Modifiable Risk Factors for New-Onset Slow Gait in Older Adults

Associations between neuropsychiatric symptoms and motoric cognitive risk syndrome

INTRODUCTION

We examined the association between neuropsychiatric symptoms (NPS) and motoric cognitive risk syndrome (MCR), a predementia condition indicating a higher risk for dementia.

METHODS

A sample of 2800 older adults (≥ 65 years) was analyzed using binomial logistic regression to investigate the cross-sectional relationship between specific NPS and MCR. Additionally, a longitudinal analysis involving 1352 adults explored whether baseline NPS predicted incident MCR risk.

RESULTS

Subjects with MCR exhibited higher prevalence of NPS. The most common NPS in MCR were affective symptoms: apathy (71.5%), anxiety (55.4%), and depression (45.7%). The prevalence of specific NPS in MCR was higher for hallucinations (OR = 1.76, 95% CI = 1.23-2.51), sleep impairment (OR = 1.40, 95% CI = 1.14-1.73), apathy (OR = 3.31, 95% CI = 2.67-4.10), delusions (OR = 1.88, 95% CI = 1.25-2.84), irritability (OR = 1.98, 95% CI = 1.56-2.53), depression (OR = 1.71, 95% CI = 1.49-1.98), and anxiety (OR = 1.92, 95% CI = 1.62-2.28). Longitudinally, baseline apathy (OR = 1.68, 95% CI = 1.17-2.42), depression (OR = 1.70, 95% CI = 1.31-2.21), and anxiety (OR = 1.68, 95% CI = 1.23-2.31) significantly predicted incident MCR (p < 0.005).

CONCLUSIONS

Findings suggest that apathy, depression, and anxiety are predictive of MCR, underscoring the importance of NPS screening in identifying individuals at risk. Early detection could facilitate the development of interventions to prevent dementia.

Association between sensory impairment and sarcopenia in older Chinese adults: a 4-Year longitudinal study

OBJECTIVES

Sarcopenia is a common geriatric syndrome that significantly increases the risk of falls, fractures, disability, and death in older adults. Sensory impairments are also prevalent among the elderly and may exacerbate the decline in physical function, even affecting muscle health. Understanding whether sensory impairments are risk factors affecting sarcopenia in older adults is crucial for developing effective public health policies and intervention strategies. Therefore, this study aims to explore the association between sensory impairments and sarcopenia and its components.

METHODS

This study, based on the Chinese Health and Retirement Longitudinal Study (CHARLS), included 4,195 participants aged 60 and above. The assessment of sensory impairment was based on self-reported visual and hearing capabilities. The diagnosis of sarcopenia followed the consensus of the Asian Working Group on Sarcopenia (AWGS) from 2019. Data analysis was conducted using an ordered logistic regression model, and the results report the odds ratios (ORs) and their 95% confidence intervals (CI).

RESULTS

Single sensory impairments at baseline showed no significant correlation with sarcopenia four years later, while dual sensory impairments (DSI) at baseline were significantly associated with sarcopenia (ORs: 1.308, 95% CI: 1.126-1.519). In the analysis of trends over time, transitions from no sensory impairments (NSI) to DSI (ORs: 1.372, 95% CI: 1.028-1.830), from hearing impairments (HI) to DSI (ORs: 1.334, 95% CI: 1.002-1.778), and persistent DSI (ORs: 1.470, 95% CI: 1.159-1.864) were all significantly associated with sarcopenia. Additionally, we found DSI is associated with poor physical performance and muscle mass but not muscle strength.

CONCLUSIONS

Our study indicates that DSI have a more severe impact on sarcopenia compared to single sensory impairments. Our findings offer a new perspective for prevention and intervention strategies, suggesting the inclusion of sensory impairment assessments in the clinical evaluation of sarcopenia risk. For elderly individuals with DSI, comprehensive intervention measures should be provided, such as sensory rehabilitation, nutritional support, and guidance on physical activities. For those with only a single sensory impairment, proactive preventive measures should be taken to prevent the progression to DSI.

Menopause-Specific Quality of Life among Rural Women: A Community-based Cross-sectional Study in Kerala, India

Aim and Objectives

The health of women in the menopausal age is often ignored by most healthcare programs in countries like India. The aim of this study is to estimate the prevalence and pattern of menopause-specific quality of life (MENQOL) and associated factors of rural women in Kerala, India.

Materials and Methods

A cross-sectional community-based study was conducted among menopausal women in the Thiruvananthapuram district of Kerala using a multistage random sampling method. We collected details of basic sociodemographic and reproductive problems using a pretested semi-structured questionnaire. MENQOL questionnaire was used to measure the quality of life.

Results

We surveyed 250 women in the age group of 48-60 years. The average score of the overall quality of life was 12.4 ± 4.3. The mean MENQOL score was significantly poor for those with lower socioeconomic status (SES), those who had any morbidity, those who had bad perceived health status, and inactive women compared to their counterparts. The majority of women (92%) used self-care to alleviate their menopause symptoms. Women of lower SES, with any morbidity, poor perceived health status, and inactive, were more likely to report more symptoms in all domains (vasomotor, physical, and psychological). In addition, employed women reported more vasomotor and psychological symptoms compared to their counterparts.

Conclusion

Menopausal symptoms are common in the population studied, and self-care is the main strategy for alleviating these symptoms. It is important to educate women about common menopause symptoms and the importance of receiving proper medical care.

Self-reported physical activity and gait in older adults without dementia: A longitudinal study

Background and Aims

Physical activity (PA) is associated with higher gait speed. We aimed to examine the associations between PA and change in spatial and temporal gait measures as well as fall risk in community-dwelling individuals free of dementia.

