Mild cognitive impairment status and mobility performance: an analysis from the Boston RISE study

Automated vehicles for older adults with cognitive impairment: a survey study

As the population is ageing, the number of older adults with cognitive impairment (CI) is increasing. Automated vehicles (AVs) can improve independence and enhance the mobility of these individuals. This study aimed to: (1) understand the perception of older adults (with and without CI) and stakeholders providing services and supports regarding care and transportation about AVs, and (2) suggest potential solutions to improve the perception of AVs for older adults with mild or moderate CI. A survey was conducted with 435 older adults with and without CI and 188 stakeholders (e.g. caregivers). The results were analysed using partial least square - structural equation modelling and multiple correspondence analysis. The findings suggested relationships between older adults' level of cognitive impairment, mobility, knowledge of AVs, and perception of AVs. The results provided recommendations to improve older adults' perception of AVs including education and adaptive driving simulation-based training.Practitioner summary: This study investigated the perception of older adults and other stakeholders regarding AVs. The findings suggested relationships between older adults' level of cognitive impairment, mobility, knowledge of AVs, and perception of AVs. The results provided guidelines to improve older adults' perception of AVs.

Reliability and minimal detectable change of the Short Physical Performance Battery in older adults with mild cognitive impairment

OBJECTIVES

Reliability of the Short Physical Performance Battery (SPPB) are rarely examined among older adults with mild cognitive impairment (MCI). This study aimed to investigate the test-retest reliability and minimal detectable change (MDC) of the SPPB in older adults with MCI.

METHODS

Participants included 100 older adults with MCI. The SPPB was assessed with the first 2 assessments separated by a 20-min interval and the third separated by a 1-week interval. The intraclass correlation coefficient (ICC) and MDC values were estimated.

RESULTS

The intraday ICC was 0.73 for the SPPB score, 0.90 for the 4-m walk time (4mwt), and 0.95 for the 5-times chair stand time (5cst); the corresponding interday ICC values were 0.76, 0.89, and 0.91, respectively. The MDC values ranged from 1.1 to 1.2 for the SPPB score, from 0.77 to 0.80 s for the 4mwt, and from 1.32 to 1.77 for the 5cst.

CONCLUSIONS

The SPPB had satisfactory reliability among older adults with MCI. The test-retest reliability of the SPPB is sufficient (>0.7) for group comparisons. Moreover, the test-retest reliability for the 4mwt and 5cst subscale performances is acceptable (> 0.9) for individual-level measurements over time.

A novel autonomous vehicle interface for older adults with cognitive impairment

The population of older Americans with cognitive impairments, especially memory loss, is growing. Autonomous vehicles (AVs) have the potential to improve the mobility of older adults with cognitive impairment; however, there are still concerns regarding AVs' usability and accessibility in this population. Study objectives were to (1) better understand the needs and requirements of older adults with mild and moderate cognitive impairments regarding AVs, and (2) create a prototype for a holistic, user-friendly interface for AV interactions. An initial (Generation 1) prototype was designed based on the literature and usability principles. Based on the findings of phone interviews and focus group meetings with older adults and caregivers (n = 23), an enhanced interface (Generation 2) was developed. This generation 2 prototype has the potential to reduce the mental workload and anxiety of older adults in their interactions with AVs and can inform the design of future in-vehicle information systems for older adults.

Changes in Mild Neurocognitive Disorder Status in Mobility Limited Older Primary Care Patients: Implications for Rehabilitative Care

OBJECTIVE

The aim of the study is to identify potential rehabilitative treatment targets associated with participants' annual cognitive status.

DESIGN

A cohort study patients with self-reported mobility limitation who completed neuropsychological, physical performance testing, and questionnaires at baseline to 2-year follow-up were categorized into three groups (persistently cognitively normal, nonpersistent mild neurocognitive disorder, and persistently mild neurocognitive disorder) based on their annual cognitive status using baseline, years 1 and 2 performance on Hopkins Verbal Learning, Trail Making, and Digit Symbol Substitution Tests. Repeated measures multinomial regression analysis was used to examine the differences between groups and associated characteristics.

RESULTS

Study included 349 participants (mean age, 76 ± 7) with 57% of participants were persistently cognitively normal, 16% persistently mild neurocognitive disorder, and 27% nonpersistent mild neurocognitive disorder over 2 yrs of follow-up. Faster gait speed (relative risk reduction, 0.64-0.89) was associated with risk reduction and increase in depressive symptoms (relative risk reduction, 1.09-1.12) was associated with greater risk of being classified into the nonpersistent or persistently mild neurocognitive disorder compared with persistently cognitively normal.

CONCLUSIONS

Variability across cognitive status over time was observed. Gait speed and depressive symptoms were modifiable risk factors associated with nonpersistent and persistent mild neurocognitive disorder status. This study reinforces the potential benefit of multifaceted rehabilitation for preventing and treating older adults with mobility and/or cognitive problems.

Exploring cognitive trajectories and their association with physical performance: evidence from the China Health and Retirement Longitudinal Study

OBJECTIVES

The long-term trends of cognitive function and its associations with physical performance remain unclear, particularly in Asian populations. The study objectives were to determine cognitive trajectories in middle-aged and elderly Chinese individuals, as well as to examine differences in physical performance across cognitive trajectory groups.

METHODS

Data were extracted from the China Health and Retirement Longitudinal Study. A total of 5,701 participants (47.7% male) with a mean age of 57.8 (standard deviation, 8.4) years at enrollment were included. A group-based trajectory model was used to identify cognitive trajectory groups for each sex. Grip strength, repeated chair stand, and standing balance tests were used to evaluate physical performance. An ordered logistic regression model was employed to analyze differences in physical performance across cognitive trajectory groups.

RESULTS

Three cognitive trajectory groups were identified for each sex: low, middle, and high. For both sexes, higher cognitive trajectory groups exhibited smaller declines with age. In the fully adjusted model, relative to the low trajectory group, the odds ratios (ORs) of better physical performance in the middle cognitive group were 1.37 (95% confidence interval [CI], 1.17 to 1.59; p<0.001) during follow-up and 1.40 (95% CI, 1.20 to 1.64; p<0.001) at the endpoint. The ORs in the high trajectory group were 1.94 (95% CI, 1.61 to 2.32; p<0.001) during follow-up and 2.04 (95% CI, 1.69 to 2.45; p<0.001) at the endpoint.

CONCLUSIONS

Cognitive function was better preserved in male participants and individuals with higher baseline cognitive function. A higher cognitive trajectory was associated with better physical performance over time.

Mild Neurocognitive Disorder, Social Engagement, and Falls Among Older Primary Care Patients

OBJECTIVES

(1) To estimate the association between social engagement (SE) and falls; (2) To examine the relation between mild neurocognitive disorder (MNCD) and falls by different levels of SE.

DESIGN

We performed a secondary data analysis using prospective cohort study design.

SETTING

Primary care.

PARTICIPANTS

A total of 425 older adult primary care patients at risk for mobility decline (N=425). As previously reported, at baseline, 42% of participants exhibit MNCD.

MAIN OUTCOME MEASURES

The outcome variable was the number of falls during 2 years of follow-up. Exposure variables at baseline included (1) MNCD identified using a cut-off of 1.5 SD below the age-adjusted mean on at least 2 measures within a cognitive performance battery and (2) SE, which was assessed using the social component of the Late-Life Function and Disability Instrument. High SE was defined as having a score ≥ median value (≥49 out of 100). All models were adjusted for age, sex, education, marital status, comorbidities, and pain status.

RESULTS

Over 2 years of follow-up, 48% of participants fell at least once. MNCD was associated with a higher rate of falls, adjusting for the covariates (Incidence Rate Ratio=1.6, 95% confidence interval: 1.1-2.3). There was no significant association between MNCD and the rate of falls among people with high SE. In participants with low SE (having a score less than 49.5 out 100), MNCD was associated with a higher rate of falls as compared with participants with no neurocognitive disorder (No-NCD).

CONCLUSIONS

Among participants with low SE, MNCD was associated with a higher rate of falls, but not among participants with high SE. The findings suggest that high SE may be protective against falls among older primary care patients with MNCD.

Association between dietary folate intake and cognitive impairment in older US adults: National Health and Nutrition Examination Survey

OBJECTIVE

To determine the association between dietary folate intake and low cognitive performance in older adults.

