The journal of nutrition, health & aging

, Volume 21, Issue 3, pp 271–275 | Cite as

Reversible states of physical and/or cognitive dysfunction: A 9-year longitudinal study

  • Clifford Qualls
  • D. L. Waters
  • B. Vellas
  • D. T. Villareal
  • P. J. Garry
  • A. Gallini
  • S. Andrieu



To determine 1) age-adjusted transition probabilities to worsening physical/cognitive function states, reversal to normal cognition/physical function, or maintenance of normal state; 2) whether these transitions are modulated by sex, BMI, education, hypertension (HTN), health status, or APOE4; 3) whether worsening gait speed preceded cognition change, or vice versa.


Analysis of 9-year prospective cohort data from the New Mexico Aging Process Study. Setting: Healthy independent-living adults. Participants: 60+ years of age (n= 598).


Gait speed, cognitive function (3MSE score), APOE4, HTN, BMI, education, health status.


Over 9 years, 2129 one-year transitions were observed. 32.6% stayed in the same state, while gait speed and cognitive function (3MSE scores) improved for 38% and 43% of participants per year, respectively. Transitions to improved function decreased with age (P<0.001), APOE4 status (P=0.02), BMI (P=0.009), and health status (P=0.009). Transitions to worse function were significantly increased for the same factors (all P<0.05). Times to lower gait speed and cognitive function did not precede each other (P=0.91).


Transitions in gait speed and cognition were mutable with substantial likelihood of transition to improvement in physical and cognitive function even in oldest-old, which may have clinical implications for treatment interventions.

Key words

Cognitive function gait speed multi-state modelling reversible transitions 

Supplementary material

12603_2017_878_MOESM1_ESM.docx (1.4 mb)
Supplementary material, approximately 1.36 MB.


