What physical performance measures predict incident cognitive decline among intact older adults? A 4.4year follow up study

Abstract

Reductions in physical performance, cognitive impairment (CI) and decline (CD), are common in older age, but few prospective cohort studies have considered the relationship between these domains. In this study we investigated whether reduced physical performance and low handgrip/lower limbs strength, could predict a higher incidence of CI/CD during a 4-year follow-up among a cohort of elderly individuals. From 3099 older community-dwelling individuals initially enrolled in the Progetto Veneto Anziani (PRO.V.A.) study, 1249 participants without CI at the baseline were included (mean age 72.2years, 59.5% females). Physical performance measures included the Short Physical Performance Battery (SPPB), 4m gait speed, chair stands time, leg extension and flexion, handgrip strength, and 6-Minute Walking Test (6MWT), categorized in gender-specific tertiles. CI was defined as a Mini-Mental State Examination (MMSE) score below 24; CD a decline of 3 or more points in the MMSE without CI. At baseline, participants developing CI during follow-up scored significantly worse across all physical performance measures compared to those that retained normal cognitive status. After adjusting for potential confounders, a significant trend for MMSE changes was noted for all physical performance tests, except for the SPPB and chair stands time. Multinomial logistic regression revealed that slow gait speed at baseline significantly predicted CD at follow up. Poor SPPB performance and slower gait speed predicted the onset of CI at the follow-up. In conclusion, slow walking speed appears to be the best independent predictor of poor cognitive status over a 4.4-year follow-up, while other items of SPPB were also significantly associated with CI.

Poor Physical Performance Predicts Future Onset of Depression in Elderly People: Progetto Veneto Anziani Longitudinal Study

“…However, when considering the ROC curve for handgrip strength, the data suggested this is not strongly associated with depression, reinforcing the concept that SPPB is probably the best test in predicting depression at the follow-up. When one considers that SPPB also appears to be useful in predicting cognitive decline 14 and mortality 16 , routine screening of physical performance in clinical practice is warranted.…”

“…18 In addition to a paucity of data, there is an absence of studies comparing the prognostic ability of the different physical performance and muscle strength tests in predicting depression in older adults. Understanding such information is important and valuable for clinicians to identify those most at risks and previous research considering objective physical performance and future mortality 16 and poor cognitive status, 14 have demonstrated that not all tests have the same predictive power. 16 Given the aforementioned limitations and gaps in the literature, the aim of the present study was thus to examine which objective physical performance measures provide an optimal predictor of incident depression in a representative cohort of older subjects over 4 years of follow-up.…”

“…Whilst helpful, physical performance data, captured via self-report questionnaires, have poor recall properties, reliability and validity in older adults and might introduce bias. 14 For instance, numerous studies have demonstrated that older adults self-report physical function is inconsistent and weakly associated with their actual physical performance when measured objectively. 15 Therefore, studies investigating self-report physical performance and depression are likely to be limited by poor reflection of older person's true functional abilities.…”

“…15 Therefore, studies investigating self-report physical performance and depression are likely to be limited by poor reflection of older person's true functional abilities. 14 Objective measures of physical performance, such as measuring gait speed, provide a more accurate measure of a person's physical capability. Objective physical performance tests have been demonstrated to be associated with various future outcomes in older age such as cognitive decline 14 and mortality.…”

“…14 Objective measures of physical performance, such as measuring gait speed, provide a more accurate measure of a person's physical capability. Objective physical performance tests have been demonstrated to be associated with various future outcomes in older age such as cognitive decline 14 and mortality. 16 To date, a paucity of research has considered if objective physical performance can predict future depression in the elderly.…”