title: Predictors of combined cognitive and physical decline.
abstract: OBJECTIVE
  To determine the incidence and correlates of combined declines in cognitive and physical performance.
  
  
  METHODS
  Cohort study of community-dwelling older women with moderate to severe disability.
  
  
  METHODS
  The community surrounding Baltimore, Maryland.
  
  
  METHODS
  Participants in the Women's Health and Aging Study I with Mini-Mental State Examination (MMSE) score or 24 or greater and walking speed greater than 0.4 m/s at baseline.
  
  
  METHODS
  Cognitive decline was defined as an MMSE score less than 24 and physical decline as a walking speed of 0.4 m/s or less in at least one of the three annual follow-up visits. Participants were stratified into groups based on cognitive or physical decline or both. Group characteristics were compared, and results were adjusted for age, race, education, and significant covariates.
  
  
  RESULTS
  Of 558 women that met the baseline MMSE and walking speed inclusion criteria, 21% developed physical decline, 12% developed cognitive decline, and 11% experienced combined cognitive and physical decline. After adjustment, physical decline was associated with age, nonwhite race, former smoking, baseline walking speed, and instrumental activities of daily living (IADL) impairment. Cognitive decline was associated with age and baseline MMSE score. Combined decline was associated with age, baseline walking speed, MMSE score, IADL impairment, as well as current smoking (odds ratio (OR)=5.66, 95% confidence interval (CI)=1.49-21.54) and hemoglobin level (OR=0.68, 95% CI=0.47-0.98).
  
  
  CONCLUSIONS
  Potential predictors of cognitive and physical performance decline were identified. The association between smoking and lower hemoglobin levels and combined cognitive and physical decline may represent potentially modifiable risk factors and should be confirmed in future studies.
authors.affiliation: Roena Kulynych Center for Memory and Cognition Research, Sticht Center on Aging, Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. hatkinso@wfubmc.edu
authors.forename: Hal H
authors.initials: HH
authors.lastname: Atkinson
authors.forename: Matteo
authors.initials: M
authors.lastname: Cesari
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Kritchevsky
authors.forename: Brenda W J H
authors.initials: BW
authors.lastname: Penninx
authors.forename: Linda P
authors.initials: LP
authors.lastname: Fried
authors.forename: Jack M
authors.initials: JM
authors.lastname: Guralnik
authors.forename: Jeff D
authors.initials: JD
authors.lastname: Williamson
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis*; D015331:Cohort Studies; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007361:Intelligence Tests; D009043:Motor Activity / Q000502:physiology*; D012907:Smoking / Q000009:adverse effects; D016138:Walking / Q000502:physiology
chemical_list: D006454:Hemoglobins