METHODS

In this cross-sectional observational study, 2011-2014 data from the 2010 National Health and Nutrition Examination Survey, including 2,524 adults aged 60 years and older, included 24-hour dietary intakes. Total folic acid intake was calculated as the sum of folic acid supplements and dietary folic acid. Cognitive function was assessed using three tests. The association between folate intake and cognitive function was assessed using a multivariate conditional logistic regression model.

RESULTS

2524 participants from two survey cycles (2011-2014) in the NHANES aged 60 years and over. In the multivariate logistic regression, the OR of developing folate was 0.96 (95% CI: 0.94∼0.98) in participants with Z test. Folate intake was negatively associated with cognitive function. Compared with Q1, Q4(≥ 616.3mg/day) in the AFT and DSST tests reduced the risk of cognitive impairment by 31% (OR = 0.69, 95% CI: 0.52-0.93) and 44% (OR = 0.56). 95% confidence interval: 0.44-0.7). In the comprehensive evaluation of IR and AFT scores, the association between dietary folate intake and low cognitive performance in US adults is linear. We also found a significant interaction between gender and cognitive ability (P value for the interaction was 0.021).

CONCLUSIONS

Dietary intake of folic acid may be inversely associated with cognitive impairment. The DSST study found an L-shaped association between dietary folate intake and cognitive decline in US adults, with an inflection point of approximately 510,383 mg/day.

Is physical exercise effective at improving body structure & function and activity outcomes in individuals with Mild Cognitive Impairment? a systematic review with quality of evidence assessment

PURPOSE

To investigate the effect of physical exercise on body structure & function and activity outcomes in individuals with Mild Cognitive Impairment (MCI).

METHODS

Six databases were searched from inception until January 2021. Randomized controlled trials (RCTs) comparing physical exercise with a control group were included.

RESULTS

Fourteen RCTs were included. Three types of physical exercise were identified: aerobic (AE), resistance (RE), and multimodal (ME). Regarding body structure & function outcomes, evidence for RE was very low and with effect for improvement in upper limb muscle strength and very low and without effect for lower limbs. For improvement in postural balance, evidence was very low and with effect with AE and very low and without effect with RE and ME. Evidence for cardiorespiratory function was very low and without effect with AE and RE. Regarding activity outcomes, evidence was low and without effect for mobility with AE and very low and without effect with RE and ME.

CONCLUSIONS

Physical exercise promoted improvements in body structure & function outcomes in individuals with MCI. Resistance exercise improvement upper limb muscle strength and AE enhanced postural balance. In contrast, physical exercise did not promote a significant benefit in activity outcomes.Implications for rehabilitationResults of this systematic review have shown that physical exercise promoted improvements in body structure & function outcomes in individuals with Mild Cognitive Impairment (MCI).Resistance exercise with elastic bands for approximately 60 minutes twice a week for a total of three months improved upper limb muscle strength.Aerobic exercise with walking for approximately 60 minutes twice per week for a total of six months enhanced postural balance.Considering the potential benefits identified in this systematic review, physical exercise can be recommended for individuals with MCI.We also highlight the importance of the use of the International Classification of Functioning, Disability and Health for rehabilitation planning.

An innovative rehabilitation program for the veterans affairs post-acute skilled nursing setting: Preliminary results

BACKGROUND

Skilled nursing rehabilitative care plays a critical role in older adults' functional recovery impacting post-discharge outcomes. Variations across post-acute rehabilitative care services and patient outcomes indicate a need to improve rehabilitative care in this setting. We adapted a successful outpatient care program (Live Long Walk Strong-LLWS) to address this need in post-acute care settings within the Veterans Health Administration. LLWS differs from standard PT care by treating impairments linked to functional decline that are not traditionally targeted by standard care, providing formalized coaching to optimize behavior change, and providing post-discharge case management to optimize long-term outcomes. The purpose was to adapt, refine and implement the LLWS program for the Community Living Center (CLC), determine its acceptability and feasibility, and evaluate its preliminary effectiveness among older adults.

METHODS

The design of the program was adapted from the original outpatient LLWS program to the CLC setting through quality improvement methods and the Replicating Effective Programs (REP) framework. Primary outcomes included measures of feasibility and acceptability of >80% enrollment and completion of sessions as well as preliminary effectiveness using performance-based and patient-reported measures of function including the Short Physical Performance Battery (SPPB), AM-PAC, a Global Rating of Change questionnaire, and a satisfaction survey.

RESULTS

After 18 months, 51 Veterans had enrolled in the LLWS program, with 94.1% maintaining enrollment. We observed >80% completion of the inpatient and home follow-up sessions. Most patients were highly satisfied with care. Improvements in the SPPB (2.3 (SD 2.2) points), gait speed (0.17 (0.14) m/s) and the AM-PAC (6.5 (SD 5.7)) surpassed clinically meaningful thresholds.

CONCLUSIONS

This novel care program is feasible and acceptable to Veterans, demonstrating preliminary effectiveness with improving functional outcomes. Future research is needed to further examine the program's impact on other important outcomes relative to standard modes of care.

Associated factors of new subjective cognitive decline complaints after a 6-month period among community-dwelling older adults during the COVID-19 pandemic in Japan

BACKGROUND

The aim of this study was to determine the number of new subjective cognitive decline (SCD) complaints and associated factors in community-dwelling older adults during the COVID-19 pandemic in Japan.

METHOD

A prospective cohort study was conducted in two periods: May to June 2020, and November 2020 to January 2021. We mailed a questionnaire to 1953 older adults in the first survey, and received 700 responses in the second. We analysed 534 participants without SCD in the first survey. We collected data on sociodemographic characteristics and administered the Questionnaire for Medical Checkup of Old-Old (QMCOO) to assess respondents' health condition. SCD was operationally defined using the QMCOO as reports of (1) forgetfulness, and (2) difficulty in naming dates. The subjects were divided into two groups by their condition at the second survey: an SCD (new SCD complaints) and a no-SCD (no new SCD complaints) group.

RESULTS

A total of 85 (15.9%) participants had new SCD complaints. The Mann-Whitney U-test and chi-squared test showed that the SCD group had significantly more risk factors of SCD: walking speed (P = 0.001), smoking (P = 0.001), and existence of person with whom the patient could consult when disordered (P = 0.002). Multiple logistic regression analysis revealed that walking speed (odds ratio (OR) = 2.115, 95% confidence interval (CI): 1.259-3.553) and the presence of person to consult (OR = 3.619, 95% CI: 1.553-8.433) were significant related factors of new SCD complaints.

CONCLUSION

Maintenance of physical condition and social support were associated with new SCD complaints during the COVID-19 pandemic.

Cognitive, psychological and social factors associated with older adults' mobility: a scoping review of self-report and performance-based measures

Although many factors have been associated with mobility among older adults, there is paucity of research that explores the complexity of factors that influence mobility. This review aims to synthesise the available evidence for factors comprising the cognitive, psychological, and social mobility determinants and their associations with mobility self-reported and performance-based outcomes in older adults (60 years). We followed Arksey and O'Malley's five stages of a scoping review and searched PubMed, EMBASE, PsychINFO, Web of Science, AgeLine, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature and Sociological Abstract databases. Reviewers in pairs independently conducted title, abstract, full-text screening and data extraction. We reported associations by analyses rather than articles because articles reported multiple associations for factors and several mobility outcomes. Associations were categorised as significantly positive, negative, or not significant. We included 183 peer-reviewed articles published in 27 countries, most of which were cross-sectional studies and conducted among community-dwelling older adults. The 183 articles reported 630 analyses, of which 381 (60.5%) were significantly associated with mobility outcomes in the expected direction. For example, older adults with higher cognitive functioning such as better executive functioning had better mobility outcomes (e.g., faster gait speed), and those with poor psychological outcomes, such as depressive symptoms, or social outcomes such as reduced social network, had poorer mobility outcomes (e.g., slower gait speed) compared to their counterparts. Studies exploring the association between cognitive factors, personality (a psychological factor) and self-reported mobility outcomes (e.g., walking for transportation or driving), and social factors and performance-based mobility outcomes in older adults are limited. Understanding the additive relationships between cognitive, psychological, and social factors highlights the complexity of older adults' mobility across different forms of mobility, including independence, use of assistive devices, transportation, and driving.

