Gait Speed and Grip Strength Reflect Cognitive Impairment and Are Modestly Related to Incident Cognitive Decline in Memory Clinic Patients With Subjective Cognitive Decline and Mild Cognitive Impairment: Findings From the 4C Study

Association of physical performance with cognitive impairment in middle-aged to older haemodialysis patients: a multicentre cross-sectional observational study

OBJECTIVE

To determine the prevalence of cognitive impairment (CI) among middle-aged to older patients receiving maintenance haemodialysis (MHD) and to investigate the potential association between CI and physical performance.

METHODS

This cross-sectional observational study enrolled participants aged 55-85 years who received MHD. Cognitive status was assessed using the Mini Mental State Examination (MMSE). Physical performance was measured by hand grip strength, the Timed Up and Go Test (TUGT) and the 4-m walking speed. Sociodemographic, clinical and laboratory parameters were recorded for each patient.

RESULTS

The study included 592 patients (363 males); and of these, 126 (21.3%) were diagnosed with CI. Compared with patients with normal cognitive function, those with CI were significantly older and had significantly longer dialysis duration, lower educational level, higher Malnutrition Inflammation Score, higher depression and higher Charlson Comorbidity Index score. After adjustment for covariates, multiple regression analysis suggested that grip strength (odds ratio [OR] = 0.959, 95% confidence interval [CI] = 0.924, 0.996) and 4-m walking speed (OR = 0.161, 95% CI = 0.070, 0.368) were protective factors. TUGT (OR = 1.037, 95%CI = 1.003, 1.071) was a risk factor.

CONCLUSION

Physical performance was correlated with CI and might be a significant indicator for the early identification of CI in middle-aged to older MHD patients.

Can motor decline be a modifiable marker of clinical progression in subjective cognitive decline? A national prospective cohort study

OBJECTIVES

Subjective cognitive decline represents a critical stage for preventing mild cognitive impairment and dementia, but the links between clinical progression in the subjective cognitive decline stage and various motor functions remain inconclusive. This cohort study aimed to elucidate the independent and joint associations between the clinical progression of subjective cognitive decline and motor functions.

METHODS

We enrolled 4880 community-dwelling elderly participants from a national cohort and used Cox proportional hazard regression model and restricted cubic spline models to explore the longitudinal associations between motor functions (gait, strength, balance, and endurance) and the clinical progression of subjective cognitive decline.

RESULTS

During 5-years follow-up, 1239 participants experienced clinical progression. After adjusting for demographics, vascular burden, body components, and polypharmacy, gait speed [hazard ratios (HRs)= 0.96, 95% confidence interval (CI) 0.94-0.99], chair stand test (HRs=1.02, 95%CI 1.01-1.03), and endurance limitation in jogging 1 kilometer (HRs=1.18, 95%CI 1.04-1.34) were significantly associated with clinical progression. Among all participants, individuals characterized by poor upper- and lower-body strength, as well as those with slow pace and reduced endurance, faced the highest risk of cognitive impairment.

CONCLUSIONS

This study emphasizes the potential of gait speed, muscle strength, and endurance as non-cognitive indicators of clinical progression in subjective cognitive decline. Understanding their combined effectiveness may reveal primary physiological mechanisms contributing to the dual decline of motor and cognition.

Bridging Reduced Grip Strength and Altered Executive Function: Specific Brain White Matter Structural Changes in Patients with Alzheimer's Disease

Objective

To investigate the correlation between specific fiber tracts and grip strength and cognitive function in patients with Alzheimer's disease (AD) by fixel-based analysis (FBA).

Methods

AD patients were divided into AD with low grip strength (AD-LGS, n=29) and AD without low grip strength (AD-nLGS, n=25), along with 31 normal controls (NC). General data, neuropsychological tests, grip strength and cranial magnetic resonance imaging (MRI) scans were collected. FBA evaluated white matter (WM) fiber metrics, including fiber density (FD), fiber cross-sectional (FC), and fiber density and cross-sectional area (FDC). The mean fiber indicators of the fiber tracts of interest (TOI) were extracted in cerebral region of significant statistical differences in FBA to further compare the differences between groups and analyze the correlation between fiber properties and neuropsychological test scores.

Results

Compared to AD-nLGS group, AD-LGS group showed significant reductions in FDC in several cerebral regions. In AD patients, FDC values of bilateral uncinate fasciculus and left superior longitudinal fasciculus were positively correlated with Clock Drawing Test scores, while FDC of splenium of corpus callosum, bilateral anterior cingulate tracts, forceps major, and bilateral inferior longitudinal fasciculus were positively correlated with the Executive Factor Score of Memory and Executive Screening scale scores.

Conclusion

Reduced grip strength in AD patients is associated with extensive impairment of WM structural integrity. Changes in FDC of specific WM fiber tracts related to executive function play a significant mediating role in the reduction of grip strength in AD patients.

Function of the hand as a predictor of early diagnosis and progression of Alzheimer's dementia: A systematic review

BACKGROUND

The dominant feature of Alzheimer's dementia (AD) is gradual cognitive decline, which can be reflected by reduced finger dexterity.

OBJECTIVE

This review analyzed reports on hand function in AD patients to determine the possibility of using it for an early diagnosis and for monitoring the disease progression of AD.

METHODS

PubMed, Web of Science, EMBASE, and Cochrane library were searched systematically (search dates: 2000-2022), and relevant articles were cross-checked for related and relevant publications.

RESULTS

Seventeen studies assessed the association of the handgrip strength or dexterity with cognitive performance. The hand dexterity was strongly correlated with the cognitive function in all studies. In the hand dexterity test using the pegboard, there was little difference in the degree of decline in hand function between the healthy elderly (HE) group and the mild cognitive impairment (MCI) group. On the other hand, there was a difference in the hand function between the HE group and the AD group. In addition, the decline in hand dexterity is likely to develop from moderate to severe dementia. In complex hand movements, movement speed variations were greater in the AD than in the HE group, and the automaticity, regularity, and rhythm were reduced.

CONCLUSIONS

HE and AD can be identified by a simple hand motion test using a pegboard. The data can be used to predict dementia progression from moderate dementia to severe dementia. An evaluation of complex hand movements can help predict the transition from MCI to AD and the progression from moderate to severe dementia.

Gender and age influence the association between gait speed and mild cognitive impairment in community-dwelling Japanese older adults: from the Japan Prospective Studies Collaboration for Ageing and Dementia (JPSC-AD)

BACKGROUND

Studies have shown that decreased gait speed is associated with impaired cognitive function. However, whether this association is equivalent across ages or genders in the older population remains unclear. Thus, we examined the association between mild cognitive impairment (MCI) and gait speed emphasising the influence of age and gender.

METHODS

Overall, 8233 Japanese participants aged ≥65 years were enrolled in this cross-sectional study between 2016 and 2018. After stratification by gender and age group, the participants' gait speeds were divided into quintiles, and the difference in MCI prevalence at each gait speed quintile was calculated. Logistic regression analyses were performed to assess the odds of MCI for each quintile and to assess the influence of age and gender.

RESULTS

Males had a consistently higher prevalence of MCI than females. The odds of MCI were increased as gait speed decreased. Logistic regression analyses revealed that in the multivariable-adjusted model 2, the odds ratios (95% confidence interval; CI) for MCI were 2.02 (1.47-2.76) for females and 1.75 (1.29-2.38) for males in the slowest gait speed quintiles compared to the fastest quintile. In the stratified analyses, only males showed an age-dependent increase in the associations between gait speed and MCI, while females exhibited comparable associations across age groups.

CONCLUSIONS

Reduced gait speed was associated with increased odds of MCI, and this association may vary according to gender and age. Therefore, gait speed could serve as a valuable screening tool for MCI, with gender- and age-dependent clinical implications.

Association of gait and cognition after surgery in patients with idiopathic normal pressure hydrocephalus

Idiopathic normal pressure hydrocephalus (iNPH) is a treatable disease in older adults. The association between gait and cognition has recently become a topic of interest. Sequential changes in this association were investigated in patients with iNPH using a newly developed statistical method. Data were extracted from the SINPHONI-2 multicenter study on iNPH. Fifty patients who underwent shunt surgery were included in this study. Gait and cognition were assessed using the Timed Up and Go (TUG) and Mini-Mental State Examination (MMSE) tests. In addition to the MMSE total score, changes in the sub-item scores were examined. The ordinal sub-items of the MMSE are usually treated as continuous or categorical; however, both are unsuitable. An ordinal smoothing penalty with a generalized additive model enables precise statistical inference of ordinal and binary predictors. The TUG time improved significantly at 3, 6, and 12 months after surgery. The MMSE total scores increased without statistical significance. Preoperatively, there was no association between TUG time and MMSE sub-items. At 3 months, the "Registration," "3-step command," "Read," and "Copy" sub-items were statistically significant. The number of significant sub-items increased after 12 months. Thus, the association between gait and cognition gradually increased after surgery in patients with iNPH.

