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Li Wang, MS; Eric B. Larson, MD, MPH; James D. Bowen, MD; Gerald van Belle, PhD

Arch Intern Med. 2006;166:1115-1120.

Background  The association of physical function with progression to dementia has not been well investigated. We aimed to determine whether physical function is associated with incident dementia and Alzheimer disease (AD).

Methods  We performed a prospective cohort study of 2288 persons 65 years and older without dementia. Patients were enrolled from 1994 to 1996 and followed up through October 2003. Main outcome measures included incident dementia and AD.

Results  During follow-up 319 participants developed dementia (221 had AD). The age-specific incidence rate of dementia was 53.1 per 1000 person-years for participants who scored lower on a performance-based physical function test at baseline (10 points) compared with 17.4 per 1000 person-years for those who scored higher (>10 points). A 1-point lower performance-based physical function score was associated with an increased risk of dementia (hazard ratio, 1.08; 95% confidence interval, 1.03-1.13; P<.001), an increased risk of AD (hazard ratio, 1.06; 95% confidence interval, 1.01-1.12; P = .01), and an increased rate of decline in the Cognitive Ability Screening Instrument scores (0.11 point per year; 95% confidence interval, 0.08-0.14; P<.001) after adjusting for age, sex, years of education, baseline cognitive function, APOE 4 allele, family history of AD, depression, coronary heart disease, and cerebrovascular disease.

Conclusions  Lower levels of physical performance were associated with an increased risk of dementia and AD. The study suggests that poor physical function may precede the onset of dementia and AD and higher levels of physical function may be associated with a delayed onset.

Author Affiliations: Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System (Ms Wang), Center for Health Studies, Group Health Cooperative (Dr Larson), and Departments of Medicine (Dr Larson), Neurology (Dr Bowen), and Biostatistics (Dr van Belle), University of Washington, Seattle.

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