Published on: October 16, 2016
by Women’s Brain Health Initiative:
In the last issue of Mind Over Matter® “The Eyes (and Nose) Have It” article, Women’s Brain Health Initiative explored the current research on smell and eye assessments for predicting the future risk of dementia. There are other types of risk prediction testing that hold promise as well. In this article, Women’s Brain Health Initiative examines two studies using tests of physical performance, such as balance and walking speed, to predict future cognitive decline.
Research has revealed two parallel links between physical performance and cognitive decline.
A lower level of motor function is a known risk factor for developing mild cognitive impairment (MCI), an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia. On the flip side, a lower level of cognitive function is a known risk factor for developing motor impairment, especially falls and more rapid decline in motor function. Given the interconnection between motor function and cognitive function, it’s not surprising that researchers are investigating how physical performance testing might be used to help predict who is at increased risk of developing dementia.
Four Simple Physical Tests May Indicate Risk of Dementia
A study conducted by researchers from University of California Irvine (UCI) between January 2003 and November 2009 examined the physical performance of 629 individuals aged 90+ using four measures: grip strength, standing balance, a timed four-metre walk, and ability to do five chair stands (i.e. stand from a sitting position with arms folded across the chest). Each task was scored from 0 (unable to perform) to 4 (best performance). The results, published in JAMA Neurology in January 2013, revealed that poor performance in any of the measures was associated with increased odds of dementia.
“The most notable effect was seen in poor performance on the 4-metre walk test,” explained Dr. Szofia Bullain, study leader and an Assistant Professor in UCI’s Department of Neurology. “Participants who were unable to walk (score 0) were almost 30 times more likely to have dementia than people who walked the fastest (score 4). However, even a minimal decrease in walking speed, from a score of 4 to 3, resulted in four times greater odds of dementia.” Poor performance in doing five chair stands had the next highest odds of increasing dementia risk, followed by grip strength, then balance.
“Our findings revealed that dementia is a complicated process that may affect both cognition and physical performance,” explained Dr. Bullain, “however, because of the design of the study, it is unknown if a decreasing ability to perform physical tasks is a cause or a result of dementia.” Although the exact nature of the relationship between physical and mental performance is not yet fully understood, this research suggests that physical performance may be a potentially modifiable risk factor for late-age dementia, meaning there is something you can do about it to possibly decrease risk. Since it is a potentially modifiable risk factor, it doesn’t hurt for people to focus on improving their physical fitness levels while waiting for additional research to reveal more.
Cognitive Complaints & Walking SpeedCombined Serve as a Simple Test of Dementia Risk
Researchers with Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center, both in New York, have assessed the prevalence of motoric cognitive risk syndrome (MCR), a newly described pre-dementia syndrome characterized by slow walking speed (gait) and cognitive complaints, and explored MCR’s link with dementia risk. Their study, published online on July 16, 2014 in Neurology, involved almost 27,000 adults aged 60+ (without dementia or disability) enrolled in 22 studies across 17 countries. It found that 9.7% of the participants met the criteria for MCR based on a simple test of how fast they walked and whether they had cognitive complaints.
To test if MCR can be used to predict future dementia, the researchers focused on four of the 22 studies, evaluating over 4,800 people annually over an average follow-up period of 12 years to see who developed dementia. Those diagnosed with MCR were almost twice as likely to develop dementia over the 12 years compared with those who did not meet the MCR criteria.
The conclusion of the Neurology paper sums up the findings, “MCR is common in older adults, and is a strong and early risk factor for cognitive decline.”
What is particularly exciting about these findings is that the test to diagnose MCR is so quick and easy. It takes just seconds to measure the speed of someone walking and ask a few simple questions about their cognitive functioning. Plus, the test does not require any medical technology, does not have to be administered by a neurologist, and can be done right in a doctor’s office, so it could easily be incorporated into regular examinations with older patients.
“It is important to keep in mind that identifying MCR is not the same as diagnosing someone with dementia. It simply alerts a person and their health care team of the higher risk for developing dementia. Knowing you are at risk can prompt investigation of potential underlying conditions that could be treated and motivate healthy lifestyle changes, possibly delaying or even preventing the onset of dementia,” explained the senior author of the paper, Dr. Joe Verghese, Professor at Einstein and Chief of Geriatrics at Einstein and Montefiore.
This continued awareness, and in some ways the simplicity (and cost effectiveness) of actually doing physical performance (and smell and eye) assessments keeps us on the right path to predicting future cognitive decline and increasing the numbers of people
getting diagnosed early.
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