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Gait speed, physical activity, cognitive function and dementia: associations in cross-sectional and longitudinal studies and validity of a physical activity questionnaire in very old people
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.ORCID iD: 0000-0002-2807-1295
2021 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Gånghastighet, fysisk aktivitet, kognitiv funktion och demens : association i tvärsnittsstudier och longitudinella studier, samt validitet av ett självskattningsformulär för fysisk aktivitet för personer i väldigt hög ålder (Swedish)
Abstract [en]

Dementia and cognitive impairment are leading causes of disability in older people (≥ 65 years) and gait speed decline seem to be an early indicator of these conditions, sometimes preceding clinical symptoms. Dementia may be delayed or prevented with management of risk factors, such as low physical activity. However, few studies have investigated associations of gait speed and physical activity with cognitive function and dementia in very old people (≥ 80 years) and a physical activity questionnaire adapted for use in this population is lacking. The overall aims of this thesis were to explore the associations of gait speed and physical activity to cognitive function and dementia in very old people, and to determine the validity of a novel self-reported physical activity questionnaire adapted for very old people (IPAQ-E 80+).

Associations of gait speed with dementia and cognitive function were investigated in a population based cohort of people aged ≥ 85 years, in cross-sectional (n=1317) and longitudinal (n=296) analyses. Gait speed was measured over 2.4 meters and cognitive function was measured with the Mini-Mental State Examination (MMSE). Associations of physical activity at baseline with dementia, cognitive function and gait speed were studied in a cohort of 541 people aged ≥ 80 years at the time of follow-up. Physical activity was measured using a six level questionnaire and categorized into low, medium and high. Cognitive function was measured with the MMSE and executive function with the Frontal Assessment Battery. ActivPAL accelerometers were used to assess the validity of IPAQ-E 80+ in 76 participants aged ≥ 80 years.

Cross-sectional linear regression analyses showed that gait speed was associated with cognitive function in very old people with and without dementia. An interaction analysis showed that walking aid use attenuated this association. Gait speed 5 years previously, and gait speed decline over 5 years were associated with dementia development in logistic regression analyses. During a two decade long follow-up, 175 (32.3%) developed dementia. Cox proportional–hazard models showed no association between physical activity around 65 years of age and subsequent dementia. In adjusted linear regression analyses, physical activity was not associated with cognitive function. Physical activity was associated with executive function in the unadjusted analysis but not after adjustments. Physical activity was associated with gait speed in unadjusted, but not analyses adjusted for traditional cardiovascular risk factors (hypertension, glucose intolerance, body mass index ≥ 30). IPAQ-E 80+ and accelerometer measures of total inactive time, night–time lying and sedentary times correlated fairly to substantially, according to Spearman’s rho values. Bland–Altman plots showed that participants underreported total inactive and sedentary times. Correlations of total active and walking time were moderate; sitting and moderate to vigorous walking and physical activity showed no correlation. The IPAQ–E 80+ showed low degrees of sensitivity and specificity for the accurate identification of participants (not) attaining the recommended physical activity level.

In conclusion, gait speed appears to be associated with cognitive function, and low or declining gait speed seems to be associated with increased odds of subsequent dementia development in very old people, among whom gait and cognitive impairments are common. Furthermore, declining gait speed seems to be associated with declining cognitive function among those who develop dementia. The present results support development of a gait speed screening index for predicting future cognitive decline, even among very old people. Walking aid use may influence the cognitive load and hence the association between gait speed and cognition. In this thesis, a low physical activity level in late middle to older age was not a risk factor for dementia development up to two decades later. The associations between physical activity and subsequent physical function seems to be mediated by traditional cardiovascular risk factors. The novel IPAQ-E 80+ may be a promising tool for studies of relationships between 24–h physical activity patterns and health in this population.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2021. , p. 88
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2146
Keywords [en]
Gait speed, cognitive function, dementia, physical activity, aged 80 and over
National Category
Physiotherapy
Research subject
physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-187220ISBN: 978-91-7855-605-2 (print)ISBN: 978-91-7855-606-9 (electronic)OAI: oai:DiVA.org:umu-187220DiVA, id: diva2:1591626
Public defence
2021-10-01, ULED Triple Helix, Universitetstorget 4 901 87 Umeå, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2021-09-10 Created: 2021-09-07 Last updated: 2022-10-03Bibliographically approved
List of papers
1. The association between cognition and gait in a representative sample of very old people - the influence of dementia and walking aid use
Open this publication in new window or tab >>The association between cognition and gait in a representative sample of very old people - the influence of dementia and walking aid use
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2020 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 20, article id 34Article in journal (Refereed) Published
Abstract [en]

Background: Cognition has been related with gait speed in older adults; however, studies involving the oldest age group, where many have mobility disability and cognitive impairment, are few. The aim was to investigate the association between global cognitive function and gait speed in a representative sample of very old people, and whether the association was affected by dementia, and walking aid use.

