Motor function and incident dementia: a systematic review and meta-analysis

Kueper, Jacqueline K; Speechley, Mark; Lingum, Navena R.; Montero‐Odasso, Manuel

doi:10.1093/ageing/afx084

Cited by 97 publications

(98 citation statements)

References 23 publications

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“…Serial assessments of motor performance seem to be critical for early detection of risk of dementia, particularly in older adults with initial normal gait velocity . Despite early studies showing that motor decline trajectories were more likely to be associated with non‐Alzheimer's dementias, mounting evidence suggests that motor impairment and declines are also associated with AD, which is aligned with our finding that 86% of participants who progressed to dementia progressed to AD …”

Section: Discussionsupporting

confidence: 83%

“…[6][7][8]10 Recent meta-analyses have also confirmed a longitudinal relationship between physical and motor function and cognition in aging independent of important comorbidities. 12,33 Our study provides new evidence that motor and cognitive declines are common in individuals who progress to dementia, who have twice the prevalence of those who do not progress. 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.…”

Section: Discussionmentioning

confidence: 73%

“…Previous population‐based cohort studies have shown decline in motor and cognitive function with aging, and in few of them, decline in gait performance preceded cognitive decline . Recent meta‐analyses have also confirmed a longitudinal relationship between physical and motor function and cognition in aging independent of important comorbidities …”

Section: Discussionmentioning

confidence: 99%

“…14,42 Despite early studies showing that motor decline trajectories were more likely to be associated with non-Alzheimer's dementias, 5,45 mounting evidence suggests that motor impairment and declines are also associated with AD, which is aligned with our finding that 86% of participants who progressed to dementia progressed to AD. 2,5,9,28,33,44,46,47 We have identified 2 patterns of declining trajectories, both associated with progression to dementia. In our cohort, the risk of progression to dementia was higher for motor than cognitive decline.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…Gait speed tests and timed "up and go tests" have been used extensively to identify early motor impairment in several conditions, and the association between these measures and future falls and hospitalization has been well established. [28][29][30]36,41,[44][45][46][47][48] In particular, slow gait speed has been consistently associated with the development of Alzheimer's disease, [49][50][51] even in its early stages, that is, with cerebral Αβ deposition. 52 Objective motor function in our study, as captured by the 1-m and 4-m gait tests, was associated with the pPD probability score even when calculated excluding UPDRSIII and even when participants with dementia or both dementia and MCI or with previous stroke were excluded from the analysis.…”

Section: Discussionmentioning

confidence: 99%

Motor function and the probability of prodromal Parkinson's disease in older adults

et al. 2019

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Background Identification and characterization of Parkinson's disease (PD) in its prodromal stage is crucial. Objective The objective of this study was to investigate the association between motor function and the probability of prodromal PD in a community‐dwelling older population. Methods We used data from a population‐based cohort of older adults (HELIAD study). Subjective motor function was evaluated with a 12‐item motor symptoms questionnaire and objective motor function indirectly with a physical activity questionnaire and two gait speed tests. The probability of prodromal PD was calculated according to the Movement Disorder Society research criteria for n = 1731 without PD. Regression multiadjusted models were used to investigate the associations between each motor measure and prodromal PD probability. Results For each unit increase in motor symptoms score and for each kcal/kg/day lower energy expenditure (corresponding to 20 minutes of light walking/day for a 75‐kg man) there was a 27% and 3% higher probability for prodromal PD, respectively (P < 0.001). Having at least one subjective motor symptom increased the odds of having possible/probable prodromal PD (n = 49; P < 0.05). Including subjective and indirect motor variables in the same model showed that both (symptoms and physical activity) contributed significantly to the model (P < 0.01). Excluding subthreshold parkinsonism from the calculation showed that gait speed less than 0.8 m/s was also associated with a higher prodromal PD probability score (P < 0.001). Conclusions Subjective motor symptoms as well as simple objective motor measures of physical activity or gait speed are associated with a higher probability of prodromal PD in older adults. These data may serve to enable the early identification of prodromal PD cohorts, particularly if they are confirmed in longitudinal studies. © 2019 International Parkinson and Movement Disorder Society

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Association of Dual Decline in Memory and Gait Speed With Risk for Dementia Among Adults Older Than 60 Years

et al. 2020

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IMPORTANCE Dual decline in both memory and gait speed may characterize a group of older individuals at high risk for future dementia. OBJECTIVE To assess the risk of dementia in older persons who experience parallel declines in memory and gait speed compared with those who experience no decline or decline in either memory or gait speed only. DESIGN, SETTING, AND PARTICIPANTS A multicohort meta-analysis was performed of 6 prospective cohort studies conducted between 1997 and 2018 in the United States and Europe. Participants were 60 years or older, had an initial gait speed of more than 0.6 m/s (ie, free of overt dismobility), with repeated measures of memory and gait speed before dementia diagnosis during a mean follow-up of 6.6 to 14.5 years. Within each study, participants were divided into 4 groups: memory decline only, gait speed decline only, dual decline, or no decline (hereafter referred to as usual agers). Gait decline was defined as a loss of 0.05 m/s or more per year; memory decline was defined as being in the cohort-specific lowest tertile of annualized change. MAIN OUTCOMES AND MEASURES Risk of incident dementia according to group membership was examined by Cox proportional hazards regression with usual agers as the reference, adjusted for baseline age, sex, race/ethnicity, educational level, study site, and baseline gait speed and memory. RESULTS Across the 6 studies of 8699 participants, mean age ranged between 70 and 74 years and mean gait speed ranged between 1.05 and 1.26 m/s. Incident dementia ranged from 5 to 21 per 1000 person-years. Compared with usual agers, participants with only memory decline had 2.2 to 4.6 times higher risk for developing dementia (pooled hazard ratio, 3.45 [95% CI, 2.45-4.86]). Those with only gait decline had 2.1 to 3.6 times higher risk (pooled hazard ratio, 2.24 [95% CI, 1.62-3.09]). Those with dual decline had 5.2 to 11.7 times the risk (pooled hazard ratio, 6.28 [95% CI, 4.56-8.64]). CONCLUSIONS AND RELEVANCE In this study, dual decline of memory and gait speed was associated with increased risk of developing dementia among older individuals, which might be a potentially valuable group for preventive or therapeutic interventions. Why dual decline is associated with an elevated risk of dementia and whether these individuals progress to dementia through specific mechanisms should be investigated by future studies.

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Motor function and incident dementia: a systematic review and meta-analysis

Cited by 97 publications

References 23 publications

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

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

Motor function and the probability of prodromal Parkinson's disease in older adults

Association of Dual Decline in Memory and Gait Speed With Risk for Dementia Among Adults Older Than 60 Years

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