Journal Mobile Options
Table of Contents
Vol. 31, No. 3, 2008
Issue release date: October 2008
Section title: Original Paper
Free Access
Neuroepidemiology 2008;31:167–173
(DOI:10.1159/000154929)

Functional Decline in Cognitive Impairment – The Relationship between Physical and Cognitive Function

Auyeung T.W.a, c · Kwok T.b · Lee J.b · Leung P.C.a · Leung J.a · Woo J.b
aJockey Club Center for Osteoporosis Care and Control and bDepartment of Medicine and Therapeutics, School of Medicine, Chinese University of Hong Kong, and cDepartment of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, SAR, China
email Corresponding Author

Abstract

Background: Physical function decline is associated with dementia, which might either be mediated by the coexisting sarcopenia or directly related to the impaired cognition. Our objectives are to examine the relationship between cognitive function and performance-based physical function and to test the hypothesis that cognitive function is related to poor physical function independent of muscle mass. Methods: We measured muscle strength, performance-based physical function and muscle mass using dual-energy X-ray absorptiometry and cognitive function using the cognitive part of the Community Screening Instrument of Dementia (CSI-D) in 4,000 community-dwelling Chinese elderly aged >65 years. A CSI-D cognitive score of >28.40 was considered as cognitively impaired. The effect of cognitive impairment on muscle strength and physical function was analyzed by multivariate analysis with adjustment for age, appendicular skeletal mass (ASM), the Physical Activity Scale for the Elderly (PASE) and other comorbidities. Results: In both genders, the cognitively impaired (CSI-D cognitive score >28.40) group had a weaker grip strength (–5.10 kg, p < 0.001 in men; –1.08 kg in women, p < 0.001) and performed worse in the two physical function tests (in men, 6-meter walk speed, –0.13 m/s, p < 0.001, chair stand test, 1.42 s, p < 0.001; in women, 6-meter walk speed, –0.08 m/s, p < 0.001, chair stand test, 1.48 s, p < 0.001). After adjustment for age, ASM, PASE and other comorbidities, significant differences in grip strength (–2.60 kg, p < 0.001 in men; –0.49 kg, p = 0.011 in women) and the two physical function tests persisted between the cognitively impaired and nonimpaired group (in men, 6-meter walk speed, –0.072 m/s, p < 0.001, chair stand test, 0.80 s, p = 0.045; in women, 6-meter walk speed, –0.049 m/s, p < 0.001, chair stand test, 0.98 s, p < 0.001). Conclusions: Poor physical function and muscle strength coexisted with cognitive impairment. This relationship was independent of muscle mass. It is likely therefore that the functional decline in dementia might be related directly to factors resulting in cognitive impairment independently of the coexisting sarcopenia.

© 2008 S. Karger AG, Basel


  

Key Words

  • Sarcopenia
  • Dementia
  • Cognition
  • Chinese elderly
  • Physical function
  • Muscle

