Older adults who experience worsening memory and slowed walking may be at greater risk of dementia than those experiencing one or none of these changes, suggests a report published today in JAMA Network Open.
“Our findings provide further evidence for the importance of adding serial gait speed measures to dementia risk screening assessments, providing the opportunity for further comprehensive assessment and early preventative treatments,” wrote Taya A. Collyer, Ph.D., of Monash University in Victoria, Australia, and colleagues.
The researchers analyzed data collected during the ASPirin in Reducing Events in the Elderly (ASPREE) trial—a randomized, controlled trial of more than 19,000 community-dwelling older adults in Australia and the United States that took place between 2010 and 2017. The trial included adults aged 70 years or older (or aged 65 or older for U.S. participants belonging to a minority group) who did not have cardiovascular disease, dementia, or physical disability at the time of enrollment.
As part of the ASPREE trial, researchers measured the gait speed (in meters/second) of the participants at the beginning of the trial; years 2, 4, and 6; and at the end of the trial in 2017. The researchers also administered a series of cognitive tests at the beginning of the trial; years 1, 3, and 5; and in 2017. The cognitive tests included the Modified Mini-Mental State examination for global cognition, Hopkins Verbal Learning Test-Revised for memory, Symbol Digit Modalities for processing speed, and Controlled Oral Word Association Test for verbal fluency. Participants with cognitive concerns over the course of the trial were flagged for additional cognitive testing, and an expert committee determined whether participants met the criteria for dementia (according to DSM-IV).
Participants whose gait slowed 0.05 meters/second or more per year were considered to have gait decline. Participants who scored in the lowest third of the annual change on the cognitive tests were considered to have cognitive decline.
Compared with the adults who did not experience any declines, adults who had gait decline along with either memory decline or global cognition decline were more than 20 times likely to develop dementia, Collyer and colleagues found. Those experiencing slowing gait along with processing speed or verbal fluency decline were about 4 to 5 times more likely to develop dementia, although this risk was about the same as for adults experiencing gait decline alone.
“These results highlight the importance of gait in dementia risk assessment and suggest that dual decline in gait speed and a memory measure may be the best combination associated with accurate assessment of future dementia risk,” the researchers wrote.
“Despite the established predictive validity of gait assessments for geriatric syndromes, an implementation barrier for routine gait assessment in clinics exists that needs to be addressed to improve care of older patients,” wrote Joe Verghese, M.D., of Albert Einstein College of Medicine in an accompanying editorial. “Routine annual assessments of gait speed and cognition will need to be established in clinical settings to identify dual decliners.”
For related information, see the Psychiatric News article “Dual-Task Gait Testing Identifies MCI Patients Likely to Develop Dementia.”
(Image: iStock/stockstudioX)
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The Mental Health Services Conference will empower all mental health service providers with practical tools and innovations to shape the future of community collaboration. Held in person in Washington, D.C., at the Capital Hilton Hotel on October 13-14, the conference will provide up to 18 continuing education credits for physicians, psychologists, social workers, and nurses. The deadline for abstracts is Thursday, June 2, at 5 p.m. ET.