Poor Gait Performance and Prediction of Dementia: Results From a Meta-Analysis

Abstract

Background Poor gait performance predicts risk of developing dementia. No structured critical evaluation has been conducted to study this association yet. The aim of this meta-analysis was to systematically examine the association of poor gait performance with incidence of dementia. Methods An English and French Medline search was conducted in June 2015, with no limit of date, using the medical subject headings terms “Gait” OR “Gait Disorders, Neurologic” OR “Gait Apraxia” OR “Gait Ataxia” AND “Dementia” OR “Frontotemporal Dementia” OR “Dementia, Multi-Infarct” OR “Dementia, Vascular” OR “Alzheimer Disease” OR “Lewy Body Disease” OR “Frontotemporal Dementia With Motor Neuron Disease” (Supplementary Concept). Poor gait performance was defined by standardized tests of walking, and dementia was diagnosed according to international consensus criteria. Four etiologies of dementia were identified: any dementia, Alzheimer disease (AD), vascular dementia (VaD), and non-AD (ie, pooling VaD, mixed dementias, and other dementias). Fixed effects meta-analyses were performed on the estimates in order to generate summary values. Results Of the 796 identified abstracts, 12 (1.5%) were included in this systematic review and meta-analysis. Poor gait performance predicted dementia [pooled hazard ratio (HR) combined with relative risk and odds ratio = 1.53 with P < .001 for any dementia, pooled HR = 1.79 with P < .001 for VaD, HR = 1.89 with P value < .001 for non-AD]. Findings were weaker for predicting AD (HR = 1.03 with P value = .004). Conclusions This meta-analysis provides evidence that poor gait performance predicts dementia. This association depends on the type of dementia; poor gait performance is a stronger predictor of non-AD dementias than AD.

Association between middle- to late-life physical performance and incident Alzheimer's disease: Recent findings and potential mechanisms

“…A relative risk (RR) including hazard ratio (HR) and odds ratio (OR) for poorer gait performance ranged from 1.37 (95% confidence interval [95%CI]: 1.05-1.78) 13) to 3.46 (95%CI: 1.88-6.40) 23) . The same association was also found in one study that examined a timed walk score as a supplementary exposure variable 11) and in a meta-analysis study 21) . This meta-analysis included pooled samples of 23,512 non-demented participants aged 60 years or older and found that those with poorer gait performance at baseline had an approximately 53% increased risk for incident total dementia when compared to their normal counterparts (HR: 1.53, 95%CI: 1.42-1.65) 21) .…”

“…After a literature search conducted in a quasi-systematic manner, 15 papers, including 14 prospective cohort studies [9][10][11][12][13][14][15][16][17][18][19][20]22,23) and one meta-analysis study 21) , were identified and are summarized in Table 1. Overall, most studies examined participants older than 70 years of age at baseline except two studies recruiting middle-aged participants 17,18) .…”

“…Overall, most studies examined participants older than 70 years of age at baseline except two studies recruiting middle-aged participants 17,18) . Baseline cognitive status was reported in 13 studies [9][10][11][12][13][14][15][16][19][20][21][22][23] . In these studies, participants were non-demented at baseline, but two studies included individuals with mild cognitive impairment (MCI) at baseline as a small part of the participants 11,21) .…”

“…Baseline cognitive status was reported in 13 studies [9][10][11][12][13][14][15][16][19][20][21][22][23] . In these studies, participants were non-demented at baseline, but two studies included individuals with mild cognitive impairment (MCI) at baseline as a small part of the participants 11,21) . Another two studies didn't examine baseline cognitive status while their participants were relatively young at baseline (average ages: 43.5 and 49.8 years) and probably unlikely to be demented 17,18) .…”

“…Another two studies didn't examine baseline cognitive status while their participants were relatively young at baseline (average ages: 43.5 and 49.8 years) and probably unlikely to be demented 17,18) . Regarding the cognitive outcome measures in the studies identified, three used the incidence of AD 12,14,19) , two used the incidence of total dementia which includes AD 18,20) , seven included both incidences [9][10][11]13,16,21,22) , and one used the combined incidence of AD and MCI 15) . Another two studies didn't directly address the incidence of AD and/or total dementia, but that of related events: mortalities due to AD/total dementia 17) and "disabling dementia" based on an evaluation for older people with dementia administered in the Japanese long-term care insurance system 23) .…”