A major challenge to developing primary preventive interventions for frailty and disability in older adults is lack of validated simple clinical tools to identify high-risk individuals without overt signs of poor health.
To examine the validity of the Walking While Talking test (WWT), a mobility stress test, to predict frailty, disability and death in high functioning older adults.
prospective cohort study.
631 community-residing adults age 70 and older participating in the Einstein Aging Study (mean follow-up 32 months). High functioning status at baseline was defined as absence of disability, dementia, and normal walking speeds.
Main outcome measures
Hazard ratios for frailty, disability, and all-cause mortality. Frailty was defined as presence of three out of the following five attributes: weight loss, weakness, exhaustion, low physical activity and slow gait. We also compared predictive validity of WWT with Short Physical Performance Battery (SPPB) for study outcomes.
218 subjects developed frailty, 88 disability, and 49 died. Each 10 cm/s decrease in WWT speed was associated with increased risk of frailty (Hazard ratio 1.12, 95% CI 1.06 to 1.18), disability (Hazard ratio 1.13, 95% CI 1.03 −1.23), and mortality (Hazard ratio 1.13, 95% CI 1.01 – 1.27). Most associations remained robust even after accounting for potential confounders and gait speed. Comparisons of HR and model fit suggest that WWT may better predict frailty whereas SPPB may better predict disability.
Mobility stress tests such as the WWT are robust predictors of risk of frailty, disability, and mortality in high functioning older adults.
Mobility; Frailty; Disability; Mortality; Gait
The attention network test (ANT) assesses the effect of alerting and orienting cues on a visual flanker task measuring executive attention. Previous findings revealed that older adults demonstrate greater reaction times (RT) benefits when provided with visual orienting cues that offer both spatial and temporal information of an ensuing target. Given the overlap of neural substrates and networks involved in multisensory processing and cueing (i.e., alerting and orienting), an investigation of multisensory cueing effects on RT was warranted. The current study was designed to determine whether participants, both old and young, benefited from receiving multisensory alerting and orienting cues. Eighteen young (M = 19.17 years; 45% female) and eighteen old (M = 76.44 years; 61% female) individuals that were determined to be non-demented and without any medical or psychiatric conditions that would affect their performance were included. Results revealed main effects for the executive attention and orienting networks, but not for the alerting network. In terms of orienting, both old and young adults demonstrated significant orienting effects for auditory-somatosensory (AS), auditory-visual (AV), and visual-somatosensory (VS) cues. RT benefits of multisensory compared to unisensory orienting effects differed by cue type and age group; younger adults demonstrated greater RT benefits for AS orienting cues whereas older adults demonstrated greater RT benefits for AV orienting cues. Both groups, however, demonstrated significant RT benefits for multisensory VS orienting cues. These findings provide evidence for the facilitative effect of multisensory orienting cues, and not multisensory alerting cues, in old and young adults.
Multisensory integration; Alerting; Orienting; Executive attention; Aging
Objective: to determine the association of high sensitivity C-reactive protein (HsCRP) levels with a risk of mobility disability and decline in older adults with and without vascular disease.
Design: prospective cohort.
Setting: community-residing population.
Subjects: six hundred and twenty-four adults age 70 and older (62% women) with gait and HsCRP assessments.
Main outcome measures: incident mobility disability (velocity <70 cm/s) and annual rates of decline on gait velocity.
Results: elevated HsCRP levels (≥3 mg/l) at baseline present in 224 of the 624 eligible subjects was associated with a faster annual decline in gait velocity of 0.91 cm/s (P = 0.02). Subjects with elevated HsCRP levels had increased risk of mobility disability (hazard ratio: 1.85, 95% CI: 1.09–3.14). Each one-unit increase in log HsCRP levels in the 406 subjects without prevalent mobility disability was associated with increased risk of mobility disability (hazard ratio: 1.33, 95% CI: 1.05–1.68). The association of baseline HsCRP levels with mobility disability and decline was stronger in the 224 individuals without vascular disease. The associations were not significant in the 400 subjects with vascular disease.
