Aging, the Central Nervous System, and Mobility in Older Adults: Neural Mechanisms of Mobility Impairment

Sorond, Farzaneh A.; Cruz-Almeida, Yenisel; Clark, David J.; Viswanathan, Anand; Scherzer, Clemens R.; Jager, Philip De; Csiszár, Anna; Laurienti, Paul J.; Hausdorff, J.M.; Chen, Wen G.; Ferrucci, L; Rosano, Caterina; Studenski, Stephanie A.; Black, Sandra E.; Lipsitz, Lewis A.

doi:10.1093/gerona/glv130

Cited by 101 publications

(80 citation statements)

References 45 publications

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“…However, more research is needed to develop a deeper understanding of the link between neurological mechanisms and different facets of gait and mobility [88]. An empirical quantification of the association between neuropathology and gait parameters will contribute to the increased use of gait measures in the clinic and for clinical trials.…”

Section: Resultsmentioning

confidence: 99%

Association between Various Brain Pathologies and Gait Disturbance

Wennberg

Savica

Mielke³

2017

Dement Geriatr Cogn Disord

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Background: Approximately 30% of older adults have disrupted gait. It is associated with increased risk of cognitive decline, disability, dementia, and death. Additionally, most older adults present with 1 or more neuropathologies at autopsy. Recently, there has been an effort to investigate the association between subclinical neuropathology and gait. Summary: We reviewed studies that investigated the association between gait and neuropathologies. Although all pathologies reviewed were associated with gait, grey matter atrophy was most consistently linked with poorer gait performance. Studies investigating the association between white matter and gait focused primarily on total white matter. Future research using more parsed regional analysis will provide more insight into this relationship. Evidence from studies investigating neuronal activity and gait suggests that gait disruption is associated with both under- and overactivation. Additional research is needed to delineate these conflicting results. Lastly, early evidence suggests that both amyloid and tau aggregation negatively impact multiple gait parameters, but additional studies are warranted. Overall, there was substantial methodological heterogeneity and a paucity of longitudinal studies. Key Messages: Longitudinal studies mapping changes in different types of neuropathology as they relate to changes in multiple gait parameters are needed to better understand trajectories of pathology and gait.

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Section: Resultsmentioning

confidence: 99%

Association between Various Brain Pathologies and Gait Disturbance

Wennberg

Savica

Mielke³

2017

Dement Geriatr Cogn Disord

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“…The novelty of our study relies in the combination of a recall memory test and gait speed which increased the prediction of survival. Poor recall memory could add some additional and diverse information on cerebral functioning and neuroplasticity compared to other global or specific tests . Hypothetically, persons with good memory and fast gait may be the ones with the major brain reserve and plasticity leading at the end to longer survival.…”

Section: Resultsmentioning

confidence: 99%

Combining Gait Speed and Recall Memory to Predict Survival in Late Life: Population‐Based Study

Marengoni

Bandinelli

Maietti

et al. 2016

J American Geriatrics Society

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OBJECTIVES To evaluate the relationship between gait speed, recall memory, and mortality. DESIGN A cohort study (last follow-up December 2009). SETTING Tuscany, Italy. PARTICIPANTS Individual data from 1,014 community-dwelling older adults aged 60 years or older with baseline gait speed and recall memory measurements and follow-up for a median time of 9.10 (IQR 7.1;9.3) years. Participants were a mean (SD) age of 73.9 (7.3) years, and 55.8% women. Participants walking faster than 0.8 m/s were defined as fast walkers; good recall memory was defined as a score of 2 or 3 in the 3-word delayed recall section of the Mini-Mental State Examination. MEASUREMENTS All-cause mortality. RESULTS There were 302 deaths and the overall 100 person-year death rate was 3.77 (95% CI: 3.37–4.22). Both low gait speed and poor recall memory were associated with mortality when analysed separately (HR = 2.47; 95% CI: 1.87–3.27 and HR = 1.47; 95% CI: 1.16–1.87, respectively). When we grouped participants according to both recall and gait speed, death rates (100 person-years) progressively increased from those with both good gait speed and memory (2.0; 95% CI: 1.6–2.5), to those with fast walk but poor memory (3.4; 95% CI: 2.8–4.2), to those with slow walk and good memory (8.8; 95% CI: 6.4–12.1), to those with both slow walk and poor memory (13.0; 95% CI: 10.6–16.1). In multivariate analysis, poor memory significantly increases mortality risk among persons with fast gait speed (HR = 1.40; 95% CI: 1.04–1.89). CONCLUSION In older persons, gait speed and recall memory are independent predictors of expected survival. Information on memory function might better stratify mortality risk among persons with fast gait speed.