Method: This cross-sectional study included 1317 participants, mean age 89.4 years, and 68% women, from the Umeå85+/Gerontological Regional Database. Self-paced gait speed was measured over 2.4 m, with or without walking aids, and global cognitive function with the Mini-Mental State Examination (MMSE). The association between cognition and gait speed was analyzed using multiple linear regression and stratified according to dementia. The influence of missing gait speed values was explored using multiple imputation. An interaction analysis was performed to investigate the influence of walking aid use.

Results: In comprehensively adjusted analyses, MMSE associated with gait speed (unstandardized β (β) 0.011 m/s, 95% Confidence Interval [CI] = 0.009, 0.013, p < 0.001) in the total sample. No association was found in people with dementia (β 0.003 m/s, 95%CI = 0.000, 0.006, p = 0.058), until missing gait speed values were compensated for by multiple imputation (β 0.007 m/s, 95% [CI] = 0.002, 0.011, p = 0.002). In interaction analysis the use of walking aids attenuated the association between cognition and gait speed (β − 0.019 m/s, 95%CI = − 0.024, − 0.013, p < 0.001).

Conclusion: Global cognitive function appears to associate with gait speed in very old people. However, in people with dementia selection bias was indicated since unless missing gait speed values were accounted for no association was observed. Walking aid use attenuated cognitive load, which may not apply to walking in daily activities, and requires further investigation.

Place, publisher, year, edition, pages
Springer, 2020
Keywords
Gait speed, Cognition, Walking aids, Dementia, Aged 80 and over
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-168829 (URN)10.1186/s12877-020-1433-3 (DOI)000513522000003 ()32005103 (PubMedID)2-s2.0-85078838554 (Scopus ID)
Funder
Swedish Research Council, K2014-99X-22610-01-6
Available from: 2020-03-19 Created: 2020-03-19 Last updated: 2021-09-09Bibliographically approved
2. Low or declining gait speed is associated with risk of developing dementia over 5 years among people aged 85 years and over
Open this publication in new window or tab >>Low or declining gait speed is associated with risk of developing dementia over 5 years among people aged 85 years and over
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2021 (English)In: Journal of Aging and Physical Activity, ISSN 1063-8652, E-ISSN 1543-267X, Vol. 29, no 4, p. 678-685Article in journal (Refereed) Published
Abstract [en]

Improving dementia screening procedures beyond simple assessment of current cognitive performance is timely given the ongoing phenomenon of population aging. A slow or declining gait speed (GS) is a potential early indicator of cognitive decline scarcely investigated in very old people. Here, we investigated the 5-year associations of baseline GS, change in GS, and cognitive function with subsequent dementia development in people aged 85 years and older (n = 296) without dementia at baseline. Declining and a slow baseline GS were associated with higher odds of dementia development after adjusting for confounders (e.g., age, sex, and dependency in activities of daily living) and missing GS values at follow-up. The GS decline was associated with cognitive decline in participants who developed dementia. The results support the potential of GS tests to predict future cognitive decline among community- and nursing home-dwelling very old people.

Place, publisher, year, edition, pages
Human Kinetics, 2021
Keywords
Cognitive decline, Dementia disorders, Very old people, Walking speed
National Category
Gerontology, specialising in Medical and Health Sciences Geriatrics
Identifiers
urn:nbn:se:umu:diva-186641 (URN)10.1123/JAPA.2020-0266 (DOI)000674164600015 ()33421958 (PubMedID)2-s2.0-85111964969 (Scopus ID)
Available from: 2021-08-25 Created: 2021-08-25 Last updated: 2021-09-07Bibliographically approved
3. Physical activity in late middle- to older-aged people and dementia, cognitive, and physical function two decades later
Open this publication in new window or tab >>Physical activity in late middle- to older-aged people and dementia, cognitive, and physical function two decades later
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2022 (English)In: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824, Vol. 51, p. 135-141Article in journal (Refereed) Published
Abstract [en]

Introduction: Low physical activity (PA) is a potential risk factor for dementia and cognitive impairment. However, few studies have focused on very old people (aged ≥80 years), the age group with highest prevalence of dementia. The aim was to investigate if PA associated with subsequent dementia, cognitive function, and gait speed (GS), in very old people.

Methods: A population-based survey was conducted in 1999 and followed-up between 2016 and 2019 in participants ≥80 years. Altogether 541 individuals (56.2% women), 64.9 ± 4.2 years of age at baseline participated. Self-rated baseline PA was categorized into low, medium, or high. Cognitive function was assessed with the Mini-Mental State Examination (MMSE), executive function with the Frontal Assessment Battery (FAB), and GS (in meters/second) was measured over 2.4 m at follow-up.

