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Background: Slow gait is common in dementia, but it remains unknown whether the slowing happens many years prior to dementia onset. We therefore examined the relationship between slow baseline gait speed (GS), change in GS, and the hazard of incident dementia in a community dwelling of elderly people., Methods: A total of 3,663 participants dementia-free at baseline (mean age, 73.5 years) were followed up for 9 years from a prospective cohort (Three-City study, France) for incident dementia (all-cause, Alzheimer's disease, vascular dementia, and other causes). GS over 6 m was assessed 4 times over the follow-up using two photoelectric cells. We used a multistate model to estimate the hazard ratio (HR) of dementia for baseline GS and tested a washout period of 4 to 7 years. The role of GS change between 65 and 85 years was examined using linear mixed models and joint models for survival and longitudinal data., Results: A total of 296 participants developed dementia during the follow-up. In age/sex-adjusted models, 1-SD (0.204 m/s) lower GS was associated with an increased hazard of dementia (HR = 1.59, 95% confidence interval [CI] = 1.39, 1.81, p < .001), with associations evident when gait assessments were taken from 4 years (HR = 1.46; CI = 1.26, 1.68) and 7 years (HR=1.30; CI = 1.00, 1.70) prior to dementia onset. Independently of baseline GS, those with a steeper decline had a higher hazard of dementia (HR per 1 SD [0.007 m/s/year] decrease = 3.39 [1.37-8.43], p = .009)., Conclusions: Gait is slower up to 7 years prior to clinical onset of dementia. Decline in GS is also more accelerated, suggesting strong links between cognitive and motor function in older adults., (© The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Walking speed (WS) predicts mortality. However, it is unclear if decline in WS increases prior to death. We examined whether (a) WS declined faster in persons who died during the follow-up compared with those who remained alive and (b) adding change in WS to a model including age, sex, and baseline WS improved prediction of mortality., Methods: Data are from 4,016 participants of the Dijon center of the Three-City study (France), aged 65-85 years. Fast WS (FWS) was measured up to five times over a 12-year period. Mortality was ascertained until 2012., Results: Linear mixed models using a backward time scale showed that FWS declined faster in 908 participants who died during the follow-up (annual change = -0.031 m/s) than in those who survived (-0.021 m/s), corresponding to a difference of -0.009 (95% confidence interval = -0.013 to -0.005) m/s. Compared with "normal" change in FWS (annual change ≥-0.04 m/s), "substantial" decline (<-0.08 m/s) was associated with a 1.4-fold greater risk of mortality (hazards ratio = 1.40, confidence interval = 1.02-1.92) and small decline (-0.08 to -0.04 m/s) with a 1.2-fold greater risk (hazards ratio = 1.18, confidence interval = 0.89-1.57). The net reclassification index when adding these categories of change in FWS to the model adjusted for age, sex, and baseline FWS was 19.0% (0.6, 36.8%)., Conclusion: Participants who died during the follow-up had a steeper decline in FWS than the others. Both baseline FWS and FWS decline predict mortality.

Background: Vascular risk factors contribute to motor decline in the elderly persons. We investigated the relationship between lipid-lowering drugs (LLDs) use and decline in walking speed (WS) in older adults., Methods: Data on 4,009 community-dwelling men and women, aged ≥65 years at baseline, are drawn from the Dijon (France) center of the Three-City study. "Fast" WS was assessed over 6 m at baseline and at 4, 6, 8, and 10 years of follow-up. Mixed linear models were used to determine the relationship between LLDs and change in WS over the follow-up., Results: At baseline, 1,295 (32%) participants used LLDs (statins, n = 643; fibrates, n = 652); mean fast WS was 152.9cm/s and not significantly different between LLDs users and nonusers. In models adjusted for age, sex, cholesterol level, and other covariates, WS decline was 25% slower in LLDs users (difference with nonusers: 0.58cm/s/y, 95% CI: 0.30, 0.86; p < .001). Both fibrates and statins were associated with slower decline, but only the effect of statins was robust in analyses that took missing values into account. The beneficial effect was more pronounced in those on LLDs continuously over the follow-up., Conclusion: Fast WS declined less in those on LLDs, suggesting that the effect of LLDs, statins in particular, extend beyond that on cardiovascular disease in the elderly persons. However, these effects were modest and their clinical relevance is unclear.

Background: Previous reports have shown links between cognitive function and physical performance in the elderly people, but it is unclear whether some specific cognitive domains are more strongly associated with measures of physical function such as walking speed. We investigated cross-sectional and longitudinal relationships between performance in five cognitive tests and walking speed among community-dwelling elderly people in the Dijon center (France) of the Three-City Study., Methods: At baseline, 3,769 participants aged 65-85 years had measurements of 6-m walking speed, global cognition (Mini-Mental State Examination), verbal fluency (Isaacs Set Test [IST]), psychomotor speed (Trail Making Test part A [TMT-A]), executive function (TMT part B), and memory (Benton Visual Retention Test). After a mean follow-up of 7 years, walking speed was again measured in 1,732 of these participants., Results: In cross-sectional analyses, slower maximum walking speed (MWS) at baseline was significantly associated with poorer performance in each cognitive test. The association was stronger with TMT-A (beta [SE] = -.127 [0.014], p < .0001) and IST (beta [SE] = .120 [0.014], p < .0001) than with the other tests. Only TMT-A (beta [SE] = -.053 [0.021], p = .01) and IST (beta [SE] = .063 [0.022], p = .004) were associated with the degree of MWS decline over time., Conclusions: This study shows both cross-sectional and longitudinal associations between cognition and walking speed among community-dwelling elderly people. Poorer verbal fluency and slower psychomotor speed were more specifically associated with slower baseline MWS and with a stronger decline in MWS over time.

Background: To better understand the contribution of frailty to health-related outcomes in elderly persons, it seems valuable to explore data from cohort studies across the world in an attempt to establish a comprehensive definition. The purpose of this report is to show the characteristics of frailty and observe its prognosis in a large sample of French community-dwelling elderly persons., Methods: We used data from 6078 persons 65 years old or older participating in the Three-City Study (3C). Frailty was defined as having at least three of the following criteria: weight loss, weakness, exhaustion, slowness, and low activity. Principal outcomes were incident disability, hospitalization, and death. Multiple covariates were used to test the predictive validity of frailty on these outcomes., Results: Four hundred twenty-six individuals (7%) met frailty criteria. Participants classified as frail were significantly older, more likely to be female, and less educated and reported more chronic diseases, lower income, and poorer self-reported health status in comparison to nonfrail participants. In multivariate analysis, frailty was significantly associated with 4-year incidence of disability in activities of daily living (ADL) and instrumental ADL. However, frailty was marginally associated with incident hospitalization and was not a statistically significant predictor of incident mobility disability or mortality adjusting for potential confounding factors., Conclusions: Frailty is not specific to a subgroup or region of the world. The construct proposed by Fried and colleagues confirms its predictive validity for adverse-health outcomes, particularly for certain components of disability, thus suggesting that it may be useful in population screening and predicting service needs.