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“…This common occurrence is not merely due to a high prevalence of these impairments in aging but to common mechanisms probably at the brain level . Gait regulation shares common brain regions and networks with cognitive processes that are essential for planning and monitoring goal‐directed behavior . Understanding gait and cognitive impairments as a result of underlying processes affecting function in these shared brain regions and networks may point to modifiable factors including vascular damage, chronic inflammation, neurodegeneration, and micronutrient deficiencies …”

Section: Discussionmentioning

confidence: 99%

Motor and Cognitive Trajectories Before Dementia: Results from Gait and Brain Study

Montero‐Odasso

Speechley

Hunter

et al. 2018

J American Geriatrics Society

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OBJECTIVES:To compare the trajectories of motor and cognitive decline in older adults who progress to dementia with the trajectories of those who do not. To evaluate the added value of measuring motor and cognitive decline longitudinally versus cross-sectionally for predicting dementia. DESIGN: Prospective cohort study with 5 years of follow-up. SETTING: Clinic based at a university hospital in London, Ontario, Canada. PARTICIPANTS: Community-dwelling participants aged 65 and older free of dementia at baseline (N5154). MEASUREMENTS: We evaluated trajectories in participants' motor performance using gait velocity and cognitive performance using the MoCA test twice a year for 5 years. We ascertained incident dementia risk using Cox regression models and attributable risk analyses. Analyses were adjusted using a time-dependent covariate. RESULTS: Overall, 14.3% progressed to dementia. The risk of dementia was almost 7 times as great for those whose gait velocity declined (hazard ratio (HR)56.89, 95% confidence interval (CI)52.18-21.75, p5.001), more than 3 times as great for those with cognitive decline (HR53.61, 95% CI51.28-10.13, p5.01), and almost 8 times as great in those with combined gait velocity and cognitive decline (HR57.83, 95% CI52.10-29.24, p5.002), with an attributable risk of 105 per 1,000 person years. Slow gait at baseline alone failed to predict dementia (HR51.16, 95% CI50.39-3.46, p5.79). CONCLUSION: Motor decline, assessed according to serial measures of gait velocity, had a higher attributable risk for incident dementia than did cognitive decline. A decline over time of both gait velocity and cognition had the highest attributable risk. A single time-point assessment was not sufficient to detect individuals at high risk of dementia. J Am Geriatr Soc 2018.Key words: cognition; gait velocity; cohort study; dementia; trajectories M otor and cognitive decline frequently occur as we age, and can lead to disability. [1][2][3] Studies have shown that the coexistence of motor and cognitive impairment are prevalent in older adults at risk of dementia 4,5 , but little is known about their natural trajectories before dementia. Cognitive decline precedes progression to dementia by several years, and emerging evidence shows that motor decline, particularly in gait velocity, can precede cognitive decline by more than a decade. 4,[6][7][8][9] This evidence guides our conceptual framework (Figure 1) for untangling the unknown behavior of independent and combined trajectories of motor and cognitive decline in those who progress to dementia and those who do not.The added value of serial over single assessments of motor and cognitive performance and whether serial assessments would improve prediction of conversion to dementia has not been previously evaluated. With limited exceptions, previous studies assessing both types of decline From the *Gait and Brain Lab, Parkwood Institute,

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Aging, the Central Nervous System, and Mobility in Older Adults: Neural Mechanisms of Mobility Impairment

Cited by 101 publications

References 45 publications

Association between Various Brain Pathologies and Gait Disturbance

Association between Various Brain Pathologies and Gait Disturbance

Combining Gait Speed and Recall Memory to Predict Survival in Late Life: Population‐Based Study

Motor and Cognitive Trajectories Before Dementia: Results from Gait and Brain Study

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