The association between cognition and gait in a representative sample of very old people – the influence of dementia and walking aid use

Abstract

Background: Cognition has been related with gait speed in older adults; however, studies involving the oldest age group, where many have mobility disability and cognitive impairment, are few. The aim was to investigate the association between global cognitive function and gait speed in a representative sample of very old people, and whether the association was affected by dementia, and walking aid use. Method: This cross-sectional study included 1317 participants, mean age 89.4 years, and 68% women, from the Umeå85+/Gerontological Regional Database. Self-paced gait speed was measured over 2.4 m, with or without walking aids, and global cognitive function with the Mini-Mental State Examination (MMSE). The association between cognition and gait speed was analyzed using multiple linear regression and stratified according to dementia. The influence of missing gait speed values was explored using multiple imputation. An interaction analysis was performed to investigate the influence of walking aid use. Results: In comprehensively adjusted analyses, MMSE associated with gait speed (unstandardized β (β) 0.011 m/s, 95% Confidence Interval [CI] = 0.009, 0.013, p < 0.001) in the total sample. No association was found in people with dementia (β 0.003 m/s, 95%CI = 0.000, 0.006, p = 0.058), until missing gait speed values were compensated for by multiple imputation (β 0.007 m/s, 95% [CI] = 0.002, 0.011, p = 0.002). In interaction analysis the use of walking aids attenuated the association between cognition and gait speed (β − 0.019 m/s, 95%CI = − 0.024, − 0.013, p < 0.001). Conclusion:Global cognitive function appears to associate with gait speed in very old people. However, in people with dementia selection bias was indicated since unless missing gait speed values were accounted for no association was observed. Walking aid use attenuated cognitive load, which may not apply to walking in daily activities, and requires further investigation.

Cognition mediates the relation between structural network efficiency and gait in small vessel disease

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Evaluation of Real Brain Activity Using an Ultracompact Brain Activity Sensor for the Assessment of Cognitive Function

“…In this study, the exercise program using dual-tasks obtained the highest scores. Despite walking being used as an exercise intervention method in many previous studies on dementia [25], the scores of walking were intermediate in this study. We did not get high scores in exercises performed with slow movements such as strength training with body weight and tai chi.…”

Cognitive, psychological and social factors associated with older adults' mobility: a scoping review of self‐report and performance‐based measures

“…The majority ( n = 129, 70.5%) of the included studies' populations were older adults with no defined conditions. The remaining 54 articles (29.5%) included older adults with dementia or cognitive impairment, 34–59 fragile X syndrome associated with tremor/ataxia, a condition resulting from a gene permutation, 60 stroke, 61,62 chronic obstructive pulmonary disease, 63 cancer, 64,65 diabetes, 66 Parkinson's disease, 17,67–74 cardiovascular disease, 14,75–80 lower back pain, 81 multiple comorbidities 82–84 and post‐menopausal conditions 85 . Most studies recruited participants from the community ( n = 164, 89.6%), and the remaining studies ( n = 19, 10.4%) recruited from the hospital and long‐term care setting or both the long‐term care and community setting, or did not report the setting from which the participants were recruited.…”

“…Reported mean ages ranged from 61.1 73,76 to 91.1 59 years. Sixty‐nine per cent ( n = 126) of the included articles had more women than men in their sample and sample sizes ranged from 13 41 to 51 338 86 …”

“…Studies reported that better global cognition (e.g., high Mini‐Mental State Exam (MMSE) scores) was associated with completing walking tests in a shorter time, 136 faster gait speed, 38,52,57–59,73,92,94,95,116,133,137–140 higher cadence, 52,94 a fewer number of steps during a turn, 73,141 greater percentage changes in stride variability, 54,94 longer stride length, 38,52,116 reduced double support time and reduced stride length and single support variability, 48 better balance scores, 52,68,98,133 better SPPB scores, 52,99,136 completing TUG 68,100,141,142 and Chair Stand Tests 52,76,133,138,140 in shorter time, and fewer driving safety errors 123,124 . In contrast, poor global cognition (e.g., cognitive impairment or dementia) was associated with longer time to complete a walking test, 40 slower gait speed, 10,37,40,55,56,65 fewer steps, 74 shorter step length, 55 increased swing time variability, 55 poor SPPB scores 40,45,65 or Physical Performance Test score, 143 longer time to complete the TUG 39,65,74,110 and Chair Stand Test, 65 more likely to fail a road test, 144 unsafe driving, 43,67,145 difficulty accessing the community, avoidance of unfamiliar areas, avoidance of high‐traffic roads, avoidance of left‐hand turns during driving, 47 and driving errors 16 …”