Cognitive Function Is Associated With the Development of Mobility Impairments in Community-Dwelling Elders

doi:10.1097/JGP.0b013e3181ef7a2e

The American Journal of Geriatric Psychiatry

Volume 19, Issue 6, June 2011, Pages 571-580

https://doi.org/10.1097/JGP.0b013e3181ef7a2e Get rights and content

Objective

To examine the association of cognitive function with the risk of incident mobility impairments and the rate of declining mobility in older adults.

Design

Prospective, observational cohort study.

Setting

Retirement communities across metropolitan Chicago.

Participants

A total of 1,154 ambulatory elders from two longitudinal studies without baseline clinical dementia or history of stroke or Parkinson disease.

Measurements

All participants underwent baseline cognitive testing and annual mobility examinations. Mobility impairments were based on annual timed walking performance. A composite mobility measure, which summarized gait and balance measures, was used to examine the annual rate of mobility change.

Results

During follow-up of 4.5 years, 423 of 836 (50.6%) participants developed impaired mobility. In a proportional hazards model controlled for age, sex, education, and race, each 1-unit higher level of baseline global cognition was associated with a reduction to about half in the risk of mobility impairments (hazard ratio = 0.51, 95% confidence interval: 0.40–0.66) and was similar to a participant being about 13 years younger at baseline. These results did not vary by sex or race and were unchanged in analyses controlling for body mass index, physical activity, vascular diseases, and risk factors. The level of cognition in five different cognitive abilities was also related to incident mobility impairment. Cognition showed similar associations with incident loss of the ability to ambulate. Linear mixed-effects models showed that global cognition at baseline was associated with the rate of declining mobility.

Conclusions

Among ambulatory elders, cognition is associated with incident mobility impairment and mobility decline.

Section snippets

Participants

Participants are from two ongoing studies of aging approved by the Institutional Review Board of Rush University Medical Center. Participants in the Memory and Aging Project (MAP) agree to annual clinical examinations and donation of brain, spinal cord, muscle, and nerve at the time of death.²³ To enrich minority representation in these analyses, we included participants from the Minority Aging Research Study (MARS) that began in 2004 and whose participants agree to annual examinations. The

Descriptive Properties of Global Cognition

There were 1,154 participants included in these analyses, and their baseline characteristics are included in Table 1. Global cognition scores at baseline ranged from −1.84 to 1.50 (mean: 0.12; SD: 0.53) with higher scores indicating better function. Global cognition was related to age (r = −0.28 [df = 1,152], p <0.001), education (r = 0.37 [df = 1,152], p <0.001), race (r = −0.09 [df = 1,152], p = 0.003), and women had higher levels of cognition (t_[1,152] = 2.57, p =0.010). Global cognition was

DISCUSSION

In this cohort of 1,154 ambulatory community-dwelling elders without dementia, history of stroke, or Parkinson disease, baseline global cognition was associated with incident mobility impairment. This association did not vary by sex or race and persisted even after adjustment for body composition, physical activity, chronic vascular diseases, and vascular risk factors. Five different cognitive abilities including episodic memory, semantic memory, visuospatial abilities, perceptual speed, and

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The authors thank all the participants in the Rush Memory and Aging Project and the Minority Aging Research Study. They also thank Traci Colvin, Sandra Mc-Cain, and Tracey Nowakowski for project coordination; Barbara Eubeler, Mary Futrell, Karen Lowe Graham, and Pam A. Smith for participant recruitment; John Gibbons and Greg Klein for data management; Wenqing Fan, M.S., for statistical programming; and the staff of the Rush Alzheimer's Disease Center.

This work was supported by National Institute on Aging grants R01AG17917 (DAB), R01AG022018 (LLB), and R01AG24480 (ASB); the Illinois Department of Public Health; and the Robert C. Borwell Endowment Fund.

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Regular Research ArticlesCognitive Function Is Associated With the Development of Mobility Impairments in Community-Dwelling Elders

Objective

Design

Setting

Participants

Measurements

Results

Conclusions

Section snippets

Participants

Descriptive Properties of Global Cognition

DISCUSSION

Brain Res Rev

Progress in Brain Research

Neuroimage

Neuroimage

Brain Res

Physical Performance Measures in the Clinical Setting

J Am Geriatr Soc

Association Between Lower Digit Symbol Substitution Test Score and Slower Gait and Greater Risk of Mortality and of Developing Incident Disability in Well-Functioning Older Adults

J Am Geriatr Soc

Prognostic Significance of Potential Frailty Criteria

J Am Geriatr Soc

Long-term function in an older cohort–the cardiovascular health study all stars study

J Am Geriatr Soc

Measures of physical performance and risk for progressive and catastrophic disability: results from the Women's Health and Aging Study

J Gerontol A Biol Sci Med Sci

Blending activity and participation sub-domains of the ICF

Disabil Rehabil

Assessment of physical functioning: a conceptual model encompassing environmental factors and individual compensation strategies

Phys Ther

Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain

Brain

A regions-of-interest volumetric analysis of mobility limitations in community-dwelling older adults

J Gerontol A Biol Sci Med Sci

Recent advances in functional neuroimaging of gait

J Neural Transm

Cognitive processes related to gait velocity: results from the Einstein Aging Study

Neuropsychology

Low socioeconomic status and disability in old age: Evidence from the InChianti study for the mediating role of physiological impairments

J Gerontol A Biol Sci Med Sci

Guest Editorial: Linking thinking, walking, and falling

J Gerontol A Biol Sci Med Sci

Association between executive attention and physical functional performance in community-dwelling older women

J Gerontol B Psychol Sci Soc Sci

Regular Research Articles
Cognitive Function Is Associated With the Development of Mobility Impairments in Community-Dwelling Elders