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Vol. 53, No. 2, 2007
Issue release date: February 2007
Section title: Clinical Section
Free Access
Gerontology 2007;53:102–110
(DOI:10.1159/000096792)

Cognitive Function, Habitual Gait Speed, and Late-Life Disability in the National Health and Nutrition Examination Survey (NHANES) 1999–2002

Kuo H.-K.a, b · Leveille S.G.d · Yu Y.-H.c · Milberg W.P.e
aDivision of Gerontology Research, National Health Research Institutes, bDepartment of Internal Medicine, National Taiwan University Hospital, and cNational Yang-Ming University, Taipei, Taiwan, ROC; dDepartment of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass., and eGeriatric Neuropsychology Laboratory, Geriatric, Research, Education and Clinical Center (GRECC), Brockton/West Roxbury Department of Veterans Affairs Medical Center, Boston, Mass., USA
email Corresponding Author

Abstract

Background: Both cognitive function and gait speed are important correlates of disability. However, little is known about the combined effect of cognitive function and gait speed on multiple domains of disability as well as about the role of gait speed in the association between cognitive function and late-life disability. Objective: To investigate (1) how cognition and habitual gait speed are related to late-life disability; (2) the role of habitual gait speed in the cognitiondisability association; and (3) the combined effect of cognitive function and habitual gait speed on late-life disability. Method: Participants (>60 years, n = 2,481) were from the National Health and Nutrition Examination Survey 1999–2002. Disability in activities of daily living (ADL), instrumental ADL (IADL), leisure and social activities (LSA), and lower extremity mobility (LEM) was obtained by self-report. Cognitive function was measured by a 2-min timed Digit Symbol Substitution Test (DSST), an executive function measure from the Wechsler Adult Intelligence Test. Habitual gait speed was obtained from a 20-foot timed walk. Multiple logistic regression was used to assess the association between cognitive function and disability. Results: Cognitive function was associated with decreased likelihood for disability in each domain. The odds ratios (ORs) for disability in ADL, IADL, LSA, and LEM for each standard deviation (SD) increase in the DSST score were 0.47 (95% confidence interval [CI] = 0.34–0.64), 0.53 (95% CI = 0.42–0.67), 0.61 (95% CI = 0.47–0.79), and 0.73 (95% CI = 0.61–0.86), respectively, in the multi-variable models. After additional adjustment for habitual gait speed in the cognition-disability relationship, DSST score was no longer a significant correlate for LSA and LEM disability. The strength of the association between DSST score and disability in ADL/IADL was also diminished. The attenuated association between cognition and disability implies that limitation in gait speed likely mediates the association between cognitive function and disability. We found additive effects of cognition and habitual gait speed on late-life disability. The OR of disability in respective domains were lowest among participants with high-DSST score (high executive function) and with high gait speed. In contrast, the OR tended to be highest among participants with low-DSST score (low executive function) and low gait speed. Conclusion: Cognitive function was associated with multiple domains of disability. There was a joint effect of cognitive function and gait speed on late-life disability. This study also suggested that habitual gait speed partially mediated the inverse association between cognitive function and late-life disability, providing a mechanistic explanation in the context of disablement process.

© 2007 S. Karger AG, Basel


  

Key Words

  • Cognition
  • Cognitive function
  • Gait speed
  • Physical function
  • National Health and Nutrition Examination

