Dual-task gait speed and mobility are positively associated with declarative memory

Abstract In the US, it is not recommended to perform routine screening assessments for cognitive function or impairment among older adults, due to the lack of effective pharmacological treatments. These common practices result in delayed identification and treatments for slowing cognitive decline progression. Thus, the purpose of the present investigation was to determine the ability to predict cognition from common measures of physical function. Seventy-five community-dwelling older adults (80.7±5.4 years) completed physical function and cognitive assessments. Physical function was assessed using the Short Physical Performance Battery (SPPB), peak velocity during a power sit-to-stand task, and dual-task walking test. Cognition (declarative memory) was assessed using a validated Visual Paired Comparison test. 38% of the variance in cognition was accounted for by the predictor variables (age, sex, education, SPPB, dual-task, peak velocity). Significant predictors included dual-task walking (p = .03), SPPB (p = .02), and education (p = .02). For each 1 second faster during the dual-task performance, cognition increased by 4 percentile units. Likewise, each 1 unit increase in SPPB resulted in an increase of 4 percentile points in cognition. The results indicate more than a third of the variance in declarative memory can be predicted by commonly assessed measures of physical function. This information is useful when identifying older adults that may have cognitive impairment before overt signs are realized. With the lack of recommended cognitive testing, using physical function declines to identify possible cognitive decline is promising. These results are preliminary in nature and longitudinal determination is warranted.

Download Full-text

Abstract 22: Visit-to-Visit Variability in Blood Pressure is Related to Late-Life Cognitive Decline

Circulation ◽

10.1161/circ.131.suppl_1.22 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Bo Qin ◽

Anthony J Viera ◽

Linda S Adair ◽

Brenda L Plassman ◽

Lloyd J Edwards ◽

...

Keyword(s):

Blood Pressure ◽

Older Adults ◽

Cognitive Function ◽

Cognitive Decline ◽

Verbal Memory ◽

Repeated Measures ◽

Community Dwelling ◽

Cognitive Testing ◽

Cognitive Test ◽

Nutrition Survey

Introduction: Recent studies suggest higher visit-to-visit variability of blood pressure (BP) is associated with worse cognitive function, but evidence based on longitudinal cognitive testing has not been reported. Hypothesis: We assessed the hypothesis that higher visit-to-visit variability in BP, but not mean BP, would be associated with faster decline in cognitive function among community-dwelling older adults. Methods: This prospective cohort study comprised 1213 adults who had two or more waves of BP measurements as part of the China Health and Nutrition Survey from 1991, up to their first cognitive tests, and completed a cognitive screening test at two or more waves in 1997, 2000 or 2004. Mean (SD) age at first cognitive test was 64 (6) y. Outcomes were repeated measures of global cognitive scores (baseline mean ± SD: 19 ± 6 points), standardized composite cognitive and verbal memory scores (standardized units [SU]). Visit-to visit BP variability was expressed as the standard deviation [SD] or as the variation independent of mean (SD/mean^x, with x derived from curve fitting) in BP measures obtained at a mean interval of 3.6 years. Multivariable-adjusted linear mixed-effects models were used to determine the association of changes in cognitive scores with visit-to visit BP variability. Results: Higher visit-to-visit variability in systolic BP, but not mean systolic BP, was associated with a faster decline of cognitive function (adjusted mean difference [95% CI] for high vs. low tertile of SD in variability (Figure): global score -0.23 points/y [-0.41 to -0.04], composite scores -0.029 SU/y [-0.056 to -0.002] and verbal memory -0.044 SU/y [-0.075 to -0.012]). Higher visit-to-visit variability in diastolic BP was associated with a faster decline of global cognitive function only among adults 55-64 years, independent of mean diastolic BP. Conclusion: Higher long-term BP visit-to-visit variability predicted a faster rate of cognitive decline among older adults.

