Mild cognitive impairment status and mobility performance: an analysis from the Boston RISE study.

BACKGROUND The prevalence of mild cognitive impairment (MCI) and mobility limitations is high among older adults. The aim of this study was to investigate the association between MCI status and both performance-based and self-report measures of mobility in community-dwelling older adults. METHODS An analysis was conducted on baseline data from the Boston Rehabilitative Impairment Study in the Elderly study, a cohort study of 430 primary care patients aged 65 or older. Neuropsychological tests identified participants with MCI and further subclassified those with impairment in memory domains (aMCI), nonmemory domains (naMCI), and multiple domains (mdMCI). Linear regression models were used to assess the association between MCI status and mobility performance in the Habitual Gait Speed, Figure of 8 Walk, Short Physical Performance Battery, and self-reported Late Life Function and Disability Instrument's Basic Lower Extremity and Advanced Lower Extremity function scales. RESULTS Participants had a mean age of 76.6 years, and 42% were characterized with MCI. Participants with MCI performed significantly worse than participants without MCI (No-MCI) on all performance and self-report measures (p < .01). All MCI subtypes performed significantly worse than No-MCI on all mobility measures (p < .05) except for aMCI versus No-MCI on the Figure of 8 Walk (p = .054) and Basic Lower Extremity (p = .11). Moreover, compared with aMCI, mdMCI manifested worse performance on the Figure of 8 Walk and Short Physical Performance Battery, and naMCI manifested worse performance on Short Physical Performance Battery and Basic Lower Extremity. CONCLUSIONS Among older community-dwelling primary care patients, performance on a broad range of mobility measures was worse among those with MCI, appearing poorest among those with nonmemory MCI.

[1]  Jeffrey Kaye,et al.  The trajectory of gait speed preceding mild cognitive impairment. , 2010, Archives of neurology.

[2]  A. Jette,et al.  Performance-Based Versus Patient-Reported Physical Function: What Are the Underlying Predictors? , 2011, Physical Therapy.

[3]  A. Jette,et al.  Late-Life Function and Disability Instrument , 2015 .

[4]  J. VanSwearingen,et al.  Walking Skill Can Be Assessed in Older Adults: Validity of the Figure-of-8 Walk Test , 2010, Physical Therapy.

[5]  Taina Rantanen,et al.  Mobility Limitations and Cognitive Deficits as Predictors of Institutionalization among Community-Dwelling Older People , 2006, Gerontology.

[6]  Suzanne G. Leveille,et al.  A comparison of straight- and curved-path walking tests among mobility-limited older adults. , 2013, The journals of gerontology. Series A, Biological sciences and medical sciences.

[7]  Suzanne G. Leveille,et al.  Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[8]  Jeffrey M. Hausdorff,et al.  Executive Function and Falls in Older Adults: New Findings from a Five-Year Prospective Study Link Fall Risk to Cognition , 2012, PloS one.

[9]  S. Studenski,et al.  Gait speed and survival in older adults. , 2011, JAMA.

[10]  E. Tangalos,et al.  Neuropsychological tests' norms above age 55: COWAT, BNT, MAE token, WRAT-R reading, AMNART, STROOP, TMT, and JLO , 1996 .

[11]  Ralph H. B. Benedict,et al.  Hopkins Verbal Learning Test—Revised: Normative data and analysis of inter-form and test–retest reliability. , 1998 .

[12]  K. Ritchie Mild cognitive impairment: an epidemiological perspective , 2004, Dialogues in clinical neuroscience.

[13]  J. Brandt,et al.  Construct and concurrent validity of the Hopkins Verbal Learning Test-revised. , 1999, The Clinical neuropsychologist.

[14]  D. Delis,et al.  Quantification of five neuropsychological approaches to defining mild cognitive impairment. , 2009, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[15]  E. Tangalos,et al.  Mild Cognitive Impairment Clinical Characterization and Outcome , 1999 .

[16]  Ronald C Petersen,et al.  Mild cognitive impairment: current research and clinical implications. , 2007, Seminars in neurology.

[17]  Alan M Jette,et al.  Late life function and disability instrument: I. Development and evaluation of the disability component. , 2002, The journals of gerontology. Series A, Biological sciences and medical sciences.

