Detection of cognitive decline by spinal posture assessment in health exams of the general older population

Abstract

The recent increase in the older adult population has led to a higher prevalence of cognitive impairment, which is often overlooked in routine health examinations. Citizens aged 50-89 years were targeted for this cohort survey by random sampling from the resident registry of a cooperating town in 2014. A total of 411 participants (202 male and 209 female) were enrolled. We analyzed the distribution of cognitive function test scores as determined by Montreal Cognitive Assessment and Mini-Mental State Examination tests in each age (50's, 60's, 70's and 80's) and sex group to examine whether cognitive decline could be detected by sagittal spinal balance measurement based on a radiological approach. Sagittal spinal balance was quantitatively measured as sagittal vertical axis (SVA). We observed significant associations for higher age and/or SVA anteriorization with lower cognitive function. In males, spinal balance anteriorization was associated with cognitive decline independently of age, with combinations of age and SVA also making valid cognitive decline determinations; male cases of SVA ≥ 100 mm at any age, SVA ≥ 90 mm at ≥ 70 years, and SVA ≥ 70 mm at ≥ 80 years were all more likely to have cognitive decline than cases below those values. For females, cognitive decline was more likely in cases of SVA ≥ 70 mm, regardless of age. Thus, spinal balance anteriorization can be regarded as an easily visible indicator of latent cognitive decline in community-dwelling older people.

Figure 1

Distributions of sagittal vertical axis with age. r denotes Pearson’s correlation coefficient between sagittal vertical axis and age. SVA sagittal vertical axis.

Figure 2

Receiver operating characteristic curves of cognitive decline prediction based on age and/or sagittal vertical axis. SVA sagittal vertical axis.

Figure 3

Sagittal vertical axis as a radiological parameter representing sagittal spinal balance. (a) SVA is the distance from the plumb line from the center of C7 to the posterior edge of the upper sacral endplate surface; (b) SVA = 0 mm, which is in sagittal balance; (c) SVA = 70 mm, which represents sagittal balance anteriorization; (d) SVA = 95 mm, which is highly anteriorized and indicates sagittal imbalance. SVA sagittal vertical axis.