Association of Gait Speed With Cognitive Outcomes in Older Adults With Hypertension: A Secondary SPRINT MIND Analysis

Abstract

Background/objectives: Hypertension is linked to slower walking pace and cognitive decline, but the ability of slow gait to predict dementia in older adults with hypertension is unclear. This study examined whether slow baseline gait predicts future cognitive impairment in older adults with hypertension enrolled in the Systolic Blood Pressure Intervention Trial (SPRINT) Memory and Cognition in Decreased Hypertension (MIND) study.

Methods: SPRINTMIND randomized adults ≥50 years of age with hypertension to intensive (target systolic blood pressure <120 mmHg) or standard (<140 mmHg) blood pressure control. Baseline gait speed was measured in participants ≥75 years of age. We defined slow gait as speed ≤0.8 m/s. Outcomes were probable dementia (pD), mild cognitive impairment (MCI), and composite pD or MCI.

Results: Among 2,351 participants, 33.3% had slow baseline gait. Over median 4-year follow-up, the slow gait group had higher rates of incident pD (13.5% vs 6.4%), MCI (19.4% vs 11.9%), and pD or MCI (29.2% vs 16.3%) compared with normal gait. Adjusted Cox regression models revealed that slow gait was associated with a 1.85-fold higher risk of pD (95% confidence interval [1.37, 2.50], p < .001), 1.52-fold higher risk of MCI (95% confidence interval [1.20, 1.93], p = .001), and 1.61-fold higher risk of pD or MCI (95% confidence interval [1.32, 1.97], p < .001). Intensive blood pressure control did not significantly affect cognitive outcomes in either gait group.

Conclusion: Slow gait speed predicts increased cognitive decline risk among older adults with hypertension. Significance/Implications: Gait speed assessment can identify older adults with hypertension at higher risk of cognitive decline, allowing earlier intervention to potentially delay progression.

Keywords: 4-meter walk test; blood pressure; cognitive decline; dementia; mild cognitive impairment.