Disability trajectories and mortality in older adults with different cognitive and physical profiles

Abstract

Background Cognitive and physical deficits independently raise the risk for negative events in older adults. Less is known about whether their co-occurrence constitutes a distinct risk profile. This study quantifies the association between cognitive impairment, no dementia (CIND), slow walking speed (WS) and their combination and disability and mortality. Methods We examined 2546 dementia-free people aged ≥ 60 years, part of the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) up to 12 years. The following four profiles were created: (1) healthy profile; (2) isolated CIND (scoring 1.5 SD below age-specific means on at least one cognitive domain); (3) isolated slow WS (< 0.8 m/s); (4) CIND+ slow WS. Disability was defined as the sum of impaired activities of daily living and trajectories of disability were derived from mixed-effect linear regression models. Piecewise proportional hazard models were used to estimate mortality rate [hazard ratios (HRs)]. Population attributable risks of death were calculated. Results Participants with both CIND and slow WS had the worst prognosis, especially in the short-term period. They experienced the steepest increase in disability and five times the mortality rate (HR 5.1; 95% CI 3.5-7.4) of participants free from these conditions. Similar but attenuated results were observed for longer follow-ups. Co-occurring CIND and slow WS accounted for 30% of short-term deaths. Conclusions Co-occurring cognitive and physical limitations constitute a distinct risk profile in older people, and account for a large proportion of short-term deaths. Assessing cognitive and physical function could enable early identification of people at high risk for adverse events.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Associations between post-stroke motor and cognitive function: a cross-sectional study

“…In the present study, we have demonstrated that, although the patients suffered mainly mild strokes with low NIHSS scores, cognitive and motor impairments as well as concurrent impairments are prevalent, as the majority of patients with impaired MoCA scores also had impaired SPPB scores and vice versa. Concurrent motor and cognitive impairments have been shown to predict poor prognosis as, for example, an increased risk of developing dementia in stroke-free populations [43,44], and there is reason to believe that these impairments can impact recovery and everyday life [45]. Therefore, we believe that, as part of the routine follow-up protocol after stroke, assessments of cognition and global motor functions should be performed to gain more information that may be relevant for prognosis and may indicate a need for continued rehabilitation even 3 months after a stroke [45].…”

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“…We found higher walking speed to attenuate decline in odor identification, an effect that persisted when excluding participants who converted to dementia. Gait speed represents an important marker of general physical condition ( 22 ). As such, gait speed may reflect overall health in a similar manner as the state of the olfactory system ( 40 ).…”

“…Neurological/psychiatric predictors encompassed current diagnosis of depression (ICD-10 F32) and history of head trauma (ICD-10 S06). Gait speed (m/s) was included as a measure of mobility and general health status ( 22 ) and assessed by asking participants to walk 6 m at their usual speed. Participants who reported difficulties walking, or for whom the assessment had to be carried out in a restricted space, were asked to walk 2.4 m. We further considered polypharmacy, measured as total number of medications ( 23 ).…”

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“…Concurrent motor and cognitive impairments have been shown to predict poor prognosis as, for example, an increased risk of developing dementia (44,45), and there is reason to believe that these impairments can impact recovery and everyday life (46). Therefore, we believe that, as part of the routine follow-up protocol after stroke, assessments of cognition and global motor functions should be performed to gain more information that may be relevant for prognosis and may indicate a need for continued rehabilitation even three months after a stroke (46).…”