Conclusions: HsCRP levels predict mobility disability and accelerated decline in walking speed in older adults. These associations were stronger in those without vascular disease.
cohort study; epidemiology; gait; inflammation elderly
Stair negotiation is a key marker for independence among older adults; however, clinically meaningful change has not been established. Our objective was to establish the values of clinically meaningful change in stair negotiation time using distribution- and anchor-based approaches.
Study participants were 371 community residing older adults (age ≥ 70) in the Einstein Aging Study with time to ascend and descend 3 steps measured at baseline and at one-year follow-up. Anchor-based estimates were obtained using functional decline (defined as one-point increment in disability score) and change in self-reported walking ability over the one-year follow-up period. Small, moderate, and large meaningful change estimates were 0.28, 0.71, and 1.15 s for stair ascent time (0.31, 0.78, and 1.25 s for stair descent time) using the distribution-based approach of effect size. The estimates of meaningful decline range from 0.47 to 0.53 s for stair ascent time (0.33–0.53 s for stair descent time) using the anchor-based approach. The estimates of meaningful improvement were smaller (0.13–0.18 s for stair ascent, 0.06–0.15 for stair descent) compared to those for decline. Based on general consistency between distribution- and anchor-based approaches, preliminary criteria suggested for stair negotiation time is 0.5 s for meaningful decline and 0.2 s for meaningful improvement.
Stair negotiation; Meaningful change; Aged
Assess the association between depressive symptoms (not meeting the criteria for major depression) and gait dysfunction in older adults.
Einstein Aging Study, a community-based longitudinal aging study.
Six hundred ten nondemented and nondepressed community-residing adults age 70 and older.
Depressive symptoms measured using the 15-item Geriatric Depression Scale. To obtain a comprehensive assessment of gait, eight individual quantitative gait parameters were assessed: velocity (cm/s), stride length (cm), cadence (steps/min), swing phase (seconds), stance phase (seconds), double support phase (seconds), stride length variability (SD of stride length), and swing time variability (SD of swing time). Multiple linear regression analysis was applied to study the association of depressive symptoms with gait, adjusting for potential confounders including demographic variables, medical illnesses, and clinical gait abnormalities.
Increased level of depressive symptoms was associated with worse velocity, stride, and swing time variability. The relationship of the remaining five gait variables with depressive symptoms was not significant in the fully adjusted models.
Higher levels of depressive symptoms are associated with worse performance in specific quantitative gait variables in community-residing older adults.
depressive symptoms; epidemiology; elderly; gait
Gait Velocity (GV) is predictive of hospitalizations and mortality in the elderly. In the US, elderly African Americans have higher rates of physical disability compared to Caucasians. Few studies have investigated if there are racial differences in GV in the elderly.
We performed a cross sectional analysis to investigate racial differences in GV.
Participants were part of the Einstein Aging Study, a longitudinal study of community-residing elderly in the Bronx, NY. They were recruited using Medicare and voter registration records. Records of 213 participants were analyzed.
Demographics, medical history, the Geriatric Depression Scale, the Blessed Information Memory Concentration Test, and the Total Pain Index (TPI) were collected. GV was measured using the GAITrite® mat.
We included 157 Caucasians and 56 African Americans. Caucasians were older (median 79.9y v 75.5y, p<0.01), more educated (median 14y v 12y, p<0.01) and had lower BMIs (mean 26.9±4.3 v 28.9±6.4, p=0.03). African Americans had higher proportions of female participants (80.4% v 59.9%, p<0.01) and diabetes (28.6% v 13.4%, p=0.01). Neither group had significantly higher pain levels. African Americans had a significantly slower GV (mean 90.2±17.9 v 99.1±20.1 cm/sec, p<0.01). This difference persists despite adjusting for multiple covariates. A 7.79 cm /sec slower gait speed in African Americans versus Caucasians was not explained by differences in common factors known to influence gait.