References

  1. Warren EJ, Grek A, Conn D: A correlation between cognitive performance and daily functioning in elderly people. J Geriatr Psychiatry Neurol 1989;2:96–100.
  2. Bassett SS, Folstein MF: Cognitive impairment and functional disability in the absence of psychiatric diagnosis. Psychol Med 1991;21:77–84.
  3. Grigsby J, Kaye K, Baxter J, Shetterly SM, Hamman RF: Executive cognitive abilities and functional status among community-dwelling older persons in the San Luis Valley Health and Aging Study. J Am Geriatr Soc 1998;46:590–596.
  4. Li CY, Wu SC: Effects of cognitive impairment and loss of physical capacities on survival of the elderly. Neuroepidemiology 1999;18:322–326.
  5. Kuo HK, Leveille SG, Yu YH, Milberg WP: Cognitive function, habitual speed, and late-life disability in the National Health and Nutrition Examination Survey (NHANES) 1999–2002. Gerontology 2007;53:102–110.
  6. Rosano C, Simonsick EM, Harris TB, et al: Association between physical and cognitive function in healthy elderly: the Health, Aging and Body Composition Study. Neuroepidemiology 2005;24:8–14.
  7. Fitzpatrick AL, Buchanan CK, Nahin RL, et al, Ginkgo Evaluation of Memory Study Investigators: Associations of gait speed and other measures of physical function with cognition in a healthy cohort of elderly persons. J Gerontol A Biol Sci Med Sci 2007;62:1244–1251.
  8. Boyle PA, Wilson RS, Buchman AS, et al: Lower extremity motor function and disability in mild cognitive impairment. Exp Aging Res 2007;33:355–371.
  9. Franssen EH, Souren LE, Torossian CL, Reisberg B: Equilibrium and limb coordination in mild cognitive impairment and mild Alzheimer’s disease. J Am Geriatr Soc 1999;47:463–469.
  10. Aguero-Torres H, Fratiglioni L, Gou Z, Viitanen M, Strauss E, Winblad B: Dementia is the major cause of functional dependence in the elderly: 3-year follow-up data from a population-based study. Am J Public Health 1998;88:1452–1456.
  11. Raji MA, Kuo Y, Snih SA, Markides KS, Peek KM, Ottenbacher KJ: Cognitive status, muscle strength, and subsequent disability in older Mexican Americans. J Am Geriatr Soc 2005;53:1462–1468.
  12. Atkinson HH, Rosano C, Simonsick EM, et al: Cognitive function, gait speed decline, and comorbidities: the health, aging, and body composition study. J Gerontol A Biol Sci Med Sci 2007;62:844–850.
  13. Black SA, Rush R: Cognitive and functional decline in adults aged 75 and older. J Am Geriatr Soc 2002;50:1978–1986.
  14. Camicioli R, Howieson D, Oken B, Sexton G, Kaye J: Motor slowing precedes cognitive impairment in the oldest old. Neurology 1998;50:1496–1498.
  15. 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.
  16. Alfaro-Acha A, Snih SA, Raji MA, Kuo YF, Markides KS, Ottenbacher KJ: Handgrip strength and cognitive decline in older Mexican Americans. J Gerontol A Biol Sci Med Sci 2006;61A:859–865.
  17. Inzitari M, Newman AB, Yaffe K, et al: Gait speed predicts decline in attention and psychomotor speed in older adults: the health aging and body composition study. Neuroepidemiology 2007;29:156–162.
  18. Nourhashemi F, Andrieu S, Gillette-Guyonnet S, et al: Is there a relationship between fat-free soft tissue mass and low cognitive function? Results from a study of 7,105 women. J Am Geriatr Soc 2002;50:1796–1801.
  19. Roubenoff R, Hughes VA: Sarcopenia: current concepts. J Gerontol A Biol Sci Med Sci 2000;55A:M716–M724.
  20. Melton LJ III, Khosla S, Crowson CS, O’Connor MK, O’Fallon WM, Riggs BL: Epidemiology of sarcopenia. J Am Geriatr Soc 2000;48:625–630.
  21. Janssen I, Heymsfield SB, Ross R: Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc 2002;50:889–890.
  22. Rolland Y, Lauwers-Cances V, Cournot M, et al: Sarcopenia, calf circumference, and physical function of elderly women: a cross-sectional study. J Am Geriatr Soc 2003;51:1120–1124.
  23. Lee JS, Auyeung TW, Kwok T, Lau EM, Leung PC, Woo J: Associated factors and health impact of sarcopenia in older Chinese men and women: a cross-sectional study. Gerontology 2007;53:166–172.

    External Resources

  24. Washburn RA, Smith KW, Jette AM, Janny CA: The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol 1993;46:153–162.
  25. Prince M, Acosta D, Chiu H, et al, 10/66 Dementia Research Group: Dementia diagnosis in developing countries: a cross cultural validation study. Lancet 2003;361:909–917.
  26. Chan TS, Lam LC, Chiu HF, Prince M: Validity and applicability of the Chinese version of Community Screening Instrument for Dementia. Dement Geriatr Cogn Disord 2003;15:10–18.
  27. Heymsfield SB, Smith R, Aulet M, et al: Appendicular skeletal muscle mass: measurement by dual-energy X-ray absorptiometry. Am J Clin Nutr 1990;52:214–218.
  28. Woo J, Ho SC, Lau S, Lau J, Yuen YK: Prevalence of cognitive impairment and associated factors among elderly Hong Kong Chinese aged 70 years and over. Neuroepidemiology 1994;13:50–58.
  29. Lam LC, Tam CW, Lui VW, et al: Prevalence of very mild and mild dementia in community-dwelling older Chinese people in Hong Kong. Int Psychogeriatr 2008;20:135–148.
  30. Hall KS, Hendrie HH, Brittain HM, et al: The development of a dementia screening interview in two distinct languages. Int J Methods Psychiatric Res 1993;3:1–28.

