Sanders Joost B, Bremmer Marijke A, Comijs Hannie C, van de Ven Peter M, Deeg Dorly J H, Beekman Aartjan T F
Department of Old Age Psychiatry, Altrecht Institute for Mental Health Care Utrecht, Utrecht, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
Am J Geriatr Psychiatry. 2017 Apr;25(4):374-385. doi: 10.1016/j.jagp.2016.12.003. Epub 2016 Dec 6.
This study investigates the independent and combined potential of slowed gait speed and slowed processing speed as predictors of adverse health outcomes. The role of depressive symptoms in these associations is also investigated.
In the prospective cohort study, using the Longitudinal Aging Study Amsterdam database, three study samples for each outcome variable were defined: persistent cognitive decline (PCD; N = 1,271, 13 years of follow-up), falls (N = 1,282, 6 years of follow-up), and mortality (N = 1,559, age 74.9 ± 5.8, 21 years of follow-up). At baseline, gait speed (6-m walk with a turn at 3 m), processing speed (coding task), depressive symptoms (Center for Epidemiologic Studies Depression Scale), and basic demographic data were assessed. Also, time to PCD, falls, and mortality were assessed. Cox (for PCD and mortality) and stratified Cox (for falls) regression models were used.
Slowed processing speed predicted PCD (HR: 7.8; 95% CI: 3.3-18.8), slowed gait speed predicted falls (HR: 1.3; 95% CI: 1.0-1.5), and both measures predicted mortality (gait speed HR: 2.1; 95% CI: 1.6-2.6; processing speed HR: 1.9; 95% CI: 1.6-2.4). Each association remained significant after adjusting for the other slowing symptom. Slowed processing speed only predicted falls in the presence of slowed gait (interaction). A slowing sum score that combines both slowing symptoms predicted all three outcomes. The associations were not influenced by depressive symptoms.
Slowing of thought is as relevant as slowing of movement to predict adverse health outcomes, because they seem to represent separate underlying pathologies.
本研究调查步态速度减慢和加工速度减慢作为不良健康结局预测因素的独立及联合潜在作用。还研究了抑郁症状在这些关联中的作用。
在这项前瞻性队列研究中，使用阿姆斯特丹纵向衰老研究数据库，为每个结局变量定义了三个研究样本：持续性认知衰退（PCD；N = 1271，随访13年）、跌倒（N = 1282，随访6年）和死亡率（N = 1559，年龄74.9±5.8，随访21年）。在基线时，评估步态速度（3米处转弯的6米步行）、加工速度（编码任务）、抑郁症状（流行病学研究中心抑郁量表）和基本人口统计学数据。此外，评估PCD、跌倒和死亡的时间。使用Cox（用于PCD和死亡率）和分层Cox（用于跌倒）回归模型。
加工速度减慢预测PCD（风险比：7.8；95%置信区间：3.3 - 18.8），步态速度减慢预测跌倒（风险比：1.3；95%置信区间：1.0 - 1.5），且两种测量方法均预测死亡率（步态速度风险比：2.1；95%置信区间：1.6 - 2.6；加工速度风险比：1.9；95%置信区间：1.6 - 2.4）。在调整另一种减慢症状后，每种关联仍然显著。仅在步态速度减慢的情况下，加工速度减慢才预测跌倒（交互作用）。结合两种减慢症状的减慢总分预测了所有三种结局。这些关联不受抑郁症状的影响。
思维减慢与运动减慢在预测不良健康结局方面同样相关，因为它们似乎代表了不同的潜在病理状况。