Methods

Longitudinal study among 4173 individuals aged ≥50 years (mean age 71 years; 2078 males; median follow-up 4 years) enrolled in the Mayo Clinic Study of Aging. Self-reported late-life PA was used to calculate overall PA and moderate-vigorous PA (MVPA) scores. Gait was assessed using GAITRite® and Zeno™ systems. Incident falls information was based on diagnostic codes retrieved from medical records. We ran linear mixed effects models to examine associations between z-scored PA variables and longitudinal gait parameters, adjusted for age, sex, education, body mass index (BMI), medical comorbidities, and including interactions between PA and time since baseline. In secondary analyses, we calculated Cox Proportional hazard models with age as time scale predicting incident falls by PA, adjusting for sex, education, BMI, medical comorbidities, and falls history.

Results

At baseline, higher PA was associated with higher velocity (overall PA: estimate 2.9935; MVPA: 2.2961; p < 0.001), higher cadence (overall PA: 1.0665; MVPA: 0.9073; p < 0.001), greater stride length (overall PA: 2.0805; MVPA: 1.4726; p < 0.001), shorter double support time (overall PA: -0.0257; MVPA: -0.0205; p < 0.001), and lower stance time variability (overall PA: -0.0204, p < 0.001; MVPA: -0.0152; p = 0.006). Overall PA was longitudinally associated with less decline in cadence, and MVPA with less increase in intraindividual stance time variability. Overall PA (Hazard ratio 0.892, 95% confidence interval 0.828-0.961, p = 0.003) and MVPA (HR 0.901; 95% CI 0.835-0.973, p = 0.008) were associated with a decreased risk of incident falls.

Conclusion

Late-life PA was associated with favorable gait outcomes and decreased risk of incident falls. Thus, late-life PA may help to maintain gait performance and decrease fall risk in old age.

Purpose in life and slow walking speed: cross-sectional and longitudinal associations

The present research examines the association between purpose in life - a component of well-being defined as the feeling that one's life is goal-oriented and has direction - and slow walking speed and the risk of developing slow walking speed over time. Participants (N = 18,825) were from three established longitudinal studies of older adults. At baseline, participants reported on their purpose in life, and interviewers measured their usual walking speed. Walking speed was measured at annual or biannual follow-up waves up to 16 years later. Random-effects meta-analysis was used to summarize the estimates from the individual studies. Every standard deviation higher in purpose in life (as a continuous measure) was associated with a lower likelihood of cross-sectional slow walking speed at baseline (meta-analytic OR = .80, 95% CI = .77-.83). Among participants who did not have slow walking speed at baseline (n = 8,448), every standard deviation higher purpose in life was associated with a lower likelihood of developing slow walking speed over the up to 16 years of follow-up (meta-analytic HR = .93, 95% CI = .89-.96). Physical activity and disease burden accounted for 25% and 14% of the cross-sectional and longitudinal associations, respectively. The associations were independent of age, sex, race, ethnicity, and education and not moderated by these factors. Higher purpose in life is associated with a lower risk of slow walking speed and a lower risk of developing slow walking speed over time. Purpose in life is a psychological resource that may help to support aspects of physical function, such as walking speed, and may help support better function with age.

The clinical characteristics of cerebral small vessel disease patients with motoric cognitive risk syndrome during single- and dual-task walking

Objective

We aimed to (1) identify neuroimaging biomarkers of distinguishing motoric cognitive risk syndrome (MCRS) risk among older Chinese adults with cerebral small vessel disease (CSVD) and (2) detect differences in gait parameters and neuroimaging biomarkers between CSVD individual with and without MCRS, especially during dual-task walking (DTW).

Methods

We enrolled 126 inpatients with CSVD who were divided into two groups according to MCRS status. Data on basic parameters, variability, asymmetry, and coordination were collected during single-task walking (STW) and DTW. Neuroimaging features (white matter hyperintensities, lacunes, and microbleeds) and total disease burden were calculated. Analysis of variance and logistic regression analyses were applied to assess the role of STW, DTW, and neuroimaging biomarkers in MCRS.

Results

In total, 126 consecutive inpatients with CSVD were included (84 and 42 patients were classified as MCRS-negative and MCRS-positive, respectively). The MCRS-positive group showed poorer performance for nearly all gait parameters compared with the MCRS-negative group during cognitive DTW. Meanwhile, all gait parameters except asymmetry were assessed in participants with MCRS for significant deterioration during cognitive DTW compared with that during STW. However, only basic parameters differed between STW and cognitive DTW in participants without MCRS. A significant independent association between total CSVD scores and MCRS was also detected.

Conclusions

For CSVD patients, with higher total CSVD burden rather than any single neuroimaging marker, was linked to a greater risk of MCRS. In addition, CSVD individuals with MCRS had higher variability and phase coordination index (PCI), especially in cognitive DTW. Thus, they should concentrate more on their gait variability or coordination and reduce secondary task loads while walking in daily life, especially in cognitive secondary tasks.

Epidemiology of Motoric Cognitive Risk Syndrome in the Kerala Einstein Study: Protocol for a Prospective Cohort Study

BACKGROUND

The southern India state of Kerala has among the highest proportion of older adults in its population in the country. An increase in chronic age-related diseases such as dementia is expected in the older Kerala population. Identifying older individuals early in the course of cognitive decline offers the best hope of introducing preventive measures early and planning management. However, the epidemiology and pathogenesis of predementia syndromes at the early stages of cognitive decline in older adults are not well established in India.

OBJECTIVE

The Kerala Einstein Study (KES) is a community-based cohort study that was established in 2008 and is based in the Kozhikode district in Kerala state. KES aims to establish risk factors and brain substrates of motoric cognitive risk syndrome (MCR), a predementia syndrome characterized by the presence of slow gait and subjective cognitive concerns in individuals without dementia or disability. This protocol describes the study design and procedures for this KES project.

