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Vol. 29, No. 3-4, 2007
Issue release date: February 2008
Free Access
Neuroepidemiology 2007;29:156–162
(DOI:10.1159/000111577)

Gait Speed Predicts Decline in Attention and Psychomotor Speed in Older Adults: The Health Aging and Body Composition Study

Inzitari M.a, h · Newman A.B.a, b · Yaffe K.c · Boudreau R.b · de Rekeneire N.d · Shorr R.e, f · Harris T.B.g · Rosano C.b
aDepartment of Medicine, Division of Geriatric Medicine, and bDepartment of Epidemiology, University of Pittsburgh, Pittsburgh, Pa., cDepartment of Psychiatry, University of California, San Francisco, Calif., dCenters for Disease Control, Atlanta, Ga., eGRECC, NF/SG Veterans Health System, and fDepartment of Aging and Geriatrics, University of Florida, Gainesville, Fla., and gLaboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, Mass., USA; hDepartment of Critical Care Medicine and Surgery, Unit of Geriatrics, University of Florence, Florence, Italy
email Corresponding Author

Abstract

Background/Aims: Gait speed is cross-sectionally associated with attention and psychomotor speed in older community dwellers. It is unclear if gait speed predicts decline in these cognitive domains over time. Methods: Usual gait speed (m/s) over 6 m was measured at baseline in 2,776 Health, Aging and Body Composition Study participants (mean age ± SD 73.5 ± 2.8 years, 53% women, 37% blacks). The Digit Symbol Substitution Test (DSST) was administered at baseline and after 5 years to assess attention and psychomotor speed. We used multivariate logistic regression models to calculate the risk of DSST 5-year decline [>1 SD from mean change (9 points)] across quartiles of gait speed, adjusting for demographics, weight, physical activity, comorbidities, depression and Modified Mini-Mental State Examination. Results: After 5 years, 389 (17.1%) participants declined in DSST. Compared to those in the highest quartile of gait speed (>1.35 m/s), participants in the lowest quartile (<1.05 m/s) were more likely to decline in DSST independently of the considered covariates (OR 1.74, 95% CI 1.21–2.51, adjusted p for trend across quartiles = 0.006). Conclusions: In this cohort of older community dwellers, gait speed independently predicted a decline in DSST after 5 years.


 goto top of outline Key Words

  • Gait speed
  • Attention
  • Psychomotor speed
  • Elderly community dwellers
  • Cognitive decline
  • Mobility

 goto top of outline Abstract

Background/Aims: Gait speed is cross-sectionally associated with attention and psychomotor speed in older community dwellers. It is unclear if gait speed predicts decline in these cognitive domains over time. Methods: Usual gait speed (m/s) over 6 m was measured at baseline in 2,776 Health, Aging and Body Composition Study participants (mean age ± SD 73.5 ± 2.8 years, 53% women, 37% blacks). The Digit Symbol Substitution Test (DSST) was administered at baseline and after 5 years to assess attention and psychomotor speed. We used multivariate logistic regression models to calculate the risk of DSST 5-year decline [>1 SD from mean change (9 points)] across quartiles of gait speed, adjusting for demographics, weight, physical activity, comorbidities, depression and Modified Mini-Mental State Examination. Results: After 5 years, 389 (17.1%) participants declined in DSST. Compared to those in the highest quartile of gait speed (>1.35 m/s), participants in the lowest quartile (<1.05 m/s) were more likely to decline in DSST independently of the considered covariates (OR 1.74, 95% CI 1.21–2.51, adjusted p for trend across quartiles = 0.006). Conclusions: In this cohort of older community dwellers, gait speed independently predicted a decline in DSST after 5 years.

