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Subtle Neurological Abnormalities as Risk Factors for Cognitive and Functional Decline, Cerebrovascular Events, and Mortality in Older Community-Dwelling Adults
Marco Inzitari, MD;
Claudia Pozzi, MD;
Luigi Ferrucci, MD, PhD;
Daniela Chiarantini, MD;
Lucio A. Rinaldi, PT;
Marco Baccini, PT;
Riccardo Pini, MD;
Giulio Masotti, MD;
Niccolò Marchionni, MD;
Mauro Di Bari, MD, PhD
Arch Intern Med. 2008;168(12):1270-1276.
Background Subtle, but clinically detectable, neurological abnormalities (SNAs) are associated with impaired physical performance in elderly persons without overt neurological diseases. We investigated whether SNAs were prospectively associated with cognitive and functional status, death, and cerebrovascular events (CVEs) in older community-dwelling individuals.
Methods In participants without history of stroke, parkinsonism and dementia, or cognitive impairment, a score (NSNA) was obtained by summing SNAs detected with a simple neurological examination. Cognitive status and disability were reassessed 4 years later, and deaths and CVEs were documented over 8 years.
Results Of 506 participants free of neurological diseases (mean [SEM] age, 71.9 [0.3] years; 42% were men), 59% had an NSNA of 1 or more (mean [SEM], 1.1 [0.06]; range, 0-8). At baseline, the NSNA increased with age and with declining cognitive and physical performance, depressive symptoms, and disability, after adjusting for several covariates, but did not increase with falls and urinary incontinence. The NSNA prospectively predicted worsening cognitive status and disability, adjusting for demographics and for baseline comorbidity and cognitive and physical performance. The mortality rates were 22.6, 23.3, 23.9, 58.6, and 91.9 per 1000 person-years in participants with an NSNA of 0, 1, 2, 3, and 4 or higher, respectively. Compared with an NSNA of less than 3, having an NSNA of 3 or higher was associated with an increased adjusted risk of death (hazard ratio, 1.77; 95% confidence interval [CI], 1.25-2.74) and of CVE (hazard ratio, 1.94; 95% CI, 1.07-3.54) over 8 years.
Conclusion In this sample of older community-dwelling persons without overt neurological diseases, multiple SNAs were associated with cognitive and functional decline and independently predicted mortality and CVEs.
Author Affiliations: Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence and Azienda Ospedaliero–Universitaria Careggi, Florence, Italy (Drs Inzitari, Pozzi, Chiarantini, Pini, Masotti, Marchionni, and Di Bari and Mr Rinaldi); Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, Maryland (Dr Ferrucci); and Unit of Geriatric Rehabilitation, Azienda Sanitaria Locale, 10, Florence (Mr Baccini).
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