Slowing as a multidomain and vascular geriatric syndrome: Apathy symptoms, gait speed and information processing speed in a geriatric memory clinic population

Abstract

AbstractBackgroundThe occurrence of slowing in mood, thinking and walking increases with age. It is, however, unclear if and how slowing in mood, thinking and walking, are interrelated and whether slowing is associated with the presence of cerebral small vessel disease (CSVD).MethodFor this study, we included 566 geriatric outpatients (49% female; age 79 ±6 years) from the Amsterdam Aging Cohort. Patients underwent brain imaging, a comprehensive geriatric assessment and a neuropsychological assessment. Three slowing aspects were investigated: apathy symptoms, processing speed and gait speed. CSVD measures included white matter hyperintensities (WMH), lacunes, and microbleeds. Associations between the slowing aspects and of cerebral small vessel disease with the slowing aspects were analyzed using multiple linear regressions and Poisson regressions for count data. To test the occurrence of CSVD in the population increased with accumulation of slowing aspects, using predefined cut‐offs, logistic regressions were used.ResultOf the total population, 18% had two or more impaired slowing aspects below predefined cut‐offs. Cross‐sectional regression analyses showed that lower gait speed was associated with lower information processing speed (B = ‐.36, 95% CI = ‐.48 to ‐.23) and more apathy symptoms (B = ‐.18, 95% CI = ‐.27 to ‐.09), independent of age, sex, education level, depressive symptoms and sedative medication. Increased WMH volume was associated with worse slowing outcomes: gait speed (B = ‐0.49, 95% CI = ‐0.71 to ‐0.28), processing speed (B = ‐0.36, 95% CI = ‐0.55 to ‐0.18) and apathy (Incident Rate Ratio = 1.29, 95% CI = 1.05 to 1.57, p <.05). Moreover, patients with a higher number of impaired slowing aspects had a higher odds of having a larger volume of WMH (Fazekas ≥ 2; ORs 1.69 to 3.47) or having more than three microbleeds (ORs 2.73 to 3.79).ConclusionThis study provides further evidence that slowing in mood, thinking and walking are closely related and more present in patients with cerebral small vessel disease. Longitudinal data is needed to unravel the direction of the complex relationship between cerebral small vessel disease and mental, cognitive and physical slowing.