Download Full-text

The Effect of Co-dependent (Thinking in Motion [tim]) Versus Single-modality (Cognifit) Interventions on Cognition and Gait Among Community Dwelling Older Adults With Cognitive Decline: a Randomized Controlled Study

10.21203/rs.3.rs-707056/v1 ◽

2022 ◽

Author(s):

Shiri Embon-Magal ◽

Tal Krasovsky ◽

Israel Doron ◽

Kfir Asraf ◽

Iris Haimov ◽

...

Keyword(s):

Older Adults ◽

Cognitive Decline ◽

Dual Task ◽

Group Intervention ◽

Community Dwelling ◽

Secondary Outcome ◽

Controlled Study ◽

Post Intervention ◽

Community Dwelling Older Adults ◽

Single Modality

Abstract Background. Cognition and motor skills are interrelated throughout the aging process and often show simultaneous deterioration among older adults with cognitive decline. Co-dependent training has the potential to ameliorate both domains; however, its effect on the gait and cognition of older adults with cognitive decline has yet to be explored. The aim of this study is to compare the effects of the well-established single-modality cognitive computerized training program, CogniFit, with “Thinking in motion (TIM),” a co-dependent group intervention, among community-dwelling older adults with cognitive decline. Methods. Employing a single-blind randomized control trial design, 47 community-dwelling older adults with cognitive decline were randomly assigned to eight-week thrice weekly trainings of TIM or CogniFit. Pre- and post-intervention assessments included cognitive performance, evaluated by a CogniFit battery, as a primary outcome, and gait, under single- and dual-task conditions, as a secondary outcome. Results. CogniFit total Z scores significantly improved from baseline to post-intervention for both groups. There was a significant main effect for time [F (1, 44) = 17.43, p<.001, ηp2=.283] but not for group [F (1, 44) = 0.001, p=.970]. No time X group interaction [F (1, 44) = 1.29, p=.261] was found. No changes in gait performance under single and dual-task performance were observed in both groups. Conclusions. The findings show that single-modality (CogniFit) and co-dependent (TIM) trainings improve cognition but not gait in older adults with cognitive decline. Such investigations should be extended to include various populations and a broader set of outcome measurements. Trial registration: anzctr Id: 371522. Date: 08/11/2016

Download Full-text

Abstract MP88: Fetuin-A, a Vascular Biomarker of Cognitive Decline in Older Adults

Circulation ◽

10.1161/circ.129.suppl_1.mp88 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Gail A Laughlin ◽

Linda K McEvoy ◽

Elizabeth Barrett-Connor ◽

Lori B Daniels ◽

Joachim H Ix

Keyword(s):

Older Adults ◽

Cognitive Function ◽

Cognitive Decline ◽

Vascular Disease ◽

Sex Education ◽

Cognitive Aging ◽

Community Dwelling ◽

Fetuin A ◽

High Functioning ◽

Age Related

Objectives: The contribution of vascular disease to neurocognitive decline is now widely recognized. Fetuin-A is an abundant plasma protein known to predict vascular disease. Prior studies have shown that fetuin-A levels are lower in patients with Alzheimer’s disease in direct proportion to the severity of cognitive impairment; however, their association with normal cognitive aging is unknown. We evaluated the association of serum fetuin-A levels with cognitive function in relatively high-functioning, community-dwelling older adults from the Rancho Bernardo Study. Methods: This is a population-based study of 1382 older adults (median age 75) who had plasma fetuin-A levels and cognitive function evaluated in 1992-96; 855 had repeat cognitive function assessment a median of 4 years later. Results: Adjusting for age, sex, education, and depression, higher levels of fetuin-A were associated with better baseline performance on the Mini-Mental Status Exam (MMSE) (P=0.012) and a tendency for better Trails Making B scores (P=0.066). In longitudinal analyses, the likelihood of a major decline (highest decile of change) in Trails B was 29% lower (P=0.010) for each SD higher baseline fetuin-A level; odds of major decline in MMSE was 42% lower (P=0.005) per SD higher fetuin-A for individuals with no known CVD, but were not related to fetuin-A in those with CVD (P=0.33). Fetuin-A was not related to Category Fluency performance. Results did not vary by sex and were not explained by numerous vascular risk factors and comorbidities. Conclusions: Higher plasma fetuin-A concentrations are associated with better performance on tests of global cognitive function and executive function and with reduced likelihood of major decline in these cognitive abilities over a 4-year period. These observations are consistent with the hypothesis that higher fetuin-A protects against cognitive decline in relatively high functioning older adults, although this may be less apparent in those with established vascular disease. Fetuin-A may serve as a biological link between vascular disease and normal age-related cognitive decline.

