Decreased gait and cognition, especially memory, are linked to an increased risk of dementia, new research suggests.
In a large study of more than 16,000 participants, this double decline was associated with a significantly higher risk of dementia than gait-only decline or cognitive decline.
The findings underscore the importance of adding gait measures to dementia screening assessments, the researchers note.
Dr. Michele Callisaya
“Measuring gait speed is really simple, cheap, and fast; and the test can be used in the clinic along with a cognitive screen to see if someone is at risk for dementia,” said study researcher Michele L. Callisaya. PhD, Associate Professor, The National Center for Healthy Aging, Monash University and the Peninsula Clinical School, Victoria, Australia, told Medscape Medical News.
He added that, unlike previous research, this new study examined gait speed and cognition over time with regard to dementia and examined various cognitive domains.
The findings were posted online on May 31 at the JAMA Network Open.
No “luxury equipment” required.
The data were collected as part of ASPREE (ASPirin in Reducing Events in the Elderly), a randomized, placebo-controlled trial of low-dose (100 mg) aspirin daily in elderly people living in the disease-free community. cardiovascular disease, dementia or physical disability. . ASPREE was held in the US and Australia from 2010 to 2017.
The researchers measured gait speed in meters per second on face-to-face visits at baseline and every 2 years until the end of the study. They used the average of two three-meter walks at a usual pace for analysis.
Callisaya noted that gait speed measurements do not require “luxury equipment”: just a stopwatch is enough. In addition, measurements can be performed at any clinic by general practitioners, physiotherapists, or other health care personnel.
The researchers also assessed cognition at the beginning and every 2 years until the end of the study.
The analysis included four different measures. Global cognitive function was measured with the Mini-Mental State Examination (3MS), delayed free memory, or memory with the revised Hopkins verbal learning test (HVLT-R-delay), and processing speed with the symbol digit modalities (SDMT), and verbal fluency with the word-controlled oral association test: one-letter version (COWAT-F).
Dementia was the main result. The researchers incorporated a “very strict” classification of dementia that included doctors’ reports; The dementia was attributed to a group of experts who used the DSM-IV criteria, Callisaya said.
In terms of gait, a cut-off point of 0.05 m / s or more per year was used to distinguish participants who experienced decreased gait from those who did not. Callisaya said that cut-off point represents “a clinically significant change.” Participants were classified as having experienced a cognitive decline if they were in the lowest annual change tertile in the 3MS, HVLT-R-delay, SDMT, or COWAT-F score.
For each of these cognitive categories, participants were classified into four groups based on the pattern of decline: no decrease, only cognitive decline, only decrease in gait speed, and dual decline, which was defined as a simultaneous decrease in both gait and cognition.
The analysis included 16,855 participants (mean age, 75 years; 56% women). Of these, 44.8% reported education levels of 12 years or older. Researchers have adjusted to demographics, country, and initial gait speed and cognitive score.
The riskiest combination
Compared with participants who did not experience any decline, the risk of dementia was higher in participants who experienced decreases in both gait and memory, as measured by HVLT-R (risk ratio). ). [HR], 24.9; 95% CI, 16.5 – 37.6), followed by those with decreased both gait and cognitive function at 3MS (HR, 22.2; 95% CI, 15.0 – 32.9 ), both gait and verbal fluency in COWAT-F (HR, 4.7; 95% CI, 3.5 – 6.3), and both gait and processing speed in SDMT (HR, 4.3; 95% CI, 3.2 – 5.8; all comparisons, P <0.001).
“All dual categories had a higher risk of dementia, but it was this combination of gait and memory that had the highest risk,” Callisaya said. “Really important, I had a higher risk of dementia than just walking away or decreasing memory.”
Participants were 70 years old and “very healthy” at the start of the study, he noted. Therefore, data is important “even in healthy people.”
The speed of walking, which is a good “general measure of general health,” begins to slow when people are between 50 and 60 years old, said Callisaya, who has training in physical therapy and calls himself a fan of march “.
Experts recommend that gait be regularly assessed in general practice with respect to the risk of falls. Walking speed can be added to a memory or cognitive screen “to give a better idea of whether a patient is at increased risk for dementia,” Callisaya said. “It’s also a great way to keep track of how someone is doing over time.”
He noted that if a patient’s speed is slowed down, doctors may consider “all those preventative interventions that we know are important to reduce the risk of dementia, such as exercise, diet, and blood pressure and diabetes and obesity. “
Does it include routine assessments?
In an editorial, Joe Verghese, MD, professor of neurology and medicine and head of the cognitive and motor aging (neurology) and geriatrics (medicine) divisions at Albert Einstein College of Medicine in New York City, notes that the study “highlights the clinical relevance of identifying markers of dementia progression in the elderly.”
Despite the predictive validity of gait assessments in the geriatric population, there is a “barrier to implementation for routine gait assessment in clinics” that “needs to be addressed to improve care for older patients.” he writes.
Verghese told Medscape Medical News that one way to remove this barrier is to put “the time and space available to conduct gait assessments in clinical settings.”
He agreed with Callisaya that the assessments of gait speed “are brief and do not require elaborate equipment or even a doctor to administer.”
Assessments of gait speed, which predict not only dementia but also falls, disability, and other geriatric syndromes, should be included as a “vital sign,” such as heart rate or blood pressure, in l ‘routine assessment of all geriatric patients,’ concluded Verghese. .
The ASPREE trial received funding from the US National Institute on Aging and the Australian National Health and Medical Research Council. AG Bayer provided matching aspirin and placebo for the trial. Callisaya has not reported any relevant financial reports. Verghese has received funding from the National Institutes of Health and served on the advisory board of Catch-U, Inc. and MedRhythms, Inc.
JAMA Netw Open. Published online May 31, 2022. Full article, Editorial
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