References

  1. Manton KG, Corder LS, Stallard E: Estimates of change in chronic disability and institutional incidence and prevalence rates in the U.S. elderly population from the 1982, 1984, and 1989 National Long Term Care Survey. J Gerontol 1993;48:S153–166.
  2. Bass S, Morris R, Oka M: Public Policy and the Old Age Revolution in Japan. New York, Haworth Press, 1996.
  3. Schulte B: Social protection for dependence in old age: the case of Germany; in Eisen R, Sloan F (eds): Long Term Care: Economic Issues and Policy Solutions. Boston, Kluwer Academic, 1996, pp 149–170.
  4. Wiener J: Long Term Care Reform: An International Perspective. Health Care Reform: The Will to Change. Paris, Organization for Economic Cooperation and Development, 1996.
  5. Jette AM: Disablement outcomes in geriatric rehabilitation. Med Care 1997;35(suppl):JS28–JS37; discussion JS38–JS44.
  6. Blaum CS, Ofstedal MB, Liang J: Low cognitive performance, comorbid disease, and task-specific disability: findings from a nationally representative survey. J Gerontol A Biol Sci Med Sci 2002;57:M523–M531.
  7. Carlson MC, Fried LP, Xue QL, Bandeen-Roche K, Zeger SL, Brandt J: Association between executive attention and physical functional performance in community-dwelling older women. J Gerontol B Psychol Sci Soc Sci 1999;54:S262–S270.
  8. Raji MA, Al Snih S, Ray LA, Patel KV, Markides KS: Cognitive status and incident disability in older Mexican Americans: findings from the Hispanic established population for the epidemiological study of the elderly. Ethn Dis 2004;14:26–31.
  9. Dodge HH, Kadowaki T, Hayakawa T, Yamakawa M, Sekikawa A, Ueshima H: Cognitive impairment as a strong predictor of incident disability in specific ADL-IADL tasks among community-dwelling elders: the Azuchi Study. Gerontologist 2005;45:222–230.
  10. Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB: Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 1995;332:556–561.
  11. Shinkai S, Watanabe S, Kumagai S, et al: Walking speed as a good predictor for the onset of functional dependence in a Japanese rural community population. Age Ageing 2000;29:441–446.
  12. Waite LM, Broe GA, Creasey H, Grayson D, Edelbrock D, O’Toole B: Neurological signs, aging, and the neurodegenerative syndromes. Arch Neurol 1996;53:498–502.
  13. Ble A, Volpato S, Zuliani G, et al: Executive function correlates with walking speed in older persons: the InCHIANTI study. J Am Geriatr Soc 2005;53:410–415.
  14. Nagi SZ: An epidemiology of disability among adults in the United States. Milbank Mem Fund Q Health Soc 1976;54:439–467.
  15. Verbrugge LM, Jette AM: The disablement process. Soc Sci Med 1994;38:1–14.
  16. 1999–2000 National Health and Nutrition Examination Survey (NHANES). Http://www.cdc.gov/nchs/about/major/nhanes/currentnhanes.htm. Bathesda, MD, National Center for Health Statistics.
  17. National Health and Nutrition Examination Survey (NHANES): Http://www.cdc.gov/nchs/about/major/nhanes/current_nhanes_01_02.htm. Bathesda, MD, National Center for Health Statistics, 2001–2002.
  18. Wechsler D: Manual for the Wechsler Adult Intelligence Scale-Revised. New York, The Psychological Corporation, 1981.
  19. Vilkki J, Holst P: Mental programming after frontal lobe lesions: results on digit symbol performance with self-selected goals. Cortex 1991;27:203–211.
  20. Parkin AJ, Java RI: Deterioration of frontal lobe function in normal aging: influences of fluid intelligence versus perceptual speed. Neuropsychology 1999;13:539–545.
  21. National Heart, Lung, and Blood Institute: Obesity Education Initiative: The Evidence Report. Bethesda, MD, Nation Institutes of Health, 1998.
  22. 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.
  23. Raji MA, Kuo YF, Snih SA, Markides KS, Kristen Peek M, Ottenbacher KJ: Cognitive status, muscle strength, and subsequent disability in older mexican americans. J Am Geriatr Soc 2005;53:1462–1468.
  24. Gill TM, Williams CS, Richardson ED, Tinetti ME: Impairments in physical performance and cognitive status as predisposing factors for functional dependence among nondisabled older persons. J Gerontol A Biol Sci Med Sci 1996;51:M283–M288.
  25. 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.
  26. Abbott RD, White LR, Ross GW, Masaki KH, Curb JD, Petrovitch H: Walking and dementia in physically capable elderly men. JAMA 2004;292:1447–1453.
  27. Puggaard L, Larsen JB, Stovring H, Jeune B: Maximal oxygen uptake, muscle strength and walking speed in 85-year-old women: effects of increased physical activity. Aging (Milano) 2000;12:180–189.
  28. Magaziner J, Simonsick EM, Kashner TM, Hebel JR: Patient-proxy response comparability on measures of patient health and functional status. J Clin Epidemiol 1988;41:1065–1074.
  29. Weinberger M, Samsa GP, Schmader K, Greenberg SM, Carr DB, Wildman DS: Comparing proxy and patients’ perceptions of patients’ functional status: results from an outpatient geriatric clinic. J Am Geriatr Soc 1992;40:585–588.

  

Author Contacts

Dr. Yau-Hua Yu
11F-2, No. 15, DaZhi Street
Taipei 10463, Taiwan (ROC)
Tel. +886 9 6608 8355, Fax +886 2 8509 3747
E-Mail yauhuayu@gmail.com

  

Article Information

Financial Disclosure: None

Received: October 30, 2005
Accepted: June 12, 2006
Published online: November 6, 2006
Number of Print Pages : 9
Number of Figures : 1, Number of Tables : 3, Number of References : 29

  

Publication Details

Gerontology (International Journal of Experimental, Clinical and Behavioural Gerontology)

Vol. 53, No. 2, Year 2007 (Cover Date: February 2007)

Journal Editor: Meier-Ruge, W. (Basel)
ISSN: 0304–324X (print), 1423–0003 (Online)

