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Terminal decline in objective and self-reported measures of motor function before death: 10 year follow-up of Whitehall II cohort study

BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1743 (Published 05 August 2021) Cite this as: BMJ 2021;374:n1743

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Monitoring changes in motor function in the years before death

  1. Benjamin Landré, postdoctoral fellow1,
  2. Aurore Fayosse, statistician1,
  3. Céline Ben Hassen, postdoctoral fellow1,
  4. Marcos D Machado-Fragua, postdoctoral fellow1,
  5. Julien Dumurgier, associate professor1 2,
  6. Mika Kivimaki, professor3,
  7. Séverine Sabia, research associate1 3,
  8. Archana Singh-Manoux, professor1 3
  1. 1Université de Paris, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
  2. 2Cognitive Neurology Center, Lariboisière – Fernand Widal Hospital, AP-HP, Université de Paris, Paris, France
  3. 3Department of Epidemiology and Public Health, University College London, London, UK
  1. Correspondence to: B Landré Benjamin.Landre{at}inserm.fr (or @epiageing on Twitter)
  • Accepted 5 July 2021

Abstract

Objectives To examine multiple objective and self-reported measures of motor function for their associations with mortality.

Design Prospective cohort study.

Setting UK based Whitehall II cohort study, which recruited participants aged 35-55 years in 1985-88; motor function component was added at the 2007-09 wave.

Participants 6194 participants with motor function measures in 2007-09 (mean age 65.6, SD 5.9), 2012-13, and 2015-16.

Main outcome measures All cause mortality between 2007 and 2019 in relation to objective measures (walking speed, grip strength, and timed chair rises) and self-reported measures (physical component summary score of the SF-36 and limitations in basic and instrumental activities of daily living (ADL)) of motor function.

Results One sex specific standard deviation poorer motor function in 2007-09 (cases/total, 610/5645) was associated with an increased mortality risk of 22% (95% confidence interval 12% to 33%) for walking speed, 15% (6% to 25%) for grip strength, 14% (7% to 23%) for timed chair rises, and 17% (8% to 26%) for physical component summary score over a mean 10.6 year follow-up. Having basic/instrumental ADL limitations was associated with a 30% (7% to 58%) increased mortality risk. These associations were progressively stronger when measures were drawn from 2012-13 (mean follow-up 6.8 years) and 2015-16 (mean follow-up 3.7 years). Analysis of trajectories showed poorer motor function in decedents (n=484) than survivors (n=6194) up to 10 years before death for timed chair rises (standardised difference 0.35, 95% confidence interval 0.12 to 0.59; equivalent to a 1.2 (men) and 1.3 (women) second difference), nine years for walking speed (0.21, 0.05 to 0.36; 5.5 (men) and 5.3 (women) cm/s difference), six years for grip strength (0.10, 0.01 to 0.20; 0.9 (men) and 0.6 (women) kg difference), seven years for physical component summary score (0.15, 0.05 to 0.25; 1.2 (men) and 1.6 (women) score difference), and four years for basic/instrumental ADL limitations (prevalence difference 2%, 0% to 4%). These differences increased in the period leading to death for timed chair rises, physical component summary score, and ADL limitations.

Conclusion Motor function in early old age has a robust association with mortality, with evidence of terminal decline emerging early in measures of overall motor function (timed chair rises and physical component summary score) and late in basic/instrumental ADL limitations.

Footnotes

  • Contributors: BL, SS, ASM, and AF developed the hypothesis and study design. BL and AF did the statistical analysis. BL wrote the first and successive drafts of the manuscript. All authors conceived and designed the study, analysed and interpreted the data, and drafted or critically revised the manuscript for important intellectual content, or, in addition, acquired data. ASM and MK obtained funding for the Whitehall II study. BL and AF had full access to the data and take responsibility for the integrity of the data and the accuracy of the data analysis. ASM and SS supervised the study and contributed equally to this work. BL is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding: The Whitehall II study is supported by grants from the National Institute on Ageing, NIH (R01AG056477, RF1AG062553); the UK Medical Research Council (R024227, S011676); and the Wellcome Trust (221854/Z/20/Z). SS is supported by the French National Research Agency (ANR-19-CE36-0004-01). MK was supported by NordForsk (75021) and the Academy of Finland (311492). The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of this manuscript.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf and declare; no support from any organisation for the submitted work other than the grants reported in the funding section; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • The lead author affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Dissemination to participants and related patient and public communities: The dissemination plan aims to target a wide audience, including members of the public, patients, and health professionals. It will be achieved using various channels: media outreach via press release from Inserm and University College London, scientific networks, and social media.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

Data availability statement

Data sharing: Data, protocols, and other metadata of the Whitehall II study are available to the scientific community via either the Whitehall II study data sharing portal (https://www.ucl.ac.uk/epidemiology-health-care/research/epidemiology-and-public-health/research/whitehall-ii/data-sharing) or the DPUK platform (https://www.dementiasplatform.uk/).

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