Association of Motor Function With Cognitive Trajectories and Structural Brain Differences: A Community-Based Cohort Study

BACKGROUND AND OBJECTIVES

The association of motor function with cognitive health remains controversial, and the mechanisms underlying this relationship are unclear. We aimed to examine the association between motor function and long-term cognitive trajectories and further explore the underlying mechanisms using brain MRI.

METHODS

In the Rush Memory and Aging Project, a prospective cohort study, a total of 2,192 volunteers were recruited from the communities in northeastern Illinois and followed up for up to 22 years (from 1997 to 2020). Individuals with dementia, disability, missing data on motor function at baseline, and missing follow-up data on cognitive function were excluded. At baseline, global motor function was evaluated using the averaged z scores of 10 motor tests covering dexterity, gait, and hand strength; the composite score was tertiled as low, moderate, or high. Global and domain-specific cognitive functions-including episodic memory, semantic memory, working memory, visuospatial ability, and perceptual speed-were measured annually through 19 cognitive tests. A subsample (n = 401) underwent brain MRI scans and regional brain volumes were measured. Data were analyzed using linear mixed-effects models and linear regression.

RESULTS

Among the 1,618 participants (mean age 79.45 ± 7.32 years) included in this study, baseline global motor function score ranged from 0.36 to 1.82 (mean 1.03 ± 0.22). Over the follow-up (median 6.03 years, interquartile range 3.00-10.01 years), low global motor function and its subcomponents were related to significantly faster declines in global cognitive function (β = -0.005, 95% CI -0.006 to -0.005) and each of the 5 cognitive domains. Of the 344 participants with available MRI data, low motor function was also associated with smaller total brain (β = -25.848, 95% CI -44.902 to -6.795), total white matter (β = -18.252, 95% CI -33.277 to -3.226), and cortical white matter (β = -17.503, 95% CI -32.215 to -2.792) volumes, but a larger volume of white matter hyperintensities (β = 0.257, 95% CI 0.118-0.397).

DISCUSSION

Low motor function is associated with an accelerated decline in global and domain-specific cognitive functions. Both neurodegenerative and cerebrovascular pathologies might contribute to this association.

Prevalence of nutrition disorders and nutrition-related conditions in older patients with Alzheimer's disease

BACKGROUNDS

Alzheimer's disease is frequently encountered with nutrition-related conditions such as malnutrition, sarcopenia, frailty, overnutrition, and micronutrient abnormalities in older patients. In this study, we aimed to evaluate the prevalence of nutrition disorders and nutrition-related conditions in the same patient group.

METHODS

A total of 253 older patients with Alzheimer's disease underwent comprehensive geriatric assessment, which included nutrition-related disorders, malnutrition via the Mini Nutritional Assessment-Short Form (MNA-SF), frailty via the Clinical Frailty Scale (CFS), and sarcopenia was diagnosed according to European Working Group on Sarcopenia in Older People-2 criteria.

RESULTS

The patients' mean age was 79.8 ± 6.5 years, and 58.1% were women. In our patients, 64.8% had malnutrition or were at risk of malnutrition; 38.3% had sarcopenia; 19.8% were prefrail; and 80.2% were frail. Malnutrition, frailty, and sarcopenia prevalence increased as the Alzheimer's disease stage progressed. Malnutrition was found to be significantly related with frailty scores via CFS (odds ratio [OR], 1.397; P = 0.0049) and muscle mass via fat-free mass index (FFMI) (OR, 0.793; P = 0.001). In logistic regression analysis, age, MNA-SF, and CFS were included in the model to detect the independent correlates of probable and confirmed sarcopenia. CFS was independently associated with probable and confirmed sarcopenia (OR, 1.822; P = 0.013; OR, 2.671; P = 0.001, respectively). Frailty was similarly related with FFMI (OR, 0.836; P = 0.031). Obesity was independently related with FFMI (OR, 0.688; P < 0.001).

CONCLUSION

In conclusion, nutrition disorders and nutrition-related conditions can present concurrently in patients with all stages of Alzheimer's disease; therefore, these frequent problems should be screened and diagnosed accordingly.

Gait variability-based classification of the stages of the cognitive decline using partial least squares-discriminant analysis

The purpose of the present study was to examine the differences in gait variability in terms of spatiotemporal, sub-gait cycle, ground reaction force, and the joint profiles of kinematics and kinetics between older individuals with and without risk of potential cognitive impairment, and to derive the crucial features to discriminating the older adults with future risk cognitive decline by using partial least squares-discriminant analysis. A total of 90 community-dwelling older adults aged over 65 years underwent cognitive function assessment and were divided into three groups depending on cognitive assessment score. The participants' level-walking was analyzed by using three-dimensional instrumented gait analysis. The coefficient of variation was extracted and then comparatively analyzed depending on the stages of the cognitive decline. To identify the most important contributor when differentiating the older adults with a risk of future cognitive decline, partial least squares-discriminant analysis was applied, and the discriminative power of the coefficients confirmed as features of great importance were investigated via the receiver operating characteristic area under the curve. The differences in gait variability were found mainly between the suspected dementia groups and other groups, especially in joint dynamics variables. Through the partial least squares-discriminant analysis, the discriminative features were found as follows: the mid-stance, the moments, and the power in the hip, knee, and ankle joints. In addition, the discrimination model was found to differentiate well between the three groups. The classification accuracy of intact cognition, diminished cognition, and suspected dementia was 0.857, 0.710, and 0.857, respectively. These findings mean that gait variability changes according to continuous cognitive decline, especially in sub-gait cycles and joint biomechanics, and suggest that measures of variation can be used as predictors to identify older individuals with a risk of potential cognitive impairment.

Arterial stiffness and physical fitness on cognitive function in community-dwelling middle-aged and older adults

PURPOSE

This study examined whether decline in cognitive function is related to arterial stiffness and reduction in physical fitness in middle-aged and older adults.

METHODS

A total of 1554 healthy middle-aged and older adults participated in this study. The trail making test parts-A (TMT-A) and B (TMT-B), brachial-ankle pulse wave velocity (baPWV), grip strength, the 30-s chair stand (CS-30) test, the 6-min walk (6MW) test, the 8-foot up-and-go (8UG) test and gait assessment were performed. Participants were classified into a middle-aged group (40-64 years; mean, 50.4 ± 0.2 years) or an older group (≥ 65 years; mean, 73.1 ± 0.5 years), as well as into three cognition (COG) groups (high, moderate, and low) based on median TMT-A and -B scores (high scores on both, either, or neither TMT-A and -B, respectively).

RESULTS

The results revealed that baPWV was significantly lower in the high-than in the moderate- and low-COG groups in both middle-aged and older adults (P < 0.05). In addition, except for a few parameters (e.g., 6MW test in middle-aged adults), physical fitness was significantly higher in the high-than in the moderate- and low-COG groups in both middle-aged and older adults (P < 0.05). Multivariate regression analysis revealed that baPWV (P < 0.05) and some physical fitness indicators (grip strength, CS-30, and 8UG) were significantly independently associated with both TMT-A and -B in the middle-aged and older groups (P < 0.05).

CONCLUSION

These results suggest that increased arterial stiffness and reduced physical fitness are associated with impaired cognitive function in middle-aged and older adults.

Regular Exercise Is Associated With Low Fatigue Levels and Good Functional Outcomes After COVID-19: A Prospective Observational Study

OBJECTIVE

The aim of the study is to identify the impact of postacute SARS-CoV-2 infection on patient outcomes.

DESIGN

This is a prospective, repeated measure, observational study of consented adults with positive SARS-CoV-2 quantitative polymerase chain reaction or antigen test more than 28 days after infection. Only data from the initial study visit are reported, including disease history, symptoms checklist, patient questionnaires, cognitive tests, social/medical histories, vitals, grip strength, and 2-min walk distance.

RESULTS

Two hundred eighteen patients were studied: 100 hospitalized (57.3 ± 15.4 yrs, 62% male, body mass index: 31.3 ± 8.0) and 118 nonhospitalized (46.2 ± 14.6 yrs, 31% male, body mass index: 29.7 ± 7.5). Post-COVID patients reported mean 1.76 symptoms; ≥15% reported fatigue, memory loss, and shortness of breath. Grip strength was 14% lower than norms ( P < 0.0001). Fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue), mood (Patient Health Questionnaire), and well-being (EuroQol 5 Dimension 5 Level) scores were lower than the population norms ( P < 0.05). Hospitalized versus nonhospitalized post-COVID patients performed worse on cognitive assessments (processing speed test-Wechsler Adult Intelligence Scale-Fourth Edition Symbol Search) and reported less regular exercise (≥30 mins ≥3× per week; P < 0.05). In addition, 30% had severe fatigue (by the Functional Assessment of Chronic Illness Therapy-Fatigue); those patients reported less exercise ( P < 0.05). In multivariate models, lack of exercise was independently associated with multiple post-COVID-19 impairments.

