Clustering of behavioural symptoms and their associations with cognitive decline in older adults

Abstract

Objectives: To examine (i) the clustering of reduced falls-efficacy, social withdrawal and physical activity withdrawal in Irish adults aged 50 years and older, and (ii) the concurrent and prospective associations of these clustered behaviours with cognitive decline. Design: Longitudinal cohort study Setting and Participants: Data were from 4571 participants (mean age 64.5±8.6, 54.9% female) in The Irish Longitudinal Study on Ageing, a population-based study. Methods: Changes in social and physical activity and falls-efficacy from 2012/13 to 2014/15 were used to define the behaviours of social withdrawal, physical activity withdrawal and reduced falls-efficacy. Patterns of behaviours were associated with concurrent (2012/13-2014/15) and prospective (2014/15-2016/17) changes in Immediate recall, delayed recall and verbal fluency using random effects mixed models. Results: 86% of participants had either social withdrawal, physical activity withdrawal or reduced falls-efficacy and 15% had all three behaviours. Participants with all three behaviours showed the greatest declines in immediate recall (concurrent: B=-0.51, CI=-0.77;-0.25; prospective: B=-0.51, CI=-0.78;-0.25), delayed recall (concurrent: B=-0.40, CI=-0.61;-0.18; prospective: B=-0.47, CI=-0.69;-0.25) and verbal fluency (concurrent: B=-1.05, CI=-1.58;-0.52; prospective: B=-1.29, CI=-1.83;-0.74). Conclusions and implications: The clustering of social withdrawal, physical activity withdrawal and reduced falls-efficacy is common. Presence of multiple behaviours was associated with greater cognitive declines, suggesting a cumulative association of these behaviours with cognitive decline. These findings guide (i) identification of vulnerable groups, (ii) intervention design, and (iii) care planning for people presenting with one or more of these changes in behaviour.