    External Resources

  31. Yaffe K, Barnes D, Nevitt M, Lui LY, Covinsky K: A prospective study of physical activity and cognitive decline in elderly women. Arch Intern Med 2001;161:1703–1708.
  32. Lytle ME, Vander BJ, Pandav R, Dodge HH, Ganguli M: Exercise level and cognitive decline: the MoVIES project. Alzheimer Dis Assoc Disord 2004;18:57–64.
  33. Weuve J, Kang JH, Manson JE, Breteler MM, Ware JH, Grodstein F: Physical activity including walking, and cognitive function in older women. JAMA 2004;292:1454–1461.
  34. Baumgartner RN, Waters DL, Gallagher D, Morley JE, Garry PJ: Predictors of skeletal muscle mass in elderly men and women. Mech Ageing Dev 1999;107:123–136.
  35. Yaffe K, Lui LY, Zmuda J, et al: Sex hormones and cognitive function in older men. J Am Geriatr Soc 2002;50:707–712.
  36. Iannuzzi-Sucich M, Prestwood KM, Kenny AM: Prevalence of sarcopenia and predictors of skeletal muscle mass in healthy, older men and women. J Gerontol Med Sci 2002;57A:M772–M777.
  37. Visser M, Pahor M, Taaffe DR, et al: Relationship of interleukin-6 and tumor necrosis factor with muscle mass and muscle strength in elderly men and women: the Health ABC Study. J Gerontol A Biol Sci Med Sci 2002;57A:M326–M332.
  38. Weaver JD, Huang MH, Albert M, et al: Interleukin-6 and risk of cognitive decline. MacArthur Studies of Successful Aging. Neurology 2002;13:371–378.

  

Author Contacts

Tung Wai Auyeung
Department of Medicine and Geriatrics
Tuen Mun Hospital
Tuen Mun, NT, Hong Kong, SAR (China)
Tel. +852 2468 5800, Fax +852 2468 5800, E-Mail auyeungtw@gmail.com

  

Article Information

Received: March 16, 2008
Accepted: July 9, 2008
Published online: September 11, 2008
Number of Print Pages : 7
Number of Figures : 0, Number of Tables : 4, Number of References : 38

  

Publication Details

Neuroepidemiology

Vol. 31, No. 3, Year 2008 (Cover Date: October 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: Physical function decline is associated with dementia, which might either be mediated by the coexisting sarcopenia or directly related to the impaired cognition. Our objectives are to examine the relationship between cognitive function and performance-based physical function and to test the hypothesis that cognitive function is related to poor physical function independent of muscle mass. Methods: We measured muscle strength, performance-based physical function and muscle mass using dual-energy X-ray absorptiometry and cognitive function using the cognitive part of the Community Screening Instrument of Dementia (CSI-D) in 4,000 community-dwelling Chinese elderly aged >65 years. A CSI-D cognitive score of >28.40 was considered as cognitively impaired. The effect of cognitive impairment on muscle strength and physical function was analyzed by multivariate analysis with adjustment for age, appendicular skeletal mass (ASM), the Physical Activity Scale for the Elderly (PASE) and other comorbidities. Results: In both genders, the cognitively impaired (CSI-D cognitive score >28.40) group had a weaker grip strength (–5.10 kg, p < 0.001 in men; –1.08 kg in women, p < 0.001) and performed worse in the two physical function tests (in men, 6-meter walk speed, –0.13 m/s, p < 0.001, chair stand test, 1.42 s, p < 0.001; in women, 6-meter walk speed, –0.08 m/s, p < 0.001, chair stand test, 1.48 s, p < 0.001). After adjustment for age, ASM, PASE and other comorbidities, significant differences in grip strength (–2.60 kg, p < 0.001 in men; –0.49 kg, p = 0.011 in women) and the two physical function tests persisted between the cognitively impaired and nonimpaired group (in men, 6-meter walk speed, –0.072 m/s, p < 0.001, chair stand test, 0.80 s, p = 0.045; in women, 6-meter walk speed, –0.049 m/s, p < 0.001, chair stand test, 0.98 s, p < 0.001). Conclusions: Poor physical function and muscle strength coexisted with cognitive impairment. This relationship was independent of muscle mass. It is likely therefore that the functional decline in dementia might be related directly to factors resulting in cognitive impairment independently of the coexisting sarcopenia.