Differences in GV persist between African Americans and Caucasians despite adjusting for many confounders. Increases of just 10cm/sec are associated with reduced mortality. Further studies are needed to evaluate if there are modifiable risk factors that potentially explain this difference and if an intervention could reduce the discrepancy between the groups.
gait velocity; health disparities; elderly; physical function
Personality and self-rated health have been linked previously to cognitive outcome in late life. However, these associations have not been shown among the oldest old. This study examined relationships between personality, self-rated health, and cognitive function in a selected sample of Ashkenazi Jewish centenarians (n = 68, 59% female) aged 95 to 106 who lived independently in the community. Personality was measured using the Personality Outlook Profile Scale (POPS), a brief measure that was validated in this population. Self-rated health was assessed by participants’ subjective rating of their present health, and Mini-Mental Status Examination was used to determine cognitive function. Results showed positive associations of the Positive Attitude Towards Life domain of the POPS and self-rated health with participants’ current cognitive function. These associations remained significant even after adjusting for the effects of participants'age, gender, marital status, education, and history of medical illnesses. Further exploratory analysis using structural equations modeling showed significant associations among the three variables, but demonstrated a borderline significant level of mediating effect of personality on the relationship between self-rated health and cognition. These results reemphasized the independent roles of personality and self-rated health on centenarians’ cognitive outcomes. Future studies will further elucidate the impact of personality and self-rated health on cognitive outcomes in the oldest old.
personality; cognition; self-rated health; centenarian; aging
The aim of this study was to develop alternate forms of the walking while talking (WWT) dual task, and to determine whether beginning the WWT in mid-alphabet vs. at the beginning of the alphabet, affects task outcomes. Alternate test forms help reduce practice effects leading to more precise estimates of change over time. We conducted a cross-sectional study in 145 community-residing older adults (mean age, 79.2 ± 6.8 y) without dementia or depression. Subjects performed four WWT trials with a different initial letter (a, b, m or n). There were no differences in velocity, correct letters, or errors on WWT trials beginning at shared points in the alphabet (`a' compared to `b' and `m' compared to `n'). However, trials initiating with letters from the beginning of the alphabet compared to mid-alphabet showed significant differences (with higher number of correct letters and fewer errors for `a' and `b' trials) but not for velocity. Thus, starting WWT in mid-alphabet is different from starting at the beginning of the alphabet. Alternate forms of the WWT with two separate initial letters from a shared point of the alphabet (specifically `a' and `b' or `m' and `n') may be used upon repeated administration to reduce practice effects.
Dual task; Alternate forms; Practice effects; Elderly; Walking
The current study critically assessed the relationship between cognitive functions and gait in nondemented older adults. Quantitative measures of gait (velocity, cadence, and a coefficient of variance in stride length) were assessed in single and dual-task conditions. Three cognitive factors captured the domains of Executive Attention, Verbal IQ, and Memory. Linear regressions showed that Executive Attention was related to velocity in both walking conditions. However, Memory and Verbal IQ were also related to velocity. Memory was related to Cadence in both walking conditions. Executive Attention was related to the coefficient of variance in stride length in both walking conditions. Linear mixed effects models showed that dual-task costs were largest in velocity followed by cadence and the coefficient of variance in stride length. The relationship between cognitive functions and gait depends, in part, on the analytic approach used, gait parameters assessed, and walking condition.
