Subtle neurological abnormalities as risk factors for cognitive and functional decline, cerebrovascular events, and mortality in older community-dwelling adults.
BACKGROUND
Subtle, but clinically detectable, neurological abnormalities (SNAs) are associated with impaired physical performance in elderly persons without overt neurological diseases. We investigated whether SNAs were prospectively associated with cognitive and functional status, death, and cerebrovascular events (CVEs) in older community-dwelling individuals.


METHODS
In participants without history of stroke, parkinsonism and dementia, or cognitive impairment, a score (N(SNA)) was obtained by summing SNAs detected with a simple neurological examination. Cognitive status and disability were reassessed 4 years later, and deaths and CVEs were documented over 8 years.


RESULTS
Of 506 participants free of neurological diseases (mean [SEM] age, 71.9 [0.3] years; 42% were men), 59% had an N(SNA) of 1 or more (mean [SEM], 1.1 [0.06]; range, 0-8). At baseline, the N(SNA) increased with age and with declining cognitive and physical performance, depressive symptoms, and disability, after adjusting for several covariates, but did not increase with falls and urinary incontinence. The N(SNA) prospectively predicted worsening cognitive status and disability, adjusting for demographics and for baseline comorbidity and cognitive and physical performance. The mortality rates were 22.6, 23.3, 23.9, 58.6, and 91.9 per 1000 person-years in participants with an N(SNA) of 0, 1, 2, 3, and 4 or higher, respectively. Compared with an N(SNA) of less than 3, having an N(SNA) of 3 or higher was associated with an increased adjusted risk of death (hazard ratio, 1.77; 95% confidence interval [CI], 1.25-2.74) and of CVE (hazard ratio, 1.94; 95% CI, 1.07-3.54) over 8 years.


CONCLUSIONS
In this sample of older community-dwelling persons without overt neurological diseases, multiple SNAs were associated with cognitive and functional decline and independently predicted mortality and CVEs.
Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence, via delle Oblate, 4, 50141 Florence, Italy. marcoinzitari@gmail.com
Marco
M
Inzitari
Claudia
C
Pozzi
Luigi
L
Ferrucci
Daniela
D
Chiarantini
Lucio A
LA
Rinaldi
Marco
M
Baccini
Riccardo
R
Pini
Giulio
G
Masotti
Niccolò
N
Marchionni
Mauro
M
Di Bari
D000203:Activities of Daily Living; D000368:Aged; D003071:Cognition; D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D015577:Geriatric Assessment; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000150:complications / Q000175:diagnosis*; D011446:Prospective Studies; D011788:Quality of Life; D012111:Residence Characteristics; D012307:Risk Factors; D012424:Rural Population; D020521:Stroke / Q000209:etiology*