  1. 1.
    Canevelli M, Cesari M, van Kan GA. Frailty and cognitive decline: how do they relate? Curr Opin Clin Nutr Metab Care. 2015;18(1):43–50.CrossRefPubMedGoogle Scholar
  2. 2.
    Kelaiditi E, Cesari M, Canevelli M, et al. Cognitive frailty: rational and definition from an (I.A.N.A./I.A.G.G.) international consensus group. J Nutr Health Aging. 2013;17(9):726–734.CrossRefPubMedGoogle Scholar
  3. 3.
    Fallah N, Mitnitski A, Searle SD, et al. Transitions in frailty status in older adults in relation to mobility: a multistate modeling approach employing a deficit count. J Am Geriatr Soc. 2011;59(3):524.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Gill TM, Allore HG, Hardy SE, et al. The dynamic nature of mobility disability in older persons. J Am Geriatr Soc. 2006;54(2):248–254.CrossRefPubMedGoogle Scholar
  5. 5.
    Hardy SE, Dubin JA, Holford TR, et al. Transitions between states of disability and independence among older persons. Am J Epidemiol. 2005;161(6):575–584.CrossRefPubMedGoogle Scholar
  6. 6.
    Hardy SE, Perera S, Roumani YF, et al. Improvement in usual gait speed predicts better survival in older adults. J Am Geriatr Soc 2007;55(11):1727–1734.CrossRefPubMedGoogle Scholar
  7. 7.
    Gill TM, Gahbauer EA. Evaluating disability over discrete periods of time. J Gerontol A Biol Sci Med Sci. 2008;63(6):588–594.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Gill TM, Gahbauer EA, Allore HG, et al. Transitions between frailty states among community-living older persons. Arch Intern Med. 2006;166(4):418–423.CrossRefPubMedGoogle Scholar
  9. 9.
    Hardy SE, Allore HG, Guo ZC, et al. The effect of prior disability history on subsequent functional transitions. J Gerontol A Biol Sci Med Sci. 2006;61(3):272–277.CrossRefPubMedGoogle Scholar
  10. 10.
    Hardy SE, Allore HG, Guo ZC, et al. Explaining the effect of gender on functional transitions in older persons. Gerontology. 2008;54(2):79–86.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Mitnitski A, Bao L, Skoog I, et al. A cross-national study of transitions in deficit counts in two birth cohorts: Implications for modeling ageing. Exp Gerontol. 2007;42(3):241–246.CrossRefPubMedGoogle Scholar
  12. 12.
    Mitnitski A, Song X, Rockwood K. Improvement and decline in health status from late middle age: Modeling age-related changes in deficit accumulation. Exp Gerontol. 2007;42(11):1109–1115.CrossRefPubMedGoogle Scholar
  13. 13.
    Scherder E, Eggermont L, Swaab D, et al. Gait in ageing and associated dementias; its relationship with cognition. Neurosci Biobehav R. 2007;31(4):485–497.CrossRefGoogle Scholar
  14. 14.
    Clouston SAP, Brewster P, Kuh D, et al. The dynamic relationship between physical function and cognition in longitudinal aging cohorts. Epidemiol Rev. 2013;35(1):33–50.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Garry PJ, Wayne SJ, Vellas B. The New Mexico Aging Process Study (1979-2003) a longitudinal study of nutrition, health and aging. J Nutr Health Aging. 2007;11(2):125–130.PubMedGoogle Scholar
  16. 16.
    Teng EL, Chui HC. The Modified Mini-Mental State (MMS) examination. J Clin Psychiatry. 1987;48(8):314–318.PubMedGoogle Scholar
  17. 17.
    Mitnitski A, Rockwood K. Transitions in cognitive test scores over 5 and 10 years in elderly people: evidence for a model of age-related deficit accumulation. BMC geriatrics. 2008;8:3.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Fragala MS, Dam TTL, Barber V, et al. Strength and function response to clinical interventions of older women categorized by weakness and low lean mass using classifications from the foundation for the national institute of health sarcopenia project. J Gerontol A Biol Sci Med Sci. 2015;70(2):202–209.CrossRefPubMedGoogle Scholar
  19. 19.
    McLean RR, Shardell MD, Alley DE, et al. Criteria for Clinically Relevant Weakness and Low Lean Mass and Their Longitudinal Association With Incident Mobility Impairment and Mortality: The Foundation for the National Institutes of Health (FNIH) Sarcopenia Project. J Gerontol A Biol Sci Med Sci. 2014;69(5):576–583.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Studenski SA, Peters KW, Alley DE, et al. The FNIH Sarcopenia Project: Rationale, Study Description, Conference Recommendations, and Final Estimates. J Gerontol A Biol Sci Med Sci. 2014;69(5):547–558.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Koehler KM. The New Mexico Aging Process Study. Nutr Rev. 1994;52(8):S34–37.CrossRefPubMedGoogle Scholar
  22. 22.
    Ip E, Zhang Q, Rejeski J, et al. Partially Ordered Mixed Hidden Markov Model for the Disablement Process of Older Adults. J Am Stat Assoc. 2013;108(502):370–384.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Mitnitski A, Song X, Rockwood K. Assessing biological aging: the origin of deficit accumulation. Biogerontology. 2013;14(6):709–717.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Mitnitski AB, Graham JE, Mogilner AJ, et al. Frailty, fitness and late-life mortality in relation to chronological and biological age. BMC geriatrics. 2002;2(1):1–8.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Mitnitski A, Bao L, Rockwood K. Going from bad to worse: A stochastic model of transitions in deficit accumulation, in relation to mortality. Mech Ageing Dev. 2006;127(5):490–493.CrossRefPubMedGoogle Scholar
  26. 26.
    Rejeski WJ, Ip EH, Marsh AP, et al. Measuring disability in older adults: the International Classification System of Functioning, Disability and Health (ICF) framework. Geriatr Gerontol Int. 2008;8(1):48–54.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Vaughan S, Wallis M, Polit D, et al. The effects of multimodal exercise on cognitive and physical functioning and brain-derived neurotrophic factor in older women: a randomised controlled trial. Age Ageing. 2014;43(5):623–629.CrossRefPubMedGoogle Scholar
  28. 28.
    Wayne SJ, Vellas BJ, Brodie SG, et al. Apolipoprotein epsilon 4 allele and problems with orientation are associated with a persistent decline in cognition in communitydwelling elderly persons. J Gerontol A Biol Sci Med Sci. 2005;60(3):375–379.CrossRefPubMedGoogle Scholar
  29. 29.
    Carmelli D, DeCarli C, Swan GE, et al. The joint effect of apolipoprotein E epsilon4 and MRI findings on lower-extremity function and decline in cognitive function. J Gerontol A Biol Sci Med Sci. 2000;55(2):M103–109.CrossRefPubMedGoogle Scholar
  30. 30.
    Rosano C, Simonsick EM, Harris TB, et al. Association between physical and cognitive function in healthy elderly: The health, aging and body composition study. Neuroepidemiology. 2005;24(1-2):8–14.CrossRefPubMedGoogle Scholar
  31. 31.
    García-Ptacek S, Faxén-Irving G, Cermáková P, et al. Body mass index in dementia. Eur J Clin Nutr. 2014;68:1204–1209.CrossRefPubMedGoogle Scholar
  32. 32.
    Dahl AK, Löppönen M, Isoaho R, et al. Overweight and Obesity in Old Age Are Not Associated with Greater Dementia Risk. J Am Geriatr Soc. 2008;56(12):2261–2266.CrossRefPubMedGoogle Scholar
  33. 33.
    Fitzpatrick AL, Kuller LH, Lopez OL, et al. Midlife and late-life obesity and the risk of dementia: cardiovascular health study. Arch Neurol. 2009;66(3):336–342.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Luchsinger JA, Patel B, Tang MX, et al. Measures of adiposity and dementia risk in elderly persons. Arch Neurol. 2007;64(3):392–398.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Watson NL, Rosano C, Boudreau RM, et al. Executive Function, Memory, and Gait Speed Decline in Well-Functioning Older Adults. J Gerontol A Biol Sci Med Sci. 2010;65A(10):1093–1100.CrossRefPubMedCentralGoogle Scholar
  36. 36.
    Callisaya ML, Blizzard CL, Wood AG, et al. Longitudinal Relationships between Cognitive Decline and Gait Slowing: The Tasmanian Study of Cognition and Gait. J Gerontol A Biol Sci Med Sci. 2014;70(10):1226–1232.CrossRefGoogle Scholar
  37. 37.
    Gale CR, Allerhand M, Sayer AA, et al. The dynamic relationship between cognitive function and walking speed: The English Longitudinal Study of Ageing. Age. 2014;36(4).Google Scholar
  38. 38.
    Krall JR, Carlson MC, Fried LP, et al. Examining the dynamic, bidirectional associations between cognitive and physical functioning in older adults. Am J Epidemiol. 2014;180(8):838–846.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Serdi and Springer-Verlag France 2017

