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Physical activity in late middle- to older-aged people and dementia, cognitive, and physical function two decades later
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.ORCID iD: 0000-0002-2807-1295
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Occupational Therapy.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.ORCID iD: 0000-0002-1617-6102
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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. Vol. 51, p. 135-141
Keywords [en]
cognitive function, dementia, executive function, gait speed, physical activity, very old people
National Category
Physiotherapy Geriatrics
Research subject
physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-187213DOI: 10.1159/000523726ISI: 000779096600001Scopus ID: 2-s2.0-85128538079OAI: oai:DiVA.org:umu-187213DiVA, id: diva2:1591378
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
In thesis
1. 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
Open this publication in new window or tab >>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
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
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
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
Gait speed, cognitive function, dementia, physical activity, aged 80 and over
National Category
Physiotherapy
Research subject
physiotherapy
Identifiers
urn:nbn:se:umu:diva-187220 (URN)978-91-7855-605-2 (ISBN)978-91-7855-606-9 (ISBN)
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

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Öhlin, JerryToots, AnnikaLittbrand, HåkanWennberg, PatrikOlofsson, BirgittaGustafson, YngveHörnsten, CarlWerneke, UrsulaNordström, PeterNiklasson, JohanSöderberg, Stefan

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Öhlin, JerryToots, AnnikaLittbrand, HåkanWennberg, PatrikOlofsson, BirgittaGustafson, YngveHörnsten, CarlWerneke, UrsulaNordström, PeterNiklasson, JohanSöderberg, Stefan
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