gerontology; motor control; aging
Stimuli are processed concurrently and across multiple sensory inputs. Here we directly compared the effect of multisensory integration (MSI) on reaction time across three paired sensory inputs in eighteen young (M=19.17 yrs) and eighteen old (M=76.44 yrs) individuals. Participants were determined to be non-demented and without any medical or psychiatric conditions that would affect their performance. Participants responded to randomly presented unisensory (auditory, visual, somatosensory) stimuli and three paired sensory inputs consisting of auditory-somatosensory (AS) auditory-visual (AV) and visual-somatosensory (VS) stimuli. Results revealed that reaction time (RT) to all multisensory pairings was significantly faster than those elicited to the constituent unisensory conditions across age groups; findings that could not be accounted for by simple probability summation. Both young and old participants responded the fastest to multisensory pairings containing somatosensory input. Compared to younger adults, older adults demonstrated a significantly greater RT benefit when processing concurrent VS information. In terms of co-activation, older adults demonstrated a significant increase in the magnitude of visual-somatosensory co-activation (i.e., multisensory integration), while younger adults demonstrated a significant increase in the magnitude of auditory-visual and auditory-somatosensory co-activation. This study provides first evidence in support of the facilitative effect of pairing somatosensory with visual stimuli in older adults.
Multisensory Integration; Cross-Modal; Sensory Processing; Aging
To establish reference values for stair ascent and descent times in community dwelling ambulatory older adults, and to examine their predictive validity for functional decline.
Longitudinal cohort study. Mean follow-up time was 1.8 year (maximum 3.2 y, total 857.9 person-years).
Older adults age 70 and older (N=513; mean age, 80.8±5.1y), without disability or dementia.
Main Outcome Measures
Time to ascend and descend 3 steps measured at baseline. 14 point Disability scale assessed functional status at baseline and at follow-up interviews every 2–3 months. Functional decline was defined as an increase in the disability score by 1-point during the follow-up period.
The mean ± standard deviation (SD) stair ascent and descent time for three steps was 2.78 ±1.49 and 2.83 ±1.61 sec respectively. The proportion of self-reported and objective difficulty was higher with longer stair ascent and descent times (P<.001 for trend for both stair ascent and descent). Of the 472 participants with at least one follow-up interview, 315 developed functional decline with a 12-month cumulative incidence of 56.6% (95% confidence interval, CI, 52.1–61.3%). The stair negotiation time was a significant predictor of functional decline after adjusting for covariates including gait velocity (adjusted hazard ratio per one-second increase, aHR 1.12, 95% CI 1.04–1.21 for stair ascent time, aHR 1.15, 95% CI 1.07–1.24 for stair descent time). Stair descent time was a significant predictor of functional decline among relatively high-functioning older adults reporting no difficulty in stair negotiation (P=.001).
The stair ascent and descent times are simple, quick, and valid clinical measures for assessing the risk of functional decline in community dwelling older adults including high-functioning individuals.
Rehabilitation; Activities of daily living; Aged
The current study examined the relationship between cognitive function and falls in elders who did not meet criteria for dementia or Mild Cognitive Impairment (n=172). To address limitations of previous research, associations between cognitive function and falls controlled for the confounding effects of gait measures and other risk factors. A neuropsychological test battery was submitted to factor analysis yielding three orthogonal factors (verbal IQ, Speed/Executive Attention, Memory). Single and recurrent falls within the last 12 months were evaluated. We hypothesized that Speed/Executive Attention would be associated with falls. Additionally, we assessed whether associations between different cognitive functions and falls varied depending on whether single or recurrent falls were examined. Multivariate logistic regressions showed that worse scores on Speed/Executive Attention were associated with increased single and recurrent falls. Worse scores on Verbal IQ were related only to increased recurrent falls. Memory was not associated with either single or recurrent falls. These findings are relevant to risk assessment and prevention of falls, and point to possible shared neural substrate of cognitive and motor function.
cognition; falls; aging
Increased inflammatory activity and gait speed decline are common with aging, but the association between the two is not well established. The objective of this study was to determine the influence of inflammatory markers, interleukin-6 (IL-6), and tumor necrosis factor alpha, on gait speed performance and decline in older adults.
