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The Protective Effects of Executive Functions and Episodic Memory on Gait Speed Decline in Aging Defined in The Context of Cognitive Reserve

Authors

  • Roee Holtzer PhD,

    Corresponding author
    1. Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York
    • Ferkauf Graduate School of Psychology, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York
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  • Cuiling Wang PhD,

    1. Department of Epidemiology, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York
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  • Richard Lipton MD,

    1. Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York
    2. Department of Epidemiology, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York
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  • Joe Verghese MD

    1. Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York
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Address correspondence to Roee Holtzer, Department of Neurology and Ferkauf Graduate School of Psychology, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY 10461. E-mail: roee.holtzer@einstein.yu.edu

Abstract

Objectives

To evaluate whether levels of cognitive reserve (CR), as measured using the Wechsler Adult Intelligence Scale (WAIS)-III vocabulary test, moderated longitudinal associations between cognitive functions and decline in gait speed in a community-based cohort of older adults without dementia, specifically, whether the protective effect of executive function (EF) and episodic memory against decline in gait speed would be greater in individuals with higher CR.

Design

Longitudinal (median number of repeated annual gait speed measures, 3; maximum number of visits, 7).

Setting

General community.

Participants

Seven hundred thirty-one community-residing individuals aged 70 and older without dementia were followed longitudinally with cognitive and gait evaluations at baseline and at annual visits.

Measurements

Decline in gait speed (cm/s) served as the primary outcome. The Free and Cued Selective Reminding Test (FCSRT) was used to assess episodic memory. The Digit Symbol Substitution Test (DSST) was used to assess attention and EF. The vocabulary test served as a marker for CR.

Results

Linear mixed effects model showed that gait speed declined over the follow-up period (P < .001). The significant three-way interactions of time by DSST by vocabulary (P = .01) and time by FCSRT by vocabulary (P = .02) revealed that levels of CR moderated the longitudinal associations between EF and episodic memory and gait speed decline.

Conclusion

The protective effects of EF and episodic memory against gait speed decline in aging are greater in individuals with higher CR.

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