Authors and Affiliations

  • Clifford Qualls
    • 1
    • 2
  • D. L. Waters
    • 3
  • B. Vellas
    • 4
  • D. T. Villareal
    • 5
    • 6
  • P. J. Garry
    • 7
  • A. Gallini
    • 8
  • S. Andrieu
    • 9
  1. 1.Department of Mathematics & Statistics and School of MedicineUniversity of New MexicoAlbuquerqueUSA
  2. 2.Biomedical Research Institute of New MexicoAlbuquerqueUSA
  3. 3.University of Otago, Department of Medicine and School of PhysiotherapyDunedinNew Zealand
  4. 4.Department of Internal and Geriatrics Medicine, Gerontopole, CHU de Toulouse, UMR 1027 INSERMUniversity Toulouse IIIToulouseFrance
  5. 5.Center for Translational Research in Inflammatory Diseases (CTRID)Michael E. DeBakey VA Medical CenterHoustonUSA
  6. 6.Baylor College of MedicineHoustonUSA
  7. 7.University of New Mexico School of Medicine, Department of PathologyAlbuquerqueUSA
  8. 8.Department of EpidemiologyCHU de Toulouse, UMR 1027 INSERMToulouseFrance
  9. 9.CHU de Toulouse, UMR 1027 INSERMUniversity Toulouse IIIToulouseFrance

Personalised recommendations