We conducted cross-sectional and longitudinal analyses of 333 adults aged 70 and older (61% women) with gait and biomarker assessments identified from participants in the Einstein Aging Study, a community-based aging study. Gait velocity measured at baseline and annual follow-up visits (median follow-up 2.3 years) was the main outcome.
At baseline, higher interleukin-6 levels were associated with slower gait velocity (estimate −4.90 cm/s, p = .008). Adjusted for age, gender, education, and medical illnesses, a one-unit increase in baseline log IL-6 levels was associated with a 0.98 cm/s faster gait speed decline per year (p = .002). The results remained significant after adjustments for additional potential confounders such as physical activity levels, body mass index, and medications. Participants in the highest IL-6 quartile had a 1.75 cm/s/year faster decline in gait velocity compared with those in the lowest quartile (p = .002). Tumor necrosis factor alpha was not associated with gait velocity at cross-section or with gait speed decline.
IL-6 levels are associated with gait performance in community residing seniors and predicts risk of gait speed decline in aging.
Mobility; Gait; Inflammation—Interleukin-6
Background and Purpose
Treadmill walking training (TWT) as an intervention to improve the gait of frail older adults has not been well studied. In this pilot study, we describe the feasibility, tolerance, and effect of TWT on specific gait parameters during overground walking in four frail older adults as a prelude to developing larger scale exercise intervention trials in this high-risk population.
Four community-residing frail older individuals (age>70) with Mini-Mental Status Examination score of 26 or higher and no activity limitations. Frailty was defined as presence of at least three out of the following five attributes: slow gait (<1 m/sec), unintentional weight loss (>10 lbs in prior year), self-report of poor grip strength, exhaustion, and low level of physical activity.
TWT consisted of 24 sessions (3 times/week for 8 weeks). Five quantitative gait parameters [velocity, stride length, swing time, percentage of double support phase, coefficient of variation (COV) of stride length] during overground walking were measured at baseline, weekly during training, and immediately post-TWT.
All participants tolerated TWT without significant complications. Following TWT, gait velocity increased in all participants by 6.4 to 26.8 cm/sec, which was larger than the reported value for meaningful change in gait velocity (4 cm/sec). Stride length and double support phase also showed improvement in all participants (mean percentage increase of 10.8 % for stride length, and 17.1% reduction for double support phase post training compared to baseline). Swing time improved in three participants (mean reduction of 4.5 %). The COV of stride length did not show consistent improvement.
This case series shows that TWT is feasible and well tolerated by frail older adults, and may improve most gait parameters in this high-risk population.
gait; exercise; frail older adults; rehabilitation
Evidence suggests that gait is influenced by higher order cognitive and cortical control mechanisms. However, less is known about the functional correlates of cortical control of gait.
Using functional near-infrared spectroscopy, the current study was designed to evaluate whether increased activations in the prefrontal cortex (PFC) were detected in walking while talking (WWT) compared with normal pace walking (NW) in 11 young and 11 old participants. Specifically, the following two hypotheses were evaluated: (a) Activation in the PFC would be increased in WWT compared with NW. (b) The increase in activation in the PFC during WWT as compared with NW would be greater in young than in old participants.
Separate linear mixed effects models with age as the two-level between-subject factor, walking condition (NW vs WWT) as the two-level repeated within-subject factor, and HbO2 levels in each of the 16 functional near-infrared spectroscopy channels as the dependent measure revealed significant task effects in 14 channels, indicating a robust bilateral increased activation in the PFC in WWT compared with NW. Furthermore, the group-by-task interaction was significant in 11 channels with young participants showing greater WWT-related increase in HbO2 levels compared with the old participants.
This study provided the first evidence that oxygenation levels are increased in the PFC during WWT compared with NW in young and old individuals. This effect was modified by age suggesting that older adults may underutilize the PFC in attention-demanding locomotion tasks.
Cognition; Gait; fNIRS
To investigate the incidence of fear of falling (FOF) and the risk factors associated with transient versus persistent FOF in community-dwelling older adults.
