Older adults with mobility dysfunction are at risk for falls, hospitalization, and death. In an earlier pilot study, individuals with asymptomatic carotid artery stenosis (ACAS) demonstrated mobility dysfunction when compared to individuals without ACAS. We tested whether carotid stenosis affected mobility function in a larger community-dwelling cohort using the Invecchaire in Chianti (InCHIANTI) database.
Methods
We analyzed data from participants in the InCHIANTI study who completed a medical history, carotid duplex testing, and mobility function testing (Short Physical Performance Battery- SPPB). Participants with a history of stroke, transient ischemic attack, or carotid endarterectomy were excluded. 709 participants met inclusion criteria (116 ACAS, 593 no ACAS). Our analytic approach sought to evaluate the impact of stenosis on mobility after accounting for age, sex and cardiovascular risk factors. Age was stratified into 2 age-groups (65-74 and 75-84 years). Two-way ANOVA was used to test the effect of stenosis-group, age-group, and their interactions on SPPB score with sex as a covariate.
Results
Stenosis-group (P = 0.0002), age-group (P < 0.0001), and the interaction between stenosis-group and age-group (P = 0.0008) significantly affected SPPB. Post-hoc testing showed that participants with ACAS demonstrated worse performance on the SPPB (9.81 ± 0.37) compared to those with no ACAS (11.10 ± 0.11) in the 65-74 years age-group (P < 0.0001).
Conclusions
65-74-year-old adults with ACAS performed significantly worse on the SPPB than those without ACAS. These results lend further support that ACAS may be associated with mobility dysfunction in older adults.
ColganMPStrodeGRSommerJDGibbsJLSumnerDS. Prevalence of asymptomatic carotid disease:results of duplex scanning in 348 unselected volunteers. J Vasc Surg. 1988;8(6):674-678. doi:10.1016/0741-5214(88)90073-0
2.
de WeerdMGrevingJPde JongAWFBuskensEBotsML. Prevalence of asymptomatic carotid artery stenosis according to age and sex: systematic review and metaregression analysis. Stroke. 2009;40(4):1105-1113. doi:10.1161/strokeaha.108.532218
3.
GrayVLGoldbergAPRogersMW, et al.Asymptomatic carotid stenosis is associated with mobility and cognitive dysfunction and heightens falls in older adults. J Vasc Surg. 2020;71:1930-1937. doi:10.1016/j.jvs.2019.09.020
4.
GuralnikJMFerrucciLSimonsickEMSaliveMEWallaceRB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995;332(9):556-561. doi:10.1056/NEJM199503023320902
5.
IezzoniLIMcCarthyEPDavisRBSiebensH. Mobility problems and perceptions of disability by self-respondents and proxy respondents. Med Care. 2000;38(10):1051-1057. doi:10.1097/00005650-200010000-00009
6.
HirvensaloMRantanenTHeikkinenE. Mobility difficulties and physical activity as predictors of mortality and loss of independence in the community-living older population. J Am Geriatr Soc. 2000;48(5):493-498. doi:10.1111/j.1532-5415.2000.tb04994.x
7.
FriedLPBandeen-RocheKChavesPHJohnsonBA. Preclinical mobility disability predicts incident mobility disability in older women. J Gerontol A Biol Sci Med Sci. 2000;55(1):M43-M52. doi:10.1093/gerona/55.1.m43
8.
HardySEKangYStudenskiSADegenholtzHB. Ability to walk 1/4 mile predicts subsequent disability, mortality, and health care costs. J Gen Intern Med. 2011;26(2):130-135. doi:10.1007/s11606-010-1543-2
9.
Courtney-longEACarrollDDZhangQC, et al.Prevalence of disability and disability type among adults — United States , 2013. MMWR Morb Mortal Wkly Rep. 2015;64(29):777-783. doi:10.15585/mmwr.mm6429a2
10.
Shumway-CookAGuralnikJMPhillipsCL, et al.Age-associated declines in complex walking task performance: the walking InCHIANTI Toolkit. J Am Geriatr Soc. 2007;55(1):58-65. doi:10.1111/j.1532-5415.2006.00962.x
11.
FerrucciLBandinelliSBenvenutiE, et al.Subsystems contributing to the decline in ability to walk: bridging the gap between epidemiology and geriatric practice in the InCHIANTI study. J Am Geriatr Soc. 2000;48(12):1618-1625. doi:10.1111/j.1532-5415.2000.tb03873.x
12.
BotsMLHoesAWKoudstaalPJHofmanAGrobbeeDE. Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation. 1997;96(5):1432-1437. doi:10.1161/01.CIR.96.5.1432
13.
Molino-LovaRMacchiCGoriAM, et al.High sensitivity C-reactive protein predicts the development of new carotid artery plaques in older persons. Nutr Metab Cardiovasc Dis. 2011;21(10):776-782. doi:10.1016/j.numecd.2010.02.003
14.
