Cognitive reserve and risk of mobility impairment in older adults.

Abstract

Cognitive reserve (CR) protects against cognitive decline and dementia but its relation to mobility impairment has not been established. To address this important gap in the literature, we conducted a longitudinal investigation to test the hypothesis that higher baseline CR was associated with a lower risk of developing mobility impairment in older adults. Participants were dementia-free older adults who received brain magnetic resonance imaging and had gait speed assessments during follow-up. Using the residuals approach, CR was computed as the variance in the Modified Mini-Mental Status Examination total score, that was left after accounting for structural brain integrity, education, and race. Mobility impairment was defined using a validated cutoff score in gait speed of 0.8 m/s. Logistic regression models using general estimating equations were utilized to examine longitudinal associations between baseline CR and the risk of developing mobility impairment across repeated assessments. Of the participants (n=237; mean age=82 years; %female=56%) who were free of mobility impairment at baseline, 103 developed mobility impairment during follow-up (mean=3.1 years). Higher CR at baseline was associated with a lower risk of developing incident mobility impairment-odds ratio (OR)=0.819, 0.67-0.98, p=0.038 (unadjusted); OR=0.815, 0.67-0.99, p=0.04 (adjusted for socio-demographic variables and depression); OR=0.819, 0.68-0.88, p=0.035 (adjusted for illness history); OR=0.824, 0.68-0.99, p=0.045 (adjusted for white matter hyperintensities); OR=0.795, 0.65-0.95, p=0.016 (adjusted for falls history). Higher CR at baseline was protective against developing incident mobility impairment during follow-up among community-residing older adults.