The Journals of Gerontology Series A: Biological Sciences and Medical Sciences Advance Access originally published online on June 17, 2009
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2009 64A(9):994-1001; doi:10.1093/gerona/glp075
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A Novel Aging Phenotype of Slow Gait, Impaired Executive Function, and Depressive Symptoms: Relationship to Blood Pressure and Other Cardiovascular Risks
1 Department of Medicine, Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
2 Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
3 Department of Psychiatry
4 Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
5 GRECC VA Boston Healthcare System, Massachusetts
6 Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
7 Boston University School of Public Health, Massachusetts
Address correspondence to Ihab Hajjar, MD, MS, Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, 1200 Center Street, Boston, MA. Email: ihabhajjar{at}hrca.harvard.edu
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Abstract |
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Background: Our objectives were to investigate the existence of a group of nondemented elderly individuals who simultaneously have impairments in cognition, mobility, and mood, and to examine the association between being a member of this group and elevated blood pressure and other cardiovascular conditions.
Methods: The Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston study is an ongoing prospective observational study of community-dwelling individuals. We analyzed the cross-sectional data collected at baseline (N = 580, mean age = 77.8 years, 64% women, 14% African American, mean Mini-Mental State Examination = 27.2). Using latent profile analysis, we investigated the existence of a group of elderly participants with impairments in executive function (Trail Making Test Part B [TMT-B]), gait speed (two 4-m walk tests), and depressive symptoms (Center for Epidemiological Studies-Depression scale [CES-D]).
Results: We identified a group (n = 99 [17%]) with prolonged TMT-B, slow gait speed, and high CES-D scores. This group did not exist when we used a memory measure. Hypertension (p = .001), diabetes (p = .0002), congestive heart failure (p = .006), stroke (p = .005), and higher Framingham cardiovascular risk score (p = .0001) were associated with an increased likelihood of being a member in this group. This association with elevated systolic and pulse pressure, and stroke remained significant after multiple covariate adjustments.
Conclusions: There exists a group of elderly individuals in whom poor executive function, slow gait speed, and depressive symptoms occur simultaneously. Memory measures did not identify such a grouping. Elevated blood pressure and other cardiovascular diseases are independently associated with being a member of this group. Assessing these domains is an important part of the evaluation of the elderly patients with high vascular risk.
Keywords Blood pressure; Cognitive function; Gait speed; Executive function; Depression; Vascular disease
Received: July 5, 2008; Accepted: March 15, 2009