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The impact of cognitive impairment on the physical ageing process

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Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background

Physical decline and cognitive degeneration characterise the ageing process.

Aim

Physical parameters, performance and the functional indexes were studied in relation to age in healthy and cognitively impaired older persons to understand the interactions and changes during normal ageing, cognitive decline and progression to frailty.

Methods

Cross-sectional analysis was performed on a data registry of an ambulatory Memory Diagnosis Centre. The quantitative gait characteristics at usual pace, body composition parameters, disability scales (activity of daily living and instrumental activity of daily living) and Rockwood frailty index were compared in cognitively healthy (CHI), mild cognitively impaired, mildly and moderately demented < 80-years old and > 80-years old adults.

Results

Quality of gait deteriorated with age in CHI and cognitively impaired. Skeletal muscle mass index decreased when cognitive status worsened. Disability and frailty correlated with increasing cognitive impairment. Age, gender, cognitive impairment, body composition and Rockwood’s Frailty scale had a combined forecasting effect, as well as the individual effect on the gait characteristics. Disability score, Frailty index, skeletal muscle mass and skeletal muscle mass index, gait speed, normalised mean step length and swing time variability in mildly demented < 80-years old adults mirrored the parameters in the CHI > 80-years old.

Conclusion

Quantitative gait characteristics, muscle mass and disabilities change along with cognitive impairment, frailty and age. A more rapid physical ageing process accompanies cognitive decline. Therefore, gait characteristics should be age-referenced and studies on gait in older persons should include muscle mass, frailty and cognitive parameters.

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Data availability

The dataset supporting the conclusions of this article is available in the Zenodo repository. https://doi.org/10.5281/zenodo.557109.

Abbreviations

ACE-R:

Addenbrook’s cognitive evaluation-revised

ADL:

Activity of daily living

BIA:

Bio-impedance analysis

BMI:

Body mass index

CDR:

Clinical Dementia Rating Scale

CHI:

Cognitively healthy individuals

Corr:

Correlation

EWGSOP:

European working group on sarcopenia in Older People

FFM:

Free fat mass

FR:

Funcitonal reach

IADL:

Instrumental activity of daily living

MCI:

Mild cognitively impairment

MDC:

Memory Diagnosis Centre

MMSE:

Mini-mental state evaluation

NPI-Q:

Neuropsychological inventory-questionnaire

RMM:

Relative muscle mass

RFM:

Relative fat mass

SLA:

Skeletal lean appendicular muscle mass (SLA)

SMI:

Skeletal muscle mass index

SMM:

Total lean skeletal muscle mass

TCST:

Timed chair stance test

TGUG:

Timed get-up-go

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Acknowledgements

We would like to thank the General Hospital of St Maarten Mechelen for providing lab test equipment and multi-disciplinary medical and paramedical staff. We also are grateful to all the participants—patients and family members—of the Memory Diagnosis Centre.

Funding

No funding was received for this research.

Author information

Authors and Affiliations

  1. Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Universiteitsplein 1, Wilrijk, Antwerp, Belgium

    Anne-Marie De Cock, Stany Perkisas, Veronique Verhoeven & Roy Remmen

  2. University Center of Geriatrics, General Hospital ZNA, Lindendreef 1, Antwerp, Belgium

    Stany Perkisas & Maurits Vandewoude

  3. StatUa Centre for Statistics, University of Antwerp, Universiteitsplein 1, Wilrijk, Antwerp, Belgium

    Erik Fransen

Authors
  1. Anne-Marie De Cock
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  2. Stany Perkisas
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  3. Veronique Verhoeven
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  4. Maurits Vandewoude
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  5. Erik Fransen
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  6. Roy Remmen
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Contributions

ADC, principal author, was responsible for the set-up of the database, design of the study, data analysis and interpretation of the quantitative gait analysis data and drafting the final paper. SP contributed in writing the manuscript and interpretation of the data regarding sarcopenia. VV contributed in writing the manuscript and interpretation of the statistical data. MVDW was a major contributor in writing the manuscript and interpretation of the data regarding sarcopenia and frailty. RR was a major contributor in writing the manuscript analysed and interpreted the patient data regarding impact on general health care. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Anne-Marie De Cock.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethics approval

The ethics committee of Emmaus—St Maarten General Hospital Mechelen approved the study design in 2012 as a retrospective study on patient data using the standard procedure in dementia diagnosis customised with gait and bio-impedance analysis (Emmaus EC 1218). All participants consented to the tests at admission to the Memory Diagnose Center.