CONCLUSIONS

Low levels of exercise are an independent risk factor for post-COVID sequelae. Patients who report less exercise have low grip strength, higher levels of fatigue, memory loss, shortness of breath, depression, and poorer quality of life.

Physical and cognitive function to explain the quality of life among older adults with cognitive impairment: exploring cognitive function as a mediator

BACKGROUND

Physical and cognitive function are both indicators of aging, characterized by a loss of adaptive response to life challenges and functional limitations, subsequently affecting their quality of life. This study aimed to identify the direct effect of physical function and the indirect effect of cognitive function on the quality of life in older adults with mild cognitive impairment.

METHODS

The study participants were 79 older adults recruited from community centers in four urban districts of Korea. All participants completed a self-reported questionnaire for demographic characteristics and outcome variables. Outcome measures included physical function (grip strength, balance, and mobility), cognitive function, and mental and physical components of quality of life (QOL). Statistical analyses were conducted using hierarchical multiple linear regression and the PROCESS macro for mediation analysis.

RESULTS

The mean age of participants was 77.46 years old with an elementary or lower education level (53.2%). The mean score of cognitive function was 16.39 (SD = 6.5). Physical function (grip strength, balance, mobility) and cognitive function explained 25% of the variance in physical (p = 0.004) and 29% in mental (p < 0.001) components of QOL after controlling for age, sex, and education level. Mobility was associated with both physical (β=-0.27, p = 0.024) and mental (β=-0.36, p = 0.002) components of QOL. The cognitive function partially mediated the relationship between balance and the physical component of QOL; the proportion of mediation was 55%.

CONCLUSION

In conclusion, physical and cognitive function were significant predictors of QOL in older adults with cognitive impairment. Specifically, balance has significant indirect effects on the physical component of QOL through cognitive function as a mediator. Health-promoting strategies could be more effective when focusing on the direct effect of physical function as well as the mediating effect of cognitive function to promote the quality of life in this population.

Association of Sarcopenia and Its Defining Components with the Degree of Cognitive Impairment in a Memory Clinic Population

BACKGROUND

Sarcopenia and cognitive impairment are two leading causes of disabilities.

OBJECTIVE

The objective was to examine the prevalence of sarcopenia and investigate the association between sarcopenia diagnostic components (muscle strength, muscle mass, and physical performance) and cognitive impairment in memory clinic patients.

METHODS

368 patients were included (age 59.0±7.25 years, women: 58.7%), displaying three clinical phenotypes of cognitive impairments, i.e., subjective cognitive impairment (SCI, 57%), mild cognitive impairment (MCI, 26%), and Alzheimer's disease (AD, 17%). Sarcopenia was defined according to diagnostic algorithm recommended by the European Working Group on Sarcopenia in Older People. Components of sarcopenia were grip strength, bioelectrical impedance analysis, and gait speed. They were further aggregated into a score (0-3 points) by counting the numbers of limited components. Multi-nominal logistic regression was applied.

RESULTS

Probable sarcopenia (i.e., reduced grip strength) was observed in 9.6% of the patients, and 3.5% were diagnosed with sarcopenia. Patients with faster gait speed showed less likelihood of MCI (odds ratio [OR]: 0.24, 95% confidence interval [CI]: 0.06-0.90) and AD (OR: 0.12, 95% CI: 0.03-0.60). One or more limited sarcopenia components was associated with worse cognitive function. After adjusting for potential confounders, the association remained significant only for AD (OR 4.29, 95% CI 1.45-11.92).

CONCLUSION

The results indicate a connection between the sarcopenia components and cognitive impairments. Limitations in the sarcopenia measures, especially slow walking speed, were related to poorer cognitive outcomes. More investigationsare required to further verify the causal relationship between sarcopenia and cognitive outcomes.

Examination of the correlation between hand grip strength and muscle mass, balance, mobility, and daily life activities in elderly individuals living in nursing homes

BACKGROUND: Aging is a process that includes progressive physiological changes. Grip strength is an important indicator of current health in the elderly. OBJECTIVE: The aim of the study was to examine the correlation between dominant-hand grip strength (HGS) and cognitive function, mid-upper arm circumference, muscle-bone mass, balance, mobility, and daily life activities in elderly individuals living in nursing homes and determine the effect rates of these factors on HGS. METHODS: Seventy-two elderly individuals aged over 65 who lived in a nursing home were included in the study. Dominant HGS and mid-upper forearm circumference were measured. Muscle and bone masses were measured with bioelectrical impedance analysis. Mid-upper arm circumference was measured using a non-elastic tape. HGS was measured using a hand dynamometer. Cognitive function was evaluated with the Standardized Mini-Mental Test (SMMT); mobility and balance were evaluated with the Timed Up and Go Test (TUGT) and Berg Balance Scale (BBS); the Katz Activities of Daily Living Scale (KATZ ADL) was used to evaluate daily life activities. RESULTS: There was a significant correlation between HGS and muscle and bone masses (p < 0.001). A significant correlation was found between HGS and TUGT, ADL (p = 0.001, p = 0.016). There was no significant correlation between HGS and BBS (p = 0.2). There was a correlation between HGS and SMMT at the statistical significance limit (p = 0.055). On HGS, the Body Mass Index had a 64.9% effect; the muscle mass had a 30.9% effect; the TUGT had a 27.7% effect. These parameters were found to explain 59.9% of the variance. CONCLUSION: As a global indicator of muscle strength, HGS can be used to predict age-related functional changes. Approaches to increase physical activity levels in elderly can be effective in reducing age-related negativities.

Association of walking speed with cognitive function in Chinese older adults: A nationally representative cohort study

BACKGROUND

Slow walking speed has been shown to predict cognitive decline in older individuals, but studies conducted among Chinese older adults are scarce. We examined the association of walking speed with cognitive function and the trajectory of cognitive decline among Chinese adults aged 60 years and older.

METHODS

Data was from the China Health and Retirement Longitudinal Study (CHARLS), an ongoing nationally representative prospective cohort study. Walking speed was evaluated over a straight 2.5-meter flat course at baseline and categorized into tertiles (the lowest, middle, and highest). Cognitive function was assessed at each wave in three domains: episodic memory, mental status, and global cognition. Data were analyzed using linear mixed-effects models.

RESULTS

A total of 3,954 older adults (48.6% female; mean age: 67.6 ± 5.55 years) were followed for up to 7 years. Participants with lowest walking speed have poorer episodic memory (β = -0.37; 95% CI: -0.46, -0.28), mental status (β = -0.45; 95% CI: -0.60, -0.29), and global cognition (β = -0.81; 95% CI: -1.03, -0.60) over the follow-up. Compared with the highest tertile of walking speed, the lowest walking speed was associated with a faster decline in episodic memory (β = -0.04; 95% CI: -0.07, -0.02), mental status (β = -0.04; 95% CI: -0.07, -0.01), and global cognition (β = -0.06; 95% CI: -0.11, -0.01).

CONCLUSION

Slower walking speed is associated with subsequent risk of poorer cognitive function and faster cognitive decline in older Chinese adults.

Combination of gait speed and grip strength to predict cognitive decline and dementia

Introduction

To determine whether slowed gait and weakened grip strength independently, or together, better identify risk of cognitive decline or dementia.

Methods

Time to walk 3 meters and grip strength were measured in a randomized placebo-controlled clinical trial involving community-dwelling, initially cognitively healthy older adults (N = 19,114).

Results

Over a median 4.7 years follow-up, slow gait and weak grip strength at baseline were independently associated with risk of incident dementia (hazard ratio [HR] = 1.44, 95% confidence interval [CI]: 1.19-1.73; and 1.24, 95% CI: 1.04-1.50, respectively) and cognitive decline (HR = 1.38, 95% CI: 1.26-1.51; and 1.04, 95% CI: 0.95-1.14, respectively) and when combined, were associated with 79% and 43% increase in risk of dementia and cognitive decline, respectively. Annual declines in gait and in grip over time showed similar results.

Discussion

Gait speed and grip strength are low-cost markers that may be useful in the clinical setting to help identify and manage individuals at greater risk, or with early signs, of dementia, particularly when measured together.

Highlights

Grip strength and gait speed are effective predictors and markers of dementia.Dementia risk is greater than cognitive decline risk with declines in gait or grip.Decline in gait speed, more so than in grip strength, predicts greater dementia risk.Greater risk prediction results from combining grip strength and gait speed.

Slowing gait speed precedes cognitive decline by several years

INTRODUCTION

In this longitudinal study, we aimed to examine if slowing gait speed preceded cognitive decline and correlated with brain amyloidosis.

