Decreased gait speed and cognition, especially memory, are associated with an increased risk of dementia, new research shows.
In a large study involving more than 16,000 participants, such a double decline was associated with a significantly higher risk of dementia than deterioration in gait alone or cognitive function alone.
The results underscore the importance of adding gait speed measures to dementia screening assessments, the researchers note.
Dr. Michele Kalisaya
“Measuring gait speed is really simple, cheap and fast; and the test can be used in the clinic along with a cognitive screen to see if anyone is at risk for dementia, ”said study researcher Michelle L. Kalisaya, PhD, Associate Professor, National Center for Healthy Aging, Monash University and Clinical School. on the peninsula, Victoria, Australia, told Medscape Medical News.
She added that, unlike previous research, this new study examines gait speed and knowledge over time for dementia and examines several cognitive areas.
The findings were published online on May 31 at the JAMA Network Open.
No “Fine Equipment” required.
Data collected as part of ASPREE (ASPirin in Reducing Events in the Elderly), a randomized, placebo-controlled study of low-dose (100 mg) daily aspirin in elderly people living in the community without cardiovascular disease, dementia or physical disability. . ASPREE is held in the United States and Australia from 2010 to 2017.
The researchers measured gait speed in meters per second during personal visits at the beginning and every 2 years until the end of the study. They used the average of two three-meter walks at the usual pace for analysis.
Kalisaya noted that gait speed measurements do not require “fine equipment” – only a stopwatch is sufficient. In addition, measurements can be performed in any clinic by general practitioners, physiotherapists or other medical staff.
Researchers also assessed cognitive abilities at the beginning and every 2 years until the end of the study.
The analysis includes four different measures. Global cognitive function was measured by the Modified Mini-Mental State (3MS) study, delayed free recall or memory with the Hopkins Verbal Learning Test – Revised (HVLT-R Delay), processing speed with the Symbol Modality Test. SDMT), and oral fluency with the Controlled Oral Association of Words – one-letter version (COWAT-F).
The main result was dementia. Researchers have included a “very strict” classification of dementia, which includes doctors’ reports; dementia has been assessed by an expert commission that uses the DSM-IV criteria, Kalisaya noted.
For gait, a breakpoint of 0.05 m / s or more per year was used to distinguish participants who had decreased gait from those who did not. Kalisaya said the break was a “clinically significant change”. Participants were classified as experiencing cognitive decline if they were in the lowest tertile of the annual change in 3MS score, HVLT-R delay, SDMT, or COWAT-F.
For each of these cognitive categories, participants were placed in four groups based on a pattern of decline: no decline, only cognitive decline, only decline in gait speed, and double decline – which was defined as a simultaneous decline in both gait speed and of knowledge.
The analysis included 16,855 participants (mean age 75 years; 56% women). Of these, 44.8% reported levels of education of 12 years or more. The researchers adjusted the demographics, the state and the basic speed of gait and the cognitive result.
The most risky combination
Compared with participants who did not have a decline, the risk of dementia was highest in participants who had a decline in both gait and memory, as measured by HVLT-R (hazard ratio). [HR]24.9; 95% CI, 16.5 – 37.6), followed by those with a decrease in both gait and cognitive function of 3MS (HR, 22.2; 95% CI, 15.0 – 32.9), as well as gait and speech fluency of COWAT-F (HR, 4.7; 95% CI, 3.5 – 6.3) and both gait and processing speed of SDMT (HR, 4.3; 95% CI) , 3.2 – 5.8, all comparisons, P <.001).
“All dual categories had an increased risk of dementia, but it was this combination of gait and memory that had the highest risk,” Kalisaya said. “The important thing is that there was a higher risk of dementia than just walking or memory impairment.
The participants were in their 70s and were “very healthy” at the start of the study, she said. Therefore, data are important “even in healthy people”.
Gait speed, which is a good “overall measure of overall health,” begins to decline when people are in their 50s and 60s, said Kalisaya, who has experience in physiotherapy and is a self-proclaimed “gait fanatic.”
Experts recommend that gait be assessed regularly in general practice with regard to the risk of falling. Gait speed can be added to memory or the cognitive screen, “to give a better idea of whether a patient is at increased risk of dementia,” Kalisaya said. “It’s also a great way to keep track of how someone is doing.”
She noted that if a patient’s gait slows, clinicians may consider “all those preventative interventions that we know are important to reduce the risk of dementia, such as exercise, diet, lowering blood pressure and tackling diabetes.” and obesity. “
Inclusion in routine assessments?
In an accompanying editorial, Joe Vergese, MD, professor of neurology and medicine and head of the departments of cognitive and motor aging (neurology) and geriatrics (medicine) at Albert Einstein Medical College, New York, noted that the study “emphasizes the clinical on the identification of gait markers for dementia in the elderly. “
Despite the predicted validity of gait assessments in the geriatric population, there is a “barrier to the application of routine gait assessments in clinics” that “needs to be addressed to improve care for older patients,” he wrote.
Vergese told Medscape Medical News that one way to remove this barrier is to make “time and space available for clinical gait assessments.”
He agreed with Kalisaya that gait speed estimates “are short and do not require complex equipment or even a clinician to administer.”
Gait speed assessments, which predict not only dementia but also falls, disability and other geriatric syndromes, should be included as a “vital sign”, as well as heart rate or blood pressure, in the routine assessment of all geriatric patients, Vergese concluded. .
The ASPREE trial was funded by the National Institute on Aging in the United States and the National Board of Health and Medical Research in Australia. AG Bayer provided aspirin and a suitable placebo for the trial. Callisaya has not reported a relevant financial relationship. Verghese received funding from the National Institutes of Health and served on the advisory board of Catch-U, Inc. and MedRhythms, Inc.
JAMA Netw Open. Published online on May 31, 2022. Full article, editing
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