麻豆传媒

A combined drop in both walking speed and cognitive function was tied to an increased risk of dementia, a study of nearly 17,000 older adults showed.

Dual decline in gait speed and cognition carried a higher risk of dementia than either gait-only decline or cognitive-only decline, reported Taya Collyer, PhD, of Monash University in Victoria, Australia, and co-authors, in .

Dementia risk was highest in people who had slower gait speeds coupled with lower memory scores over time.

"Slowing gait and failing memory may be the best combination of clinical measures to identify people at risk of future dementia," co-author Michele Callisaya, PhD, of the National Center for Healthy Aging at Monash University and Peninsula Health, told 麻豆传媒.

"By the time a diagnosis of dementia is made, there's already been a substantial buildup of pathology in the brain," Callisaya said. "It's important to identify at-risk individuals early to address modifiable risk factors for dementia prevention and start new treatments as they become available."

"Gait speed is quick to measure and only requires a measured distance and a stopwatch," she pointed out. "Slowing of more than 0.05 meters per second per year should trigger a more comprehensive assessment."

Gait evaluations often are not performed in clinics, noted Joe Verghese, MD, of Albert Einstein College of Medicine in New York City, in an .

"Despite the established predictive validity of gait assessments for geriatric syndromes, an implementation barrier for routine gait assessment in clinics exists that needs to be addressed to improve care of older patients," Verghese observed.

Traditionally, gait dysfunction has not been considered an early clinical feature of Alzheimer's disease and was seen more as a marker of non-Alzheimer's pathology, Verghese noted.

"However, systematic longitudinal studies and finer-grain analysis of gait performance in the context of cognitive decline is calling this view into question," he wrote. A recent exploratory study suggested Alzheimer's and Lewy body disease have unique signatures of gait impairment that may reflect underlying pathology, for example.

Collyer and colleagues analyzed data from 16,885 participants in the trial of low-dose aspirin, which ran from 2010 to 2017 in the U.S. and Australia. Mean age of participants was 75 and 56% were women.

At baseline and at years 2, 4, 6, and study close-out, participants had gait speed measured by completing two walks of 3 meters each. Gait decline was defined as a drop in speed of at least 0.05 meters/second/year across the study.

At baseline and years 1, 3, 5, and close-out, participants underwent four different cognitive assessments: the Modified Mini-Mental State Examination to measure global cognitive function, the Hopkins Verbal Learning Test Revised to assess memory, the Controlled Oral Word Association Test for verbal fluency, and the Symbol Digit Modalities Test for processing speed. Cognitive decline was defined as the the lowest tertile of annual change.

Compared with non-decliners, dementia incidence was highest in people who had declines in both gait and memory (HR 24.7), followed by gait and global cognition (HR 22.2), gait and verbal fluency (HR 4.7), and gait and processing speed (HR 4.3).

"Importantly, we answer the question as to whether dual decline in gait speed and a test of processing speed or verbal fluency exhibits a similar association with progression to dementia as decline in memory (delayed recall) or global cognition," Collyer and co-authors wrote.

The analysis had a few limitations, the researchers noted. Gait and cognition were measured at separate time points throughout the study. ASPREE participants also were healthier than many older adults, and results might not apply to other populations.

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