Emiel O Hoogendijk1, Judith J M Rijnhart2, Johan Skoog3, Annie Robitaille4, Ardo van den Hout5, Luigi Ferrucci6, Martijn Huisman7, Ingmar Skoog8, Andrea M Piccinin9, Scott M Hofer9, Graciela Muniz Terrera10. 1. Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC - location VU University Medical Center, Amsterdam, the Netherlands. Electronic address: e.hoogendijk@amsterdamumc.nl. 2. Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC - location VU University Medical Center, Amsterdam, the Netherlands. 3. Department of Psychology, Centre for Health and Ageing AGECAP, University of Gothenburg, Gothenburg, Sweden. 4. Département de Psychologie, Université du Québec, Montréal, QC, Canada. 5. Department of Statistical Science, University College London, London, UK. 6. National Institute on Aging, Baltimore, MD, USA. 7. Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC - location VU University Medical Center, Amsterdam, the Netherlands; Department of Sociology, VU University, Amsterdam, the Netherlands. 8. Institute of Neuroscience and Physiology, Centre for Health and Ageing AGECAP, University of Gothenburg, Gothenburg, Sweden. 9. Department of Psychology, University of Victoria, Victoria, BC, Canada. 10. Department of Psychology, University of Victoria, Victoria, BC, Canada; Centre for Dementia Prevention, The University of Edinburgh, Edinburgh, UK.
Abstract
OBJECTIVES: Very few studies looking at slow gait speed as early marker of cognitive decline investigated the competing risk of death. The current study examines associations between slow gait speed and transitions between cognitive states and death in later life. METHODS: We performed a coordinated analysis of three longitudinal studies with 9 to 25 years of follow-up. Data were used from older adults participating in H70 (Sweden; n = 441; aged ≥70 years), InCHIANTI (Italy; n = 955; aged ≥65 years), and LASA (the Netherlands; n = 2824; aged ≥55 years). Cognitive states were distinguished using the Mini-Mental State Examination. Slow gait speed was defined as the lowest sex-specific quintile at baseline. Multistate models were performed, adjusted for age, sex and education. RESULTS: Most effect estimates pointed in the same direction, with slow gait speed predicting forward transitions. In two cohort studies, slow gait speed predicted transitioning from mild to severe cognitive impairment (InCHIANTI: HR = 2.08, 95%CI = 1.40-3.07; LASA: HR = 1.33, 95%CI = 1.01-1.75) and transitioning from a cognitively healthy state to death (H70: HR = 3.30, 95%CI = 1.74-6.28; LASA: HR = 1.70, 95%CI = 1.30-2.21). CONCLUSIONS: Screening for slow gait speed may be useful for identifying older adults at risk of adverse outcomes such as cognitive decline and death. However, once in the stage of more advanced cognitive impairment, slow gait speed does not seem to predict transitioning to death anymore.
OBJECTIVES: Very few studies looking at slow gait speed as early marker of cognitive decline investigated the competing risk of death. The current study examines associations between slow gait speed and transitions between cognitive states and death in later life. METHODS: We performed a coordinated analysis of three longitudinal studies with 9 to 25 years of follow-up. Data were used from older adults participating in H70 (Sweden; n = 441; aged ≥70 years), InCHIANTI (Italy; n = 955; aged ≥65 years), and LASA (the Netherlands; n = 2824; aged ≥55 years). Cognitive states were distinguished using the Mini-Mental State Examination. Slow gait speed was defined as the lowest sex-specific quintile at baseline. Multistate models were performed, adjusted for age, sex and education. RESULTS: Most effect estimates pointed in the same direction, with slow gait speed predicting forward transitions. In two cohort studies, slow gait speed predicted transitioning from mild to severe cognitive impairment (InCHIANTI: HR = 2.08, 95%CI = 1.40-3.07; LASA: HR = 1.33, 95%CI = 1.01-1.75) and transitioning from a cognitively healthy state to death (H70: HR = 3.30, 95%CI = 1.74-6.28; LASA: HR = 1.70, 95%CI = 1.30-2.21). CONCLUSIONS: Screening for slow gait speed may be useful for identifying older adults at risk of adverse outcomes such as cognitive decline and death. However, once in the stage of more advanced cognitive impairment, slow gait speed does not seem to predict transitioning to death anymore.
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