TY - JOUR
T1 - Gait speed, cognition and falls in people living with mild-to-moderate Alzheimer disease
T2 - Data from NILVAD
AU - NILVAD Study Group
AU - Dyer, Adam H.
AU - Murphy, Claire
AU - Lawlor, Brian
AU - Kennelly, Sean P.
AU - Segurado, Ricardo
AU - Olde Rikkert, Marcel G.M.
AU - Howard, Robert
AU - Pasquier, Florence
AU - Börjesson-Hanson, Anne
AU - Tsolaki, Magda
AU - Lucca, Ugo
AU - Molloy, D. William
AU - Coen, Robert
AU - Riepe, Matthias W.
AU - Kálmán, János
AU - Kenny, Rose Anne
AU - Cregg, Fiona
AU - O'Dwyer, Sarah
AU - Walsh, Cathal
AU - Adams, Jessica
AU - Banzi, Rita
AU - Breuilh, Laetitia
AU - Daly, Leslie
AU - Hendrix, Suzanne
AU - Aisen, Paul
AU - Gaynor, Siobhan
AU - Sheikhi, Ali
AU - Taekema, Diana G.
AU - Verhey, Frans R.
AU - Nemni, Raffaello
AU - Nobili, Flavio
AU - Franceschi, Massimo
AU - Frisoni, Giovanni
AU - Zanetti, Orazio
AU - Konsta, Anastasia
AU - Anastasios, Orologas
AU - Nenopoulou, Styliani
AU - Tsolaki-Tagaraki, Fani
AU - Pakaski, Magdolna
AU - Dereeper, Olivier
AU - Sayette, Vincent de la
AU - Sénéchal, Olivier
AU - Lavenu, Isabelle
AU - Devendeville, Agnès
AU - Calais, Gauthier
AU - Crawford, Fiona
AU - Mullan, Michael
AU - Aalten, Pauline
AU - Berglund, Maria A.
AU - Claassen, Jurgen A.
N1 - Publisher Copyright:
© 2020 The Author(s).
PY - 2020/3/30
Y1 - 2020/3/30
N2 - Background: Previous evidence suggests that slower gait speed is longitudinally associated with cognitive impairment, dementia and falls in older adults. Despite this, the longitudinal relationship between gait speed, cognition and falls in those with a diagnosis of dementia remains poorly explored. We sought to assess this longitudinal relationship in a cohort of older adults with mild to-moderate Alzheimer Disease (AD). Methods: Analysis of data from NILVAD, an 18-month randomised-controlled trial of Nilvadipine in mild to moderate AD. We examined: (i) the cross-sectional (baseline) association between slow gait speed and cognitive function, (ii) the relationship between baseline slow gait speed and cognitive function at 18 months (Alzheimer Disease Assessment Scale, Cognitive Subsection: ADAS-Cog), (iii) the relationship between baseline cognitive function and incident slow gait speed at 18 months and finally (iv) the relationship of baseline slow gait speed and incident falls over the study period. Results: Overall, one-tenth (10.03%, N = 37/369) of participants with mild-to-moderate AD met criteria for slow gait speed at baseline and a further 14.09% (N = 52/369) developed incident slow gait speed at 18 months. At baseline, there was a significant association between poorer cognition and slow gait speed (OR 1.05, 95% CI 1.01-1.09, p = 0.025). Whilst there was no association between baseline slow gait speed and change in ADAS-Cog score at 18 months, a greater cognitive severity at baseline predicted incident slow gait speed over 18 months (OR 1.04, 1.01-1.08, p = 0.011). Further, slow gait speed at baseline was associated with a significant risk of incident falls over the study period, which persisted after covariate adjustment (IRR 3.48, 2.05-5.92, p < 0.001). Conclusions: Poorer baseline cognition was associated with both baseline and incident slow gait speed. Slow gait speed was associated with a significantly increased risk of falls over the study period. Our study adds further evidence to the complex relationship between gait and cognition in this vulnerable group and highlights increased falls risk in older adults with AD and slow gait speed. Trial registration: Secondary analysis of the NILVAD trial (Clincaltrials.gov NCT02017340; EudraCT number 2012-002764-27). First registered: 20/12/2013.
AB - Background: Previous evidence suggests that slower gait speed is longitudinally associated with cognitive impairment, dementia and falls in older adults. Despite this, the longitudinal relationship between gait speed, cognition and falls in those with a diagnosis of dementia remains poorly explored. We sought to assess this longitudinal relationship in a cohort of older adults with mild to-moderate Alzheimer Disease (AD). Methods: Analysis of data from NILVAD, an 18-month randomised-controlled trial of Nilvadipine in mild to moderate AD. We examined: (i) the cross-sectional (baseline) association between slow gait speed and cognitive function, (ii) the relationship between baseline slow gait speed and cognitive function at 18 months (Alzheimer Disease Assessment Scale, Cognitive Subsection: ADAS-Cog), (iii) the relationship between baseline cognitive function and incident slow gait speed at 18 months and finally (iv) the relationship of baseline slow gait speed and incident falls over the study period. Results: Overall, one-tenth (10.03%, N = 37/369) of participants with mild-to-moderate AD met criteria for slow gait speed at baseline and a further 14.09% (N = 52/369) developed incident slow gait speed at 18 months. At baseline, there was a significant association between poorer cognition and slow gait speed (OR 1.05, 95% CI 1.01-1.09, p = 0.025). Whilst there was no association between baseline slow gait speed and change in ADAS-Cog score at 18 months, a greater cognitive severity at baseline predicted incident slow gait speed over 18 months (OR 1.04, 1.01-1.08, p = 0.011). Further, slow gait speed at baseline was associated with a significant risk of incident falls over the study period, which persisted after covariate adjustment (IRR 3.48, 2.05-5.92, p < 0.001). Conclusions: Poorer baseline cognition was associated with both baseline and incident slow gait speed. Slow gait speed was associated with a significantly increased risk of falls over the study period. Our study adds further evidence to the complex relationship between gait and cognition in this vulnerable group and highlights increased falls risk in older adults with AD and slow gait speed. Trial registration: Secondary analysis of the NILVAD trial (Clincaltrials.gov NCT02017340; EudraCT number 2012-002764-27). First registered: 20/12/2013.
KW - Alzheimer disease
KW - Cognition
KW - Dementia
KW - Falls
UR - http://www.scopus.com/inward/record.url?scp=85082790701&partnerID=8YFLogxK
U2 - 10.1186/s12877-020-01531-w
DO - 10.1186/s12877-020-01531-w
M3 - Article
C2 - 32228468
AN - SCOPUS:85082790701
SN - 1471-2318
VL - 20
SP - 117
JO - BMC Geriatrics
JF - BMC Geriatrics
IS - 1
M1 - 117
ER -