Mild cognitive impairment in patients with acute heart failure does not limit the effectiveness of early phase II cardiac rehabilitation

BACKGROUND

Cardiac rehabilitation (CR) is commonly performed in patients with heart failure (HF) with mild cognitive impairment (MCI). However, whether MCI diminishes the benefit of early phase II CR is unclear.

AIM

This study aimed to clarify whether MCI diminishes the benefit of early phase II CR in patients hospitalized for HF.

DESIGN

The design of the work is a case-control study.

SETTING

All HF patients who underwent CR in acute care hospitals in Japan from April 2016 to March 2021.

POPULATION

Among the 574 patients who underwent CR, 204 were included in this study. Exclusion criteria were age <65 years, dependence for activities of daily living (ADLs) prior to admission, diagnosis of dementia or delirium, mini-mental state examination (MMSE) score at the commencement of CR<19, missing data, in-hospital death, and transfer to another department during hospitalization.

METHODS

Patients were divided into two groups, those with MCI (MCI group, N.=134) and those without MCI (non-MCI group, N.=70), based on MMSE score at the commencement of CR. Cognitive impairment was defined as a score of <19. MCI was defined as an MMSE score between 19 and 26, and normal cognitive function was defined as MMSE >26. The primary outcomes were the 6-minute walking distance (6MWD), Barthel Index (BI), and Short Physical Performance Battery (SPPB). All patients underwent guideline-based CR programs.

RESULTS

On admission, MCI patients had significantly lower BI (P<0.01, confidence interval [CI]: 4.9-20.4) and SPPB (P<0.01, CI: 1.1-3.1), despite being independent for ADLs before admission. In addition, 6MWD (P<0.01, CI: 31.2-97.2), BI (P=0.01, CI: 1.0-8.4), and SPPB (P<0.01, CI: 0.6-2.5) were significantly lower in the MCI group at the time of discharge. However, after propensity score matching to adjust for baseline characteristics, no significant differences in any primary outcome were found between the two groups.

CONCLUSIONS

The BI, SPPB, and 6MWD improvements due to CR were similar, regardless of MCI.

CLINICAL REHABILITATION IMPACT

Our results may inform the selection of appropriate rehabilitation interventions for patients with HF and MCI.

Assessment of a Robotic Walker in Older Adults With Parkinson's Disease in Daily Living Activities

The constant growth of the population with mobility impairments, such as older adults and people suffering from neurological pathologies like Parkinson's disease (PD), has encouraged the development of multiple devices for gait assistance. Robotic walkers have emerged, improving physical stability and balance and providing cognitive aid in rehabilitation scenarios. Different studies evaluated human gait behavior with passive and active walkers to understand such rehabilitation processes. However, there is no evidence in the literature of studies with robotic walkers in daily living scenarios with older adults with Parkinson's disease. This study presents the assessment of the AGoRA Smart Walker using Ramps Tests and Timed Up and Go Test (TUGT). Ten older adults participated in the study, four had PD, and the remaining six had underlying conditions and fractures. Each of them underwent a physical assessment (i.e., Senior Fitness, hip, and knee strength tests) and then interacted with the AGoRA SW. Kinematic and physical interaction data were collected through the AGoRA walker's sensory interface. It was found that for lower limb strength tests, older adults with PD had increases of at least 15% in all parameters assessed. For the Sit to Stand Test, the Parkinson's group evidenced an increase of 23%, while for the Chair Sit and Reach Test (CSRT), this same group was only 0.04 m away from reaching the target. For the Ramp Up Test (RUT), the subjects had to make a greater effort, and significant differences (p-value = 0.04) were evidenced in the force they applied to the device. For the Ramp Down Test (RDT), the Parkinson's group exhibited a decrease in torque, and there were statistically significant differences (p-value = 0.01) due to the increase in the complexity of the task. In the Timed Up and Go Test (TUGT), the subjects presented significant differences in torque (p-value of 0.05) but not in force (p-value of 0.22) due to the effect of the admittance controller implemented in the study. Finally, the results suggested that the walker, represents a valuable tool for assisting people with gait motor deficits in tasks that demanded more physical effort adapting its behavior to the specific needs of each user.

Participation in cognitive activities is associated with foot reaction time and gait speed in older adults

BACKGROUND

Given the evidence of the links between cognition and mobility, participation in cognitive activities may benefit neuromotor performance and mobility in older adults.

AIMS

To examine the association between participation in cognitive activities and foot reaction time (RT) and gait speed in community-dwelling older adults.

METHODS

The MOBILIZE Boston Study II (MBSII) re-enrolled 354 community-dwelling older adults aged ≥ 70 years from the original MBS cohort. Of these, 310 completed the performance testing and we excluded three participants who had Parkinson's disease. Cognitive Activities Scale (CAS) assessed participation in 17 cognitive activities. Simple and Choice foot RT (SRT, CRT, msec) and gait speed (m/s) were measured using a sensored GAITRite® gait mat.

RESULTS

The average age of the 307 participants was 84 years; 79% were white and 65% were women. The average CAS score was 25.5 ± 11.7, indicating participation in approximately 26 activities per week on average. The average foot SRT was 245 ± 57msec and average CRT was 323 ± 85msec. Usual-paced gait speed was 0.9 ± 0.3 m/s on average. More frequent participation in cognitive activities was associated with shorter SRT (β = - 0.759, p = 0.015) and CRT (β = - 1.125, p = 0.013), and faster gait speed (β = 0.003, p = 0.026), after adjusting for potential confounders.

DISCUSSION

Participation in cognitively stimulating activities may be beneficial for neuromotor performance and mobility in older adults.

CONCLUSIONS

Prospective and intervention studies are needed to determine whether participation in cognitive activities may prevent mobility decline over time, and thus reduce fall risk.

Takes Two to Tango: Cognitive Impairment and Sexual Activity in Older Individuals and Dyads

OBJECTIVES

This paper examines the association between cognitive impairment, including mild cognitive impairment (MCI) and early dementia (ED), and sexual activity in a large, longitudinal sample of community-dwelling older adults. We focus here on sexual activity, which includes both sexual activity with a partner and masturbation.

METHODS

We analyzed 3777 older individuals and members of 955 intimate dyads using the National Social Life, Health and Aging Project (2010 and 2015). We used ordered-probit regression, cross-lagged panels models, and probit regression.

RESULTS

We find that older adults with cognitive limitations, either MCI or early dementia, are about as likely to be sexually active with a partner as those with normal cognitive function. This is the case both in the cross section and longitudinally. Both men and women with early dementia are less likely to have masturbated, however. Among married and cohabiting couples, we find no association between cognitive impairment in either the husband, the wife, or in both partners and their joint sexual activity. Women whose measured cognitive function is lower than their husband's are less likely to report any masturbation.

DISCUSSION

Sex with a partner, a fundamentally social activity, seems to be conserved in the face of cognitive limitation but masturbation, a solitary activity, does not. We argue that the intimate dyad plays an important role in conserving partnered sexual activity. Results can inform strategies to maintain sexual well-being of older adults with cognitive impairment and their partners as part of overall strategies to improve quality of life.

Metabolic Syndrome and Physical Performance: The Moderating Role of Cognition among Middle-to-Older-Aged Adults

OBJECTIVE

Mobility limitation and cognitive decline are related. Metabolic syndrome (MetS), the clustering of three or more cardiovascular risk factors, is associated with decline in both mobility and cognition. However, the interrelationship among MetS, mobility, and cognition is unknown. This study investigated a proposed pathway where cognition moderates the relationship between MetS and Mobility.

METHOD

Adults ages 45-90 years were recruited. MetS risk factors and mobility performance (Short Physical Performance Battery (SPPB) and gait speed) were evaluated. Cognition was assessed using a comprehensive neuropsychological battery. A factor analysis of neuropsychological test scores yielded three factors: executive function, explicit memory, and semantic/contextual memory. Multivariable linear regression models were used to examine the relationship among MetS, mobility, and cognition.

RESULTS

Of the 74 participants (average age 61 ± 9 years; 41% female; 69% White), 27 (36%) participants manifested MetS. Mean SPPB score was 10.9 ± 1.2 out of 12 and gait speed was 1.0 ± 0.2 m/s. There were no statistically significant differences in mobility by MetS status. However, increase in any one of the MetS risk factors was associated with decreased mobility performance after adjusting for age and gender (SPPB score: β (SE) -.17 (0.08), p < .05; gait speed: -.03 (.01), p < .01). Further adjusting for cognitive factors (SPPB score: explicit memory .31 (.14), p = .03; executive function 0.45 (0.13), p < .01; gait speed: explicit memory 0.04 (0.02), p = .03; executive function 0.06 (0.02), p < .01) moderated the relationships between number of metabolic risk factors and mobility.