METHODS

KES is proposing to enroll a sample of 1000 adults ≥60 years old from urban and rural areas in the Kozhikode district of Kerala state: 200 recruited in the previous phase of KES and 800 new participants to be recruited in this project. MCR is the cognitive phenotype of primary interest. The associations between previously established risk factors for dementia as well as novel risk factors (apathy and traumatic brain injury) and MCR will be examined in KES. Risk factor profiles for MCR will be compared between urban and rural residents as well as with individuals who meet the criteria for mild cognitive impairment (MCI). Cognitive and physical function, medical history and medications, sociodemographic characteristics, lifestyle patterns, and activities of daily living will be evaluated. Participants will also undergo magnetic resonance imaging and electrocardiogram investigations. Longitudinal follow-up is planned in a subset of participants as a prelude to future longitudinal studies.

RESULTS

KES (2R01AG039330-07) was funded by the US National Institutes of Health in September 2019 and received approval from the Indian Medical Council of Research to start the study in June 2021. We had recruited 433 new participants from urban and rural sites in Kozhikode as of May 2023: 41.1% (178/433) women, 67.7% (293/433) rural residents, and 13.4% (58/433) MCR cases. Enrollment is actively ongoing at all the KES recruitment sites.

CONCLUSIONS

KES will provide new insights into risk factors and brain substrates associated with MCR in India and will help guide future development of regionally specific preventive interventions for dementia.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/49933.

Artificial Intelligence Distinguishes Pathological Gait: The Analysis of Markerless Motion Capture Gait Data Acquired by an iOS Application (TDPT-GT)

Distinguishing pathological gait is challenging in neurology because of the difficulty of capturing total body movement and its analysis. We aimed to obtain a convenient recording with an iPhone and establish an algorithm based on deep learning. From May 2021 to November 2022 at Yamagata University Hospital, Shiga University, and Takahata Town, patients with idiopathic normal pressure hydrocephalus (n = 48), Parkinson's disease (n = 21), and other neuromuscular diseases (n = 45) comprised the pathological gait group (n = 114), and the control group consisted of 160 healthy volunteers. iPhone application TDPT-GT captured the subjects walking in a circular path of about 1 meter in diameter, a markerless motion capture system, with an iPhone camera, which generated the three-axis 30 frames per second (fps) relative coordinates of 27 body points. A light gradient boosting machine (Light GBM) with stratified k-fold cross-validation (k = 5) was applied for gait collection for about 1 min per person. The median ability model tested 200 frames of each person's data for its distinction capability, which resulted in the area under a curve of 0.719. The pathological gait captured by the iPhone could be distinguished by artificial intelligence.

Biological Age Acceleration and Motoric Cognitive Risk Syndrome

OBJECTIVE

Motoric cognitive risk (MCR) syndrome, a predementia syndrome characterized by slow gait and subjective cognitive concerns, is associated with multiple age-related risk factors. We hypothesized that MCR is associated with biological age acceleration. We examined the associations of biological age acceleration with MCR, and mortality risk in MCR cases.

METHODS

Biological age was determined using proteomic and epigenetic clocks in participants aged 65 years and older in the LonGenity study (N = 700, females = 57.9%) and Health and Retirement Study (HRS; N = 1,043, females = 57.1%) cohorts. Age acceleration (AgeAccel) was operationally defined as the residual from regressing predicted biological age (from both clocks separately) on chronological age. Association of AgeAccel with incident MCR in the overall sample as well as with mortality risk in MCR cases was examined using Cox models and reported as hazard ratios (HRs).

RESULTS

AgeAccel scores derived from a proteomic clock were associated with prevalent MCR (odds ratio adjusted for age, gender, education years, and chronic illnesses [aOR] = 1.36, 95% confidence interval [CI] = 1.09-1.71) as well as predicted incident MCR (HR = 1.19, 95% CI = 1.00-1.41) in the LonGenity cohort. In HRS, the association of AgeAccel using an epigenetic clock with prevalent MCR was confirmed (aOR = 1.47, 95% CI = 1.16-1.85). Participants with MCR and accelerated aging (positive AgeAccel score) were at the highest risk for mortality in both LonGenity (HR = 3.38, 95% CI = 2.01-5.69) and HRS (HR = 2.47, 95% CI = 1.20-5.10).

INTERPRETATION

Accelerated aging predicts risk for MCR, and is associated with higher mortality in MCR patients. ANN NEUROL 2023;93:1187-1197.

Physical reserve: construct development and predictive utility

BACKGROUND

Physical reserve (PR) refers to one's ability to maintain physical functioning despite age, illness, or injury. The measurement and predictive utility of PR, however, are not well established.

AIMS

We quantified PR using a residual measurement approach by extracting standardized residuals from gait speed, while accounting for demographic and clinical/disease variables, and used it to predict fall-risk.

METHODS

Participants (n = 510; age ≥ 70ys) were enrolled in a longitudinal study. Falls were assessed annually (in-person) and bimonthly (via structured telephone interview).

RESULTS

General Estimating Equations (GEE) revealed that higher baseline PR was associated with reduced odds of reporting falls over repeated assessments in the total sample, and incident falls among those without fall's history. The protective effect of PR against fall risk remained significant when adjusting for multiple demographic and medical confounders.

DISCUSSION/CONCLUSION

We propose a novel framework to assessing PR and demonstrate that higher PR is protective against fall-risk in older adults.

Risk factors for decline in gait speed during walking while talking in older adults

BACKGROUND & AIMS

Slow gait speed during Walking While Talking (walking while reciting alternate letters of the alphabet; WWT) is associated with an increased risk of developing dementia and falls. The aim of this study was to examine longitudinal changes in WWT-speed and to identify risk factors that may modify the rate of change in WWT-speed.