© 2008 S. Karger AG, Basel


  

Author Contacts

Tung Wai Auyeung
Department of Medicine and Geriatrics
Tuen Mun Hospital
Tuen Mun, NT, Hong Kong, SAR (China)
Tel. +852 2468 5800, Fax +852 2468 5800, E-Mail auyeungtw@gmail.com

  

Article Information

Received: March 16, 2008
Accepted: July 9, 2008
Published online: September 11, 2008
Number of Print Pages : 7
Number of Figures : 0, Number of Tables : 4, Number of References : 38

  

Publication Details

Neuroepidemiology

Vol. 31, No. 3, Year 2008 (Cover Date: October 2008)

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

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


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 3/16/2008
Accepted: 7/9/2008
Published online: 9/11/2008
Issue release date: October 2008

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 4

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. Warren EJ, Grek A, Conn D: A correlation between cognitive performance and daily functioning in elderly people. J Geriatr Psychiatry Neurol 1989;2:96–100.
  2. Bassett SS, Folstein MF: Cognitive impairment and functional disability in the absence of psychiatric diagnosis. Psychol Med 1991;21:77–84.
  3. Grigsby J, Kaye K, Baxter J, Shetterly SM, Hamman RF: Executive cognitive abilities and functional status among community-dwelling older persons in the San Luis Valley Health and Aging Study. J Am Geriatr Soc 1998;46:590–596.
  4. Li CY, Wu SC: Effects of cognitive impairment and loss of physical capacities on survival of the elderly. Neuroepidemiology 1999;18:322–326.
  5. Kuo HK, Leveille SG, Yu YH, Milberg WP: Cognitive function, habitual speed, and late-life disability in the National Health and Nutrition Examination Survey (NHANES) 1999–2002. Gerontology 2007;53:102–110.
  6. Rosano C, Simonsick EM, Harris TB, et al: Association between physical and cognitive function in healthy elderly: the Health, Aging and Body Composition Study. Neuroepidemiology 2005;24:8–14.
  7. Fitzpatrick AL, Buchanan CK, Nahin RL, et al, Ginkgo Evaluation of Memory Study Investigators: Associations of gait speed and other measures of physical function with cognition in a healthy cohort of elderly persons. J Gerontol A Biol Sci Med Sci 2007;62:1244–1251.
  8. Boyle PA, Wilson RS, Buchman AS, et al: Lower extremity motor function and disability in mild cognitive impairment. Exp Aging Res 2007;33:355–371.
  9. Franssen EH, Souren LE, Torossian CL, Reisberg B: Equilibrium and limb coordination in mild cognitive impairment and mild Alzheimer’s disease. J Am Geriatr Soc 1999;47:463–469.
  10. Aguero-Torres H, Fratiglioni L, Gou Z, Viitanen M, Strauss E, Winblad B: Dementia is the major cause of functional dependence in the elderly: 3-year follow-up data from a population-based study. Am J Public Health 1998;88:1452–1456.
  11. Raji MA, Kuo Y, Snih SA, Markides KS, Peek KM, Ottenbacher KJ: Cognitive status, muscle strength, and subsequent disability in older Mexican Americans. J Am Geriatr Soc 2005;53:1462–1468.
  12. Atkinson HH, Rosano C, Simonsick EM, et al: Cognitive function, gait speed decline, and comorbidities: the health, aging, and body composition study. J Gerontol A Biol Sci Med Sci 2007;62:844–850.
  13. Black SA, Rush R: Cognitive and functional decline in adults aged 75 and older. J Am Geriatr Soc 2002;50:1978–1986.
  14. Camicioli R, Howieson D, Oken B, Sexton G, Kaye J: Motor slowing precedes cognitive impairment in the oldest old. Neurology 1998;50:1496–1498.
  15. 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.
  16. Alfaro-Acha A, Snih SA, Raji MA, Kuo YF, Markides KS, Ottenbacher KJ: Handgrip strength and cognitive decline in older Mexican Americans. J Gerontol A Biol Sci Med Sci 2006;61A:859–865.
  17. Inzitari M, Newman AB, Yaffe K, et al: Gait speed predicts decline in attention and psychomotor speed in older adults: the health aging and body composition study. Neuroepidemiology 2007;29:156–162.
  18. Nourhashemi F, Andrieu S, Gillette-Guyonnet S, et al: Is there a relationship between fat-free soft tissue mass and low cognitive function? Results from a study of 7,105 women. J Am Geriatr Soc 2002;50:1796–1801.
  19. Roubenoff R, Hughes VA: Sarcopenia: current concepts. J Gerontol A Biol Sci Med Sci 2000;55A:M716–M724.
  20. Melton LJ III, Khosla S, Crowson CS, O’Connor MK, O’Fallon WM, Riggs BL: Epidemiology of sarcopenia. J Am Geriatr Soc 2000;48:625–630.
  21. Janssen I, Heymsfield SB, Ross R: Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc 2002;50:889–890.
  22. Rolland Y, Lauwers-Cances V, Cournot M, et al: Sarcopenia, calf circumference, and physical function of elderly women: a cross-sectional study. J Am Geriatr Soc 2003;51:1120–1124.
  23. Lee JS, Auyeung TW, Kwok T, Lau EM, Leung PC, Woo J: Associated factors and health impact of sarcopenia in older Chinese men and women: a cross-sectional study. Gerontology 2007;53:166–172.