CONCLUSION

The relationship between metabolic risk factors and mobility may be moderated by cognitive performance, specifically through executive function and explicit memory.

Cognitive decline negatively impacts physical function

Many older adults report difficulty performing one or more activities of daily living. These difficulties may be attributed to cognitive decline and as a result, measuring cognitive status among aging adults may help provide an understanding of current functional status. The purpose of the present investigation was to determine the association between cognitive status and measures of physical functioning. Seventy-six older adults participated in this study; 41 were categorized as normal memory function (NM) and 35 were poor memory function (PM). NM participants had significantly higher physical function as measured by Short Physical Performance Battery (SPPB; 9.4 ± 2.2 vs. 8.4 ± 2.0; p = .03) and peak velocity (0.67 ± 0.16 vs. 0.56 ± 0.19; p = .04) during a quick sit-to-stand task. Dual-task walking velocities were 22% and 126% slower between cognitive groups for the fast and habitual trials, respectively when compared to the single-task walking condition. Significant correlations existed between measures of memory and physical function. The largest correlations with memory were for peak (r = 0.42) and average (r = 0.38) velocity. The results suggest a positive relationship between physical function and cognitive status. However, further research is needed to determine the mechanism of the underlying relationships between physical and cognitive function.

Choice reaction time and subsequent mobility decline: Prospective observational findings from The Irish Longitudinal Study on Ageing (TILDA)

BACKGROUND

Cognitive and motor function in ageing are intertwined, but whether slower motor response time (MRT) to a cognitive stimulus could herald accelerated mobility decline is unknown. Using data from The Irish Longitudinal Study on Ageing (TILDA), we examined whether slower MRT may predict a greater than expected increase in Time Up and Go (TUG) after 4 years.

METHODS

Participants aged 50 years or older were divided into two groups based on their mean MRT (< 250 ms versus ≥ 250 ms). A repeated measures ANOVA compared TUG trajectories between groups, controlling for baseline age, sex, height, education level, mini mental-state examination (MMSE) score, self-reported vision and hearing, medical conditions (cardiovascular, cerebrovascular disease, diabetes), and number of medications.

FINDINGS

At Wave 1, 1982 (58.7%) had a mean MRT of < 250 ms, with a mean TUG of 8.1 s (SD 1.6); and 1397 (41.3%) had an MRT of ≥ 250 ms, with a TUG of 9.0 s (SD 2.2). At Wave 3, TUG increased to 8.8 s (SD 2.0) and 10.2 s (SD 3.9), respectively. The results of the adjusted repeated measures ANOVA suggested that there was a statistically significant interaction between MRT group and Wave (P = 0.023, η2 p = 0.002).

INTERPRETATION

TILDA participants in the slower MRT group seemed to have faster mobility decline, but this effect was statistically and clinically small.

FUNDING

TILDA is funded by Atlantic Philanthropies, the Irish Department of Health and Irish Life. Roman Romero-Ortuno is funded by Science Foundation Ireland (grant number 18/FRL/6188).

Mobility in Older Community-Dwelling Persons: A Narrative Review

Due to the demographic changes and the increasing awareness of the role of physical function, mobility in older age is becoming an important topic. Mobility limitations have been reported as increasingly prevalent in older persons affecting about 35% of persons aged 70 and the majority of persons over 85 years. Mobility limitations have been associated with increased fall risk, hospitalization, a decreased quality of life, and even mortality. As concepts of mobility are multifactorial and complex, in this narrative review, definitions, physical factors, and their age-related changes associated with mobility will be presented. Also, areas of cognitive decline and their impact on mobility, as well as neuromuscular factors related to mobility will be addressed. Another section will relate psychological factors such as Fall-related psychological concerns and sedentary behavior to mobility. Assessment of mobility as well as effective exercise interventions are only shortly addressed. In the last part, gaps and future work on mobility in older persons are discussed.

Predictors of Quality of Life among Older People with Mild Cognitive Impairment Attending Urban Primary Care Clinics

OBJECTIVES

To study the prevalence of Mild Cognitive Impairment (MCI) among older people attending primary care clinics and its predictors of QOL.

METHODS

A cross-sectional study was conducted at two primary care clinics in Kuala Lumpur, Malaysia, recruiting 271 participants by utilizing the universal sampling method. Every patient who attended both the clinics during the study period and met the inclusion and exclusion criteria were approached and briefed about the study. Patients who gave consent were recruited as study participants. Information on sociodemographic, medical condition, and lifestyle behaviors were obtained. The Montreal Cognitive Assessment (MoCA) was used to screen for MCI at a score < 23. The World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire was used to evaluate QOL.

RESULTS

Prevalence of MCI was 27.3%. Lower QOL scores were found in the physical (67.3 ± 1.4), psychological (67.3 ± 1.4), social (66.9 ± 1.6) and environmental (71.3 ± 1.3) domains among participants with MCI. Among them, predictors of QOL were depression in the physical domain, age and stroke in the psychological domain, presence of other types of disorders in the social domain and diabetes and stroke in the environmental domain.

CONCLUSIONS

MCI was prevalent among study participants and were associated with poorer QOL in all domains of QOL. A better understanding of predictors of QOL in older people with MCI is deemed important.

CLINICAL IMPLICATION

Routine cognitive screening at primary care clinics will facilitate early recognition of MCI and facilitates referral to memory clinics for further assessment and treatment.

Interrelated Neuromuscular and Clinical Risk Factors That Contribute to Falls

BACKGROUND

Neuromuscular and clinical factors contribute to falls among older adults, yet the interrelated nature of these factors is not well understood. We investigated the relationships between these factors and how they contribute to falls, which may help optimize fall risk assessment and prevention.

METHODS

A total of 365 primary care patients (age = 77 ± 7, 67% female) were included from the Boston Rehabilitative Impairment Study of the Elderly. Neuromuscular measures included leg strength and leg velocity, trunk extensor endurance, and knee range of motion. Clinical measures included memory, executive function, depressive symptoms, pain, sensory loss, vision, comorbidity, physical activity, mobility self-efficacy, and psychiatric medication. Factor analysis was used to evaluate clustering of factors. Negative binomial regression assessed the relationship of factors with three-year fall rate. Interactions were tested to examine whether clinical factors modified the relationship between neuromuscular factors and falls.

RESULTS

Three factors emerged: (i) neuromuscular factors, pain, and self-efficacy; (ii) memory; and (iii) executive function. Having three neuromuscular impairments predicted higher fall rate (incidence rate ratio [95% confidence interval]: 3.39 [1.82-6.32]) but was attenuated by memory (1.69 [1.10-2.61]), mobility self-efficacy (0.99 [0.98-0.99]), psychiatric medication use (1.54 [1.10-2.14]), and pain (1.13 [1.04-1.23]). Pain modified the relationship between neuromuscular impairment burden (number of neuromuscular impairments) and falls. Having three neuromuscular impairments was associated with a higher fall rate in patients with high levels of pain (5.73 [2.46-13.34]) but not among those with low pain.

CONCLUSIONS

Neuromuscular impairment burden was strongly associated with fall rate in older adults with pain. These factors should be considered together during fall risk assessment, post fall assessment, and prevention.

The "develOpment of metabolic and functional markers of Dementia IN Older people" (ODINO) Study: Rationale, Design and Methods

Mild cognitive impairment (MCI), also termed mild neurocognitive disorder, includes a heterogeneous group of conditions characterized by declines in one or more cognitive domains greater than that expected during "normal" aging but not severe enough to impair functional abilities. MCI has been associated with an increased risk of developing dementia and even considered an early stage of it. Therefore, noninvasively accessible biomarkers of MCI are highly sought after for early identification of the condition. Systemic inflammation, metabolic perturbations, and declining physical performance have been described in people with MCI. However, whether biological and functional parameters differ across MCI neuropsychological subtypes is presently debated. Likewise, the predictive value of existing biomarkers toward MCI conversion into dementia is unclear. The "develOpment of metabolic and functional markers of Dementia IN Older people" (ODINO) study was conceived as a multi-dimensional investigation in which multi-marker discovery will be coupled with innovative statistical approaches to characterize patterns of systemic inflammation, metabolic perturbations, and physical performance in older adults with MCI. The ultimate aim of ODINO is to identify potential biomarkers specific for MCI subtypes and predictive of MCI conversion into Alzheimer's disease or other forms of dementia over a three-year follow-up. Here, we describe the rationale, design, and methods of ODINO.

