Balance, Strength, and Risk of Dementia: Findings From the Health and Retirement Study and the English Longitudinal Study of Ageing

Background: Slow gait speed has been consistently associated with an increased risk of dementia. This study examined whether measures of balance and lower limb strength are similarly related to the risk of developing dementia. Methods: Participants from the Health and Retirement Study (HRS, N = 5 658, mean age = 73.23, standard deviation [SD] = 6.22) and the English Longitudinal Study of Ageing (ELSA, N = 3667, mean age = 69.90, SD = 7.02) completed measures of gait speed, semi-tandem balance, chair stand (ELSA only), and cognitive status at baseline. Cognitive status was assessed over up to 15 years. Results: Baseline slower gait speed (hazard ratio [HR]HRS = 1.52, 95% confidence interval [CI] = 1.32-1.75, p < .001; HRELSA = 1.73, 95% CI = 1.37-2.18, p < .001); and balance impairment (HRHRS = 1.58, 95% CI = 1.26-1.96, p < .001; HRELSA = 1.97, 95% CI = 1.24-3.14, p < .01) were related to a higher risk of incident dementia, adjusting for demographic factors. The combination of slower gait and impaired balance was associated with a two-to-three times higher risk of dementia in HRS and ELSA. Worse performance on the chair stand at baseline was associated with a higher risk of dementia in ELSA (HR = 1.56, 95% CI = 1.23-1.99, p < .001). All performance measures remained significant when entered simultaneously and accounted for obesity, diabetes, blood pressure, physical activity, smoking, and depressive symptoms. There was little evidence that age, sex, or APOE epsilon 4 moderated the association. Conclusions: Similar to gait speed, measures of balance and strength are associated with a higher risk of incident dementia. The findings have implications for clinical practice, given that these routinely used geriatric assessment tools are similarly related to dementia risk.