METHODS

The sample (n = 287) was derived from the Gothenburg H70 Birth Cohort Studies, with follow-ups between 2000 and 2015. Gait speed was measured by indoor walk, and cognition using the Clinical Dementia Rating (CDR) score. All participants had CDR = 0 at baseline. Some participants had data on cerebrospinal fluid (CSF) amyloid beta (Aβ)_1-42 concentrations at the 2009 examination.

RESULTS

Gait speed for participants who worsened in CDR score during follow-up was slower at most examinations. Baseline gait speed could significantly predict CDR change from baseline to follow-up. Subjects with pathological CSF Aβ_{1- 42} concentrations at the 2009 visit had lost more gait speed compared to previous examinations.

DISCUSSION

Our results indicate that gait speed decline precedes cognitive decline, is linked to Alzheimer's pathology, and might be used for early detection of increased risk for dementia development.

Vestibular therapy to reduce falls in people with Alzheimer's disease: study protocol for a pilot randomized controlled trial

BACKGROUND

Falls are highly common in patients with Alzheimer's disease (AD); around two-thirds of AD patients fall annually. Fall events are major drivers of injury, early institutionalization, and shorter survival. Balance and mobility impairment are among the most important fall risk factors in AD patients. Vestibular therapy (VT) is an effective rehabilitation intervention in improving balance and fall risk through vestibular function, but not often used in AD. We want to evaluate the feasibility of using VT to reduce falls and improve balance function in patients with AD and drive use of an existing, potentially beneficial therapy in a patient population whose high level of vestibular deficits is currently unaddressed.

METHODS

The proposed pilot clinical trial will be a parallel-group randomized controlled trial. Patients with a diagnosis of mild-moderate AD, age ≥ 60, and the presence of a caregiver will be recruited from the Johns Hopkins Memory and Alzheimer's Treatment Center. Eligible patients will be offered vestibular testing. Patients with vestibular loss will be offered participation in the VT trial. One-hundred AD patients with vestibular loss will be enrolled and randomized 1:1 into the control and intervention arms of the trial. All patients will undergo baseline balance and cognitive assessment, followed by 8 weeks of active control therapy or VT, consisting of ~25-min office sessions with a vestibular therapist. Patients will be tracked for falls and undergo follow-up balance and cognitive assessment at 8 and 52 weeks (1 year) to assess the potential short-term and longer-term effects, respectively, of VT on balance and cognition. The main outcomes of this trial are falls, balance (using the Berg Balance Scale and the Timed Up and Go test), and cognition (using the clock drawing test, the Card Rotations test, the Money Road Map test, and the triangle completion task).

DISCUSSION

As the population ages and the number of individuals with AD in the US grows to a projected 14 million in 2050, managing falls in AD will continue to grow as a critical public health concern; this trial assesses feasibility of a potential solution.

TRIAL REGISTRATION

ClinicalTrial.Gov identifier - NCT03799991 . Registered 01 August 2019.

Cortical Thickness and White Matter Hyperintensity Changes Are Associated With Sarcopenia in the Cognitively Normal Older Adults

OBJECTIVE

We aimed to explore the impact of sarcopenia on the cortical thickness, white matter hyperintensity (WMH), and subcortical volumes in the cognitively normal older adults.

METHODS

Sixty cognitively normal older adults with and without sarcopenia were enrolled in the study. They underwent T1 and FLAIR magnetic resonance imaging. Information on muscle mass, muscle strength and muscle function were measured using bioelectrical impedance analysis, handgrip strength and 5 time-chair stand test (CST) respectively. Structural magnetic resonance images were analyzed and processed using Freesurfer v6.0.

RESULTS

Compared to the control group, the sarcopenia group demonstrated reduced cortical thickness in left superior frontal, precentral, right post central, inferior parietal, rostral middle frontal superior parietal and both lateral occipital and paracentral gyrus. Volumes of left hippocampus, and periventricular WMH were also reduced in the Sarcopenia group. In addition, we found a significant positive correlation between the left precuneus thickness and muscle mass. Periventricular WMH volumes were also positively correlated with the 5CST score.

CONCLUSION

Sarcopenia affects cortical and subcortical structures in the cognitively normal older adults. These structural changes might be associated with underlying neurobiological mechanisms of sarcopenia in the cognitively normal older adults.

Association between walking speed and cognitive domain functions in Chinese suburban-dwelling older adults

Objective

To examine the relationship among walking speed, cognitive impairment, and cognitive domain functions in older men and women living in a Chinese suburban community.

Methods

In total, 625 elderly (72.54 ± 5.80 years old) men (n = 258) and women (n = 367) from the Chongming district of Shanghai participated in this study. All participants had Mini-Mental State Examination (MMSE), 4-m walking test, medical history questionnaire, and physical examination. They were grouped according to walking speed (&gt;0.8 vs. ≤ 0.8 m/s) with the stratification of sex. The odds ratio (OR) and the 95% confidence interval (CI) were assessed using the chi-square test and logistic regression analysis.

Results

Around 11.6% of men and 14.2% of women had slow walking speeds. After adjusting for age, body mass index (BMI), education level, spouse, faller, the Geriatric Depression Scale (GDS) score, heart disease, stroke, arthritis, and low back pain, walking speed was negatively related to cognitive impairment in men (OR 0.11 [95% CI: 0.01, 0.94]; p = 0.043). In addition, the relationship between walking speed and impaired orientation was significant in both men (OR 0.003 [95% CI: 0.001, 0.05]; p &lt; 0.001) and women (OR 0.15 [95% CI: 0.03, 0.75]; p = 0.021).

Conclusion

The relationship between walking speed and cognitive impairment was only significant in men, but the association with impaired orientation was found in both men and women. Assessing the walking speed of the elderly is beneficial, which may help with early detection and early therapeutic prevention of cognitive impairment.

Grip Strength Trajectories and Cognition in English and Chilean Older Adults: A Cross-Cohort Study

Growing evidence about the link between cognitive and physical decline suggests the early changes in physical functioning as a potential biomarker for cognitive impairment. Thus, we compared grip-strength trajectories over 12-16 years in three groups classified according to their cognitive status (two stable patterns, normal and impaired cognitive performance, and a declining pattern) in two representative UK and Chilean older adult samples. The samples consisted of 7069 UK (ELSA) and 1363 Chilean participants (ALEXANDROS). Linear Mixed models were performed. Adjustments included socio-demographics and health variables. The Declined and Impaired group had significantly lower grip-strength at baseline when compared to the Non-Impaired. In ELSA, the Declined and Impaired showed a faster decline in their grip strength compared to the Non-Impaired group but differences disappeared in the fully adjusted models. In ALEXANDROS, the differences were only found between the Declined and Non-Impaired and they were partially attenuated by covariates. Our study provides robust evidence of the association between grip strength and cognitive performance and how socio-economic factors might be key to understanding this association and their variability across countries. This has implications for future epidemiological research, as hand-grip strength measurements have the potential to be used as an indicator of cognitive performance.

Detection of cognitive decline by spinal posture assessment in health exams of the general older population

The recent increase in the older adult population has led to a higher prevalence of cognitive impairment, which is often overlooked in routine health examinations. Citizens aged 50-89 years were targeted for this cohort survey by random sampling from the resident registry of a cooperating town in 2014. A total of 411 participants (202 male and 209 female) were enrolled. We analyzed the distribution of cognitive function test scores as determined by Montreal Cognitive Assessment and Mini-Mental State Examination tests in each age (50's, 60's, 70's and 80's) and sex group to examine whether cognitive decline could be detected by sagittal spinal balance measurement based on a radiological approach. Sagittal spinal balance was quantitatively measured as sagittal vertical axis (SVA). We observed significant associations for higher age and/or SVA anteriorization with lower cognitive function. In males, spinal balance anteriorization was associated with cognitive decline independently of age, with combinations of age and SVA also making valid cognitive decline determinations; male cases of SVA ≥ 100 mm at any age, SVA ≥ 90 mm at ≥ 70 years, and SVA ≥ 70 mm at ≥ 80 years were all more likely to have cognitive decline than cases below those values. For females, cognitive decline was more likely in cases of SVA ≥ 70 mm, regardless of age. Thus, spinal balance anteriorization can be regarded as an easily visible indicator of latent cognitive decline in community-dwelling older people.