Gait and postural control patterns and rehabilitation in Down syndrome: a systematic review

[Purpose] To describe (1) the current knowledge on gait and postural control in individuals with Down syndrome in terms of spatiotemporal, kinematics and kinetics, and (2) relevant rehabilitation strategies. [Methods] Randomized and non-randomized clinical trials published between January 1997 and October 2019 were selected by searching four scientific databases. We included studies on patients with Down syndrome involving gait analysis or postural control. A custom data-extraction and appraisal form was developed to collect the key features of each article. The PEDro Scale was used to evaluate the methodological quality of the studies. [Results] A total of 37 out of 146 cross-sectional and longitudinal studies were included in the review. The main abnormalities included: reduction of gait velocity and step length, poor static balance with increased anteroposterior and mediolateral oscillations and a larger step width. [Conclusion] A number of compensatory patterns during movement was observed, with a direct influence on improvements in stability and postural control throughout daily life. Intensive gait training at an early age appears to produce long-term improvements in this population. Future research should focus on the interaction between the motor and cognitive function, and on the functional effects due to the exposure to an enriched environment.

Effects of Exercise on Inflammatory, Oxidative, and Neurotrophic Biomarkers on Cognitively Impaired Individuals Diagnosed With Dementia or Mild Cognitive Impairment: A Systematic Review and Meta-Analysis

Although the effects of physical exercise (PE) on cognitive function in dementia and mild cognitive impairment (MCI) have been largely studied, its biochemical effect is still poorly explored. The aim of this systematic review was to investigate the effects of PE on inflammatory, oxidative, and neurotrophic biomarkers of participants with MCI or dementia. Six electronic databases, (PubMed, Cochrane Central, Embase, PEDro, PsycINFO, and SportDiscus) were searched for randomized controlled trials assessing the effects of PE on serum and/or plasma biomarkers of elderly participants with MCI or dementia. After selection process, eight studies were included. Meta-analysis was performed by comparison of changes from baseline, using the random effects method. Meta-analysis showed a significant effect of aerobic exercise on interleukin-6 and tumor necrosis factor alpha decrease and positive effects on brain-derived neurotrophic factor expression. As only one study was included with oxidative biomarker assessment, the effects of PE on oxidative process remain unclear. Finally, even though it was possible to observe positive effects of PE on some biomarkers of MCI and dementia individuals, current evidence does not allow drawing specific practical recommendations such as type, frequency, intensity, or duration of PE in these population. Further researches aiming to estimate the PE effectiveness on biomarkers of MCI and Alzheimer's disease are needed.

Accuracy of mobility tests for screening the risk of falls in patients with mild cognitive impairment and alzheimer’s disease

ABSTRACT Identifying gait and balance disorders in the earlier stages of Alzheimer’s disease (AD) and Mild Cognitive Impairment (MCI) could reduce or prevent falls in older adults. This cross-sectional study aimed to determine which mobility tests best discriminate the risk of falls in MCI and mild AD. Functional mobility was assessed by the timed up and go test (TUG) and 10-meter walk test (10MWT). A calendar of falls was produced, with follow-up via telephone calls during 6 months. For the MCI Group (n=38), time spent on the 10MWT was the best variable for discriminating fallers, with a cut-off point of 10.69 seconds associated with the highest accuracy (76.3%). In the AD Group (n=37), 10MWT cadence was the best variable for discriminating fallers, with a cut-off point of 101.39 steps per minute associated with an accuracy of 81.1%. As a conclusion, 10MWT time and cadence were the most accurate variables for screening the risk of falls in MCI and mild AD, respectively. The 10MWT is a functional, simple and easy test and it should be widely used in clinical practice.

Validation of a Modified Life-Space Assessment in Multimorbid Older Persons With Cognitive Impairment

BACKGROUND AND OBJECTIVES

To investigate the validity, reliability, sensitivity to change, and feasibility of a modified University of Alabama at Birmingham Study of Aging Life-Space Assessment (UAB-LSA) in older persons with cognitive impairment (CI).

RESEARCH DESIGN AND METHODS

The UAB-LSA was modified for use in persons with CI Life-Space Assessment for Persons with Cognitive Impairment (LSA-CI). Measurement properties of the LSA-CI were investigated using data of 118 multimorbid older participants with CI [mean age (SD): 82.3 (6.0) years, mean Mini-Mental State Examination score: 23.3 (2.4) points] from a randomized controlled trial (RCT) to improve motor performance and physical activity. Construct validity was asessed by Spearman's rank (rs) and point-biseral correlations (rpb) with age, gender, motor, and cognitive status, psychosocial factors, and sensor-derived (outdoor) physical activity variables. Test-retest reliability was analyzed using intra-class correlation coefficients (ICCs). Sensitivity to change was determined by standardized response means (SRMs) calculated for the RCT intervention group.

RESULTS

The LSA-CI demonstrated moderate to high construct validity, with significant correlations of the LSA-CI scores with (outdoor) physical activity (rs = .23-.63), motor status (rs = .27-.56), fear of falling-related psychosocial variables (rs = |.24-.44|), and demographic characteristics (rpb = |.27-.32|). Test-retest reliability was good to excellent (ICC = .65-.91). Sensitivity to change was excellent for the LSA-CI composite score (SRM = .80) and small to moderate for the LSA-CI subscores (SRM = .35-.60). A completion rate of 100% and a mean completion time of 4.1 min) documented good feasibility.

DISCUSSION AND IMPLICATIONS

The LSA-CI represents a valid, reliable, sensitive, and feasible interview-based life-space assessment tool in multimorbid older persons with CI.

Evaluating the Influence of Social Engagement on Cognitive Impairment and Mobility Outcomes Within the Boston RISE Cohort Study

OBJECTIVE

We investigated the associations between mild cognitive impairment (MCI), social engagement (SE), and mobility.

DESIGN

We evaluated data from a cohort study of older adult primary care patients (N = 430). Outcomes included self-reported function (Late-Life Function Instrument [LLFI]) and performance-based mobility (Short Physical Performance Battery score [SPPB]). Linear regression models evaluated the association between MCI and mobility, MCI and SE, mobility measures and SE, and whether SE mediated the association between MCI status and mobility.

RESULTS

Participants with MCI had significantly lower mobility and lower SE as compared with those without MCI (LLFI: 53.5 vs. 56.9, P < 0.001; SPPB: 7.9 vs. 9.3, P < 0.001; SE score: 44.9 vs. 49.0, P < 0.001). Mild cognitive impairment was significantly associated with both LLFI and SPPB (LLFI β = -2.93, P < 0.001; SPPB β = -1.26, P < 0.001) and SE (β = -3.20, P < 0.001). Social engagement was significantly associated with both LLFI and SPPB (LLFI β = 0.22; P < 0.001; SPPB β = 0.08; P < 0.001). There was a positive association between SE and mobility (P< 0.05). A mediator effect of SE was supported when evaluating the association between MCI and mobility.

CONCLUSIONS

Among older adult primary care patients at risk for mobility decline, higher levels of SE mitigate the association between MCI and mobility.

Inability to Perform the Repeated Chair Stand Task Predicts Fall-Related Injury in Older Primary Care Patients

OBJECTIVE

The aim of the study was to examine whether the chair stand component of the Short Physical Performance Battery predicts fall-related injury among older adult primary care patients.

DESIGN

A 2-yr longitudinal cohort study of 430 Boston-area primary care patients aged ≥65 yrs screened to be at risk for mobility decline was conducted. The three components of the Short Physical Performance Battery (balance time, gait speed, and chair stand time) were measured at baseline. Participants reported incidence of fall-related injuries quarterly for 2 yrs. Complementary log-log discrete time hazard models were constructed to examine the hazard of fall-related injury across Short Physical Performance Battery scores, adjusting for age, sex, race, Digit Symbol Substitution Test score, and fall history.