Copyright © 2007 S. Karger AG, Basel


 goto top of outline References
  1. Rosano C, Simonsick EM, Harris TB, Kritchevsky SB, Brach J, Visser M, Yaffe K, Newman AB: Association between physical and cognitive function in healthy elderly: the health, aging and body composition study. Neuroepidemiology 2005;24:8–14.
  2. Richards M, Stern Y, Mayeux R: Subtle extrapyramidal signs and incident dementia: a follow-up analysis. Neurology 1995;45:1942.
  3. Verghese J, Lipton RB, Hall CB, Kuslansky G, Katz MJ, Buschke H: Abnormality of gait as a predictor of non-Alzheimer’s dementia. N Engl J Med 2002;347:1761–1768.
  4. Scarmeas N, Albert M, Brandt J, Blacker D, Hadjigeorgiou G, Papadimitriou A, Dubois B, Sarazin M, Wegesin D, Marder K, Bell K, Honig L, Stern Y: Motor signs predict poor outcomes in Alzheimer disease. Neurology 2005;64:1696–1703.
  5. Wang L, Larson EB, Bowen JD, van Belle G: Performance-based physical function and future dementia in older people. Arch Intern Med 2006;166:1115–1120.
  6. Camicioli R, Howieson D, Oken B, Sexton G, Kaye J: Motor slowing precedes cognitive impairment in the oldest old. Neurology 1998;50:1496–1498.
  7. Marquis S, Moore MM, Howieson DB, Sexton G, Payami H, Kaye JA, Camicioli R: Independent predictors of cognitive decline in healthy elderly persons. Arch Neurol 2002;59:601–606.
  8. Elkins JS, Knopman DS, Yaffe K, Johnston SC: Cognitive function predicts first-time stroke and heart disease. Neurology 2005;64:1750–1755.
  9. Rapp MA, Reischies FM: Attention and executive control predict Alzheimer disease in late life: results from the Berlin Aging Study (BASE). Am J Geriatr Psychiatry 2005;13:134–141.
  10. Fried LP, Kronmal RA, Newman AB, Bild DE, Mittelmark MB, Polak JF, Robbins JA, Gardin JM: Risk factors for 5-year mortality in older adults: the cardiovascular health study. JAMA 1998;279:585–592.
  11. Pavlik VN, de Moraes SA, Szklo M, Knopman DS, Mosley TH Jr, Hyman DJ: Relation between cognitive function and mortality in middle-aged adults: the atherosclerosis risk in communities study. Am J Epidemiol 2003;157:327–334.
  12. Longstreth WT Jr, Arnold AM, Beauchamp NJ Jr, Manolio TA, Lefkowitz D, Jungreis C, Hirsch CH, O’Leary DH, Furberg CD: Incidence, manifestations, and predictors of worsening white matter on serial cranial magnetic resonance imaging in the elderly: The Cardiovascular Health Study. Stroke 2005;36:56–61.
  13. Kuo HK, Leveille SG, Yu YH, Milberg WP: Cognitive function, habitual gait speed, and late-life disability in the National Health and Nutrition Examination Survey (NHANES) 1999–2002. Gerontology 2006;53:102–110.
  14. Guralnik JM, Ferrucci L, Pieper CF, Leveille SG, Markides KS, Ostir GV, Studenski S, Berkman LF, Wallace RB: Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci 2000;55:M221–M231.
  15. Studenski S, Perera S, Wallace D, Chandler JM, Duncan PW, Rooney E, Fox M, Guralnik JM: Physical performance measures in the clinical setting. J Am Geriatr Soc 2003;51:314–322.
  16. Montero-Odasso M, Schapira M, Soriano ER, Varela M, Kaplan R, Camera LA, Mayorga LM: Gait velocity as a single predictor of adverse events in healthy seniors aged 75 years and older. J Gerontol A Biol Sci Med Sci 2005;60:1304–1309.
  17. Wechsler D (ed): Wechsler Adult Intelligence Scale – Revised. San Antonio, Psychological Corporation, 1981.
  18. Rooks RN, Simonsick EM, Miles T, Newman A, Kritchevsky SB, Schulz R, Harris T: The association of race and socioeconomic status with cardiovascular disease indicators among older adults in the health, aging, and body composition study. J Gerontol B Psychol Sci Soc Sci 2002;57:S247–S256.
  19. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, O’Brien WL, Bassett DR Jr, Schmitz KH, Emplaincourt PO, Jacobs DR Jr, Leon AS: Compendium of physical activities: an update of activity codes and met intensities. Med Sci Sports Exerc 2000;32:S498–504.
  20. Yaffe K, Barnes D, Nevitt M, Lui LY, Covinsky K: A prospective study of physical activity and cognitive decline in elderly women: women who walk. Arch Intern Med 2001;161:1703–1708.
  21. Andresen EM, Malmgren JA, Carter WB, Patrick DL: Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med 1994;10:77–84.
  22. Wilson RS, Mendes De Leon CF, Bennett DA, Bienias JL, Evans DA: Depressive symptoms and cognitive decline in a community population of older persons. J Neurol Neurosurg Psychiatry 2004;75:126–129.
  23. Kuo HK, Sorond F, Iloputaife I, Gagnon M, Milberg W, Lipsitz LA: Effect of blood pressure on cognitive functions in elderly persons. J Gerontol A Biol Sci Med Sci 2004;59:1191–1194.
  24. Kuo HK, Jones RN, Milberg WP, Tennstedt S, Talbot L, Morris JN, Lipsitz LA: Effect of blood pressure and diabetes mellitus on cognitive and physical functions in older adults: a longitudinal analysis of the advanced cognitive training for independent and vital elderly cohort. J Am Geriatr Soc 2005;53:1154–1161.
  25. Newman AB, Arnold AM, Naydeck BL, Fried LP, Burke GL, Enright P, Gottdiener J, Hirsch C, O’Leary D, Tracy R: ‘Successful aging’: effect of subclinical cardiovascular disease. Arch Intern Med 2003;163:2315–2322.
  26. Stuss DT, Peterkin I, Guzman DA, Guzman C, Troyer AK: Chronic obstructive pulmonary disease: effects of hypoxia on neurological and neuropsychological measures. J Clin Exp Neuropsychol 1997;19:515–524.
  27. Teng EL, Chui HC: The Modified Mini-Mental State (3MS) examination. J Clin Psychiatry 1987;48:314–318.
  28. Lopez OL, Kuller LH, Fitzpatrick A, Ives D, Becker JT, Beauchamp N: Evaluation of dementia in the cardiovascular health cognition study. Neuroepidemiology 2003;22:1–12.
  29. Verghese J, Wang C, Holtzer R, Lipton R, Xue X: Quantitative gait dysfunction and risk of cognitive decline and dementia. J Neurol Neurosurg Psychiatry 2007;78:929–935.
  30. Inzitari M, Baldereschi M, Di Carlo A, Di Bari M, Marchionni N, Scafato E, Farchi G, Inzitari D: Impaired attention predicts motor performance decline in older community-dwellers with normal baseline mobility: results from the Italian Longitudinal Study On Aging (ILSA). J Gerontol A Biol Sci Med Sci 2007;62:837–843.