The Relationship Between Muscle Strength and Cognitive Performance Across Alzheimer's Disease Clinical Continuum

Alzheimer's disease (AD) is a neurodegenerative disorder characterized by a progressive cognitive decline, mostly prominent in the domain of memory, but also associated with other cognitive deficits and non-cognitive symptoms. Reduced muscle strength is common in AD. However, the current understanding of its relationship with cognitive decline is limited. This study investigates the relationship between muscle strength and cognition in patients with AD and mild cognitive impairment (MCI). We enrolled 148 consecutive subjects, including 74 patients with probable AD dementia, 37 MCI, and 37 controls. Participants underwent neuropsychological evaluation focused on attention, working memory, declarative memory and learning. Muscle strength and muscle mass were measured through hand dynamometer and bio-electrical impedance analysis, respectively. Patients with AD dementia were divided with respect to the severity of cognitive impairment into mild and moderate-to-severe patients. Moderate-to-severe patients with AD presented lower handgrip strength than MCI and controls. No differences were observed in muscle mass. In MCI and AD dementia, handgrip strength was associated with overall cognitive functioning, attentional and memory performance. The routine implementation of handgrip strength assessment in the clinical work-up of patients with MCI and AD could potentially represent a simple method to monitor functional and cognitive decline along the disease course.

Physical decline and cognitive impairment in frail hypertensive elders during COVID-19

BACKGROUND

Hypertension is common in older adults and its incidence increases with age. We investigated the correlation between physical and cognitive impairment in older adults with frailty and hypertension.

METHODS

We recruited frail hypertensive older adults during the COVID-19 pandemic, between March 2021 and December 2021. Global cognitive function was assessed through the Montreal Cognitive Assessment (MoCA), physical frailty assessment was performed following the Fried criteria, and all patients underwent physical evaluation through 5-meter gait speed test.

RESULTS

We enrolled 203 frail hypertensive older adults and we found a significant correlation between MoCA score and gait speed test (r: 0.495; p<0.001) in our population. To evaluate the impact of comorbidities and other factors on our results, we applied a linear regression analysis with MoCA score as a dependent variable, observing a significant association with age, diabetes, chronic obstructive pulmonary disease (COPD), and gait speed test.

CONCLUSIONS

Our study revealed for the first time a significant correlation between physical and cognitive impairment in frail hypertensive elderly subjects.

Relationship between physical performance and mild cognitive impairment in elderly hemodialysis patients is modified by the presence of diabetes: A multicenter cross-sectional study

OBJECTIVE

The purpose of this study was to observe the relationship between physical performance and mild cognitive impairment (MCI) in the presence or absence of type 2 diabetes in elderly hemodialysis patients.

METHODS

In this multicenter cross-sectional study, 396 clinically stable and aged ≥60 years hemodialysis patients (255 men; mean age: 68.3 ± 5.9 years) were included from seven dialysis units in Shanghai, China. The Chinese version of the Modified Mini-Mental State Examination (MMSE) and the Instrumental Activities of Daily Living (IADL) scale were utilized to assess MCI. The performance-based assessments consisted of three physical tests, grip strength (GS), Timed Up and Go Test (TUGT), and 4-m walking test, which respectively represent muscle strength, mobility, and walking speed (WS). Logistic regression and multivariate linear regression were used for analysis.

RESULTS

Hemodialysis patients with diabetes had a high prevalence of MCI (20.6%). The odds ratio (OR) of MCI for the interacted items [(TUGT) * (diabetes) and (WS) * (diabetes)] was significant (p < 0.05). In diabetes patients, TUGT was positively associated with MCI, and WS was negatively associated with MCI after adjusting covariates [OR = 0.129; 95% confidence interval (CI) = 0.028-0.704, p = 0.021]. However, no significant association was found between physical performance and MCI in the non-diabetes hemodialysis patients (p > 0.05). Further analysis showed that TUGT was negatively associated with attention and calculation and language. WS was positively associated with recall and language in diabetic hemodialysis patients.

CONCLUSIONS

Physical performance was associated with MCI in diabetic hemodialysis patients rather than the non-diabetes group. Whether increasing mobility or WS can positively influence MCI in individuals with type 2 diabetes requires further study.

Screening recall in older cancer survivors detects differences in balance and mobility

PURPOSE

Cognitive impairments have been reported by up to two-thirds of cancer survivors whose primary cancer did not occur in the central nervous system. Physical impairments as sequelae of cancer-related cognitive impairment (CRCI) have not been well described in previous studies. Furthermore, there is scarcity of literature describing differences among physical performance in those with and without CRCI. The purpose of this study is to examine the differences in physical function of older cancer survivors based on cognitive ability to determine if physical performance differs when different cognitive screening measures are employed.

METHODS

Adults age 65 + with a history of cancer from the 2010 Health and Retirement Study (n = 1,953) were assigned to groups according to their cognitive ability. Between-group demographic, mobility, and cognitive differences were analyzed using chi-squared and t tests. Recall and orientation were used as cognitive variables, and physical performance outcomes included gait speed, balance, and grip strength.

RESULTS

Respondents with Low Recall had more impaired balance (semi-tandem, tandem) (p < .05) and slower gait speeds (p < .05). Respondents that were Not-Oriented had slower gait speed (p < .05). Between-group differences in demographics were found by recall and orientation groups.

CONCLUSIONS

Impairments in balance and gait speed are able to be detected when recall is screened in a population of older cancer survivors. When assessing how physical mobility is related to fall risk, a screen of cognition should go beyond just orientation.

Bidirectional association between executive and physical functions among older adults: A systematic review

OBJECTIVE

We aimed to examine the bidirectional associations between specific executive function (EF) and physical function (PF) subdomains among older adults.

METHODS

A systematic literature search (MEDLINE, EMBASE, PsycINFO, EBSCOHOST, Scopus and EmCare) was undertaken from February 2018 to May 2020. Observational studies measuring associations between EF and PF subdomains among older adults were included.

RESULTS

Twenty-nine studies met the inclusion criteria. Twenty-seven studies reported associations between EF and PF. There were bidirectional associations between slower processing speed and slower gait speed; slower processing speed and lower muscle strength; and lower verbal fluency and slower gait speed. Lower muscle strength was unilaterally associated with lower working memory.

CONCLUSIONS

We found consistent bidirectional associations between processing speed with gait speed and muscle strength, and verbal fluency and gait speed. There was a unidirectional association between muscle strength and working memory. Common causal mechanisms for EF and PF require further studies.

Depressive symptoms and cognitive impairment: A 10-year follow-up study from the Survey of Health, Ageing and Retirement in Europe

Background

Depressive symptoms and cognitive impairment often coexisted in the elderly. This study investigates the effect of late-life depressive symptoms on risk of mild cognitive impairment (MCI).

Methods

A total of 14,231 dementia- and MCI free participants aged 60+ from the Survey of Health, Ageing, and Retirement in Europe were followed-up for 10 years to detect incident MCI. MCI was defined as 1.5 standard deviation (SD) below the mean of the standardized global cognition score. Depressive symptoms were assessed by a 12-item Europe-depression scale (EURO-D). Severity of depressive symptoms was grouped as: no/minimal (score 0–3), moderate (score 4–5), and severe (score 6–12). Significant depressive symptoms (SDSs) were defined as EURO-D score ≥ 4.

Results

During an average of 8.2 (SD = 2.4)-year follow-up, 1,352 (9.50%) incident MCI cases were identified. SDSs were related to higher MCI risk (hazard ratio [HR] = 1.26, 95% confidence intervals [CI]: 1.10–1.44) in total population, individuals aged 70+ (HR = 1.35, 95% CI: 1.14–1.61) and women (HR = 1.28, 95% CI: 1.08–1.51) in Cox proportional hazard model adjusting for confounders. In addition, there was a dose–response association between the severity of depressive symptoms and MCI incidence in total population, people aged ≥70 years and women (p-trend <0.001).

Conclusions

Significant depressive symptoms were associated with higher incidence of MCI in a dose–response fashion, especially among people aged 70+ years and women. Treating depressive symptoms targeting older population and women may be effective in preventing MCI.

Association between handgrip strength and cognition in a Chinese population with Alzheimer's disease and mild cognitive impairment

Background

This study aimed to explore the level and changes in handgrip strength among preclinical Alzheimer’s disease (AD) and AD patients and to evaluate the association between handgrip strength and cognitive function.

Methods

A total of 1431 participants from the memory clinic of Shanghai JiaoTong University Affiliated Sixth People’s Hospital and community were enrolled in the final analysis, including 596 AD, 288 mild cognitive impairment (MCI), and 547 normal individuals (NC). All participants received a comprehensive neuropsychological assessment. Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment-Basic (MoCA-BC), and the Chinese version of Addenbrooke’s Cognitive Examination III (ACE-III-CV) were used as cognitive tests. The receiver operating characteristic curve (ROC) was plotted to assess the power of handgrip strength as a screening measure to discriminate AD and MCI.

Results

The results showed that handgrip strength in the MCI group was significantly lower than that of NC group, and the AD group had a further decline (both P < 0.01). Multivariate logistic regression was performed with the handgrip strength quartiles, and the results showed that the ORs of AD for increasing levels of handgrip strength were 1.00, 0.58 (0.46–0.78), 0.51 (0.36–0.73), and 0.50 (0.35–0.68), showing a decreasing trend (P_{for trend} < 0.01). The ROC curve demonstrated that the handgrip strength cutoff points for the identification of AD were 16.8 and 20.7 kg among the female participants above and under 70 yrs and 24.4 and 33.3 kg for the male participants above and under 70 yrs, respectively. Similarly, for the identification of MCI, cutoff points were 17.5 and 21.9 kg for females above 70 yrs and under 70 yrs, and 25.8 and 36.2 kg for males above 70 yrs and under 70 yrs, respectively.