METHODS

A total of 431 older participants (55.7% female; M Age=76.8 ± 6.4 years; mean follow up 2.1 ± 1.8 years) enrolled in the Central Control of Mobility in Aging study were examined. WWT-speed (cm/s) was measured with a computerized walkway. The following baseline measures were examined as risk factors: demographics [age, sex, education], medical illnesses [hypertension, diabetes, cardiac arrhythmias, history of stroke, Parkinson's disease, kidney disease, arthritis], cognitive functions [global cognition, executive function, processing speed], physical and sensory functions [unipedal stance time, gait speed during single task walking, visual acuity], psychological variables [depression, anxiety] and falls. Linear mixed effect models were used to examine 1) change in WWT-speed over time, and 2) risk factors associated with change in WWT-speed over time.

RESULTS

WWT-speed declined in an accelerating non-linear fashion over time after adjusting for baseline age, sex and education. The rate of decline in WWT-speed was modified by older age (b -0.16 95%CI -0.22, -0.09), poorer balance (b -1.73 95%CI -2.57, -0.90), and faster gait speed during single task walking (b -0.06 95%CI -0.08, -0.04).

SIGNIFICANCE

This study identified fixed and modifiable risk factors of faster decline in WWT-speed over time in community-residing older adults.

Association between age-related sensory impairment with sarcopenia and its related components in older adults: a systematic review

Sensory impairments and sarcopenia are both highly prevalent age-related conditions, with the former having been postulated to contribute to the pathogenesis of the latter condition. Confirming this hypothesis may therefore help to better inform strategies for early treatment and intervention of sarcopenia. We performed a systematic review of the current literature examining the relationships between four major sensory impairments [vision (VI), hearing (HI), smell (SI), and taste (TI)] with (i) sarcopenia; and (ii) its associated components (low handgrip strength, slow gait speed, and low muscle mass). PubMed, EMBASE, CINAHL, and Cochrane Library databases were searched for observational studies investigating the relationship of VI, HI, SI, and TI with sarcopenia, low handgrip strength, slow gait speed, and low muscle mass, in adults aged 50 years or older, from inception until 24 May 2021. The risk of bias of the included studies was assessed using the Newcastle-Ottawa Scale. This study was registered with PROSPERO, reference CRD42021247967. Ten cross-sectional and three longitudinal population-based studies of community-dwelling adults (N = 68 235) were included, with five studies investigating more than one sensory impairment. In total, 8, 6, 3, and 1 studies investigated the relationship between VI, HI, SI, and TI and sarcopenia and its related components, respectively. Follow-up duration for the longitudinal studies ranged from 4 to 11 years. All studies had a low or moderate risk of bias. We found that the presence of VI and SI, but not TI, independently increased the odds of sarcopenia. In addition, VI and SI were each independently associated with low muscle mass; and VI, HI, and SI were each independently associated with slow gait speed. However, we found inconclusive evidence for the associations between VI, HI and SI, and low handgrip strength. Our systematic review suggests a potential association between the presence of single or multiple sensory impairments and a greater likelihood of sarcopenia and/or deficits in its associated components, especially for VI, HI, and SI. Prospective studies are needed to untangle the relationship between sensory impairment and sarcopenia to better inform clinical guidelines for disease prevention and management.

Gait Kinematic and Kinetic Characteristics of Older Adults With Mild Cognitive Impairment and Subjective Cognitive Decline: A Cross-Sectional Study

Background

Older adults with mild cognitive impairment (MCI) have slower gait speed and poor gait performance under dual-task conditions. However, gait kinematic and kinetic characteristics in older adults with MCI or subjective cognitive decline (SCD) remain unknown. This study was designed to explore the difference in gait kinematics and kinetics during level walking among older people with MCI, SCD, and normal cognition (NC).

Methods

This cross-sectional study recruited 181 participants from July to December 2019; only 82 met the inclusion criteria and consented to participate and only 79 completed gait analysis. Kinematic and kinetic data were obtained using three-dimensional motion capture system during level walking, and joint movements of the lower limbs in the sagittal plane were analyzed by Visual 3D software. Differences in gait kinematics and kinetics among the groups were analyzed using multivariate analysis of covariance (MANCOVA) with Bonferroni post-hoc analysis. After adjusting for multiple comparisons, the significance level was p < 0.002 for MANCOVA and p < 0.0008 for post-hoc analysis.

Results

Twenty-two participants were MCI [mean ± standard deviation (SD) age, 71.23 ± 6.65 years], 33 were SCD (age, 72.73 ± 5.25 years), and 24 were NC (age, 71.96 ± 5.30 years). MANCOVA adjusted for age, gender, body mass index (BMI), gait speed, years of education, diabetes mellitus, and Geriatric Depression Scale (GDS) revealed a significant multivariate effect of group in knee peak extension angle (F = 8.77, p < 0.0001) and knee heel strike angle (F = 8.07, p = 0.001) on the right side. Post-hoc comparisons with Bonferroni correction showed a significant increase of 5.91° in knee peak extension angle (p < 0.0001) and a noticeable decrease of 6.21°in knee heel strike angle (p = 0.001) in MCI compared with NC on the right side. However, no significant intergroup difference was found in gait kinetics, including dorsiflexion, plantar flexion, knee flexion, knee extension, hip flexion, and hip extension(p > 0.002).

Conclusion

An increase of right knee peak extension angle and a decrease of right knee heel strike angle during level walking were found among older adults with MCI compared to those with NC.

Potentially modifiable risk factors for slow gait in community-dwelling older adults: A systematic review

PURPOSE

Slow gait speed in older adults is associated with increased risk for falls and fractures, functional dependence, multimorbidity, and even mortality. The risk of these adverse outcomes can be reduced by intervening on potentially modifiable risk factors. The purpose of this systematic review was to identify potentially modifiable risk factors associated with slow gait speed and clinically meaningful gait speed decline in older community-dwelling adults.