Statement of human and animal rights

The procedures followed were in accordance with the ethical standards for human experiments and approved by the ethical committee of the General Hospital St-Maarten.

Informed consent

The clinical data records used in this study were anonymized before their use. Every participant signed an informed consent (IC). This IC procedure was part of the quality procedure maintained in the memory clinic to insure that patients and relatives are aware of the diagnostic pathway they will follow. For participants with cognitive impairment the information is given to the patient and the legal guardian. The signed document is also obtained from the patient and the legal guardian.

Electronic supplementary material

Below is the link to the electronic supplementary material.

40520_2018_1016_MOESM1_ESM.docx

List of all parameters (demographic, cognitive tests and questionnaires, functional assessment, physical assessment) studied in this research paper with their reference (DOCX 17 KB)

40520_2018_1016_MOESM2_ESM.docx

List of all technical parameters (gait domain characteristics and Body composition characteristics) studied in this research paper with their reference (DOCX 17 KB)

40520_2018_1016_MOESM3_ESM.docx

Schematic representation of the statistical process used to differentiate between the four cognitive stages (CHI = cognitively healthy individuals group, MCI = mild cognitively impaired group, Mild = mild dementia group, Mod = moderate dementia group) in the two age groups: comparison between cognitive stages within the same age group, comparison between the two cognitively healthy age groups and correlations study (goodness of fit) between the &#x003E;80-years-old CHI reference age group and other cognitive stages and age groups (DOCX 16 KB)

40520_2018_1016_MOESM4_ESM.docx

Descriptive statistics and detailed test statistics (One -way ANOVA F (df1, df2) = y, p-value, and Chi-square test X2 (df, N = x)= y, p-value) of the study parameters in the four different cognitive stages (cognitively healthy, mild cognitive impaired, mildly demented and moderately demented) in two age groups, &#x003C;80-years old and &#x003E;80-years old adults (DOCX 128 KB)

40520_2018_1016_MOESM5_ESM.docx

Multiple Regression Analysis describing the relation of gait characteristics with independent variables: Age -Body Composition (Skeletal muscle mass (SMM), Skeletal Appendicular muscle mass (SLA), Body Fat mass (BFM), Relative Fat mass (RFM), Relative Muscle Mass (RMM)) –Cognitive impairment per CDR (0;0.5;1;2&#x0026;3), Rockwood’s Frailty scale (0 tot 9). *Statistical results F b (regression coefficient), se (standard error of regression coefficient, p-value). Models were simplified using stepwise forward building. Only the p-values and effect sizes from the final model are reported. Prediction expression per gait characteristic = intercept + b1 component X1 + b2 component X2…etc (DOCX 27 KB)

40520_2018_1016_MOESM6_ESM.docx

Multiple Regression Analysis describing the relation of gait characteristics with independent variables: Age -Body Composition (Skeletal muscle mass (SMM), Skeletal Appendicular muscle mass (SLA), Body Fat mass (BFM), Relative Fat mass (RFM), Relative Muscle Mass (RMM)) –Cognitive impairment per CDR (0;0.5;1;2&#x0026;3), Rockwood’s Frailty scale (0 tot 9). *Statistical results F b (regression coefficient), se (standard error of regression coefficient, p-value). Models were simplified using stepwise forward building. Only the p-values and effect sizes from the final model are reported. Prediction expression per gait characteristic = intercept + b1 component X1 + b2 component X2…etc (DOCX 109 KB)

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De Cock, AM., Perkisas, S., Verhoeven, V. et al. The impact of cognitive impairment on the physical ageing process. Aging Clin Exp Res 30, 1297–1306 (2018). https://doi.org/10.1007/s40520-018-1016-8

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