title: Predictors of decline in walking ability in community-dwelling Alzheimer's disease patients: Results from the 4-years prospective REAL.FR study.
abstract: BACKGROUND
  The aim of this study was to explore the predictors of decline in walking ability in patients with Alzheimer's disease (AD).
  
  
  METHODS
  The prospective REseau surla maladie ALzheimer FRançais (REAL.FR) study enrolled six hundred eighty four community-dwelling AD subjects (71.20% women; mean age 77.84 Standard Deviation, SD, 6.82 years, Mini-Mental State Examination 20.02, SD 4.23). Decline in walking ability was defined as the first loss of 0.5 points or more in the walking ability item of the Activities of Daily Living scale (ADL), where higher score means greater independence, during the four-years of follow-up. Demographic characteristics, co-morbidities, and level of education were reported at baseline. Disability, caregiver burden, cognitive and nutritional status, body mass index, balance, behavioral and psychological symptoms of dementia, medication, hospitalization, institutionalization and death were reported every six months during the four years. Cox survival analyses were performed to assess the independent factors associated with decline in walking ability.
  
  
  RESULTS
  The mean incident decline in walking ability was 12.76% per year (95% Confidence Interval (CI) 10.86 to 14.66). After adjustment for confounders, the risk of decline in walking ability was independently associated with older age (Relative Risk, RR = 1.05 (95% CI 1.02 to 1.08)), time from diagnosis of dementia (RR = 1.16 (1.01 to 1.33)), painful osteoarthritis (RR = 1.84 (1.19 to 2.85)), hospitalization for fracture of the lower limb (RR = 6.35 (3.02 to 13.37)), higher baseline ADL score (RR = 0.49 (0.43 to 0.56)), and the use of acetylcholinesterase inhibitors (RR = 0.52 (0.28 to 0.96)).
  
  
  CONCLUSIONS
  The risk of decline in walking ability is predicted by older age, increased dementia severity, poor functional score, and orthopedic factors and seems to be prevented by the use of acetylcholinesterase inhibitors medication.
authors: INSERM, U1027, F-31073 Toulouse, France ; University of Toulouse III, F-31073 Toulouse, France ; Gerontopole, Toulouse University Hospital, Toulouse, France ; Service de Médecine Interne et de Gérontologie Clinique, Pavillon Junot, 170 avenue de Casselardit. Hôpital La Grave-Casselardit, Toulouse, France.
authors: Yves
authors: Y
authors: Rolland
authors: INSERM, U1027, F-31073 Toulouse, France ; University of Toulouse III, F-31073 Toulouse, France ; Gerontopole, Toulouse University Hospital, Toulouse, France.
authors: Christelle
authors: C
authors: Cantet
authors: Gerontopole, Toulouse University Hospital, Toulouse, France.
authors: Philipe de Souto
authors: Pde S
authors: Barreto
authors: INSERM, U1027, F-31073 Toulouse, France ; University of Toulouse III, F-31073 Toulouse, France ; Gerontopole, Toulouse University Hospital, Toulouse, France.
authors: Matteo
authors: M
authors: Cesari
authors: INSERM, U1027, F-31073 Toulouse, France ; University of Toulouse III, F-31073 Toulouse, France ; Gerontopole, Toulouse University Hospital, Toulouse, France.
authors: Gabor
authors: G
authors: Abellan van Kan
authors: INSERM, U1027, F-31073 Toulouse, France ; University of Toulouse III, F-31073 Toulouse, France ; Gerontopole, Toulouse University Hospital, Toulouse, France.
authors: Bruno
authors: B
authors: Vellas