RESULTS

Participants were 68% female and 83% white, with a mean (SD) age of 76.6 (7.0). A total of 137 (32%) reported a fall-related injury during the follow-up period. Overall, inability to perform the chair stand task was a significant predictor of fall-related injury (hazard ratio = 2.11, 95% confidence interval = 1.23-3.62, P = 0.01). Total Short Physical Performance Battery score, gait component score, and balance component score were not predictive of fall-related injury.

CONCLUSIONS

Inability to perform the repeated chair stand task was associated with increased hazard of an injurious fall for 2 yrs among a cohort of older adult primary care patients.

The role of cognitive function and physical activity in physical decline in older adults across the cognitive spectrum

OBJECTIVES

The aim of this study was to investigate physical decline over 1-year in a cohort of older people across the cognitive spectrum.

METHODS

Physical function was assessed using the Physiological Profile Assessment (PPA) in 593 participants (cognitively normal [CN]: n = 342, mild cognitive impairment [MCI]: n = 77, dementia: n = 174) at baseline and in 490 participants available for reassessment 1-year later. Neuropsychological performance and physical activity (PA) were assessed at baseline.

RESULTS

Median baseline PPA scores for CN, MCI and dementia groups were 0.41 (IQR = -0.09-1.02), 0.66 (IQR = -0.06-1.15) and 2.37 (IQR = 0.93-3.78) respectively. All baseline neuropsychological domains and PA were significantly associated with baseline PPA. There were significant interaction terms (Time × Cognitive Group, Global Cognition, Processing Speed, Executive Function and PA) in the models investigating PPA decline. In multivariate analysis the Time × Executive Function and PA interaction terms were significant, indicating that participants with poorer baseline executive function and reduced PA demonstrated greater physical decline when compared to individuals with better executive function and PA respectively.

DISCUSSION

Having MCI or dementia is associated with greater physical decline compared to CN older people. Physical inactivity and executive dysfunction were associated with physical decline in this sample, which included participants with MCI and dementia. Both factors influencing physical decline are potentially amenable to interventions e.g. exercise.

Human-Robot-Environment Interaction Interface for Smart Walker Assisted Gait: AGoRA Walker

The constant growth of the population with mobility impairments has led to the development of several gait assistance devices. Among these, smart walkers have emerged to provide physical and cognitive interactions during rehabilitation and assistance therapies, by means of robotic and electronic technologies. In this sense, this paper presents the development and implementation of a human-robot-environment interface on a robotic platform that emulates a smart walker, the AGoRA Walker. The interface includes modules such as a navigation system, a human detection system, a safety rules system, a user interaction system, a social interaction system and a set of autonomous and shared control strategies. The interface was validated through several tests on healthy volunteers with no gait impairments. The platform performance and usability was assessed, finding natural and intuitive interaction over the implemented control strategies.

Brain gray matter volume associations with gait speed and related structural covariance networks in cognitively healthy individuals and in patients with mild cognitive impairment: A cross-sectional study

INTRODUCTION

Gait speed is slower in patients with mild cognitive impairment (MCI) compared to cognitively healthy individuals (CHI). We examined the patterns of brain gray matter (GM) volume association and covariance with gait speed in CHI and in patients with MCI.

METHODS

A total of 96 CHI and 99 patients with MCI were recruited in this cross-sectional study. Brain GM volumes measured with voxel-based morphometry and self-paced gait speed were used as outcomes.

RESULTS

The right middle frontal and precentral gyri volumes were positively associated with gait speed in CHI and covariated with frontal cortex. Striatum (i.e. left putamen and bilateral caudate nuclei) volumes were positively associated with gait speed in patients with MCI and covariated with striatal structures.

CONCLUSIONS

Two different patterns of brain GM volume association and covariance with gait speed were found and involving frontal cortex in CHI and the striatum in patients with MCI.

Executive functions and working memory in motor control: Does the type of MCI matter?

The purpose of this study was to evaluate the association between functional mobility performance and executive functions in older adults with the amnestic (aMCI) and nonamnestic (naMCI) type of mild cognitive impairment (MCI), as well as in a control group. A cross-sectional study was conducted among 800 older adults (147 with MCI) who participated in a longitudinal study consisting in an interdisciplinary geriatric assessment and rehabilitation program in Kraków. Motor performance was measured with the Timed Up and Go test (TUG), while standard neuropsychological tests were used to assess different cognitive domains. Analysis of the entire sample showed that almost all cognitive domains and the presence of MCI are associated with functional mobility. Executive functions, letter fluency, and working memory were associated with TUG in the MCI group. The MCI type was not a significant moderator of the relationship between cognitive and motor performance. In group analyses, various cognitive predictors for TUG in the aMCI group, naMCI, and control group were demonstrated. Our results suggest that executive functions and working memory in aMCI and letter fluency in naMCI are independently associated with functional mobility performance. Executive functions are important for gait control in MCI.

A path analysis of the interdependent relationships between life space assessment scores and relevant factors in an elderly Japanese community

[Purpose] This study aimed to examine the direct and indirect effects of factors influencing the risk of life space assessment using path analysis. [Participants and Methods] A sample of 212 elderly residents (at least 65 years old) with no clear indications of cognitive dysfunction, visual impairment, and physical dysfunction were recruited for the study. Data on these factors were collected from the participants at a community gathering using measures of life space assessment, skeletal muscle mass, lower extremity muscle strength, mobility, cognitive function, and fear of falling. Correlational and path analyses were used to investigate the relationships between these variables. [Results] The final path model satisfied the requisite statistical criteria, and subsequently, the relationships between the physiological and psychological factors associated with life space assessment were structured and represented visually. Age, skeletal muscle mass, fear of falling, and mobility had a direct effect on life space assessment, whereas lower extremity muscle strength and cognitive function affected it indirectly. [Conclusion] In this study, direct and indirect effects of physiological and psychological factors related to risk of life space assessment of the elderly were clarified using path analysis.

The Relationship Between Cognitive Impairment and Upper Extremity Function in Older Primary Care Patients

BACKGROUND

Individuals with mild cognitive impairment (MCI), often a precursor to dementia, experience limitations in completing daily activities. These limitations are particularly important to understand, as they predict risk for dementia. Relations between functional changes and both cognitive decline and upper extremity motor impairments have been reported, but the contribution of motor function to relations between cognitive function and functional independence remains poorly understood. We examined the relationship between cognition and upper extremity activities, and whether this relation was mediated by motor function.

METHODS

A total of 430 community-dwelling primary care patients aged at least 65 years from the Boston Rehabilitative Impairment Study of the Elderly completed self-report measures of upper extremity function, tests of neuromuscular attributes to measure motor function (reaction time, pronosupination of the hands), and neuropsychological measures. Participants were classified based on cognitive performance into groups: MCI and without MCI, with MCI further classified by cognitive subtype. Regression and mediation analyses examined group differences and relations between cognitive function, upper extremity function, and neuromuscular attributes.

RESULTS

MCI participants demonstrated poorer neuromuscular attributes and self-reported upper extremity function, and neuromuscular attributes significantly mediated positive relations between cognitive status and self-reported upper extremity function. Poorer self-reported upper extremity function was most prominent for groups with executive dysfunction.

CONCLUSIONS

Together with previous research, results suggest that the relationship between cognitive function, motor function, and functional activities is not confined to mobility tasks but universally related to body systems and functional activities. These findings inform new approaches for dementia risk screening and rehabilitative care.

The Association Between Social Engagement, Mild Cognitive Impairment, and Falls Among Older Primary Care Patients

OBJECTIVES

To examine associations between mild cognitive impairment (MCI) and falls among primary care patients, and to investigate whether social engagement (SE) modifies these associations.

DESIGN

Cross sectional analysis using baseline data from an observational cohort study.

SETTING

Primary care.

PARTICIPANTS

Community-dwelling older adults (N=430) at risk of mobility decline with a mean age of 76.6 years (range 65-96y).

MAIN OUTCOME MEASURES

The number of falls in the past year was reported at the baseline interview. MCI was identified using a cutoff of 1.5 SD below the age-adjusted mean on at least 2 of the standardized cognitive performance tests. SE (eg, keeping in touch with friends and family, volunteering, participating social activities…) was assessed with the Late Life Function and Disability Instrument, and required a score above the median value 49.5 out of 100.