Results: During a mean of 19.0 ± 1.1 years, 175 (32.3%) developed dementia. Low or medium PA compared to high PA did not associate with subsequent dementia, and PA did not associate with future cognitive function (MMSE). PA associated with executive function (FAB) (unstandardized beta [95% confidence interval]) (0.67 [0.07–1.27]), but not after adjustments. PA associated with subsequent GS in the unadjusted model and after adjustment for age, sex, smoking, and education (0.06 [0.02–0.09], and 0.04 [0.01–0.08], respectively), but not after adding adjustment for hypertension, obesity, and glucose intolerance.

Conclusion: No support was found for the hypothesis that low PA is a potential risk factor for dementia in very high age. However, PA and executive function were associated in unadjusted analyses which indicate that PA may be important for at least one aspect of cognitive function. The association between PA and GS around 2 decades later seems attenuated by cardiometabolic risk factors. Future investigations regarding PA, dementia, and cognitive decline may consider cardiometabolic risk factors such as hypertension, obesity, and glucose intolerance, and include repeated measures of PA over the life course.

Place, publisher, year, edition, pages
S. Karger, 2022
Keywords
cognitive function, dementia, executive function, gait speed, physical activity, very old people
National Category
Physiotherapy Geriatrics
Research subject
physiotherapy
Identifiers
urn:nbn:se:umu:diva-187213 (URN)10.1159/000523726 (DOI)000779096600001 ()2-s2.0-85128538079 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-01074Swedish Research Council, K2014-99X22610-01-6The Dementia Association - The National Association for the Rights of the DementedKonung Gustaf V:s och Drottning Victorias Frimurarestiftelse
Note

Originally included in thesis in manuscript form.

Available from: 2021-09-06 Created: 2021-09-06 Last updated: 2023-05-26Bibliographically approved
4. Concurrent validity of the International Physical Activity Questionnaire adapted for adults aged ≥ 80 years (IPAQ-E 80 +) - tested with accelerometer data from the SilverMONICA study
Open this publication in new window or tab >>Concurrent validity of the International Physical Activity Questionnaire adapted for adults aged ≥ 80 years (IPAQ-E 80 +) - tested with accelerometer data from the SilverMONICA study
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2022 (English)In: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 92, p. 135-143Article in journal (Refereed) Published
Abstract [en]

Background: Physical activity and sedentary behavior vary across the life span, and in very old people activity behavior can vary considerably over 24 h. A physical activity questionnaire adapted for this age group is lacking. This study was conducted to validate such a newly developed questionnaire suitable for use in very old people.

Research question: Is the International Physical Activity Questionnaire adapted for adults aged ≥ 80 years (IPAQ-E 80 +) a valid measure of physical activity in very old people?

Methods: Seventy-six participants (55.3% women) with a mean age of 84.4 ± 3.8 years wore accelerometers for ≥ 5 consecutive days, and completed the IPAQ-E 80 +. Spearman's rho and Bland-Altman plots were used to analyze the validity of IPAQ-E 80 + against accelerometer measures. Analyses were conducted for the separate items sitting, laying down at daytime and nighttime, walking, moderate to vigorous (MV) walking, and moderate to vigorous physical activity (MVPA), and the summary measures: total inactive time, sedentary time (i.e. lying down at daytime + sitting), total active time, and total MVPA + MV walking.

Results: The IPAQ-E 80 + correlated with the accelerometer measures of total inactive- (r = 0.55, p < 0.001), sedentary- (r = 0.28, p = 0.015), walking- (r = 0.54 p < 0.001) and total active- (r = 0.60, p < 0.001) times, but not with measures of intensity of walking or physical activity; MV walking (r = 0.06, p = 0.58), MVPA (r = 0.17, p = 0.13).

Significance: In this study the IPAQ-E 80 + showed fair to substantial correlations with accelerometers, and it therefore seems able to rank very old people according to levels of PA (total inactive-, sedentary-, and total active time, and walking time). The IPAQ-E 80 + seems promising for use in studies investigating associations between activity behavior and health in this population. Further investigation is needed to determine whether the IPAQ-E 80 + can accurately measure PA intensity.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Validity, Physical activity questionnaire, Sedentary behavior, Very old people, Accelerometry
National Category
Physiotherapy Geriatrics Public Health, Global Health, Social Medicine and Epidemiology
Research subject
physiotherapy
Identifiers
urn:nbn:se:umu:diva-187217 (URN)10.1016/j.gaitpost.2021.11.019 (DOI)000788079500011 ()34847411 (PubMedID)2-s2.0-85120962874 (Scopus ID)
Funder
Swedish Research Council Formas, 2016-01074Swedish Research Council, K2014-99X-22610-01-6
Note

Originally included in thesis in manuscript form.

Available from: 2021-09-06 Created: 2021-09-06 Last updated: 2023-09-05Bibliographically approved

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