    External Resources

  31. Tabbarah M, Crimmins EM, Seeman TE: The relationship between cognitive and physical performance: MacArthur Studies of Successful Aging. J Gerontol A Biol Sci Med Sci 2002;57:M228–M235.
  32. Proust-Lima C, Amieva H, Dartigues JF, Jacqmin-Gadda H: Sensitivity of four psychometric tests to measure cognitive changes in brain aging-population-based studies. Am J Epidemiol 2007;165:344–350.

 goto top of outline Author Contacts

Marco Inzitari, MD
Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh
130 N Bellefield St, Room 518
Pittsburgh, PA 15213 (USA)
Tel. +1 412 383 1305, Fax +1 412 383 1308, E-Mail inzitarim@edc.pitt.edu


 goto top of outline Article Information

Published online: November 27, 2007
Number of Print Pages : 7
Number of Figures : 2, Number of Tables : 2, Number of References : 32


 goto top of outline Publication Details

Neuroepidemiology

Vol. 29, No. 3-4, Year 2007 (Cover Date: February 2008)

Journal Editor: Feigin, V.L. (Auckland)
ISSN: 0251–5350 (Print), eISSN: 1423–0208 (Online)

For additional information: http://www.karger.com/NED


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Background/Aims: Gait speed is cross-sectionally associated with attention and psychomotor speed in older community dwellers. It is unclear if gait speed predicts decline in these cognitive domains over time. Methods: Usual gait speed (m/s) over 6 m was measured at baseline in 2,776 Health, Aging and Body Composition Study participants (mean age ± SD 73.5 ± 2.8 years, 53% women, 37% blacks). The Digit Symbol Substitution Test (DSST) was administered at baseline and after 5 years to assess attention and psychomotor speed. We used multivariate logistic regression models to calculate the risk of DSST 5-year decline [>1 SD from mean change (9 points)] across quartiles of gait speed, adjusting for demographics, weight, physical activity, comorbidities, depression and Modified Mini-Mental State Examination. Results: After 5 years, 389 (17.1%) participants declined in DSST. Compared to those in the highest quartile of gait speed (>1.35 m/s), participants in the lowest quartile (<1.05 m/s) were more likely to decline in DSST independently of the considered covariates (OR 1.74, 95% CI 1.21–2.51, adjusted p for trend across quartiles = 0.006). Conclusions: In this cohort of older community dwellers, gait speed independently predicted a decline in DSST after 5 years.