METHODS

Literature searches were conducted in MEDLINE, EMBASE, and CINAHL, Google Scholar, and in the bibliographies of retrieved articles.

RESULTS

Forty studies met the inclusion criteria for qualitative review. Study designs were cross-sectional and longitudinal. Operational definitions of 'slow gait' and 'meaningful gait speed decline' were variable and based on sample distributions (e.g. quartiles), external criteria (e.g. < 0.8 m/s), and dynamic changes over time (e.g. ≥ 0.05 m/s decline per year). Twenty-six potentially modifiable risk factors were assessed in at least two studies. The risk factors most commonly investigated and that showed significant associations with slow gait and/or meaningful gait speed decline include physical activity, education, body mass index-obesity, pain, and depression/depressive symptoms.

CONCLUSION

Our results suggest that there are modifiable targets to maintain gait speed that are amenable to potential treatment.

Associations Between Potentially Modifiable and Nonmodifiable Risk Factors and Gait Speed in Middle- and Older-Aged Adults: Results From the Canadian Longitudinal Study on Aging

BACKGROUND

Gait speed is a strong predictor of morbidity and mortality in older adults. Understanding the factors associated with gait speed and the associated adverse outcomes will inform mitigation strategies. We assessed the potentially modifiable and nonmodifiable factors associated with gait speed in a large national cohort of middle and older-aged Canadian adults.

METHODS

We examined cross-sectional baseline data from the Canadian Longitudinal Study on Aging (CLSA) Comprehensive cohort. The study sample included 20 201 community-dwelling adults aged 45-85 years. The associations between sociodemographic and anthropometric factors, chronic conditions, and cognitive, clinical, and lifestyle factors and 4-m usual gait speed (m/s) were estimated using hierarchical multivariable linear regression.

RESULTS

The coefficient of determination, R 2, of the final regression model was 19.7%, with 12.9% of gait speed variability explained by sociodemographic and anthropometric factors, and nonmodifiable chronic conditions and 6.8% explained by potentially modifiable chronic conditions, cognitive, clinical, and lifestyle factors. Potentially modifiable factors significantly associated with gait speed include cardiovascular conditions (unstandardized regression coefficient, B = -0.018; p < .001), stroke (B = -0.025; p = .003), hypertension (B = -0.007; p = .026), serum Vitamin D (B = 0.004; p < .001), C-reactive protein (B = -0.005; p = .005), depressive symptoms (B = -0.003; p < .001), physical activity (B = 0.0001; p < .001), grip strength (B = 0.003; p < .001), current smoking (B = -0.026; p < .001), severe obesity (B = -0.086; p < .001), and chronic pain (B = -0.008; p = .018).

CONCLUSIONS

The correlates of gait speed in adulthood are multifactorial, with many being potentially modifiable through interventions and education. Our results provide a life-course-perspective framework for future longitudinal assessments risk factors affecting gait speed.

Subjective Motoric Complaints and New Onset Slow Gait

BACKGROUND

While reports of mobility problems are common with aging, their relationship to new onset of slow gait is unknown. Our objective was to examine the validity of subjective motoric complaints for predicting the incidence of slow gait.

METHODS

Ambulatory community-residing participants (mean age 76.6, 55% women) with gait speeds in the normal range enrolled in an aging cohort. Five subjective motoric complaints were assessed. Incident slow gait (walking speed 1 SD below age and sex means) was the primary outcome.

RESULTS

Of the 548 participants at baseline, 90 had prevalent slow gait and 253 participants (73.7%) reported one or more subjective motoric complaints. Subjective motoric complaints were more common in women than men (1.78 vs 1.23). Over a median follow-up of 3.34 years, 68 participants developed new onset slow gait. All 5 questions predicted incident slow gait (adjusted hazard ratios varying from 2.26 to 4.44). More subjective motoric complaints were associated with increased risk of developing incident slow gait (hazard ratio per complaint 1.81). Predictive validity of subjective motoric complaints for incident slow gait was unchanged when using alternate outcome definitions, accounting for diagnostic misclassification, recall bias, or adjusting for multiple confounders.

CONCLUSIONS

Subjective motoric complaints are a harbinger of mobility disability, and can help improve clinical risk assessments and identify high-risk individuals for interventions to prevent onset of slow gait.

A comparison of turn and straight walking phases as predictors of incident falls

BACKGROUND

While gait assessments are recommended to evaluate fall risk in older adults, these often involve walking in a straight line, even though one-third of steps taken throughout the day involve turning. Falls that occur during a turn tend to be more serious than falls that occur during a straight walk, but little is known about how gait variables collected during a turn can predict falls.

RESEARCH QUESTION

How do gait characteristics collected from straight and turning walking phases predict falls in older adults?

METHODS

We prospectively examined the association between six quantitative gait variables measured during normal walking turn and straight walking phases as predictors of incident falls in a community-based sample of older adults (N = 253; mean age 78.5; 51% women). Cox regressions adjusted for multiple potential confounders were used to examine the associations.

RESULTS

Participants had significantly slower stride velocity (57.81 vs 83.26 cm/s), shorter stride length (74.76 vs 101.81 cm,), lower swing (30.1 vs 32.41%), higher double support (39.79 vs 35.19%), and more swing (30.09 vs 32.41%) and stride length variability (31.86 vs 6.35 %) during turns compared with straights. Higher swing percent in both turns (adjusted hazard ratio; HR 0.92, 95% CI 0.87, 0.97) and straights (HR 0.89, 95% CI 0.84, 0.96) was associated with reduced risk of falls. Higher double support percent during both turns (HR 1.04, 95% CI 1.01, 1.07) and straights (HR 1.06, 95% CI 1.02, 1.09) was associated with increased risk of falls. More swing variability during turns (HR 1.03, 95% CI 1.00, 1.06), but not straights, was associated with increased risk of falls.