RESULTS

MCI was present among 42% of participants and 42% reported at least 1 fall in the preceding year. Using generalized estimating equations, MCI was associated with a 77% greater rate of falls (P<.05). There was a statistically significant interaction between SE and MCI on the rate of falls (P<.01), such that at a high level of SE, MCI was not statistically associated with falls (P=.83). In participants with lower levels of SE, MCI is associated with 1.3 times greater rate of falls (P<.01).

CONCLUSIONS

While MCI is associated with a greater risk for falls, higher levels of SE may play a protective role.

Mild cognitive impairment: A concept analysis

AIM

To clarify the concept of mild cognitive impairment (MCI) and identify its attributes to enhance understanding of its implications for nursing practice and research.

BACKGROUND

MCI is a concept that has evolved, thus clarification of this concept is essential for the advancement of nursing science.

DESIGN

Walker and Avant's eight steps of concept analysis strategy was used.

DATA SOURCE

Manuals of mental disorders and databases such as PubMed, Springer, PsychINFO, Cumulative Index to Nursing and Allied Health Literature, and Education Resources Information Center (ERIC) from 1982 to 2018.

REVIEW METHODS

A literature search was conducted using keywords such as "mild," "cognitive," "impairment," and "deterioration."

RESULTS

The concept of MCI is defined as the transitional state between cognitive state normal for age and the early manifestation of dementia states. It is characterized by the presence of objective and subjective evidence of impairment in one or multiple cognitive domains, independence in daily activities, can be reversible, and is a risk factor for dementia.

CONCLUSIONS

Clarification of MCI serves as a framework for identification, treatment, and interventions that may support healthy aging in older adults.

Rhythmic Interlimb Coordination Impairments and the Risk for Developing Mobility Limitations

BACKGROUND

The identification of novel rehabilitative impairments that are risk factors for mobility limitations may improve their prevention and treatment among older adults. We tested the hypothesis that impaired rhythmic interlimb ankle and shoulder coordination are risk factors for subsequent mobility limitations among older adults.

METHODS

We conducted a 1-year prospective cohort study of community-dwelling older adults (N = 99) aged 67 years and older who did not have mobility limitations (Short Physical Performance Battery score > 9) at baseline. Participants performed antiphase coordination of the right and left ankles or shoulders while paced by an auditory metronome. Using multivariable logistic regression, we determined odds ratios (ORs) for mobility limitations at 1-year follow-up as a function of coordination variability and asymmetry.

RESULTS

After adjusting for age, sex, body mass index, Mini-Mental State Examination score, number of chronic conditions, and baseline Short Physical Performance Battery score, ORs were significant for developing mobility limitations based on a 1 SD difference in the variability of ankle (OR = 1.88; 95% confidence interval [CI]: 1.16-3.05) and shoulder (OR = 1.96; 95% CI: 1.17-3.29) coordination. ORs were significant for asymmetry of shoulder (OR = 2.11; 95% CI: 1.25-3.57), but not ankle (OR = 0.95; 95% CI: 0.59-1.55) coordination. Similar results were found in unadjusted analyses.

CONCLUSIONS

The results support our hypothesis that impaired interlimb ankle and shoulder coordination are risk factors for the development of mobility limitations. Future work is needed to further examine the peripheral and central mechanisms underlying this relationship and to test whether enhancing coordination alters mobility limitations.

Association of Dual-Task Gait With Incident Dementia in Mild Cognitive Impairment: Results From the Gait and Brain Study

Importance

Gait performance is affected by neurodegeneration in aging and has the potential to be used as a clinical marker for progression from mild cognitive impairment (MCI) to dementia. A dual-task gait test evaluating the cognitive-motor interface may predict dementia progression in older adults with MCI.

Objective

To determine whether a dual-task gait test is associated with incident dementia in MCI.

Design, Setting, and Participants

The Gait and Brain Study is an ongoing prospective cohort study of community-dwelling older adults that enrolled 112 older adults with MCI. Participants were followed up for 6 years, with biannual visits including neurologic, cognitive, and gait assessments. Data were collected from July 2007 to March 2016.

Main Outcomes and Measures

Incident all-cause dementia was the main outcome measure, and single- and dual-task gait velocity and dual-task gait costs were the independent variables. A neuropsychological test battery was used to assess cognition. Gait velocity was recorded under single-task and 3 separate dual-task conditions using an electronic walkway. Dual-task gait cost was defined as the percentage change between single- and dual-task gait velocities: ([single-task gait velocity - dual-task gait velocity]/ single-task gait velocity) × 100. Cox proportional hazard models were used to estimate the association between risk of progression to dementia and the independent variables, adjusted for age, sex, education, comorbidities, and cognition.

Results

Among 112 study participants with MCI, mean (SD) age was 76.6 (6.9) years, 55 were women (49.1%), and 27 progressed to dementia (24.1%), with an incidence rate of 121 per 1000 person-years. Slow single-task gait velocity (<0.8 m/second) was not associated with progression to dementia (hazard ratio [HR], 3.41; 95% CI, 0.99-11.71; P = .05)while high dual-task gait cost while counting backward (HR, 3.79; 95% CI, 1.57-9.15; P = .003) and naming animals (HR, 2.41; 95% CI, 1.04-5.59; P = .04) were associated with dementia progression (incidence rate, 155 per 1000 person-years). The models remained robust after adjusting by baseline cognition except for dual-task gait cost when dichotomized.

Conclusions and Relevance

Dual-task gait is associated with progression to dementia in patients with MCI. Dual-task gait testing is easy to administer and may be used by clinicians to decide further biomarker testing, preventive strategies, and follow-up planning in patients with MCI.

Trial Registration

clinicaltrials.gov: NCT03020381.

Gender Differences in the Incidence and Determinants of Components of the Frailty Phenotype Among Older Adults: Findings From the SABE Study

Objective: To analyze gender differences in incidence and determinants of the components of the frailty phenotype. Method: A total of 1,413 older adults were selected in 2006. To estimate the incidence of each frailty component, only individuals who did not exhibit a given component at baseline (independently of the presence of other components) were included in the study. The variables of interest were socioeconomic, behavioral, clinical, anthropometric factors and physical performance. The incidence of each component in 2010 was the outcome. Results: Unintentional weight loss and slowness were more incident in men up to 74 years of age. The other frailty components were more incident in women at all age groups, except weakness. Besides age, the determinants of incidence of the components of frailty were different between genders. Discussion: Strategies for preventing or delaying the installation of frailty need to address gender differences, considering the greater complexity in the network determinants among women.

Falls and Fall Prevention in Older Adults With Early-Stage Dementia: An Integrative Review

Older adults with mild cognitive impairment (MCI) and early-stage dementia have an increased risk of falling, with risks to their health and quality of life. The purpose of the current integrative review was to evaluate evidence on fall risk and fall prevention in this population. Studies were included if they examined falls or fall risk factors in older adults with MCI or early-stage dementia, or reported interventions in this population; 40 studies met criteria. Evidence supports the increased risk of falls in individuals even in the early stages of dementia or MCI, and changes in gait, balance, and fear of falling that may be related to this increased fall risk. Interventions included exercise and multifactorial interventions that demonstrated some potential to reduce falls in this population. Few studies had strong designs to provide evidence for recommendations. Further study in this area is warranted. [Res Gerontol Nurs. 2017; 10(03):139-148.].

Effect of Pain and Mild Cognitive Impairment on Mobility

OBJECTIVES

To examine the effect of pain and mild cognitive impairment (MCI)-together and separately-on performance-based and self-reported mobility outcomes in older adults in primary care with mild to moderate self-reported mobility limitations.

DESIGN

Cross-sectional analysis.

SETTING

Academic community outpatient clinic.

PARTICIPANTS

Individuals aged 65 and older in primary care enrolled in the Boston Rehabilitative Impairment Study in the Elderly who were at risk of mobility decline (N=430).

MEASUREMENTS

Participants with an average score greater than three on the Brief Pain Inventory (BPI) were defined as having pain. MCI was defined using age-adjusted scores on a neuropsychological battery. Multivariable linear regression models assessed associations between pain and MCI, together and separately, and mobility performance (habitual gait speed, Short Physical Performance Battery), and self-reports of function and disability in various day-to-day activities (Late Life Function and Disability Instrument).

RESULTS

The prevalence of pain was 34% and of MCI was 42%; 17% had pain only, 25% had MCI only, 17% had pain and MCI, and 41% had neither. Participants with pain and MCI performed significantly worse than all others on all mobility outcomes (P<.001). Participants with MCI only or pain only also performed significantly worse on all mobility outcomes than those with neither (P<.001).