 goto top of outline Author Contacts

Marco Inzitari, MD
Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh
130 N Bellefield St, Room 518
Pittsburgh, PA 15213 (USA)
Tel. +1 412 383 1305, Fax +1 412 383 1308, E-Mail inzitarim@edc.pitt.edu


 goto top of outline Article Information

Published online: November 27, 2007
Number of Print Pages : 7
Number of Figures : 2, Number of Tables : 2, Number of References : 32


 goto top of outline Publication Details

Neuroepidemiology

Vol. 29, No. 3-4, Year 2007 (Cover Date: February 2008)

Journal Editor: Feigin, V.L. (Auckland)
ISSN: 0251–5350 (Print), eISSN: 1423–0208 (Online)

For additional information: http://www.karger.com/NED


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Rosano C, Simonsick EM, Harris TB, Kritchevsky SB, Brach J, Visser M, Yaffe K, Newman AB: Association between physical and cognitive function in healthy elderly: the health, aging and body composition study. Neuroepidemiology 2005;24:8–14.
  2. Richards M, Stern Y, Mayeux R: Subtle extrapyramidal signs and incident dementia: a follow-up analysis. Neurology 1995;45:1942.
  3. Verghese J, Lipton RB, Hall CB, Kuslansky G, Katz MJ, Buschke H: Abnormality of gait as a predictor of non-Alzheimer’s dementia. N Engl J Med 2002;347:1761–1768.
  4. Scarmeas N, Albert M, Brandt J, Blacker D, Hadjigeorgiou G, Papadimitriou A, Dubois B, Sarazin M, Wegesin D, Marder K, Bell K, Honig L, Stern Y: Motor signs predict poor outcomes in Alzheimer disease. Neurology 2005;64:1696–1703.
  5. Wang L, Larson EB, Bowen JD, van Belle G: Performance-based physical function and future dementia in older people. Arch Intern Med 2006;166:1115–1120.
  6. Camicioli R, Howieson D, Oken B, Sexton G, Kaye J: Motor slowing precedes cognitive impairment in the oldest old. Neurology 1998;50:1496–1498.
  7. Marquis S, Moore MM, Howieson DB, Sexton G, Payami H, Kaye JA, Camicioli R: Independent predictors of cognitive decline in healthy elderly persons. Arch Neurol 2002;59:601–606.
  8. Elkins JS, Knopman DS, Yaffe K, Johnston SC: Cognitive function predicts first-time stroke and heart disease. Neurology 2005;64:1750–1755.
  9. Rapp MA, Reischies FM: Attention and executive control predict Alzheimer disease in late life: results from the Berlin Aging Study (BASE). Am J Geriatr Psychiatry 2005;13:134–141.
  10. Fried LP, Kronmal RA, Newman AB, Bild DE, Mittelmark MB, Polak JF, Robbins JA, Gardin JM: Risk factors for 5-year mortality in older adults: the cardiovascular health study. JAMA 1998;279:585–592.
  11. Pavlik VN, de Moraes SA, Szklo M, Knopman DS, Mosley TH Jr, Hyman DJ: Relation between cognitive function and mortality in middle-aged adults: the atherosclerosis risk in communities study. Am J Epidemiol 2003;157:327–334.
  12. Longstreth WT Jr, Arnold AM, Beauchamp NJ Jr, Manolio TA, Lefkowitz D, Jungreis C, Hirsch CH, O’Leary DH, Furberg CD: Incidence, manifestations, and predictors of worsening white matter on serial cranial magnetic resonance imaging in the elderly: The Cardiovascular Health Study. Stroke 2005;36:56–61.
  13. Kuo HK, Leveille SG, Yu YH, Milberg WP: Cognitive function, habitual gait speed, and late-life disability in the National Health and Nutrition Examination Survey (NHANES) 1999–2002. Gerontology 2006;53:102–110.
  14. Guralnik JM, Ferrucci L, Pieper CF, Leveille SG, Markides KS, Ostir GV, Studenski S, Berkman LF, Wallace RB: Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci 2000;55:M221–M231.
  15. Studenski S, Perera S, Wallace D, Chandler JM, Duncan PW, Rooney E, Fox M, Guralnik JM: Physical performance measures in the clinical setting. J Am Geriatr Soc 2003;51:314–322.