Download Full-text

Low Cognitive Function Is Associated With Reduced Functional Fitness Among Community-Dwelling Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.512 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 157-157

Author(s):

Michelle Gray ◽

Joshua Gills ◽

Jordan Glenn ◽

Erica Madero ◽

Aidan Hall ◽

...

Keyword(s):

Older Adults ◽

Cognitive Function ◽

Dual Task ◽

Paired Comparison ◽

Community Dwelling ◽

Future Research ◽

Functional Fitness ◽

Comparison Task ◽

Chair Stand ◽

High Cognitive Function

Abstract Among older adults over 70, 22-30% report difficulty performing at least one activity of daily living (ADL). While the precipitants of ADL decline are multifactorial, over 50% of cognitively impaired adults require assistance with ADLs. The exact relationship between cognitive and functional decline remains unknown, but it is important to understand their relationship. Eighty-three older adults (80.9 + 5.4 years) enrolled in this study and completed functional fitness and cognitive assessments. Functional fitness assessments included: Short Physical Performance Battery (SPPB), 10-meter walk, dual-task, and power chair stand (average and peak). Cognition was assessed using the Montreal Cognitive Assessment (MoCA) and Visual Paired Comparison task (VPC). Categories of low cognitive function (LCF) and high cognitive function (HCF) were determined by VPC scores. SPPB was 10.2% greater among the HCF group. The HCF group walked 12.6% (0.16 m/s) faster than the LCF group. Dual-task (fast) performance was 13.2% faster among the HCF group. Additionally, when rising from a seated position during the average and peak power chair stand task, the HCF group moved 16.7% and 16.1% faster than the LCF group, respectively. MoCA scores were 2.8 points greater among the HCF group. Based on the current results, significant differences exist between cognitive groups suggesting a relationship between functional fitness and cognition. What remains unknown is the ability to influence functional fitness by changing cognition or vice versa. Future research is warranted to determine the relationship of change in either domain over time.

Download Full-text

Cognitive decline after elective and nonelective hospitalizations in older adults

Neurology ◽

10.1212/wnl.0000000000006918 ◽

2019 ◽

Vol 92 (7) ◽

pp. e690-e699 ◽

Cited By ~ 7

Author(s):

Bryan D. James ◽

Robert S. Wilson ◽

Ana W. Capuano ◽

Patricia A. Boyle ◽

Raj C. Shah ◽

...

Keyword(s):