Conclusions

Our study provided the further knowledge on the relationship between noncognitive features and cognition in populations with differing cognitive status, revealed that the stronger handgrip strength was associated with better performances on cognitive function. It can be speculated that handgrip strength can help early recognition of Chinese AD patients.

Cross-Sectional Examination of Homocysteine Levels with Sarcopenia and Its Components in Memory Clinic Outpatients

BACKGROUND

Homocysteine is a common risk factor for cognitive impairment and sarcopenia. However, very few studies have shown an association between sarcopenia and serum homocysteine levels after adjustment for cognitive function.

OBJECTIVE

The purpose of this study was to investigate the relationship between homocysteine and sarcopenia in memory clinic patients.

METHODS

This cross-sectional study investigated outpatients in a memory clinic. We enrolled 1,774 participants (≥65 years old) with measured skeletal muscle mass index (SMI), hand grip strength (HGS), and homocysteine. All participants had undergone cognitive assessments and were diagnosed with dementia, mild cognitive impairment, or normal cognition. Patient characteristics were compared according to sarcopenia presence, SMI level, or HGS. Multivariate logistic regression analysis was performed to determine the association of homocysteine with sarcopenia, low SMI, or low HGS. Next, linear regression analysis was performed using HGS as a continuous variable.

RESULTS

Logistic regression analysis showed that low HGS was significantly associated with homocysteine levels (p = 0.002), but sarcopenia and low SMI were not. In linear regression analysis, HGS was negatively associated with homocysteine levels after adjustment for Mini-Mental State Examination score (β= -2.790, p < 0.001) or clinical diagnosis of dementia (β= -3.145, p < 0.001). These results were similar for men and women.

CONCLUSION

Our results showed a negative association between homocysteine and HGS after adjustment for cognitive function. Our findings strengthen the assumed association between homocysteine and HGS. Further research is needed to determine whether lower homocysteine levels lead to prevent muscle weakness.

Gait Disturbances are Associated with Increased Cognitive Impairment and Cerebrospinal Fluid Tau Levels in a Memory Clinic Cohort

Background:

Gait analysis with accelerometers is a relatively inexpensive and easy to use method to potentially support clinical diagnoses of Alzheimer’s disease and other dementias. It is not clear, however, which gait features are most informative and how these measures relate to Alzheimer’s disease pathology.

Objective:

In this study, we tested if calculated features of gait 1) differ between cognitively normal subjects (CN), mild cognitive impairment (MCI) patients, and dementia patients, 2) are correlated with cerebrospinal fluid (CSF) biomarkers related to Alzheimer’s disease, and 3) predict cognitive decline.

Methods:

Gait was measured using tri-axial accelerometers attached to the fifth lumbar vertebra (L5) in 58 CN, 58 MCI, and 26 dementia participants, while performing a walk and dual task. Ten gait features were calculated from the vertical L5 accelerations, following principal component analysis clustered in four domains, namely pace, rhythm, time variability, and length variability. Cognitive decline over time was measured using MMSE, and CSF biomarkers were available in a sub-group.

Results:

Linear mixed models showed that dementia patients had lower pace scores than MCI patients and CN subjects (p < 0.05). In addition, we found associations between the rhythm domain and CSF-tau, especially in the dual task. Gait was not associated with CSF Aβ₄₂ levels and cognitive decline over time as measured with the MMSE.

Conclusion:

These findings suggest that gait — particularly measures related to pace and rhythm — are altered in dementia and have a direct link with measures of neurodegeneration.

Lockdown Effects on Healthy Cognitive Aging During the COVID-19 Pandemic: A Longitudinal Study

The COVID-19 pandemic is a health issue leading older adults to an increased vulnerability to unfavorable outcomes. Indeed, the presence of physical frailty has recently led to higher mortality due to SARS-CoV-2 infection. However, no longitudinal studies have investigated the role of neuropsychogeriatric factors associated with lockdown fatigue in healthy cognitive aging. Eighty-one healthy older adults were evaluated for their neuropsychological characteristics, including physical frailty, before the pandemic (T0). Subsequently, 50 of them agreed to be interviewed and neuropsychologically re-assessed during the lockdown (T1) and immediately after it (T2). Moreover, during another home confinement, they performed a psychological screening (T3) to evaluate possible mood changes and fatigue. According to Fried's frailty criteria, at T0, 63% of the sample was robust, 34.5% pre-frail, and only 2.5% frail. Significantly, these subjects presented a decrease in handgrip strength and walking speed (29.6 and 6.1%, respectively). Results from Principal Component Analyses and multiple regression models highlighted the contribution of “cognitive” and “psychological” factors (i.e., attentive-executive performance and mood deflections) in explaining handgrip strength and gait speed. At T3, lockdown fatigue was explained by higher scores on the Beck Depression Inventory and lower scores on the Trail Making Test part A. Results from a moderated-mediation model showed that the effect of psychomotor speed on lockdown fatigue was mediated by depression, with a moderating effect of gait speed. Our findings highlight the complex interrelationship between cognitive, psychological, and physical factors in the emergence of pandemic fatigue in a carefully selected older population.

How gait influences frailty models and health-related outcomes in clinical-based and population-based studies: a systematic review

Aging is often associated with a decline in physical function that eventually leads to loss of autonomy in activities of daily living (ADL). Walking is a very common ADL, important for main determinants of quality of life in older age, and it requires the integration of many physiological systems. Gait speed has been described as the 'sixth vital sign' because it is a core indicator of health and function in aging and disease. We reviewed original studies up to June 2020 that assessed frailty in both longitudinal and cross-sectional observational studies, paying particular attention to how gait is measured in older population and how the gait parameter adopted may influence the estimated frailty models and the health-related outcomes of the various studies (i.e. clinical, cognitive, physical, and nutritional outcomes). Eighty-five studies met the search strategy and were included in the present systematic review. According to the frailty tools, more than 60% of the studies used the physical phenotype model proposed by Fried and colleagues, while one-third referred to multi-domain indexes or models and only 5% referred to other single-domain frailty models (social or cognitive). The great heterogeneity observed in gait measurements and protocols limited the possibility to directly compare the results of the studies and it could represent an important issue causing variability in the different outcome measures in both clinical-and population-based settings. Gait appeared to be an indicator of health and function also in frail older adults, and different gait parameters appeared to predict adverse health-related outcomes in clinical, cognitive, and physical domains and, to a lesser extent, in nutritional domain. Gait has the potential to elucidate the common basic mechanisms of cognitive and motor decline. Advances in technology may extend the validity of gait in different clinical settings also in frail older adults, and technology-based assessment should be encouraged. Combining various gait parameters may enhance frailty prediction and classification of different frailty phenotypes.

Associations between Cognition and Hand Function in Older People Diagnosed with Mild Cognitive Impairment or Dementia

Background/Aims

The aim of this study was to examine the associations between different cognitive domains and hand function in older people diagnosed with mild cognitive impairment (MCI) or dementia.

Methods

This study is cross-sectional, including 98 community-living older people aged ≥65 years with MCI or dementia. Assessments of hand function included grip strength, the Finger Tapping Test, and the Grooved Pegboard. Cognitive assessments were the Mini-Mental State Examination, the Clock Drawing Test, and Trail Making Tests A and B, as well as a 10-word List Learning Test. Statistical analyses were based on descriptive statistics and univariable and multivariable analyses.

Results

Sixty participants were diagnosed with MCI and 38 were diagnosed with dementia. The mean age was 78.8 years (SD 7.4). Analyses of hand function, cognitive tests, and demographic factors showed an association between cognitive tests, in particular executive function (EF), and hand function.

Conclusions

The findings indicated an association between physical and cognitive function. Among the cognitive domains, declines in EF were most related to a reduced physical function.

Grip Strength and the Risk of Cognitive Decline and Dementia: A Systematic Review and Meta-Analysis of Longitudinal Cohort Studies

Purpose: Loss of grip strength and cognitive impairment are prevalent in the elderly, and they may share the pathogenesis in common. Several original studies have investigated the association between them, but the results remained controversial. In this systematic review and meta-analysis, we aimed to quantitatively determine the relationship between baseline grip strength and the risk of cognitive impairment and provide evidence for clinical work.

Methods: We performed a systematic review using PubMed, EMBASE, Cochrane, and Web of Science up to March 23, 2020, and focused on the association between baseline grip strength and onset of cognitive impairment. Next, we conducted a meta-analysis using a hazard ratio (HR) and 95% confidence interval (CI) as effect measures. Heterogeneity between the studies was examined using I² and p-value. Sensitivity analyses and subgroup analyses were also performed, and publication bias was assessed by Begg's and Egger's tests.

