The Journals of Gerontology Series A: Biological Sciences and Medical Sciences Advance Access published online on September 29, 2009
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, doi:10.1093/gerona/glp149
The Relationship Between Cognitive Function and Physical Performance in Older Women: Results From the Women’s Health Initiative Memory Study
1 Wake Forest University School of Medicine, Sticht Center on Aging, Roena Kulynych Center for Memory and Cognition Research, and Departments of Internal Medicine (Gerontology and Geriatric Medicine), Psychiatry, and Public Health Sciences, Winston-Salem, North Carolina
2 Absher Neurology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
3 University of Cincinnati, Ohio
4 Stanford University, California
5 University of Tennessee Health Science Center, Memphis
6 Robert Wood Johnson Medical School, Piscataway, New Jersey
7 Howard University School of Medicine, Washington, DC
8 University of Massachusetts Medical Center, Worcester
9 Stony Brook University, New York
Address correspondence to Hal H. Atkinson, MD, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157. Email: hatkinso{at}wfubmc.edu
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Abstract |
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Background: Cognitive function and physical performance are associated, but the common sequence of cognitive and physical decline remains unclear.
Methods: In the Women’s Health Initiative Memory Study (WHIMS) clinical trial, we examined associations at baseline and over a 6-year follow-up period between the Modified Mini-Mental State (3MS) Examination and three physical performance measures (PPMs): gait speed (meters/second), chair stands (number of stands in 15 seconds), and grip strength (kilograms). Using mixed models, we examined the baseline 3MS as predictor of change in PPM, change in the 3MS as predictor of change in PPM, and baseline PPM as predictors of 3MS change.
Results: Among 1,793 women (mean age = 70.3 years, 89% white, and mean 3MS score = 95.1), PPM were weakly correlated with 3MS—gait speed: r = .06, p = .02; chair stands: r = .09, p < .001; and grip strength: r = .10, p < .001. Baseline 3MS score was associated with subsequent PPM decline after adjustment for demographics, comorbid conditions, medications, and lifestyle factors. For every SD (4.2 points) higher 3MS score, 0.04 SD (0.04 m/s) less gait speed and 0.05 SD (0.29 kg) less grip strength decline is expected over 6 years (p 
.01 both). Changes in 3MS and PPM were associated, particularly with chair stands and grip strength (p < .003 both). Baseline PPMs were not associated with subsequent 3MS change.
Conclusions: Baseline global cognitive function and change in global cognitive function were associated with physical performance change, but baseline physical performance was not associated with cognitive change in this cohort. These analyses support the hypothesis that cognitive decline on average precedes or co-occurs with physical performance decline.
Keywords Cognitive function; Physical performance; Cognition; Physical function
Received: August 20, 2008; Accepted: September 2, 2009