SIGNIFICANCE

Gait variables collected during turning and walking straight were similar in their predictions of future falls. In the future, clinical research that builds on these findings could improve identification and prevention of falls.

Relationship of different intensities of physical activity and quality of life in postmenopausal women

BACKGROUND

It is known that the elderly population remains most of the time in light activity. Physical activity plays a key role in the primary prevention of chronic diseases to mitigate various deleterious effects of aging and improve quality of life. The objective of the present study was to evaluate whether the time that postmenopausal women remain in light activities during the day are related to better quality of life and compare these results with the quality of life of those who remain longer in moderate intensity and vigorous activity.

METHODS

This is a cross sectional study there were evaluated 102 women, aged 50 to 79 years, all postmenopausal. Physical activity was measured by triaxial accelerometers. The quality of life was assessed using a Brazilian validated version of the SF-36 questionnaire. The sample was divided in three groups (G1, G2 and G3) according to tercile of time spent per week on light, moderate and moderate+vigorous physical activity. The comparisons between groups were made by ANOVA One Way, and the relationship between variables were made through the Spearman's correlation coefficient, and the significance was set at 5%.

RESULTS

We found that the amount of time of light physical activity shows a higher correlation values compared to the moderate and moderate+vigorous physical activity (p < 0,05) and presented significant correlation in all domains of quality of life. Vigorous physical activity did not presented significant correlation in all domains of quality of life.

CONCLUSION

Our data suggests that light intensity physical activity presented influence on the quality of life of postmenopausal women.

TRIAL REGISTRATION

(NCT02804308). Registered on 17 june 2016 (retrospectively registred).

Home-Based Gait Speed Assessment: Normative Data and Racial/Ethnic Correlates Among Older Adults

OBJECTIVES

To determine home-based gait speed performance and its associations with sociodemographic and health-related factors among older adults.

DESIGN

Cross-sectional analysis of a nationally representative US population sample.

SETTING AND PARTICIPANTS

Homes of Health and Retirement Study (HRS) participants.

METHODS

Walk test data measured at home over 2.5 m were aggregated for 6983 individuals, aged ≥65 years (mean age 74.8 ± 6.9 years, 54.2% women), from the 2006 and 2008 HRS waves. Means for gait speed at normal pace were determined for demographic and clinical groupings; association of gait speed with demographic, socioeconomic status, and health factors were examined. Four-year mortality was predicted from baseline slow gait status defined using demographic-based cutoff scores as well as commonly recommended cutoff scores (100 or 60 cm/s).

RESULTS

Home-based gait speed (cm/s) means were lower for female than male (9.6% difference), older than younger (18.0% difference), African American than white (20.5% difference), and Hispanic than Non-Hispanic (10.3% difference) participants. Differences by age group, race, and ethnicity remained significant within sexes (P < .001). Lower speed was associated with African American race and all health problems; higher speed was associated with higher socioeconomic status and alcohol consumption. Four-year mortality was predicted by slow gait status. Predictive validity was, in general, higher for slow gait cutoff scores defined by demographic characteristics.

CONCLUSIONS AND IMPLICATIONS

Mean gait speed measured at home differs among older (aged ≥65 years) US resident population groups defined by sex, age, race, ethnicity, health status, and combinations of these factors, and predicts 4-year mortality when substantially slower than group-based norms. These findings may assist researchers and clinicians in determining normal and abnormal gait performance in older adults in community settings.

Is the 10 metre walk test on sloped surfaces associated with age and physical activity in healthy adults?

BACKGROUND

Preferred walking speed is considered an important indicator of health in older adults and is measured on level ground. However, this may not represent the complex demands of community ambulation such as walking on sloped surfaces. Performing a 10 m walk test on a sloped surface is a novel test, and may be a more sensitive measure of walking capacity which may better discriminate age or health-related changes in gait speed compared to a traditional level 10 m walk test. The purpose of this investigation was to determine healthy adults' performance in the 10 m walk test across various inclines and speeds, and which version of the 10 m walk test would be best at discriminating age-related changes in walking speed. Further, this study aimed to determine whether measures of general health and physical activity are associated with the performance of each test.

METHODS

Healthy Adults (n = 181) aged 20-80 years completed the 10 m walk test on level, downhill and uphill surfaces (8° inclination) at fastest and preferred speeds. Descriptive statistics were calculated for walking speed for males and females across each decade of life. Repeated measures ANOVA was performed to discriminate age-related changes in gait speed by decade, for the 10 m walk test at each speed and slope. Multiple linear regression analyses were conducted to examine the association between waist to height ratio, resting heart rate, age and self-reported physical activity upon preferred and fastest walking speeds at each incline (level/downhill/uphill).

RESULTS

The 10 m walk test best discriminated age-related changes in gait speed when performed at fastest speeds on each slope, or at a preferred speed on an uphill slope. Waist to height ratio, age and the physical activity index were all significantly associated with fastest walking speeds over each incline and preferred uphill speed. Only waist to height ratio was associated with preferred walking speed on level and downhill surfaces.

CONCLUSIONS

The 10 m walk test has the greatest ability to discriminate age- and health-related changes in gait speed when it is performed at a fastest speed on any slope, or uphill at a preferred speed. The normative data reported in this study may be used to compare the performance of the 10 m walk test to that of healthy adults at preferred and fastest speeds on sloped surfaces.

Genetic basis of motoric cognitive risk syndrome in the Health and Retirement Study

OBJECTIVE

To examine polygenic inheritance of motoric cognitive risk syndrome (MCR), a predementia syndrome characterized by the presence of subjective cognitive complaints and slow gait.

