Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway; Department of Geriatric Medicine, Oslo University Hospital, Norway; Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway.
Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway; Department of Geriatric Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Arch Gerontol Geriatr. 2021 Jul-Aug;95:104400. doi: 10.1016/j.archger.2021.104400. Epub 2021 Mar 24.
Literature on physical performance in older adults across the cognitive spectrum remains inconclusive, and knowledge on differences between dementia subtypes is lacking. We aim to identify distinct physical-performance deficits across the cognitive spectrum and between dementia subtypes.
11,466 persons were included from the 70-year-and-older cohort in the fourth wave of the Trøndelag Health Study (HUNT4 70+). Physical performance was assessed with the Short Physical Performance Battery (SPPB), 4-meter gait speed, five-times-sit-to-stand (FTSS), grip strength and one-leg-standing (OLS). Clinical experts diagnosed dementia per DSM-5 criteria. Multiple linear and logistic regression were performed to analyze differences between groups. Age, sex, education, somatic comorbidity, physical activity and smoking status were used as covariates.
Gait speed declined across the cognitive spectrum, beginning in people with subjective cognitive decline (SCD). Participants with mild cognitive impairment (MCI) additionally showed reduced lower-limb muscle strength, balance and grip strength. Those with dementia scored lowest on all physical-performance measures. Participants with Alzheimer's disease (AD) had a higher SPPB sum score and faster gait speed than participants with vascular dementia (VaD) and Lewy body dementia (LBD); participants with VaD and LBD had lower odds of being able to perform FTSS and OLS than participants with AD.
Physical performance declined across the spectrum from cognitively healthy to SCD to MCI and to dementia. Participants with AD performed better on all assessments except grip strength than participants with VaD and LBD. Stage of cognitive impairment and dementia subtype should guide exercise interventions to prevent mobility decline and dependency.
关于认知谱范围内老年人身体表现的文献仍然没有定论，并且对痴呆症亚型之间的差异知之甚少。我们旨在确定认知谱范围内和痴呆症亚型之间不同的身体表现缺陷。
从特隆赫姆健康研究（HUNT4 70+）的第四波中纳入了 11466 名 70 岁及以上的人。身体表现通过短体适能表现测试（SPPB）、4 米步行速度、五次坐立站起（FTSS）、握力和单腿站立（OLS）来评估。临床专家根据 DSM-5 标准诊断痴呆症。进行多元线性和逻辑回归分析以分析组间差异。年龄、性别、教育程度、躯体共病、身体活动和吸烟状况被用作协变量。
步态速度沿着认知谱下降，从有主观认知下降（SCD）的人群开始。有轻度认知障碍（MCI）的参与者还表现出下肢肌肉力量、平衡和握力下降。有痴呆症的参与者在所有身体表现测量中得分最低。有阿尔茨海默病（AD）的参与者的 SPPB 总分和步行速度比有血管性痴呆（VaD）和路易体痴呆（LBD）的参与者高；与 AD 相比，VaD 和 LBD 参与者完成 FTSS 和 OLS 的可能性较低。
身体表现从认知健康到 SCD、MCI 再到痴呆症逐渐下降。除了握力外，有 AD 的参与者在所有评估中表现都优于有 VaD 和 LBD 的参与者。认知障碍的阶段和痴呆症亚型应指导运动干预，以防止行动能力下降和依赖。
