Poor physical performance and dementia in the oldest old: the 90+ study

Abstract

Objective: To examine the cross-sectional relationship between physical performance and dementia in the oldest old (those ≥ 90 years of age).

Design: Cross-sectional study.

Setting: The 90+ Study is a population-based, longitudinal, epidemiologic study of aging and dementia performed at the University of California, Irvine, from January 1, 2003, through November 30, 2009.

Participants: A total of 629 participants from The 90+ Study were included in the study. The mean age was 94 years, and most (72.5%) were women.

Main outcome measures: All-cause dementia, based on Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria, was the main outcome measure. The independent variables were physical performance measures, including 4-m walk, 5 chair stands, standing balance, and grip strength, each scored from 0 to 4 (0, unable to perform; 4, best performance). Odds of dementia in relation to the physical performance measures were estimated by logistic regression after adjustment for age and sex. RESULTS Poor physical performance in all measures was significantly associated with increased odds of dementia (P< .001). Odds ratios for every unit decrease in physical performance score were 2.1 for 4-m walk, 2.1 for chair stands, 1.9 for standing balance, and 1.7 for grip strength.

Conclusions: We found a strong cross-sectional relationship between poor physical performance and dementia in people 90 years and older. Our findings suggest that dementia is a complex neurodegenerative process that may affect physical performance and cognition. Additional research is necessary to determine the temporal relationship between poor physical performance and cognitive dysfunction.

Figure 1

Flowchart of participant selection process. Main analyses include participants with complete physical performance evaluations (all 4 tasks evaluated). Secondary analyses include additional participants with incomplete physical performance evaluations (at least 1 but not all 4 tasks evaluated).

Figure 2

Odds of dementia for 4 physical performance measures in the oldest old. Odds of dementia and 95% CIs (error bars) were estimated from logistic regression models adjusted for age and sex. A total of 629 individuals participated in all 4 physical performance tasks.