METHODS

We analyzed 4,915 individuals, age 65 years and above, with European ancestry (mean age 75.0 ± 6.8 years, 56.6% women) in the Health and Retirement Study. Polygenic scores (PGS) were calculated as weighted sums of the effect of single nucleotide polymorphisms, with effect sizes derived from genome-wide association studies. The association between PGSs of 9 phenotypes (general cognition, body mass index [BMI], mean arterial pressure, education, Alzheimer disease [AD], neuroticism, well-being, waist circumference, and depressive symptoms) and MCR as well as its key components (cognitive complaints and slow gait) were examined by logistic regression, adjusting for age, sex, education, and genetic ancestry, and reported as odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS

There were 260 prevalent MCR cases, 529 with slow gait, and 1,928 with subjective cognitive complaints. Higher PGSs for BMI (OR 1.22, 95% CI 1.07-1.39) and waist circumference (OR 1.23, 95% CI 1.07-1.40) were associated with MCR, and PGS of AD showed a suggestive association (OR 1.16, 95% CI 1.02-1.32). Higher PGS for neuroticism (OR 1.10, 95% CI 1.03-1.18) was associated with cognitive complaints, whereas higher well-being PGS (OR 0.92, 95% CI 0.87-0.98) was protective. PGS for BMI (OR 1.16, 95% CI 1.06-1.28), waist circumference (OR 1.19, 95% CI 1.08-1.31), and AD (OR 1.13, 95% CI 1.03-1.24) was associated with slow gait.

CONCLUSION

Obesity-related genetic traits increase risk of MCR syndrome; further investigation is required to identify potential therapeutic targets.

Gait and dementia

Cognitive decline and neurodegenerative disease have been implicated in gait dysfunction via disturbance of top-down control mechanisms. Gait velocity decreases, variability increases, and ability to multitask while walking is impaired as cognition declines. Changes in gait can be used to predict incident mild cognitive impairment states as well as dementia. Slow gait velocity together with a cognitive complaint, the Motoric Cognitive Risk syndrome, can serve as a clinical biomarker for high risk of neurologic decline. While patients with Alzheimer's disease typically have quantitative gait impairment, those with other forms of dementia often manifest more overt, qualitative changes to walking. A variety of interventions may be useful to improve gait, including physical and cognitive rehabilitation, treatment of specific underlying causes of gait problems, and treatment of the dementia itself. Understanding the relationship between gait and dementia can elucidate pathology and improve patient care.

Neurologic examination in the elderly

Clinical evaluation of neurologic disorders in the elderly requires seeking a thorough history and performing an age-appropriate neurologic examination with special attention to changes that occur with normal aging. The history should be obtained from the patient as well as collateral sources close to the patient to ensure accuracy and should include contextual elements such as medical history, social, economic, and psychological background, as well as an assessment of current functional state beyond activities of daily living. The safety of the patient, including the presence of physical, psychological, and financial threats, should be addressed during the interview. The neurological examination in older adults may need to be modified to circumvent disabilities such as hearing and visual impairment. Some elements of the neurological examination are expected to be affected by the process of aging, including pupillary reactivity, presbyopia, difficulty with ocular pursuit and up-gaze, reduced or absent distal reflexes, slower motor speed, and reduced ability to tandem walk, among others. In addition to a screening neurological assessment, evaluation of older adults with a particular complaint may require additional interview queries and examination manoeuvres. Common symptoms in the elderly include cognitive difficulties, balance and gait disorders, tremors, and neuropathy. A specialized approach to patients with cognitive difficulties must include assessment of each cognitive domain, including attention, executive function, learning and memory, perceptual-motor function, and social cognition. Balance and gait are essential parts of the neurological examination, and in patients with a history of falls or mobility issues, should become a central part of the evaluation. In patient with tremors, careful observation of the tremor quality (amplitude, frequency, and alleviating/exacerbating factors such as rest, movement, and posture) can aid diagnosis. Evaluation of neuropathy includes determining modality (numbness, tingling, pain, and weakness) and the distribution of symptoms in order to localize the site of nerve injury, which can be supplemented with nerve conduction studies/electromyography, to guide further diagnostic workup and treatment. A combination of detailed history and examination often will suggest a likely underlying neurodegenerative disorder and guide further diagnostic workup to establish a specific diagnosis.

Predicting the Future Need of Walking Device or Assistance by Moderate to Vigorous Physical Activity: A 2-Year Prospective Study of Women Aged 75 Years and Above

Objective

To examine the association between daily moderate to vigorous physical activity (MVPA) and the change in mobility function among community-dwelling Japanese women aged 75 years and above.

Methods

This prospective study included 330 older women aged 75 years and above who could walk without a walking device or assistance. MVPA and light-intensity physical activity (LPA) were assessed using an accelerometer for seven consecutive days. MVPA was defined as an activity with an intensity of >3 metabolic equivalents. The study outcome was a change in mobility function, defined as the need of walking device or assistance, during the two-year period.

Results

The results of the logistic regression analysis showed that MVPA was inversely associated with a decline in mobility function after controlling for LPA and potential confounders (adjusted odds ratio (OR) = 0.93 per 1 min/d, 95% confidence interval (CI) = 0.88-0.99; P = 0.017), whereas LPA was not when adjusted for MVPA and confounders (adjusted OR = 0.99 per 1 min/d, 95% CI = 0.96-1.01; P = 0.245). The receiver operating characteristics analysis identified a 7.9 min/d of MVPA as the cut-off value.

Conclusions

The results of this study suggest the importance of promoting daily MVPA for preventing mobility limitation in older women aged 75 years and above.

Cardiovascular Risk Burden and Future Risk of Walking Speed Limitation in Older Adults

OBJECTIVES

To explore the association between cardiovascular risk factor (CRF) burden and limitation in walking speed, balance, and chair stand and to verify whether these associations vary according to age and cognitive status.

