Cognitive, physical and disability trajectories in community-dwelling elderly people

Backgrounds and aims Health trajectories in aging, rather than single time-point assessments, could be early indicators of the onset of conditions such as dementia. The aim of this study was to identify different aging trajectories and to investigate their influence on the cumulative incidence of dementia. Methods We evaluated data referring to 993 elders from the InveCe.Ab study cohort. All subjects were free from dementia at baseline and re-assessed on at least one other occasion thereafter. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), physical function using the Walking Speed Test (WST), and disability on the basis of the Activities of Daily Living (ADL) score. To describe the different courses of the three outcomes combined, the Group-Based Trajectory Model (GBTM) method was applied. We looked for differences in age, gender, education, ApoE-e4 carrier status and obesity, and then investigated the influence of the observed trajectories on the incidence of dementia. Results Three trajectories were identified: a good scenario was observed in 703 (70.2%) individuals, who showed substantially stable cognitive and physical function and no disability; an intermediate scenario in 248 subjects (25.5%), who recorded a longer walking time, lower MMSE score, and a one-point higher ADL score; and a severe scenario in 42 elders (4.3%), who recorded declines in all the outcomes. Female gender, obesity and low education were most represented in the severe group. ApoE-e4 carrier status showed no difference between groups. The estimated cumulative incidence of dementia was higher in the severe (37%) than in the intermediate (7%) and good (< 1%) scenarios. Conclusions Using simple measurements, we built different aging trajectories, and observed that the worst performers had the highest incidence of dementia. Better knowledge of trajectories of aging would be useful for preventive interventions aimed at promoting healthier aging.

Automated summary

This study evaluated 993 elders and identified three different aging trajectories, finding that individuals with the worst performance had the highest incidence of dementia. Factors such as female gender, obesity, and low education were more represented in the severe trajectory group.