CONCLUSION

Mild to moderate pain and MCI were independently associated with poor mobility, and the presence of both comorbidities was associated with the poorest status. Primary care practitioners who encounter older adults in need of mobility rehabilitation should consider screening them for pain and MCI to better inform subsequent therapeutic interventions.

Supervised progressive cross-continuum strength training compared with usual care in older medical patients: study protocol for a randomized controlled trial (the STAND-Cph trial)

BACKGROUND

Hospitalization in older adults is characterized by physical inactivity and a risk of losing function and independence. Systematic strength training can improve muscle strength and functional performance in older adults. Few studies have examined the effect of a program initiated during hospitalization and continued after discharge. We conducted a feasibility study prior to this trial and found a progression model for loaded sit-to-stands feasible in older medical patients. This study aims to determine whether a simple supervised strength training program for the lower extremities (based on the model), combined with post-training protein supplementation initiated during hospitalization and continued at home for 4 weeks, is superior to usual care on change in mobility 4 weeks after discharge in older medical patients.

METHODS

Eighty older medical patients (65 years or older) acutely admitted from their own homes will be included in this randomized, controlled, parallel-group, investigator-blinded, superiority trial. After baseline assessments patients will be randomized to (1) intervention: progressive strength training during hospitalization and after discharge (home-based), or (2) control: usual care. Shortly after discharge, 4 weeks after discharge (primary end point) and 6 months after discharge patients will be assessed in their own homes. The intervention encompasses strength training consisting of two lower extremity exercises (sit-to-stand and heel raise) daily during hospitalization and three times per week for 4 weeks after discharge. Both exercises follow pre-defined models for progression and will be performed for three sets of 8-12 repetitions maximum in each training session. Thereafter, the patient will be asked to consume a protein supplement given orally containing 18 g milk-based protein. The primary outcome will be change in the de Morton Mobility Index score from baseline to 4 weeks after discharge. Secondary outcomes will be 24-h mobility level, isometric knee extension strength, the 30-sec sit-to-stand test, habitual gait speed, hand-grip strength, and Activities of Daily Living.

DISCUSSION

We chose to investigate the effect of a minimal time-consuming treatment approach, i.e. two well-performed strength training exercises combined with protein supplementation, to facilitate implementation in a busy clinical care setting, given a positive trial outcome.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01964482 .

Gait dyspraxia as a clinical marker of cognitive decline in Down syndrome: A review of theory and proposed mechanisms

Down syndrome (DS) is the most common genetic cause of intellectual disability in children. With aging, DS is associated with an increased risk for Alzheimer's disease (AD). The development of AD neuropathology in individuals with DS can result in further disturbances in cognition and behavior and may significantly exacerbate caregiver burden. Early detection may allow for appropriate preparation by caregivers. Recent literature suggests that declines in gait may serve as an early marker of AD-related cognitive disorders; however, this relationship has not been examined in individuals with DS. The theory regarding gait dyspraxia and cognitive decline in the general population is reviewed, and potential applications to the population with individuals with DS are highlighted. Challenges and benefits in the line of inquiry are discussed. In particular, it appears that gait declines in aging individuals with DS may be associated with known declines in frontoparietal gray matter, development of AD-related pathology, and white matter losses in tracts critical to motor control. These changes are also potentially related to the cognitive and functional changes often observed during the same chronological period as gait declines in adults with DS. Gait declines may be an early marker of cognitive change, related to the development of underlying AD-related pathology, in individuals with DS. Future investigations in this area may provide insight into the clinical changes associated with development of AD pathology in both the population with DS and the general population, enhancing efforts for optimal patient and caregiver support and propelling investigations regarding safety/quality of life interventions and disease-modifying interventions.

Effect of Preexisting Cognitive Impairment on In-Patient Treatment and Discharge Management among Elderly Patients with Hip Fractures

OBJECTIVE

To examine the influence of cognitive impairment on the functional outcomes and complication rates of patients with hip fracture during in-patient treatment.

METHODS

A total of 402 patients who were surgically treated for hip fractures were consecutively enrolled at a single trauma center. The patients were grouped according to their results on the Mini-Mental State Examination (MMSE), i.e., ≥20 points (group I) and ≤19 points (group II). Complication and in-hospital mortality rates as well as postoperative functional outcomes according to the Barthel Index (BI) were compared between the groups. A multivariate regression analysis was performed to control for additional factors.

RESULTS

33% of the patients had MMSE scores ≤19 points. The complication rates were similar between the groups (p > 0.05). Likewise, the overall in-hospital mortality rates were similar between the patients in group I (4.5%) and those in group II (9.8%; β = 0.218, p < 0.740). Functional outcomes, as assessed by the BI, were lower in group II (β = -0.266, p < 0.001). The patients in group II were transferred to a rehabilitation clinic less frequently (52.3 vs. 76.0%, p < 0.001).

CONCLUSIONS

Patients with lower MMSE scores are at a higher risk for poorer functional outcomes. Perioperative care should focus on the preservation of functional abilities to protect these patients from an additional loss of independence and disadvantageous clinical course.

Association Between Objectively Measured Physical Activity and Cognitive Function in Older Adults-The Reasons for Geographic and Racial Differences in Stroke Study

OBJECTIVES

To examine the relationship between objectively measured physical activity (PA) and cognitive function in white and black older adults.

DESIGN

Cross-sectional.

SETTING

REasons for Geographic and Racial Differences in Stroke (REGARDS) study.

PARTICIPANTS

Older adults who provided valid data from accelerometer and cognitive function tests (N = 7,098).

MEASUREMENTS

Accelerometers provided estimates of PA variables for 4 to 7 consecutive days. PA cut-points of 50 counts per minute (cpm) and 1,065 cpm were applied to differentiate between being sedentary and light PA and between light and moderate to vigorous PA (MVPA), respectively. Prevalence of cognitive impairment was defined using the Six-Item Screener (<4/6). Letter fluency, animal fluency, word list learning, and Montreal Cognitive Assessment (orientation and recall) were used to assess memory and executive function.

RESULTS

Of 7,098 participants (aged 70.1 ± 8.5, 54.2% female, 31.5% black), 359 (5.1%) had impaired cognition within ±12 months of PA measurement. The average proportion of time spent in MVPA (MVPA%) was 1.4 ± 1.9%. Participants in the highest quartile of MVPA% (~258.3 min/wk) were less likely to be cognitively impaired than those in the lowest quartile (odds ratio = 0.65, 95% confidence interval = 0.43-0.97). MVPA% was also significantly associated with executive function and memory z-scores (P < .001). Similar analyses of proportion of time spent in light PA (LPA%) and sedentary time (ST%) showed no significant associations with cognitive function.

CONCLUSION

Higher levels of objectively measured MVPA%, rather than LPA% or ST%, were associated with lower prevalence of cognitive impairment and better performance in memory and executive function in aging people. The amount of MVPA associated with lower prevalence of cognitive impairment is consistent with meeting PA guidelines.

Mild Cognitive Impairment, Slow Gait, and Risk of Disability: A Prospective Study

OBJECTIVES

Mild cognitive impairment (MCI) may be a risk for disability, and co-occurrence of slow gait (SG) and MCI may increase this risk.

DESIGN

Prospective study.

SETTING

General community.

PARTICIPANTS

The study included 3482 older adults (mean age: 71.4 years) without disability at baseline.

MEASUREMENTS

We collected information on demographic variables, measured gait speed and cognitive function to diagnose MCI at baseline. During the follow-up period, the incident disability was monitored. Participants were divided into groups without MCI and SG (control), with SG without MCI (SG), without SG and with MCI in single (sMCI) or multiple (mMCI) domains, and with SG and MCI in single (sMCI + SG) and multiple (mMCI + SG) domains.

RESULTS

During follow-up, 134 participants developed disability (mean follow-up: 29.4 months). The proportions of incident disability were higher in the MCI with SG, MCI, and SG groups, compared with the control group. SG [hazard ratio 2.27 (95% confidence interval: 1.38-3.73)], mMCI [2.56 (1.31-5.02)], sMCI + SG [2.46 (1.21-5.00)], and mMCI + SG [3.48 (1.79-6.76)] participants had risks for disability.

CONCLUSIONS

Co-occurrence of SG and MCI in multiple domains has a higher risk of disability than each condition alone.