Background Motor and gait disturbances are evident in early Alzheimer and non-Alzheimer dementias and may predict the likelihood of mild cognitive impairment (MCI) or progression to dementia. Objective We investigated the Timed-Up-and-Go (TUG) measure of functional mobility in predicting cognitive decline and incident MCI or early dementia (MCI–dementia). Design Prospective cohort study with 4.5 years follow-up. Setting Population based. Participants 2,544 community-dwelling older adults aged 55+ years. Methods Participants with baseline data on TUG, fast gait speed (GS), knee extension strength (KES) and performance-oriented mobility assessment (POMA) gait and balance were followed up for cognitive decline (Mini-Mental State Exam; MMSE drop of ≥2, among 1,336 dementia-free participants) and incident MCI–dementia (among 1,208 cognitively normal participants). Odds ratio (OR) and 95% confidence intervals (95% CI) were adjusted for age, sex, education, smoking, physical, social and productive activity, multi-morbidity, metabolic syndrome and MMSE. Results Per standard deviation increase in TUG, POMA, GS and KES were significantly associated with incident MCI–dementia: TUG (OR = 2.84, 95% CI = 2.02–3.99), GS (OR = 2.17, 95% CI = 1.62–2.91), POMA (OR = 1.88, 95% CI = 1.22–2.92) and KES (OR = 1.52, 95% CI = 1.15–2.02). Adjusted OR remained significant only for TUG (OR = 1.52, 95% CI = 1.01–2.31) and GS (OR = 1.53, 95% CI = 1.08–2.16). Areas under the curve (AUC) for TUG (AUC = 0.729, 95% CI = 0.671–0.787) were significantly greater than GS (AUC = 0.683, 95% CI = 0.619–0.746), KES (AUC = 0.624, 95% CI = 0.558–0.689) and POMA (AUC = 0.561, 95% CI = 0.485–0.637). Similar associations with cognitive decline were significant though less pronounced, and adjusted ORs remained significant for TUG, GS and POMA. Conclusion Functional mobility decline precedes incident MCI and early dementia. The TUG appears to be especially accurate in predicting the future risks of adverse cognitive outcomes. Trial Registration ClinicalTrials.gov NCT03405675. Registered 23 January 2018 (retrospectively registered).

中文翻译：

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社区老年人的功能性活动能力下降和轻度认知障碍事件以及早期痴呆症：新加坡纵向老龄化研究

背景运动和步态障碍在早期阿尔茨海默和非阿尔茨海默痴呆中很明显，并且可能预测轻度认知障碍 (MCI) 或进展为痴呆的可能性。目的 我们研究了功能移动性的计时起步 (TUG) 测量在预测认知能力下降和 MCI 事件或早期痴呆 (MCI-痴呆) 方面的作用。设计具有 4.5 年随访期的前瞻性队列研究。设置基于人口。参与者 2,544 名 55 岁以上居住在社区的老年人。方法 对具有 TUG、快速步态速度 (GS)、伸膝力量 (KES) 和以性能为导向的活动性评估 (POMA) 步态和平衡的基线数据的参与者进行认知下降跟踪（迷你精神状态测试；MMSE 下降≥ 2，在 1,336 名无痴呆参与者中）和事件 MCI-痴呆（在 1，208 名认知正常的参与者）。比值比 (OR) 和 95% 置信区间 (95% CI) 针对年龄、性别、教育、吸烟、身体、社会和生产活动、多种疾病、代谢综合征和 MMSE 进行了调整。结果 TUG、POMA、GS 和 KES 的每标准差增加与 MCI 痴呆事件显着相关：TUG（OR = 2.84，95% CI = 2.02–3.99），GS（OR = 2.17，95% CI = 1.62–2.91 )、POMA (OR = 1.88, 95% CI = 1.22–2.92) 和 KES (OR = 1.52, 95% CI = 1.15–2.02)。调整后的 OR 仅对 TUG (OR = 1.52, 95% CI = 1.01–2.31) 和 GS (OR = 1.53, 95% CI = 1.08–2.16) 仍然显着。TUG (AUC = 0.729, 95% CI = 0.671–0.787) 的曲线下面积 (AUC) 显着大于 GS (AUC = 0.683, 95% CI = 0.619–0.746)、KES (AUC = 0.624, 95% CI) = 0.558–0.689) 和 POMA (AUC = 0.561, 95% CI = 0.485–0.637)。与认知能力下降的类似关联虽然不太明显，但调整后的 OR 对 TUG、GS 和 POMA 仍然很重要。结论 功能活动性下降先于 MCI 事件和早期痴呆。TUG 在预测不良认知结果的未来风险方面似乎特别准确。试验注册 ClinicalTrials.gov NCT03405675。2018 年 1 月 23 日注册（追溯注册）。