Results: Fifteen studies were included in this systematic review. After sensitivity analyses, poorer grip strength was associated with more risk of cognitive decline and dementia (HR = 1.99, 95%CI: 1.71–2.32; HR = 1.54, 95%CI: 1.32–1.79, respectively). Furthermore, subgroup analysis indicated that people with poorer strength had more risk of Alzheimer's disease (AD) and non-AD dementia (HR = 1.41, 95%CI: 1.09–1.81; HR = 1.45, 95%CI: 1.10–1.91, respectively).

Conclusions: Lower grip strength is associated with more risk of onset of cognitive decline and dementia despite of subtype of dementia. We should be alert for the individuals with poor grip strength and identify cognitive dysfunction early.

Deterioration in Motor Function Over Time in Older Adults With Type 2 Diabetes is Associated with Accelerated Cognitive Decline

OBJECTIVE

Type 2 diabetes (T2D) is associated with motor impairments and a higher dementia risk. The relationships of motor decline with cognitive decline in T2D older adults has rarely been studied. Using data from the Israel Diabetes and Cognitive Decline study (N = 892), we examined associations of decline in motor function with cognitive decline over a 54-month period.

METHODS

Motor function measures were strength (handgrip) and gait speed (time to walk 3 m). Participants completed a neuropsychologic battery of 13 tests transformed into z-scores, summarized into 4 cognitive domains: episodic memory, attention/working memory, executive functions, and language/semantic categorization. The average of the 4 domains' z-scores defined global cognition. Motor and cognitive functions were assessed in 18-months intervals. A random coefficients model delineated longitudinal relationships of cognitive decline with baseline and change from baseline in motor function, adjusting for sociodemographic, cardiovascular, and T2D-related covariates.

RESULTS

Slower baseline gait speed levels were significantly associated with more rapid decline in global cognition (P = .004), language/semantic categorization (P = .006) and episodic memory (P = .029). Greater decline over time in gait speed was associated with an accelerated rate of decline in global cognition (P = .050), attention/working memory (P = .047) and language/semantic categorization (P<.001). Baseline strength levels were not associated with cognitive decline but the rate of declining strength was associated with an accelerated decline in executive functions (P = .025) and language/semantic categorization (P = .006).

CONCLUSION

In T2D older adults, the rate of decline in motor function, beyond baseline levels, was associated with accelerated cognitive decline, suggesting that cognitive and motor decline share common neuropathologic mechanisms in T2D.

Relationship Between Physical Performance and Mild Cognitive Impairment in Chinese Community-Dwelling Older Adults

Objective

This study aimed to examine the relationship between physical performance and mild cognitive impairment (MCI) in Chinese older adults.

Methods

The sample comprised 956 relatively healthy and aged ≥65 years old Chinese community-dwelling participants (mean age, 72.56 ± 5.43 years; 56.8% female), which did not include those with dementia, severe cognitive impairment, mental illness etc. The Mini-Mental State Examination (MMSE) and the Instrumental Activities of Daily Living (IADL) scale were used for the initial classification of patients with MCI. Physical performance was measured via hand grip, Timed Up and Go Test (TUGT), and 4-m walking speed.

Results

The physical performance (grip strength, TUGT, and 4-m walking speed) correlated with MCI. The grip strength [odds ratio (OR) = 0.96, 95% confidence interval (CI) = 0.93–0.99] and 4-m walking speed (OR = 0.25, 95% CI = 0.10–0.64) correlated negatively with MCI, while TUGT (OR = 1.08, 95% CI = 1.03–1.13) and MCI correlated positively.

Conclusion

The physical performance (grip strength, TUGT, and 4-m walking speed) correlated with MCI. Further analysis showed that the grip strength was associated with overall cognition, time orientation, recall, and language, while TUGT and 4-m walking speed were associated with overall cognition and various cognitive domains, except recall.

Portals to frailty? Data-driven analyses detect early frailty profiles

BACKGROUND

Frailty is an aging condition that reflects multisystem decline and an increased risk for adverse outcomes, including differential cognitive decline and impairment. Two prominent approaches for measuring frailty are the frailty phenotype and the frailty index. We explored a complementary data-driven approach for frailty assessment that could detect early frailty profiles (or subtypes) in relatively healthy older adults. Specifically, we tested whether (1) modalities of early frailty profiles could be empirically determined, (2) the extracted profiles were differentially related to longitudinal cognitive decline, and (3) the profile and prediction patterns were robust for males and females.

METHODS

Participants (n = 649; M age = 70.61, range 53-95) were community-dwelling older adults from the Victoria Longitudinal Study who contributed data for baseline multi-morbidity assessment and longitudinal cognitive trajectory analyses. An exploratory factor analysis on 50 multi-morbidity items produced 7 separable health domains. The proportion of deficits in each domain was calculated and used as continuous indicators in a data-driven latent profile analysis (LPA). We subsequently examined how frailty profiles related to the level and rate of change in a latent neurocognitive speed variable.

RESULTS

LPA results distinguished three profiles: not-clinically-frail (NCF; characterized by limited impairment across indicators; 84%), mobility-type frailty (MTF; characterized by impaired mobility function; 9%), and respiratory-type frailty (RTF; characterized by impaired respiratory function; 7%). These profiles showed differential neurocognitive slowing, such that MTF was associated with the steepest decline, followed by RTF, and then NCF. The baseline frailty index scores were the highest for MTF and RTF and increased over time. All observations were robust across sex.

CONCLUSIONS

A data-driven approach to early frailty assessment detected differentiable profiles that may be characterized as morbidity-intensive portals into broader and chronic frailty. Early inventions targeting mobility or respiratory deficits may have positive downstream effects on frailty progression and cognitive decline.

Physical Performance and Cognition in a Diverse Cohort: Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study

BACKGROUND

The authors assessed the cross-sectional association of physical function measures with cognition in the Kaiser Healthy Aging and Diverse Life Experiences Cohort.

METHODS

Analyses included 1369 participants (24% Asian, 26% Black, 18% Latino, 32% White). Grip strength was measured using a hand-held dynamometer (kilograms) and gait speed was measured over a 4-m walk (seconds/meter). The Spanish and English Neuropsychological Assessment Scales was used to evaluate cognitive domains of executive function, semantic memory, and verbal episodic memory. Physical function measures (per SD) were associated with cognitive test z-scores in linear regression models adjusted for demographic, behavioral, and clinical factors. Racial/ethnic differences were tested using interaction terms and stratification.

RESULTS

Stronger grip was associated with better executive function [β=0.10 (95% confidence interval, 0.05-0.15)], semantic memory [β=0.13 (0.09-0.18)] and verbal episodic memory [β=0.07 (0.02-0.13)] with no racial/ethnic differences. Faster gait was associated with better executive function [β=0.29 (0.22-0.36)], semantic memory [β=0.23 (0.16-0.30)], and verbal episodic memory [β=0.20 (0.13-0.27)]; however, the association between gait speed and executive function varied by race/ethnicity with the strongest associations in Asians and Whites.

CONCLUSION

Across race/ethnicity, grip strength and gait speed were associated with cognition with racial/ethnic differences in the association of gait speed and executive function.

A Possible Association Between Executive Dysfunction and Frailty in Patients With Neurocognitive Disorders

Frailty is an age-related dynamic status, characterized by a reduced resistance to stressors due to the cumulative decline of multiple physiological systems. Several researches have highlighted a relationship between physical frailty and cognitive decline; however, the role of specific cognitive domains has not been deeply clarified yet. Current studies have hypothesized that physical frailty and neuropsychological deficits may share systemic inflammation and increased oxidative stress in different neurodegenerative disorders, such as Alzheimer’s and Parkinson’s disease. However, the role of the executive dysfunction should be investigated in a more detailed way using a multidimensional approach. With this aim, we conducted a review of the literature on the few experimental articles published to discuss the existence of a relationship between frailty and cognitive impairment in neurocognitive disorders, particularly focusing on the domain of executive dysfunction. The data suggest that physical frailty and cognitive decline, especially executive dysfunction, are two aspects strongly linked in mild and major neurocognitive disorders due to Alzheimer’s and Parkinson’s disease. In light of this, a new framework linking aging, cognitive decline, and neurodegenerative diseases is needed. In order to analyze the effects that aging processes have on neural decline and neurocognitive disease, and to identify relevant groups of users and patients, future longitudinal studies should adopt a multidimensional approach, in the field of primary prevention and in the continuum from mild to major neurocognitive disorder.