[18]  Astrid Bergland,et al.  Investigation into the reliability and validity of the measurement of elderly people's clinical walking speed: A systematic review , 2012, Physiotherapy theory and practice.

[19]  Anne B. Newman,et al.  Association between Physical and Cognitive Function in Healthy Elderly: The Health, Aging and Body Composition Study , 2004, Neuroepidemiology.

[20]  Suzanne G. Leveille,et al.  The Boston Rehabilitative Impairment Study of the Elderly: a description of methods. , 2013, Archives of physical medicine and rehabilitation.

[21]  Ronald C Petersen,et al.  Assessing the temporal relationship between cognition and gait: slow gait predicts cognitive decline in the Mayo Clinic Study of Aging. , 2013, The journals of gerontology. Series A, Biological sciences and medical sciences.

[22]  Alan M Jette,et al.  Late Life Function and Disability Instrument: II. Development and evaluation of the function component. , 2002, The journals of gerontology. Series A, Biological sciences and medical sciences.

[23]  Xiaonan Xue,et al.  Gait Dysfunction in Mild Cognitive Impairment Syndromes , 2008, Journal of the American Geriatrics Society.

[24]  W. Satariano,et al.  Reliability of physical performance and self-reported functional measures in an older population. , 1998, The journals of gerontology. Series A, Biological sciences and medical sciences.

[25]  S. Studenski,et al.  Contributions of cognitive function to straight- and curved-path walking in older adults. , 2012, Archives of physical medicine and rehabilitation.

[26]  A. Jette,et al.  Validation of the Late‐Life Function and Disability Instrument , 2004, Journal of the American Geriatrics Society.

[27]  Jeffrey M. Hausdorff,et al.  Gait and Cognition: A Complementary Approach to Understanding Brain Function and the Risk of Falling , 2012, Journal of the American Geriatrics Society.

[28]  M. Dewey,et al.  Dementia, cognitive impairment and mortality in persons aged 65 and over living in the community: a systematic review of the literature , 2001, International journal of geriatric psychiatry.

[29]  V. E. Kelly,et al.  Associations Between Physical Performance and Executive Function in Older Adults With Mild Cognitive Impairment: Gait Speed and the Timed “Up & Go” Test , 2011, Physical Therapy.

[30]  S. Studenski,et al.  What is a meaningful change in physical performance? Findings from a clinical trial in older adults (the LIFE-P study) , 2009, The journal of nutrition, health & aging.

[31]  H. Makizako,et al.  Cognitive function affects trainability for physical performance in exercise intervention among older adults with mild cognitive impairment , 2013, Clinical interventions in aging.

[32]  Philip D. Harvey,et al.  Administration and interpretation of the Trail Making Test , 2006, Nature Protocols.

[33]  G. Courtine,et al.  Human walking along a curved path. I. Body trajectory, segment orientation and the effect of vision , 2003, The European journal of neuroscience.

[34]  R. Lipton,et al.  Motoric cognitive risk syndrome and the risk of dementia. , 2013, The journals of gerontology. Series A, Biological sciences and medical sciences.

[35]  P. Heyn,et al.  Endurance and strength training outcomes on cognitively impaired and cognitively intact older adults: A meta-analysis , 2008, The journal of nutrition, health & aging.

[36]  L. Ferrucci,et al.  A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. , 1994, Journal of gerontology.

[37]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[38]  Y. Gustafson,et al.  Usual gait speed independently predicts mortality in very old people: a population-based study. , 2013, Journal of the American Medical Directors Association.

[39]  J. Bobes,et al.  Functional impairment as a defining feature of: amnestic MCI cognitive, emotional, and demographic correlates , 2012, International Psychogeriatrics.

[40]  R. Petersen,et al.  Mild cognitive impairment , 2006, The Lancet.

[41]  M. Liang,et al.  The Self-Administered Comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research. , 2003, Arthritis and rheumatism.

[42]  R. Petersen Clinical practice. Mild cognitive impairment. , 2011, The New England journal of medicine.

[43]  A. Parker,et al.  Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial. , 2012, Journal of evaluation in clinical practice.

[44]  C. Jack,et al.  Mild cognitive impairment – beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment , 2004, Journal of internal medicine.

[45]  J. Morris,et al.  Mild cognitive impairment as a clinical entity and treatment target. , 2005, Archives of neurology.