DESIGN

Longitudinal population-based study.

SETTING

Urban area of Stockholm, Sweden.

PARTICIPANTS

Individuals aged 60 and older who participated in the Swedish National Study on Aging and Care in Kungsholmen and were free of limitations in walking speed (n = 1,441), balance (n = 1,154), or chair stands (n = 1,496) at baseline (2001-04).

MEASUREMENTS

At baseline, data on demographic characteristics, CRFs, other lifestyle factors, C-reactive protein, and cognitive function were collected. CRF burden was measured using the Framingham general cardiovascular risk score (FRS). Limitations in walking speed (<0.8 m/s), balance (<5 seconds), and chair stand (inability to rise 5 times) were determined at 3-, 6-, and 9-year follow-up. Data were analyzed using Cox proportional hazards models stratified according to age (<78, ≥78).

RESULTS

During follow-up, 326 persons developed limitations in walking speed, 303 in balance, and 374 in chair stands. An association between the FRS and walking speed limitation was evident only in adults younger than 78 (for each 1-point increase in FRS: hazard ratio (HR) = 1.09, 95% confidence interval (CI) = 1.02-1.17) after controlling for potential confounders including cognitive function (correspondingly, in adults aged ≥78: HR = 0.98, 95% CI = 0.92-1.03). Also, higher FRS was significantly associated with faster decline in walking speed (P < .001).

CONCLUSION

A higher FRS is associated with greater risk of subsequent development of walking speed limitation in adults younger than 78, independent of cognitive function. Interventions targeting multiple CRFs in younger-old people may help in maintaining mobility function.

The correlates of slow gait and its relation with social network among older adults in Singapore

OBJECTIVES

This study aimed to identify socio-demographic correlates of slow gait speed among Singapore older adult residents and to examine the relationship between slow gait speed and the older adult residents' social network, physical health status, disability and mental health status.

METHODS

Trained interviewers administered the adapted 10/66 research protocol through face-to-face interviews to 2565 respondents aged 60 and over. Information on gait test, socio-demographic characteristics, obesity, social network, physical status and activity, overall health, disability and mental health status were collected. The gait test was completed by 2192 participants. Slow gait was defined as walking speed of 1 standard deviation (SD) below age and gender specific mean gait of the sample.

RESULTS

The prevalence of slow gait speed after adjusting for age and gender was 13.7%. Slow gait speed was more prevalent among Indians, respondents with low education, and those who were retired. Those with slow gait speed were significantly associated with lower probability of being unemployed and attending religious activities. They were significantly associated with not being physically active and reported a higher disability score.

CONCLUSION

Older adult residents' socio-demographic factors were found to be associated with gait speed. Those with slow gait speed were not physically active and had less frequent contact with people through religious activities and this might place them at risk of being socially isolated, which can have consequences. Gait speed can be included as a routine assessment tool to identify at-risk groups for interventions which aim to keep the older adults socially engaged and healthy.

Association of anti-inflammatory cytokine IL10 polymorphisms with motoric cognitive risk syndrome in an Ashkenazi Jewish population

Motoric cognitive risk (MCR) syndrome is a newly described predementia syndrome characterized by the presence of cognitive complaints and slow gait, which is associated with increased risk of conversion to dementia. The underlying biological mechanisms for MCR have not yet been established. Neuroinflammation mediated through cytokines plays a pivotal role in the pathogenesis of dementia. Hence, our objective was to prospectively examine whether variations in cytokine genes (CRP, IFNG, IL1A, IL1B, IL4, IL6, IL10, IL18, TNF, and IL12A) play a role in MCR incidence in 530 community-dwelling Ashkenazi Jewish adults aged 65 years and older without MCR or dementia at baseline enrolled in the LonGenity study. Over a median follow-up of 2.99 years, 70 participants developed MCR. Single nucleotide polymorphisms (SNPs) in the transcriptional regulatory regions of cytokine IL10, rs1800896 (hazard ratio adjusted for age, gender, and education, aHR: 1.667; 95% CI: 1.198-2.321) and rs3024498 (aHR: 1.926; 95% CI: 1.315-2.822), were associated with incident MCR. Functional analysis using in silico approaches indicated associated SNP rs3024498 "C" allele being the local expression quantitative trait locus. Associated alleles of both the SNPs, rs1800896 and rs3024498, were implicated with overexpression of IL10 gene. None of the variants in the neuroinflammatory pathway studied were associated with incident mild cognitive impairment syndrome. These observations support a role for the IL10 gene in dementia pathogenesis by increasing risk of developing MCR in older adults.

The complex genetics of gait speed: genome-wide meta-analysis approach

Emerging evidence suggests that the basis for variation in late-life mobility is attributable, in part, to genetic factors, which may become increasingly important with age. Our objective was to systematically assess the contribution of genetic variation to gait speed in older individuals. We conducted a meta-analysis of gait speed GWASs in 31,478 older adults from 17 cohorts of the CHARGE consortium, and validated our results in 2,588 older adults from 4 independent studies. We followed our initial discoveries with network and eQTL analysis of candidate signals in tissues. The meta-analysis resulted in a list of 536 suggestive genome wide significant SNPs in or near 69 genes. Further interrogation with Pathway Analysis placed gait speed as a polygenic complex trait in five major networks. Subsequent eQTL analysis revealed several SNPs significantly associated with the expression of PRSS16, WDSUB1 and PTPRT, which in addition to the meta-analysis and pathway suggested that genetic effects on gait speed may occur through synaptic function and neuronal development pathways. No genome-wide significant signals for gait speed were identified from this moderately large sample of older adults, suggesting that more refined physical function phenotypes will be needed to identify the genetic basis of gait speed in aging.