Prospective cohort study.
Bronx County, New York.
Three hundred eighty participants without FOF at baseline in the Einstein Aging Study aged 70 and older.
FOF was assessed at baseline and during follow-up interviews at 2- to 3-month intervals for a minimum 2 years. Incident FOF was classified as transient or persistent FOF. Transient FOF was defined as new-onset FOF reported at only one interview, and persistent FOF was FOF reported at two or more interviews over a 2-year period.
Twenty-four-month cumulative incidence of incident FOF was 45.4%, with 60.0% of FOF being persistent. Predictors of incident FOF included female sex (adjusted hazard ratio (aHR) = 1.55, 95% confidence interval (CI) = 1.08–2.23), depressive symptoms (aHR = 1.16, 95% CI = 1.07–1.26), falls (aHR = 1.50, 95% CI = 1.01–2.21), and clinical gait abnormality (aHR = 2.07, 95% CI = 1.42–3.01). The proportion of participants with incident FOF increased linearly with increasing number of risk factors. Predictors for transient and persistent FOF were depressive symptoms and clinical gait abnormality. Female sex and previous falls were predictors of persistent but not transient FOF.
FOF status in older adults may change over time, with shared and distinct risk factors for persistent and transient FOF. Understanding the dynamic nature of FOF and these risk factors will help identify high-risk groups and design future intervention studies.
fear of falling; risk factors; older adults
To examine the ability of clinic based assessments of gait speed to capture limitations in a broad range of home and community based activities.
Community based aging cohort study
655 community residing individuals (61% women) who were age 70 and older (mean 80.4 years).
Main outcome measures
Limitations on three gait related activities of daily living (walking inside home and climbing up and down stairs) and six motor based but gait independent activities (bathing, dressing, getting up from a chair, toileting, shopping, and using public transportation).
Gait speed was associated with presence of self-reported difficulty on all three home based activities that were directly gait related and in 5 out of the 6 motor based activities. Gait speed of ≤1 m/sec was associated with increased risk of limitations on at least one out the nine selected activities (odds ratio 3.21, 95% CI 2.24 to 4.58, p <0.001).
Gait speed measured in clinical settings has ecological validity as a clinical marker of functional status in older adults for use in clinical and research settings.
gait speed; elderly; activities of daily living; screening
Presence of performance inconsistency during repeated assessments of gait may reflect underlying subclinical disease, and help shed light on the earliest stages of disablement. We studied inter-session fluctuations on three selected gait measures (velocity, stride length, and stride length variability) during normal pace walking as well as during a cognitively demanding ‘walking while talking’ condition using a repeated measurement burst design (six sessions within a 2-week period) in 71 nondisabled and nondemented community residing older adults, 40 with predisability (does activities of daily living unassisted but with difficulty). Subjects with predisability had slower gait velocity and shorter stride length on both the normal and walking while talking conditions at baseline compared to nondisabled subjects. However, there was no significant pattern of fluctuations across the six sessions on the three selected gait variables comparing the two groups during normal walking as well as on the walking while talking conditions. Our findings support consistency of gait measurements during the earliest stages of disability.
gait; elderly; measurement; variability; disability
We examined the effect of cognitive fatigue on the Attention Networks Test (ANT). Participants were 228 non-demented older adults. Cognitive fatigue was operationally defined as decline in alerting, orienting, and executive attention performance over the course ANT. Anchored in a theoretical model implicating the frontal basal ganglia circuitry as the core substrate of fatigue, we hypothesized that cognitive fatigue would be observed only in executive attention. Consistent with our prediction, significant cognitive fatigue effect was observed in executive attention but not in alerting or orienting. In contrast, orienting improved over the course of the ANT and alerting showed a trend, though insignificant, that was consistent with learning. Cognitive fatigue is conceptualized as an executive failure to maintain and optimize performance over acute but sustained cognitive effort resulting in performance that is lower and more variable than the individual’s optimal ability.