Sarcopenia and frailty in individuals with dementia: A systematic review

BACKGROUND

Population aging has resulted in an increase in age-related conditions. Sarcopenia, the progressive loss of muscle mass and strength, and frailty, vulnerability to poor resolution of homeostasis after a stressor, are common causes of functional decline in older individuals. There is a paucity of work on how they interrelate with dementia. The objective of this review was to examine the literature on sarcopenia and frailty in dementia.

METHODS AND RESULTS

Studies of sarcopenia and frailty in dementia were searched for in EMBASE, PubMed and Web of Science, and via hand-searching. Citations were screened for independently by two reviewers, with disagreements resolved by a third reviewer. To be eligible for inclusion, the articles needed to fulfil: (1) English language; (2) human studies; and (3) full-text available. Dementia of any aetiology was included. 303 non-duplicate recorders were identified, of which 270 irrelevant papers were excluded. Of the remaining 33, 27 examined frailty and 13 sarcopenia, with six of these measuring both. An increased prevalence of frailty and sarcopenia was noted in dementia patients. However, nine papers did not specify dementia aetiologies. Of those that did (n = 21), 20 examined Alzheimer's disease, with three also including Lewy body dementia, three vascular dementia, and one Parkinson's disease dementia.

CONCLUSION

Most papers examined frailty, rather than sarcopenia, in dementia. The studies were heterogeneous, using different protocols and non-validated definitions. However, dementia patients may have an increased prevalence of frailty and sarcopenia. This review highlights key gaps in accurate diagnosis of frailty/sarcopenia and in non-Alzheimer's dementia.

The Unraveling: Cardiac and Musculoskeletal Defects and Their Role in Common Alzheimer Disease Morbidity and Mortality

Alzheimer disease (AD) is characterized by deterioration of cognitive capabilities with an estimated 44 million individuals worldwide living with it. Beyond memory deficits, the most common AD co-morbidities include swallowing defects (muscle), fractures (bone, muscle), and heart failure. The underlying causes of these co-morbidities and their role in AD pathophysiology are currently unknown. This review is the first to summarize the emerging picture of the cardiac and musculoskeletal deficits in human AD. We present the involvement of the heart, characterized by diastolic heart failure, the presence of amyloid deposits, and electrophysiological changes, compared with age-matched control subjects. The characteristic musculoskeletal defects in AD come from recent clinical studies and include potential underlying mechanisms (bone) in animal models. These studies detail a primary muscle weakness (without a loss of muscle mass) in patients with mild cognitive impairment, with progression of cognitive impairment to AD associating with ongoing muscle weakness and the onset of muscle atrophy. We conclude by reviewing the loss of bone density in patients with AD, paralleling the increase in fracture and fall risk in specific populations. These studies paint AD as a systemic disease in broad strokes, which may help elucidate AD pathophysiology and to allow for new ways of thinking about therapeutic interventions, diagnostic biomarkers, and the pathogenesis of this multidisciplinary disease.

Prediction equation for estimating cognitive function using physical fitness parameters in older adults

Ageing is associated with declines in cognitive functions and physical fitness (PF). Physical exercise training and physical activity (PA) have been shown to have positive effects on cognitive functions and brain plasticity. This study aims to establish a practical equation for evaluating cognitive functions using PF parameters in healthy older adults. One-hundred and two older subjects were physically and clinically evaluated. Participants performed the Short Physical Performance Battery (SPPB) and handgrip test (HG); general cognitive functions were examined using the Mini Mental State Examination (MMSE). For all of them, a multiple regression analysis was used to predict MMSE from age, SPPB and HG variables. The new equation was cross validated to determine its prediction accuracy. Considering that SPPB and MMSE reference score are not different between genders, only one equation was developed for females and males. Age, SPPB and HG correlated significantly (p<0.01) with the MMSE score. The developed equation was MMSE = 19.479 + (1.548 x SPPB)-(0.130 x age) (R2 = 0.72 and root mean square errors of 3.6). The results of PF are useful for exercise specialists to achieve the best physical exercise training and PA in older adults. In conclusion, this study showed for the first time that our new equation can be used to predict subjects' cognitive functions based on SPPB results and subject age. We suggest its use when patients' cognitive functions or more appropriate clinical tests cannot be pursued.

Gait speed, cognition and falls in people living with mild-to-moderate Alzheimer disease: data from NILVAD

Background

Previous evidence suggests that slower gait speed is longitudinally associated with cognitive impairment, dementia and falls in older adults. Despite this, the longitudinal relationship between gait speed, cognition and falls in those with a diagnosis of dementia remains poorly explored. We sought to assess this longitudinal relationship in a cohort of older adults with mild to-moderate Alzheimer Disease (AD).

Methods

Analysis of data from NILVAD, an 18-month randomised-controlled trial of Nilvadipine in mild to moderate AD. We examined: (i) the cross-sectional (baseline) association between slow gait speed and cognitive function, (ii) the relationship between baseline slow gait speed and cognitive function at 18 months (Alzheimer Disease Assessment Scale, Cognitive Subsection: ADAS-Cog), (iii) the relationship between baseline cognitive function and incident slow gait speed at 18 months and finally (iv) the relationship of baseline slow gait speed and incident falls over the study period.

Results

Overall, one-tenth (10.03%, N = 37/369) of participants with mild-to-moderate AD met criteria for slow gait speed at baseline and a further 14.09% (N = 52/369) developed incident slow gait speed at 18 months. At baseline, there was a significant association between poorer cognition and slow gait speed (OR 1.05, 95% CI 1.01–1.09, p = 0.025). Whilst there was no association between baseline slow gait speed and change in ADAS-Cog score at 18 months, a greater cognitive severity at baseline predicted incident slow gait speed over 18 months (OR 1.04, 1.01–1.08, p = 0.011). Further, slow gait speed at baseline was associated with a significant risk of incident falls over the study period, which persisted after covariate adjustment (IRR 3.48, 2.05–5.92, p < 0.001).

Conclusions

Poorer baseline cognition was associated with both baseline and incident slow gait speed. Slow gait speed was associated with a significantly increased risk of falls over the study period. Our study adds further evidence to the complex relationship between gait and cognition in this vulnerable group and highlights increased falls risk in older adults with AD and slow gait speed.

Trial registration

Secondary analysis of the NILVAD trial (Clincaltrials.gov NCT02017340; EudraCT number 2012–002764-27). First registered: 20/12/2013.

Frailty, Neurocognitive Impairment, or Both in Predicting Poor Health Outcomes Among Adults Living With Human Immunodeficiency Virus

Background

Neurocognitive impairment (NCI) is strongly associated with frailty in people living with human immunodeficiency virus (PLWH); the overlap of frailty and NCI and the impact on health outcomes in PLWH are unknown.

Methods

PLWH in a longitudinal, observational study of aging completed entry evaluations for frailty and NCI. Outcomes of falls (recurrent) increased limitations in independent activities of daily living (IADL), or mortality were combined. Poisson regression models estimated prevalence ratios (PR) for ≥1 outcome over 2 years.

Results

Among 987 participants, the median age at entry was 51 years; 19% were female; the median CD4 count was 616 cells/µL; and HIV-1 RNA was <200 copies/mL in 94%. Most (79%) participants had neither frailty nor NCI; 2% had both; 4% frailty only; and 15% NCI only. Over 2 years of observation, 100 (10%) participants experienced recurrent falls; 175 (18%) had worsening IADL limitations; 17 (2%) died; and 254 (26%) experienced ≥1 poor health outcome. In adjusted models, frailty with NCI was associated with more than double the risk of a poor health outcome (PR 2.65; 95% CI 1.98, 3.54); a significant association was also seen with frailty alone (PR 2.26; 95%CI 1.71, 2.99) and NCI alone (PR 1.73; 95% CI 1.36, 2.20).

Conclusions

The presence of frailty with NCI was associated with a greater risk of falls, disability, or death in PLWH than NCI alone. Interventions that target prevention or reversal of both frailty and NCI (such as increased physical activity) may significantly limit poor health outcomes among PLWH.

Personality and memory performance over twenty years: Findings from three prospective studies

OBJECTIVE

The present study examined whether personality traits are related to episodic memory over the long-term.

METHOD

Participants were adults from the Wisconsin Longitudinal Study Graduate (WLSG, N = 3726) and Sibling samples (WLSS, N = 1720), and the Midlife in the United States Study (MIDUS, N = 2411). Five factor model personality traits and demographic factors were measured at baseline. Memory performance on immediate and delayed free recall tasks was assessed at follow-up, almost 20 years later.

RESULTS

In regression models that accounted for demographic factors, consistent evidence was found across three samples that middle-aged adults who scored higher on neuroticism performed significantly worse on a memory test 20 years later. In the WLSG and WLSS and a meta-analysis, higher openness was also associated with better memory at follow-up. High neuroticism and low openness were also associated with a 20 to 40% increased risk of performing below one and a half standard deviation from the sample mean on the memory task.

CONCLUSIONS

The present study extends previous research with evidence that the association between personality traits and memory function persist over two decades.