Association between lower digit symbol substitution test score and slower gait and greater risk of mortality and of developing incident disability in well-functioning older adults
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OBJECTIVES: To determine whether, in well‐functioning older adults, a lower score on the Digit Symbol Substitution Test (DSST) and slower gait are associated with greater risk of mortality and of developing incident disability independent of other risk factors, including brain structural abnormalities (white matter hyperintensities, brain infarcts, ventricular enlargement) and whether the combination of varying levels of DSST score and gait speed are associated with a greater risk of mortality and disability than low DSST or slow gait alone. DESIGN: Observational cohort study. SETTING: Community. PARTICIPANTS: Three thousand one hundred fifty‐six (43% men, 29% black, mean age 70.4) participants in the Cardiovascular Health Study (CHS), free from stroke and physical disability and with a modified Mini‐Mental State Examination (3MS) score of 80 or higher. MEASUREMENTS: Total mortality and incident disability (self‐report of any difficulty performing one or more of the six activities of daily living) ascertained over a median follow‐up time of 8.4 years. RESULTS: By the end of follow‐up, 704 participants had died and 1,096 had incident disability. In Cox proportional hazards models adjusted for age, sex, race, education, cardiovascular disease, and brain magnetic resonance imaging abnormalities, lower DSST score and slower gait remained significantly associated with greater risk of mortality and of incident disability. Mortality rates were higher in those who had both low DSST score (<27 points) and slow gait (speed <1.0 m/s) than in those who had only low DSST score, only slow gait, or neither (rates per 1,000 person years (p‐y): 61.2, 42.8, 20.8, and 16.3, respectively). A similar risk gradient was observed for incident disability (82.0, 57.9, 47.9, and 36.0/1,000 p‐y, respectively). CONCLUSION: In well‐functioning older adults, low DSST score and slow gait, alone or in combination, could be risk factors for mortality and for developing disability, independent of other risk factors, including measures of brain integrity.
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Short-term mortality is strongly predicted by usual gait speed, and a cutpoint of 1 ms-1 predicts risk of mortality in many cohorts of autonomous older people.
“Short-term mortality was also strongly predicted by usual gait speed, and a cutpoint of 1 ms-1 predicted risk of mortality in many cohorts of autonomous older people”
In the Cardiovascular Health Study, gait speed over 1 ms-1 presented a hazard ratio of 0.88 (95% CI 0.81-0.97) in predicting incident disability.
“Gait speed over 1 ms-1 presented a Hazard Ratio, HR of 0.88 (95% CI 0.81-0.97) in predicting incident disability”
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- Authors
- Rosano, C., Newman, A. B., Katz, R., Hirsch, C. H., & Kuller, L. H.
- Affiliations
- University of Pittsburgh (US)
- Corresponding author
- Rosano, Caterina
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2008-09
- Volume
- 56
- Issue
- 9
- Pages
- 1618-1625
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC2631090
- OpenAlex
- W2105525405
- Cited by
- 280
- References
- 53
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 17 · 2023: 15 · 2022: 18 · 2021: 9 · 2020: 27 · 2019: 19 · 2018: 16 · 2017: 15 · 2016: 25 · 2015: 19 · 2014: 20 · 2013: 15 · 2012: 12
- FWCI
- 5.15
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (K23AG028966, R01AG029232, R03AG025076, P30AG024827)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- Digit Symbol Substitution Test, walking speed, mortality, incident disability, activities of daily living, cognitive impairment, older adults, white matter hyperintensities, cerebral infarction, ventriculomegaly, structural brain abnormalities, risk factors
- MeSH terms
- Activities of Daily Living, Aged, Aged, 80 and over, Analysis of Variance, Atrophy, Brain, Brain Diseases, Cause of Death, Disability Evaluation, Discrimination Learning, Female, Gait, Humans, Male, Memory, Short-Term, Neuropsychological Tests, Pattern Recognition, Visual, Psychometrics, Psychomotor Performance, Risk Factors, Cohort Studies, Mobility Limitation
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