associated with ageing resulting in an increase in adverse outcomes. It is considered the greatest challenge facing an ageing population affecting an estimated 16% of community-dwelling populations worldwide. Aim The aim of this systematic review is to explore how wearable sensors have been used to assess frailty in older adults. Method Electronic databases Medline, Science Direct, Scopus, and CINAHL were systematically searched March 2020 and November 2020. A search constraint of articles published in English, between January 2010 and November 2020 was applied. Papers included were primary observational studies involving; older adults aged > 60 years, used a wearable sensor to provide quantitative measurements of physical activity (PA) or mobility and a measure of frailty. Studies were excluded if they used non-wearable sensors for outcome measurement or outlined an algorithm or application development exclusively. The methodological quality of the selected studies was assessed using the Appraisal Tool for Cross-sectional Studies (AXIS). Results Twenty-nine studies examining the use of wearable sensors to assess and discriminate between stages of frailty in older adults were included. Thirteen different body-worn sensors were used in eight different body-locations. Participants were community-dwelling older adults. Studies were performed in home, laboratory or hospital settings. Postural transitions, number of steps, percentage of time in PA and intensity of PA together were the most frequently measured parameters followed closely by gait speed. All but one study demonstrated an association between PA and level of frailty. All reports of gait speed indicate correlation with frailty. Conclusions Wearable sensors have been successfully used to evaluate frailty in older adults. Further research is needed to identify a feasible, user-friendly device and body-location that can be used to identify signs of pre-frailty in community-dwelling older adults. This would facilitate early identification and targeted intervention to reduce the burden of frailty in an ageing population.

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Respirometric Profiling of Muscle Mitochondria and Blood Cells Are Associated With Differences in Gait Speed Among Community-Dwelling Older Adults

The Journals of Gerontology Series A ◽

10.1093/gerona/glu096 ◽

2014 ◽

Vol 70 (11) ◽

pp. 1394-1399 ◽

Cited By ~ 45

Author(s):

Daniel J. Tyrrell ◽

Manish S. Bharadwaj ◽

Cynthia G. Van Horn ◽

Stephen B. Kritchevsky ◽

Barbara J. Nicklas ◽

...

Keyword(s):

Older Adults ◽

Blood Cells ◽

Gait Speed ◽

Community Dwelling ◽

Muscle Mitochondria ◽

Community Dwelling Older Adults

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EFFECTS OF COMPUTERIZED COGNITIVE TRAINING ON GAIT SPEED IN COMMUNITY DWELLING OLDER ADULTS, A PILOT STUDY

Journal of Prevention of Alzheimer's Disease ◽

10.14283/jpad.2016.102 ◽

2016 ◽

pp. 1-6

Author(s):

J. Blackwood ◽

T. Houston

Keyword(s):

Older Adults ◽

Cognitive Training ◽

Gait Speed ◽

Independent Living ◽

Functional Decline ◽

Community Dwelling ◽

Computerized Cognitive Training ◽

Home Based ◽

Improved Function ◽

Community Dwelling Older Adults

Background: In older adults declines in gait speed have been identified as predictors of functional decline and have been found in those with cognitive dysfunction. Cognitive training interventions that emphasize addressing executive function (EF) have resulted in a transfer effect from training cognitive processes into improved function. However research examining the effects of an EF specific computerized cognitive training (CCT) program on gait speed (GS) is limited. Objectives: To compare the effects of a six week EF specific CCT program on GS in community dwelling older adults using a pretest/posttest experimental design with subgroup comparisons based on a cutoff GS of 1.0m/s. Setting: Home based Participants: Forty independent living older adults (>65 years) without diagnosed cognitive impairment participated in either the intervention or control groups. Intervention: A six week long progressively challenging EF focused CCT program was performed at home. Measurements: Demographic variables, cognitive function (Trail-Making Test Part B) and GS were measured at baseline at week 7. Between group comparisons were completed for the whole sample initially with subgroup comparisons performed based on participants’ initial GS (Slow walkers: GS<1.0m/s; Fast Walkers: GS>1.0m/s). Results: No differences in GS were found for the whole population, but subgroup analyses restricted to slow walkers demonstrated a statistically significant improvement in GS after 6 weeks of CCT (µ =0.33 m/s, p = 0.03). Other outcomes measures were not statistically different at posttest. Conclusions: Older adults who walk at speeds <1.0m/s may benefit from a progressively challenging CCT program when self-administered in the home.

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Body Composition in Community-Dwelling Older Adults Before and After SARS-CoV-2 Infection: A Longitudinal Prospective Study in a Rural Village Struck by the Pandemic

Journal of Primary Care & Community Health ◽

10.1177/21501327211047781 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110477

Author(s):

Oscar H. Del Brutto ◽

Robertino M. Mera ◽

Denisse A. Rumbea ◽

Pedro Pérez ◽

Bettsy Y. Recalde ◽

...