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


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References

  1. Manton KG, Corder LS, Stallard E: Estimates of change in chronic disability and institutional incidence and prevalence rates in the U.S. elderly population from the 1982, 1984, and 1989 National Long Term Care Survey. J Gerontol 1993;48:S153–166.
  2. Bass S, Morris R, Oka M: Public Policy and the Old Age Revolution in Japan. New York, Haworth Press, 1996.
  3. Schulte B: Social protection for dependence in old age: the case of Germany; in Eisen R, Sloan F (eds): Long Term Care: Economic Issues and Policy Solutions. Boston, Kluwer Academic, 1996, pp 149–170.
  4. Wiener J: Long Term Care Reform: An International Perspective. Health Care Reform: The Will to Change. Paris, Organization for Economic Cooperation and Development, 1996.
  5. Jette AM: Disablement outcomes in geriatric rehabilitation. Med Care 1997;35(suppl):JS28–JS37; discussion JS38–JS44.
  6. Blaum CS, Ofstedal MB, Liang J: Low cognitive performance, comorbid disease, and task-specific disability: findings from a nationally representative survey. J Gerontol A Biol Sci Med Sci 2002;57:M523–M531.
  7. Carlson MC, Fried LP, Xue QL, Bandeen-Roche K, Zeger SL, Brandt J: Association between executive attention and physical functional performance in community-dwelling older women. J Gerontol B Psychol Sci Soc Sci 1999;54:S262–S270.
  8. Raji MA, Al Snih S, Ray LA, Patel KV, Markides KS: Cognitive status and incident disability in older Mexican Americans: findings from the Hispanic established population for the epidemiological study of the elderly. Ethn Dis 2004;14:26–31.
  9. Dodge HH, Kadowaki T, Hayakawa T, Yamakawa M, Sekikawa A, Ueshima H: Cognitive impairment as a strong predictor of incident disability in specific ADL-IADL tasks among community-dwelling elders: the Azuchi Study. Gerontologist 2005;45:222–230.
  10. Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB: Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 1995;332:556–561.
  11. Shinkai S, Watanabe S, Kumagai S, et al: Walking speed as a good predictor for the onset of functional dependence in a Japanese rural community population. Age Ageing 2000;29:441–446.
  12. Waite LM, Broe GA, Creasey H, Grayson D, Edelbrock D, O’Toole B: Neurological signs, aging, and the neurodegenerative syndromes. Arch Neurol 1996;53:498–502.
  13. Ble A, Volpato S, Zuliani G, et al: Executive function correlates with walking speed in older persons: the InCHIANTI study. J Am Geriatr Soc 2005;53:410–415.
  14. Nagi SZ: An epidemiology of disability among adults in the United States. Milbank Mem Fund Q Health Soc 1976;54:439–467.
  15. Verbrugge LM, Jette AM: The disablement process. Soc Sci Med 1994;38:1–14.
  16. 1999–2000 National Health and Nutrition Examination Survey (NHANES). Http://www.cdc.gov/nchs/about/major/nhanes/currentnhanes.htm. Bathesda, MD, National Center for Health Statistics.
  17. National Health and Nutrition Examination Survey (NHANES): Http://www.cdc.gov/nchs/about/major/nhanes/current_nhanes_01_02.htm. Bathesda, MD, National Center for Health Statistics, 2001–2002.
  18. Wechsler D: Manual for the Wechsler Adult Intelligence Scale-Revised. New York, The Psychological Corporation, 1981.
  19. Vilkki J, Holst P: Mental programming after frontal lobe lesions: results on digit symbol performance with self-selected goals. Cortex 1991;27:203–211.
  20. Parkin AJ, Java RI: Deterioration of frontal lobe function in normal aging: influences of fluid intelligence versus perceptual speed. Neuropsychology 1999;13:539–545.
  21. National Heart, Lung, and Blood Institute: Obesity Education Initiative: The Evidence Report. Bethesda, MD, Nation Institutes of Health, 1998.
  22. 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.
  23. Raji MA, Kuo YF, Snih SA, Markides KS, Kristen Peek M, Ottenbacher KJ: Cognitive status, muscle strength, and subsequent disability in older mexican americans. J Am Geriatr Soc 2005;53:1462–1468.
  24. Gill TM, Williams CS, Richardson ED, Tinetti ME: Impairments in physical performance and cognitive status as predisposing factors for functional dependence among nondisabled older persons. J Gerontol A Biol Sci Med Sci 1996;51:M283–M288.
  25. 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.
  26. Abbott RD, White LR, Ross GW, Masaki KH, Curb JD, Petrovitch H: Walking and dementia in physically capable elderly men. JAMA 2004;292:1447–1453.
  27. Puggaard L, Larsen JB, Stovring H, Jeune B: Maximal oxygen uptake, muscle strength and walking speed in 85-year-old women: effects of increased physical activity. Aging (Milano) 2000;12:180–189.
  28. Magaziner J, Simonsick EM, Kashner TM, Hebel JR: Patient-proxy response comparability on measures of patient health and functional status. J Clin Epidemiol 1988;41:1065–1074.
  29. Weinberger M, Samsa GP, Schmader K, Greenberg SM, Carr DB, Wildman DS: Comparing proxy and patients’ perceptions of patients’ functional status: results from an outpatient geriatric clinic. J Am Geriatr Soc 1992;40:585–588.