GuralnikJMSimonsickEFerrucciL, et al.A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85-M94. doi:10.1093/geronj/49.2.m85
15.
WilbyML. Physical mobility impairment and risk for cardiovascular disease. Health Equity. 2019;3(1):527-531. doi:10.1089/heq.2019.0065
16.
JuopperiSSundRRikkonenTKrögerHSirolaJ. Cardiovascular and musculoskeletal health disorders associate with greater decreases in physical capability in older women. BMC Musculoskelet Disord. 2021;22(1):192. doi:10.1186/s12891-021-04056-4
17.
FerrucciLCooperRShardellMSimonsickEMSchrackJAKuhD. Age-related change in mobility: perspectives from life course epidemiology and geroscience. J Gerontol A Biol Sci Med Sci. 2016;71(9):1184-1194. doi:10.1093/gerona/glw043
18.
FreibergerESieberCCKobR. Mobility in older community-dwelling persons: a narrative review. Front Physiol. 2020;11:881. doi:10.3389/fphys.2020.00881
19.
LandgraffNCWhitneySLRubinsteinENYonasH. Use of the physical performance test to assess preclinical disability in subjects with asymptomatic carotid artery disease. Phys Ther. 2006;86(4):541-548. doi:10.1093/ptj/86.4.541
20.
LandgraffNCWhitneySLRubinsteinENYonasH. Cognitive and physical performance in patients with asymptomatic carotid artery disease. J Neurol. 2010;257(6):982-991. doi:10.1007/s00415-009-5449-z
21.
de Fátima Ribeiro SilvaCOharaDGMatosAPPintoACPNPegorariMS. Short physical performance battery as a measure of physical performance and mortality predictor in older adults: a comprehensive literature review. Int J Environ Res Public Health. 2021;18(20):10612. doi:10.3390/ijerph182010612
22.
VolpatoSCavalieriMSioulisF, et al.Predictive value of the Short Physical Performance Battery following hospitalization in older patients. J Gerontol A Biol Sci Med Sci. 2011;66(1):89-96. doi:10.1093/gerona/glq167
23.
PavasiniRGuralnikJBrownJC, et al.Short physical performance battery and all-cause mortality: systematic review and meta-analysis. BMC Med. 2016;14(1):215-219. doi:10.1186/s12916-016-0763-7
24.
VasunilashornSCoppinAKPatelKV, et al.Use of the short physical performance battery score to predict loss of ability to walk 400 meters: analysis from the InCHIANTI study. J Gerontol A Biol Sci Med Sci. 2009;64(2):223-229. doi:10.1093/gerona/gln022
25.
BrownCJFloodKL. Mobility limitation in the older patient: a clinical review. JAMA. 2013;310(11):1168-1177. doi:10.1001/jama.2013.276566
26.
AyisSGooberman-HillRBowlingAEbrahimS. Predicting catastrophic decline in mobility among older people. Age Ageing. 2006;35(4):382-387. doi:10.1093/ageing/afl004
27.
BerglandAJørgensenLEmausNStrandBH. Mobility as a predictor of all-cause mortality in older men and women: 11.8 year follow-up in the Tromsø study. BMC Health Serv Res. 2017;17(1):22-27. doi:10.1186/s12913-016-1950-0
28.
TreacyDHassettL. The short physical performance battery. J Physiother. 2018;64(1):61. doi:10.1016/J.JPHYS.2017.04.002
29.
SoubraRChkeirANovellaJL. A systematic review of thirty-one assessment tests to evaluate mobility in older adults. BioMed Res Int. 2019;2019(i):1354362. doi:10.1155/2019/1354362
30.
GrayVLDesikanSKKhanAA, et al.Revascularization for asymptomatic carotid artery stenosis improves balance and mobility. J Vasc Surg. 2021;74(4):1272-1280. doi:10.1016/j.jvs.2021.04.056
31.
De WeerdMGrevingJPHedbladB, et al.Prevalence of asymptomatic carotid artery stenosis in the general population: an individual participant data meta-analysis. Stroke. 2010;41(6):1294-1297. doi:10.1161/STROKEAHA.110.581058
32.
LalBKMeschiaJFBrottTG, et al.Race differences in high-grade carotid artery stenosis. Stroke. 2021;52:2053-2059. doi:10.1161/STROKEAHA.120.032723
33.
SuCYangXWeiSZhaoR. Association of cerebral small vessel disease with gait and balance disorders. Front Aging Neurosci. 2022;14:834496. doi:10.3389/fnagi.2022.834496
34.
SharmaBWangMMcCrearyCRCamicioliRSmithEE. Gait and falls in cerebral small vessel disease: a systematic review and meta-analysis. Age Ageing. 2023;52(3):afad011. doi:10.1093/ageing/afad011
35.
PinterDRitchieSJDoubalF, et al.Impact of small vessel disease in the brain on gait and balance. Sci Rep. 2017;7:41637. doi:10.1038/srep41637