Older Adults ◽

Cognitive Decline ◽

Sex Education ◽

Hospital Admissions ◽

Community Dwelling ◽

Significant Difference ◽

Before And After ◽

Education Medical ◽

Global Cognition ◽

Rate Of Decline

ObjectiveTo determine whether emergent and urgent (nonelective) hospitalizations are associated with faster acceleration of cognitive decline compared to elective hospitalizations, accounting for prehospital decline.MethodsData came from the Rush Memory and Aging Project, a prospective cohort study of community-dwelling older persons without baseline dementia. Annual measures of cognition via a battery of 19 tests were linked to 1999 to 2010 Medicare claims records.ResultsOf 777 participants, 460 (59.2%) were hospitalized over a mean of 5.0 (SD = 2.6) years; 222 (28.6%) had at least one elective and 418 (53.8%) at least one nonelective hospitalization. Mixed-effects regression models estimated change in global cognition before and after each type of hospitalization compared to no hospitalization, adjusted for age, sex, education, medical conditions, length of stay, surgery, intensive care unit, and comorbidities. Persons who were not hospitalized had a mean loss of 0.051 unit global cognition per year. In comparison, there was no significant difference in rate of decline before (0.044 unit per year) or after (0.048 unit per year) elective hospitalizations. In contrast, decline before nonelective hospitalization was faster (0.076 unit per year; estimate = −0.024, SE = 0.011, p = 0.032), and accelerated by 0.036 unit (SE = 0.005, p < 0.001) to mean loss of 0.112 unit per year after nonelective hospitalizations, more than doubling the rate in those not hospitalized.ConclusionsNonelective hospitalizations are related to more dramatic acceleration in cognitive decline compared to elective hospitalizations, even after accounting for prehospital decline. These findings may inform which hospital admissions pose the greatest risk to the cognitive health of older adults.

Download Full-text

Clinical Applicability of Gait Analysis in the Early Detection of Cognitive Decline: A Cross-Sectional Study.

10.21203/rs.3.rs-107338/v1 ◽

2020 ◽

Author(s):

Tine Roman de Mettelinge ◽

Patrick Desimpelaere ◽

Dirk Cambier

Keyword(s):

Older Adults ◽

Cognitive Decline ◽

Gait Analysis ◽

Dual Task ◽

Early Stage ◽

Digit Span ◽

Warning Signal ◽

Cross Sectional Study ◽

Community Dwelling ◽

Cross Sectional

Abstract BACKGROUND Although promising results concerning dual-task gait predicting dementia progression in older adults with Mild Cognitive Impairment have been established, the question remains whether this can also be applied to older adults who are not yet suffering from overt cognitive impairments. Spatiotemporal gait analysis has proven to be valuable and reliable in this context. Nevertheless, these instruments are not common in clinical environments. This study aims to investigate whether easy applicable, inexpensive instruments can be used in the detection of gait alterations associated with early cognitive decrements.METHODS Eighty-two healthy community-dwelling older adults (age 60-89) with a MMSE ≥27 were enrolled in this study. Gait analyses using 10-meter walk test (10MWT) and GAITRite-instrument were performed under single and dual-task conditions. Performance on MMSE, CDT, MoCA, TMT-A, TMT-B, Digit Span Forward and Digit Span Backward were registered. Based on the tertiles of dual-task costs (DTC), subjects were categorized as “poor walkers” or “good walkers”. Comparative and predictive statistical analyses were conducted.RESULTS During both types of dual-task 10MWT “poor walkers” performed significantly worse on CDT, MMSECDT, TMT-A and Digit Span Backward compared to “good walkers”. Spatiotemporal gait analysis revealed that temporal DTC resulted in poorer performance on MMSE, CDT, MMSECDT and MoCA orientation whereas spatial DTC showed significantly lower scores on MoCA language, TMT-B and ΔTMT for “poor walkers” compared to “good walkers”. The effort it took to perform either the verbal fluency or the arithmetic dual-task during 10MWT predicted TMT-A and Digit Span Backward outcome. Regarding spatiotemporal dual-task gait analysis, performance on MMSE could be predicted by DTC stride velocity and performance on MoCA language could be predicted by DTC step and stride length.CONCLUSIONS Poor walking abilities can be associated with early cognitive decrements, even in a very early stage when cognitive performance is still more or less intact. Poor walking performance might therefore be considered a clinical precursor or warning signal for beginning cognitive decline. The subtle cognitive and gait decrements can be identified using inexpensive tools, which are easy applicable in all clinical settings.Trial registration Not applicable

Download Full-text

Cognitive Motor Dual Task Costs in Older Adults with Motoric Cognitive Risk Syndrome

Journal of Frailty & Aging ◽

10.14283/jfa.2021.27 ◽

2021 ◽

pp. 1-6

Author(s):

N. Ward ◽

A. Menta ◽

S. Peach ◽

S.A. White ◽

S. Jaffe ◽

...

