Gait speed, cognition and falls in people living with mild-to-moderate Alzheimer disease: data from NILVAD
Abstract 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 e...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2020-03-01
|
| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12877-020-01531-w |
| _version_ | 1818216167158841344 |
|---|---|
| author | Adam H. Dyer Brian Lawlor Sean P. Kennelly for the NILVAD Study Group |
| author_facet | Adam H. Dyer Brian Lawlor Sean P. Kennelly for the NILVAD Study Group |
| author_sort | Adam H. Dyer |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-12T06:47:40Z |
| format | Article |
| id | doaj.art-66997f25611746c4b3112df79d1b90cc |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-12-12T06:47:40Z |
| publishDate | 2020-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-66997f25611746c4b3112df79d1b90cc2022-12-22T00:34:08ZengBMCBMC Geriatrics1471-23182020-03-0120111010.1186/s12877-020-01531-wGait speed, cognition and falls in people living with mild-to-moderate Alzheimer disease: data from NILVADAdam H. Dyer0Brian Lawlor1Sean P. Kennelly2for the NILVAD Study GroupDepartment of Age-Related Healthcare, Tallaght University HospitalDepartment of Medical Gerontology, School of Medicine, Trinity College DublinDepartment of Age-Related Healthcare, Tallaght University HospitalAbstract 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.http://link.springer.com/article/10.1186/s12877-020-01531-wDementiaAlzheimer diseaseCognitionFalls |
| spellingShingle | Adam H. Dyer Brian Lawlor Sean P. Kennelly for the NILVAD Study Group Gait speed, cognition and falls in people living with mild-to-moderate Alzheimer disease: data from NILVAD BMC Geriatrics Dementia Alzheimer disease Cognition Falls |
| title | Gait speed, cognition and falls in people living with mild-to-moderate Alzheimer disease: data from NILVAD |
| title_full | Gait speed, cognition and falls in people living with mild-to-moderate Alzheimer disease: data from NILVAD |
| title_fullStr | Gait speed, cognition and falls in people living with mild-to-moderate Alzheimer disease: data from NILVAD |
| title_full_unstemmed | Gait speed, cognition and falls in people living with mild-to-moderate Alzheimer disease: data from NILVAD |
| title_short | Gait speed, cognition and falls in people living with mild-to-moderate Alzheimer disease: data from NILVAD |
| title_sort | gait speed cognition and falls in people living with mild to moderate alzheimer disease data from nilvad |
| topic | Dementia Alzheimer disease Cognition Falls |
| url | http://link.springer.com/article/10.1186/s12877-020-01531-w |
| work_keys_str_mv | AT adamhdyer gaitspeedcognitionandfallsinpeoplelivingwithmildtomoderatealzheimerdiseasedatafromnilvad AT brianlawlor gaitspeedcognitionandfallsinpeoplelivingwithmildtomoderatealzheimerdiseasedatafromnilvad AT seanpkennelly gaitspeedcognitionandfallsinpeoplelivingwithmildtomoderatealzheimerdiseasedatafromnilvad AT forthenilvadstudygroup gaitspeedcognitionandfallsinpeoplelivingwithmildtomoderatealzheimerdiseasedatafromnilvad |