Cognitive Fatigue; Executive Control; Aging; Attention Networks
The Attention Network Test (ANT) assesses alerting, orienting, and executive attention. The current study was designed to achieve three main objectives. First, we determined the reliability, effects, and interactions of attention networks in a relatively large cohort of non-demented older adults (n = 184). Second, in the context of this aged cohort, we examined the effect of chronological age on attention networks. Third, the effect of blood pressure on ANT performance was evaluated. Results revealed high-reliability for the ANT as a whole, and for specific cue and flanker types. We found significant main effects for the three attention networks as well as diminished alerting but enhanced orienting effects during conflict resolution trials. Furthermore, increased chronological age and low blood pressure were both associated with significantly worse performance on the executive attention network. These findings are consistent with executive function decline in older adults and the plausible effect of reduced blood flow to the frontal lobes on individual differences in attention demanding tasks.
Aging; Attention; Executive function; Blood pressure; Processing speed
While gait is widely used to assess health status in older adults, normative data is lacking. Our objective was to develop and compare norms for widely used gait parameters in adults age 70 and older using cross-sectional (conventional) and longitudinal (robust) approaches accounting for important confounders such as disease effects on gait.
Community-dwelling older adults (age>70, N=824) without dementia or disability
Eight quantitative gait parameters measured using an instrumented walkway.
Of the 824 subjects (conventional normal; CN sample), 304 were included in a ‘robust normal’ (RN) sample after excluding those with either prevalent or incident clinical gait abnormalities developing within one year of the baseline assessment to account for disease effects on gait performance. Descriptively, the RN sample showed better performance on all selected gait variables compared to the CN sample. For instance, mean gait velocity (± standard deviation) was 105.9±17.9 cm/sec in the RN sample compared to 93.3±23.2 cm/sec in the overall CN sample. Applying a one standard deviation below the mean (70.1 cm/sec) derived from CN sample to define slow gait, 15.9% (131) in overall cohort were classified as abnormal whereas the RN cut-off (88.0 cm/sec) classified 39.7% (327) in the overall cohort as abnormal.
Our findings suggest that cross-sectional conventional norms may under-estimate gait performance in aging. Longitudinal robust norms provide more accurate estimates of normal gait performance and thus may improve early detection of gait disorders in older adults.
gait; reference values; elderly
To determine whether offspring of parents with exceptional longevity (OPEL) have a lower rate of dementia than offspring of parents with usual survival (OPUS).
Community based prospective cohort study.
Bronx, New York
A volunteer sample of 424 non-demented, community residing older adults (age 75–85) recruited from Bronx County starting in 1980 and followed for up to 23 years.
Epidemiologic, clinical and neuropsychological assessments were completed every 12 to 18 months. OPEL were defined as having at least one parent who reached the age of at least 85 years. OPUS were those for whom neither parent reached the age of 85 years. Dementia was diagnosed by case conference consensus based on DSM-IIIR criteria without access to information on parental longevity. Alzheimer’s disease was diagnosed using established criteria.
Of 424 subjects, 149 (35%) were OPEL and 275 (65%) were OPUS. Mean age at entry for both groups was 79. In comparison with OPUS, the OPEL group had a reduced incidence of Alzheimer’s disease (HR 0.57; 95% CI: 0.35 – 0.93). After adjusting for sex, education, race, hypertension, myocardial infarction, diabetes and stroke results were essentially unchanged. OPEL also had a significantly reduced rate of memory decline on the Selective Reminding Test (SRT) in comparison with the OPUS group (p=0.034).
OPEL develop dementia and Alzheimer’s disease at a significantly lower rate than OPUS. This result is not explained by demographic or medical confounders. Factors associated with longevity may protect against dementia and Alzheimer’s Disease.
Memory decline; dementia; parental longevity; Alzheimer’s disease
frail; screening; gait; elderly