Journal
EXPERIMENTAL GERONTOLOGY
Volume 129, Issue -, Pages -Publisher
PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.exger.2019.110783
Keywords
Cognition; Dementia; Walking speed; Multistate modeling
Categories
Funding
- U.S. National Institute on Aging of the National Institutes of Health, Integrative Analysis of Longitudinal Studies of Aging and Dementia (IALSA) [P01AG043362]
- Intramural Research Program at the National Institute on Aging
- Swedish Research Council [2015-02830]
- Swedish Research Council for Health, Working Life and Welfare [2010-0870, 2013-1202, 2013-2300, 2013-2496, 2013-0475, 2018-00471]
- Hjarnfonden
- Alzheimerfonden
- Alzheimer's Association [IIRG-00-2159]
- Swedish government [ALF 716681]
- Italian Ministry of Health [ICS110.1/RF97.71]
- U.S. National Institute on Aging, Bethesda, Maryland [236 MD 916413, 236 MD 821336]
- U.S. National Institute on Aging [N.1-AG-1-1, N.1-AG-1-2111, N01-AG-5-0002]
- Netherlands Ministry of Health, Welfare and Sports, Directorate of Long-Term Care
- NWO/ZonMw Veni fellowship [91618067]
- NATIONAL INSTITUTE ON AGING [ZIAAG001050] Funding Source: NIH RePORTER
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Objectives: Very few studies looking at slow gait speed as early marker of cognitive decline investigated the competing risk of death. The current study examines associations between slow gait speed and transitions between cognitive states and death in later life. Methods: We performed a coordinated analysis of three longitudinal studies with 9 to 25 years of follow-up. Data were used from older adults participating in H70 (Sweden; n = 441; aged >= 70 years), InCHIANTI (Italy; n = 955; aged >= 65 years), and LASA (the Netherlands; n = 2824; aged >= 55 years). Cognitive states were distinguished using the Mini-Mental State Examination. Slow gait speed was defined as the lowest sex-specific quintile at baseline. Multistate models were performed, adjusted for age, sex and education. Results: Most effect estimates pointed in the same direction, with slow gait speed predicting forward transitions. In two cohort studies, slow gait speed predicted transitioning from mild to severe cognitive impairment (InCHIANTI: HR = 2.08, 95%CI = 1.40-3.07; LASA: HR = 1.33, 95%CI = 1.01-1.75) and transitioning from a cognitively healthy state to death (H70: HR = 3.30, 95%CI = 1.74-6.28; LASA: HR = 1.70, 95%CI = 1.30-2.21). Conclusions: Screening for slow gait speed may be useful for identifying older adults at risk of adverse outcomes such as cognitive decline and death. However, once in the stage of more advanced cognitive impairment, slow gait speed does not seem to predict transitioning to death anymore.
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