  16. Montero-Odasso M, Schapira M, Soriano ER, Varela M, Kaplan R, Camera LA, Mayorga LM: Gait velocity as a single predictor of adverse events in healthy seniors aged 75 years and older. J Gerontol A Biol Sci Med Sci 2005;60:1304–1309.
  17. Wechsler D (ed): Wechsler Adult Intelligence Scale – Revised. San Antonio, Psychological Corporation, 1981.
  18. Rooks RN, Simonsick EM, Miles T, Newman A, Kritchevsky SB, Schulz R, Harris T: The association of race and socioeconomic status with cardiovascular disease indicators among older adults in the health, aging, and body composition study. J Gerontol B Psychol Sci Soc Sci 2002;57:S247–S256.
  19. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, O’Brien WL, Bassett DR Jr, Schmitz KH, Emplaincourt PO, Jacobs DR Jr, Leon AS: Compendium of physical activities: an update of activity codes and met intensities. Med Sci Sports Exerc 2000;32:S498–504.
  20. Yaffe K, Barnes D, Nevitt M, Lui LY, Covinsky K: A prospective study of physical activity and cognitive decline in elderly women: women who walk. Arch Intern Med 2001;161:1703–1708.
  21. Andresen EM, Malmgren JA, Carter WB, Patrick DL: Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med 1994;10:77–84.
  22. Wilson RS, Mendes De Leon CF, Bennett DA, Bienias JL, Evans DA: Depressive symptoms and cognitive decline in a community population of older persons. J Neurol Neurosurg Psychiatry 2004;75:126–129.
  23. Kuo HK, Sorond F, Iloputaife I, Gagnon M, Milberg W, Lipsitz LA: Effect of blood pressure on cognitive functions in elderly persons. J Gerontol A Biol Sci Med Sci 2004;59:1191–1194.
  24. Kuo HK, Jones RN, Milberg WP, Tennstedt S, Talbot L, Morris JN, Lipsitz LA: Effect of blood pressure and diabetes mellitus on cognitive and physical functions in older adults: a longitudinal analysis of the advanced cognitive training for independent and vital elderly cohort. J Am Geriatr Soc 2005;53:1154–1161.
  25. Newman AB, Arnold AM, Naydeck BL, Fried LP, Burke GL, Enright P, Gottdiener J, Hirsch C, O’Leary D, Tracy R: ‘Successful aging’: effect of subclinical cardiovascular disease. Arch Intern Med 2003;163:2315–2322.
  26. Stuss DT, Peterkin I, Guzman DA, Guzman C, Troyer AK: Chronic obstructive pulmonary disease: effects of hypoxia on neurological and neuropsychological measures. J Clin Exp Neuropsychol 1997;19:515–524.
  27. Teng EL, Chui HC: The Modified Mini-Mental State (3MS) examination. J Clin Psychiatry 1987;48:314–318.
  28. Lopez OL, Kuller LH, Fitzpatrick A, Ives D, Becker JT, Beauchamp N: Evaluation of dementia in the cardiovascular health cognition study. Neuroepidemiology 2003;22:1–12.
  29. Verghese J, Wang C, Holtzer R, Lipton R, Xue X: Quantitative gait dysfunction and risk of cognitive decline and dementia. J Neurol Neurosurg Psychiatry 2007;78:929–935.
  30. Inzitari M, Baldereschi M, Di Carlo A, Di Bari M, Marchionni N, Scafato E, Farchi G, Inzitari D: Impaired attention predicts motor performance decline in older community-dwellers with normal baseline mobility: results from the Italian Longitudinal Study On Aging (ILSA). J Gerontol A Biol Sci Med Sci 2007;62:837–843.

    External Resources

  31. Tabbarah M, Crimmins EM, Seeman TE: The relationship between cognitive and physical performance: MacArthur Studies of Successful Aging. J Gerontol A Biol Sci Med Sci 2002;57:M228–M235.
  32. Proust-Lima C, Amieva H, Dartigues JF, Jacqmin-Gadda H: Sensitivity of four psychometric tests to measure cognitive changes in brain aging-population-based studies. Am J Epidemiol 2007;165:344–350.