Background Physical and cognitive function decline with age. Slow walking speed has been associated with negative health outcomes and dementia is often preceded by cognitive decline. This study investigated walking speed, cognitive function and the interaction between changes in these measures in relation to dementia risk. Method Walking speed and cognition were assessed in 3,932 individuals aged ≥60 years at wave 1 (2002–03) and 2 (2004–05) of the English Longitudinal Study of Ageing. New dementia cases were assessed from wave 3 (2006–07) to wave 7 (2014–15). The associations were modelled using Cox proportional hazards regression. Results Participants with faster baseline walking speeds (HR 0.36; 95% CI 0.22 – 0.60) had a decreased risk of dementia. Those who had a greater decline in walking speed (waves 1 – 2 (HR 1.23; 95% CI 1.03 – 1.47) had an increased dementia risk. Participants with greater baseline cognition (HR 0.42; 95% CI 0.34 – 0.54) had a reduced dementia risk. Those who had a greater decline in cognition (waves 1–2) had a greater risk of dementia (HR 1.78; 95% CI 1.53 – 2.06). Change in walking speed and change in cognition did not interact significantly in relation to dementia risk (HR 1.01; 95% CI 0.88 – 1.17). Conclusions In this community-dwelling sample of English adults those with slower walking speeds and a greater decline in speed over time had an increased risk of developing dementia independent of changes in cognition. Further research is required to understand the mechanisms that may drive these associations.

Our study confirms and extends findings from other countries, demonstrating cross-sectional associations between moderate and poor self-rated vision and dementia in England in all participants aged 50 and older and longitudinally over an 11-year period in those aged 50 to 69. These results help establish vision loss as a risk factor for dementia, although it is unclear why. Research is needed to determine whether screening and treatment for vision loss may slow cognitive decline.

When making decisions about whether or not to record drug misuse, GPs face complex choices. Aside from their own views, they reported feelings of pressure from the general practice environment in which they worked and their clinical commissioning group, as well as government policies.

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This proposal is motivated by an analysis of the English Longitudinal Study of Ageing (ELSA), which aims to investigate the role of loneliness in explaining the negative impact of hearing loss on dementia. The methodological challenges that complicate this mediation analysis include the use of a time-to-event endpoint subject to competing risks, as well as the presence of feedback relationships between the mediator and confounders that are both repeatedly measured over time. To account for these challenges, we introduce natural effect proportional (cause-specific) hazard models. These extend marginal structural proportional (cause-specific) hazard models to enable effect decomposition. We show that under certain causal assumptions, the path-specific direct and indirect effects indexing this model are identifiable from the observed data. We next propose an inverse probability weighting approach to estimate these effects. On the ELSA data, this approach reveals little evidence that the total efect of hearing loss on dementia is mediated through the feeling of loneliness, with a non-statistically significant indirect effect equal to 1.012 (hazard ratio (HR) scale; 95% confidence interval (CI) 0.986 to 1.053).

BackgroundTo determine the potential mediating role of loneliness in the relationship between hearing ability and dementia.MethodsDesign: Longitudinal observational study. Setting: English Longitudinal Study of Ageing (ELSA). Participants: Individuals aged 50 and older (N = 4232). Measurements: Self‐reported hearing ability and loneliness were assessed from Wave 2 (2004–2005) to Wave 7 (2014–2015) of ELSA. Dementia cases were ascertained via self‐ or carer‐report or dementia medication at these waves. The medeff command in Stata version 17 was used to do cross‐section mediation analysis between hearing ability, loneliness, and dementia (Waves 3–7). Path‐specific effects proportional (cause‐specific) hazard models were then used to investigate longitudinal mediation (Waves 2–7).ResultsIn cross‐sectional analyses in Wave 7 alone, loneliness only mediated 5.4% of the total effects of limited hearing on dementia (indirect effects = increased risk of 0.06%; 95% CI: 0.002%–0.15%) under limited hearing and 0.04% (95% CI: 0.001%–0.11%) under normal hearing). In longitudinal analyses, there was no statistical evidence of a mediating role for loneliness in explaining the relationship between hearing ability and time‐to‐dementia (indirect effect estimate hazard ratio = 1.01 (95% CI: 0.99–1.05).ConclusionIn this community‐dwelling sample of English adults, there is a lack of evidence that loneliness mediates the relationship between hearing ability and dementia in both cross‐sectional and longitudinal analyses. However, as the number of dementia cases in this cohort was low, replication in other cohorts with larger sample sizes is required to confirm the absence of a mediated effect via loneliness.