Keyword(s):

Physical Activity ◽

Older Adults ◽

Body Composition ◽

Regression Models ◽

Community Dwelling ◽

The Body ◽

Study Results ◽

The Impact ◽

Community Dwelling Older Adults

Background: Information on the body composition of inhabitants of remote communities during the SARS-CoV-2 pandemic is limited. Using a longitudinal population-based study design, we assessed the association between SARS-CoV-2 infection and changes in body composition. Methods: Community-dwelling older adults living in a rural Ecuadorian village received body composition determinations before and 1 year after the pandemic as well as serological tests for detection of SARS-CoV-2 antibodies. The independent association between SARS-CoV-2 infection and abnormalities in body composition at follow-up was assessed by fitting linear mixed models for longitudinal data. Results: Of 327 enrolled individuals, 277 (85%) received baseline and follow-up body composition determinations, and 175 (63%) of them became SARS-CoV-2 seropositive. Overall, diet and physical activity deteriorated during the follow-up. Multivariate random-effects generalized least squares regression models that included the impact of time and seropositivity on follow-up body composition, showed that neither variable contributed to a worsening in body composition. Multivariate logistic regression models disclosed that the serological status at follow-up cannot be predicted by differences in body composition and other baseline covariates. Conclusions: Study results suggest no increased susceptibility to SARS-CoV-2 infection among older adults with abnormal body composition and no significant changes as a result of worse physical activity and dietary habits or seropositivity during the length of the study. Together with a previous study in the same population that showed decrease in hand-grip strength after SARS-CoV-2, results confirm that dynapenia (and not sarcopenia) is associated with SARS-CoV-2 infection in older adults.

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Longitudinal validity of using digital hand photographs for assessing hand osteoarthritis progression over 7 years in community-dwelling older adults with hand pain

10.21203/rs.2.12778/v1 ◽

2019 ◽

Author(s):

Michelle Marshall ◽

Helgi Jonsson ◽

Gudrun Helgadottir ◽

Elaine Nicholls ◽

Helen L Myers ◽

...

Keyword(s):

Older Adults ◽

Construct Validity ◽

Community Dwelling ◽

Analysis Of Covariance ◽

Hand Osteoarthritis ◽

Clinical Progression ◽

Chi Square ◽

Term Change ◽

Community Dwelling Older Adults ◽

Longitudinal Construct Validity

Abstract Background: To determine the longitudinal construct validity of assessing hand OA progression on digital photographs over 7 years compared with progression determined from radiographs, clinical features and change in symptoms. Methods: Participants were community-dwelling older adults (≥50 years) in North Staffordshire, UK. Standardized digital hand photographs were taken at baseline and 7 years, and hand joints graded for OA severity using an established photographic atlas. Radiographic hand OA was assessed using the Kellgren and Lawrence grading system. Hand examination determined the presence of nodes, bony enlargement and deformity. Symptoms were reported in self-complete questionnaires. Radiographic and clinical progression and change in symptoms were compared to photographic progression. Differences were examined using analysis of covariance and Chi-Square tests. Results: Of 253 individuals (61% women, mean age 63 years) the proportion with photographic progression at the joint and joint group-level was higher, though not statistically significantly, in those with radiographic or clinical progression compared to those without. At the person-level, those with moderate photographic progression over 7 years had significantly higher summed radiographic and clinical scores after adjustment for baseline scores compared to those with no or mild photographic progression. Similar findings were observed for change in symptoms, although differences were small and not statistically significant. Conclusion: Assessing hand OA on photographs shows modest longitudinal construct validity over 7 years compared with change in radiographic and clinical hand OA at the person-level. Using hand photographs for determining long-term change may be a reasonable alternative when hand examinations and radiographs are not feasible.

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Physical Performance Predictors for Incident Dementia Among Japanese Community-Dwelling Older Adults

Physical Therapy ◽

10.1093/ptj/pzz077 ◽

2019 ◽

Vol 99 (9) ◽

pp. 1132-1140

Author(s):

Takehiko Doi ◽

Kota Tsutsumimoto ◽

Sho Nakakubo ◽

Min-Ji Kim ◽

Satoshi Kurita ◽

...

Keyword(s):

Older Adults ◽

Risk Assessment ◽

Grip Strength ◽

Physical Performance ◽

Performance Level ◽

Community Dwelling ◽

Sit To Stand ◽

Dementia Risk ◽

Incident Dementia ◽

Community Dwelling Older Adults

Abstract Background Evaluating physical performance could facilitate dementia risk assessment. However, findings differ regarding which type of physical performance best predicts dementia. Objective The objective of this study was to examine the association between physical performance and incidence of dementia in Japanese community-dwelling older adults. Design This was a prospective study of community-dwelling older adults. Methods Of 14,313 invited individuals who were ≥ 65 years old, 5104 agreed to participate from 2011 to 2012, and 4086 (52% women; mean age = 72.0 years) met the criteria. Baseline assessments of the following physical performance indicators were obtained: grip strength, the Five-Times Sit-to-Stand Test, and the Timed “Up & Go” Test. The physical performance level in each test was categorized as C1 (highest), C2 (middle–high), C3 (middle–low), or C4 (lowest) on the basis of sex-stratified quartile values. Incident dementia status was obtained from medical records that were updated monthly. Results During follow-up (mean duration = 42.9 months), there were 243 incident cases of dementia (5.9%). Log-rank test results indicated that a lower physical performance level constituted a significant risk factor for dementia. After adjustment for covariates, Cox proportional hazards models (reference: highest physical performance level [C1]) demonstrated that the Five-Times Sit-to-Stand Test in the group with the lowest physical performance level (hazard ratio = 1.69; 95% CI = 1.10–2.59) was significantly associated with a risk of dementia. Likewise, the Timed “Up & Go” Test in the group with the lowest physical performance level (hazard ratio = 1.54; 95% CI = 1.01–2.35) was significantly associated with a risk of dementia. However, grip strength was not significantly associated with a risk of dementia. Limitations This study was limited by the use of medical record data. Conclusions A lower mobility-related physical performance level was associated with dementia risk. Dementia risk assessment should include an adequate evaluation of physical function.

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