Abstract
Mobility disability and parkinsonism are associated with decreased survival in older adults. This study examined the transition from no motor impairment to mobility disability and parkinsonism and their associations with death. 867 community-dwelling older adults without mobility disability or parkinsonism at baseline were examined annually. Mobility disability was based on annual measured gait speed. Parkinsonism was based on the annual assessment of 26 items from the motor portion of the Unified Parkinson's Disease Rating Scale. A multistate Cox model simultaneously examined the incidences of mobility disability and parkinsonism and their associations with death. Average age at baseline was 75 years old and 318 (37%) died during 10 years of follow-up. Mobility disability was almost 2-fold more common than parkinsonism. Some participants developed mobility disability alone (42%), or parkinsonism alone (5%), while many developed both (41%). Individuals with mobility disability or parkinsonism alone had an increased risk of death, but their risk was less than the risk in individuals with both impairments. The risk of death did not depend on the order in which impairments occurred. The varied patterns of transitions from no motor impairment to motor impairment highlights the heterogeneity of late-life motor impairment and its contribution to survival. Further studies are needed to elucidate the underlying biology of these different transitions and how they might impact survival.
Highlights
Motor impairment is common and affects up to half or more of older adults [1,2,3] and is associated with diverse adverse health outcomes including death [4,5,6]
Individuals with mobility disability or parkinsonism alone had an increased risk of death, but their risk was less than the risk in individuals with both impairments
The varied patterns of transitions from no motor impairment to motor impairment highlights the heterogeneity of late-life motor impairment and its contribution to survival
Summary
Motor impairment is common and affects up to half or more of older adults [1,2,3] and is associated with diverse adverse health outcomes including death [4,5,6]. We reported that gait speed and the severity of parkinsonism in the same individuals are independently related to risk of mortality [9] These findings suggest that these two phenotypes are not duplicative, but rather may capture distinct facets of motor function that might explain why their combination is more strongly associated with risk of death than either alone. This prior study examined the association of continuous measures of these two motor phenotypes at one point in time with survival It is unknown whether the risk of death varies as older adults without initial mobility disability or parkinsonism develop one or both of these motor impairments over time or if the order of the development of these impairments affects an individual’s risk of death. This study examined the transition from no motor impairment to mobility disability and parkinsonism and their associations with death
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