    External Resources

  24. Washburn RA, Smith KW, Jette AM, Janny CA: The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol 1993;46:153–162.
  25. Prince M, Acosta D, Chiu H, et al, 10/66 Dementia Research Group: Dementia diagnosis in developing countries: a cross cultural validation study. Lancet 2003;361:909–917.
  26. Chan TS, Lam LC, Chiu HF, Prince M: Validity and applicability of the Chinese version of Community Screening Instrument for Dementia. Dement Geriatr Cogn Disord 2003;15:10–18.
  27. Heymsfield SB, Smith R, Aulet M, et al: Appendicular skeletal muscle mass: measurement by dual-energy X-ray absorptiometry. Am J Clin Nutr 1990;52:214–218.
  28. Woo J, Ho SC, Lau S, Lau J, Yuen YK: Prevalence of cognitive impairment and associated factors among elderly Hong Kong Chinese aged 70 years and over. Neuroepidemiology 1994;13:50–58.
  29. Lam LC, Tam CW, Lui VW, et al: Prevalence of very mild and mild dementia in community-dwelling older Chinese people in Hong Kong. Int Psychogeriatr 2008;20:135–148.
  30. Hall KS, Hendrie HH, Brittain HM, et al: The development of a dementia screening interview in two distinct languages. Int J Methods Psychiatric Res 1993;3:1–28.

    External Resources

  31. Yaffe K, Barnes D, Nevitt M, Lui LY, Covinsky K: A prospective study of physical activity and cognitive decline in elderly women. Arch Intern Med 2001;161:1703–1708.
  32. Lytle ME, Vander BJ, Pandav R, Dodge HH, Ganguli M: Exercise level and cognitive decline: the MoVIES project. Alzheimer Dis Assoc Disord 2004;18:57–64.
  33. Weuve J, Kang JH, Manson JE, Breteler MM, Ware JH, Grodstein F: Physical activity including walking, and cognitive function in older women. JAMA 2004;292:1454–1461.
  34. Baumgartner RN, Waters DL, Gallagher D, Morley JE, Garry PJ: Predictors of skeletal muscle mass in elderly men and women. Mech Ageing Dev 1999;107:123–136.
  35. Yaffe K, Lui LY, Zmuda J, et al: Sex hormones and cognitive function in older men. J Am Geriatr Soc 2002;50:707–712.
  36. Iannuzzi-Sucich M, Prestwood KM, Kenny AM: Prevalence of sarcopenia and predictors of skeletal muscle mass in healthy, older men and women. J Gerontol Med Sci 2002;57A:M772–M777.
  37. Visser M, Pahor M, Taaffe DR, et al: Relationship of interleukin-6 and tumor necrosis factor with muscle mass and muscle strength in elderly men and women: the Health ABC Study. J Gerontol A Biol Sci Med Sci 2002;57A:M326–M332.
  38. Weaver JD, Huang MH, Albert M, et al: Interleukin-6 and risk of cognitive decline. MacArthur Studies of Successful Aging. Neurology 2002;13:371–378.