Keyword(s):

Older Adults ◽

Working Memory ◽

Dual Task ◽

Processing Speed ◽

Community Dwelling ◽

Cognitive Testing ◽

Gait Velocity ◽

Memory Processing ◽

Composite Measures ◽

Cognitive Risk

The purpose of this study was to characterize Cognitive Motor Dual Task (CMDT) costs for a community-based sample of older adults with Motoric Cognitive Risk Syndrome (MCR), as well as investigate associations between CMDT costs and cognitive performance. Twenty-five community-dwelling older adults (ages 60-89 years) with MCR performed single and dual task complex walking scenarios, as well as a computerized cognitive testing battery. Participants with lower CMDT costs had higher scores on composite measures of Working Memory, Processing Speed, and Shifting, as well as an overall cognitive composite measure. In addition, participants with faster single task gait velocity had higher scores on composite measures of Working Memory, Processing Speed, and overall cognition. Taken together, these results suggest that CMDT paradigms can help to elucidate the interplay between cognitive and motor abilities for older adults with MCR.

Download Full-text

MIND Diet, Common Brain Pathologies, and Cognition in Community-Dwelling Older Adults

Journal of Alzheimer s Disease ◽

10.3233/jad-210107 ◽

2021 ◽

pp. 1-10

Author(s):

Klodian Dhana ◽

Bryan D. James ◽

Puja Agarwal ◽

Neelum T. Aggarwal ◽

Laurel J. Cherian ◽

...

Keyword(s):

Older Adults ◽

Cognitive Functioning ◽

Sex Education ◽

The Elderly ◽

Community Dwelling ◽

Cognitive Testing ◽

Postmortem Diagnosis ◽

Cognitive Activities ◽

The Mind ◽

Mind Diet

Background: MIND diet, a hybrid of the Mediterranean diet and the Dietary Approaches to Stop Hypertension diet, is associated with a slower cognitive decline and lower risk of Alzheimer’s disease (AD) dementia in older adults. Objective: We aim to examine whether the association of the MIND diet with cognition is independent of common brain pathologies. Methods: Utilizing data from the Rush Memory and Aging Project (MAP), a longitudinal clinical-pathologic study, we studied 569 decedents with valid dietary data, cognitive testing proximate to death, and complete autopsy data at the time of these analyses. A series of regression analyses were used to examine associations of the MIND diet, dementia-related brain pathologies, and global cognition proximate to death adjusting for age, sex, education, APOE ɛ4, late-life cognitive activities, and total energy intake. Results: A higher MIND diet score was associated with better global cognitive functioning proximate to death (β= 0.119, SE = 0.040, p = 0.003), and neither the strength nor the significance of association changed substantially when AD pathology and other brain pathologies were included in the model. The β-estimate after controlling for global AD pathology was 0.111 (SE = 0.037, p = 0.003). The MIND diet-cognition relationship remained significant when we restricted our analysis to individuals without mild cognitive impairment at the baseline (β= 0.121, SE = 0.042, p = 0.005) or in people diagnosed with postmortem diagnosis of AD based on NIA-Reagan consensus recommendations (β= 0.114, SE = 0.050, p = 0.023). Conclusion: MIND diet is associated with better cognitive functioning independently of common brain pathology, suggesting that the MIND diet may contribute to cognitive resilience in the elderly.

