Movement performance in elderly women. Relation to neuroimaging findings, medical conditions and activities of daily living

Abstract: Aims: To study age-related changes of movement performance and their relation to cerebral white matter lesions, brain atrophy, obesity indices, serum lipids, medical conditions and instrumental activities of daily living (IADL).Methods: Study samples were part of the Prospective Population Study of Women and the Gerontological and Geriatric Population Studies (H 70) in Göteborg, Sweden. In 1992-93, 873 women aged 38, 50, 62, 70, 74, 78 and 84 were examined with an optoelectronic movement test, the Postural-Locomotor-Manual (PLM) test. Eighty-eight 70-year-old participants of the population studies in 1992-93 were followed and reexamined with a PLM test in 2000-01. PLM test movement contains a natural everyday act of lifting an object from the floor (postural phase), walking forward a few steps (locomotor phase), and placing the object on a shelf (manual phase). During the PLM test, the total movement time and the duration of the postural, locomotor and manual phases were measured with an optoelectronic system, and the coordination of the three phases was calculated. Subgroups of women were investigated with a cranial CT scan, anthropometric measurements, blood sampling, a general medical examination and an interview on daily mobility and IADL. Results: Older women showed longer movement time (total movement time and each phase duration) and poorer phase coordination in the PLM test compared to younger women in the cross-sectional study. Total movement time increased from age 70 to 78 in the longitudinal study. This change was mainly due to prolonged duration of the locomotor phase. Cerebral white matter lesions were found in 25% of the women aged 70, 74 and 78, and were associated with slow mobility of the lower extremities, i.e. a long locomotor phase in the PLM test. High sylvian fissure ratio and temporal lobe atrophy, seen on CT scans of 44% of the women aged 70, 74, and 78, were correlated to a long total movement time, locomotor phase and manual phase. High waist-to-hip ratio, high serum triglyceride concentration, and low high-density lipoprotein cholesterol concentration were associated with long movement time and/or poor phase coordination in the PLM test. Elderly women with hypertension, cerebrovascular disease, orthostatic hypotension, chronic bronchitis, depression, arthritis, dizziness, chest pain, dyspnea, joint problems, leg pain or tiredness showed longer movement time and/or poorer phase coordination than women without corresponding medical condition. IADL dependent women showed longer movement time and poorer phase coordination in the PLM test than IADL independent women. Self-reported mobility difficulties and a long locomotor phase in the PLM test were independently associated with IADL dependence. Conclusions: Movement performance deteriorated with advancing age. The age-related mobility decline was more striking in the lower extremities than in the upper extremities. Cerebral white matter lesions, temporal lobe atrophy, abdominal obesity, dyslipidaemia, hypertension, cerebrovascular diseases, orthostatic hypotension, chronic bronchitis, depression, arthritis, dizziness, chest pain, dyspnea, joint problems, leg pain and tiredness were related to impaired motor function. The combination of self-reported mobility and the performance test may improve the assessment of an individual's mobility status.