Download Full-text

Long-term participation in community group exercise improves lower extremity muscle strength and delays age-related declines in walking speed and physical function in older adults

European Review of Aging and Physical Activity ◽

10.1186/s11556-021-00260-2 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Chisato Hayashi ◽

Soshiro Ogata ◽

Tadashi Okano ◽

Hiromitsu Toyoda ◽

Sonoe Mashino

Keyword(s):

Older Adults ◽

Muscle Strength ◽

Physical Exercise ◽

Lower Extremity ◽

Physical Function ◽

Community Dwelling ◽

Group Exercise ◽

Community Based ◽

Lower Extremity Muscle

Abstract Background The effects of group exercise on the physical function of community-dwelling older adults remain unclear. The changes in lower extremity muscle strength, timed up and go (TUG) time, and the motor fitness scale (MFS), over time, among older adults who expressed a willingness to participate in community-based physical exercise groups, were determined using multilevel modelling. Methods We analyzed data of 2407 older adults between April 2010 and December 2019 from the registry of physical tests of community-based physical exercise groups. We conducted a retrospective cohort study to assess the effect of physical exercise on lower extremity muscle strength, TUG time, and MFS scores. The durations of the exercises were evaluated by frequency of physical test’s participate. Results A deterioration in lower extremity muscle strength was found in the short-term participant group only. However, in the mid-term and long-term participation groups, lower extremity muscle strength showed a trend of improvement. The TUG time and the MFS score were negatively correlated with increasing age in both groups divided by the duration of participation. However, there was a slower rate of deterioration in the long-term participation group. Discussion Lower extremity muscle strength, TUG time, and MFS scores decline with increasing age and there were differences in the slope of deterioration that depended on the duration of participation in community-based group exercise. Conclusion Participation in group exercise improved lower extremity muscle strength, TUG time, and MFS scores of older adults living in a community. The positive effects of group exercise were dependent on long-term participation.

Download Full-text

A Modified CAIDE Risk Score as a Screening Tool for Cognitive Impairment in Older Adults

Journal of Alzheimer s Disease ◽

10.3233/jad-210269 ◽

2021 ◽

pp. 1-14

Author(s):

Magdalena I. Tolea ◽

Jaeyeong Heo ◽

Stephanie Chrisphonte ◽

James E. Galvin

Keyword(s):

Risk Factors ◽

Older Adults ◽

Cognitive Impairment ◽

Risk Score ◽

Clinical Sample ◽

Community Sample ◽

Community Dwelling ◽

Cognitive Testing ◽

Risk Scores ◽

Predictive Values

Background: Although an efficacious dementia-risk score system, Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) was derived using midlife risk factors in a population with low educational attainment that does not reflect today’s US population, and requires laboratory biomarkers, which are not always available. Objective: Develop and validate a modified CAIDE (mCAIDE) system and test its ability to predict presence, severity, and etiology of cognitive impairment in older adults. Methods: Population consisted of 449 participants in dementia research (N = 230; community sample; 67.9±10.0 years old, 29.6%male, 13.7±4.1 years education) or receiving dementia clinical services (N = 219; clinical sample; 74.3±9.8 years old, 50.2%male, 15.5±2.6 years education). The mCAIDE, which includes self-reported and performance-based rather than blood-derived measures, was developed in the community sample and tested in the independent clinical sample. Validity against Framingham, Hachinski, and CAIDE risk scores was assessed. Results: Higher mCAIDE quartiles were associated with lower performance on global and domain-specific cognitive tests. Each one-point increase in mCAIDE increased the odds of mild cognitive impairment (MCI) by up to 65%, those of AD by 69%, and those for non-AD dementia by > 85%, with highest scores in cases with vascular etiologies. Being in the highest mCAIDE risk group improved ability to discriminate dementia from MCI and controls and MCI from controls, with a cut-off of ≥7 points offering the highest sensitivity, specificity, and positive and negative predictive values. Conclusion: mCAIDE is a robust indicator of cognitive impairment in community-dwelling seniors, which can discriminate well between dementia severity including MCI versus controls. The mCAIDE may be a valuable tool for case ascertainment in research studies, helping flag primary care patients for cognitive testing, and identify those in need of lifestyle interventions for symptomatic control.

Download Full-text