Associations of word memory, verbal fluency, processing speed and crystallised cognitive ability with one-legged balance performance in mid and later life

BACKGROUND: Cognitive integration of sensory input and motor output plays an important role in balance. Despite this, it is not clear if specific cognitive processes are associated with balance and how these associations change with age. We examined longitudinal associations of word memory, verbal fluency, search speed and reading ability with repeated measures of one-legged balance performance. METHODS: Up to 2934 participants in the MRC National Survey of Health and Development, a British birth cohort study, were included. At age 53, word memory, verbal fluency, search speed and reading ability were assessed. One-legged balance times (eyes closed) were measured at ages 53, 60-64 and 69 years. Associations between each cognitive measure and balance time were assessed using random-effects models. Adjustments were made for sex, death, attrition, height, body mass index, health conditions, health behaviours, education, and occupational class. RESULTS: In sex-adjusted models, one SD higher scores in word memory, search speed and verbal fluency were associated with 14.1% (95%CI: 11.3,16.8), 7.2% (4.4,9.9) and 10.3% (7.5,13.0) better balance times at age 53, respectively. Higher reading scores were associated with better balance, although this association plateaued. Associations were partially attenuated in mutually-adjusted models and effect sizes were smaller at ages 60-64 and 69. In fully-adjusted models, associations were largely explained by education, although remained for word memory and search speed. CONCLUSIONS: Higher cognitive performance across all measures was independently associated with better balance performance in midlife. Identification of individual cognitive mechanisms involved in balance could lead to opportunities for targeted interventions in midlife

Bidirectional associations between word memory and one-legged balance performance in mid and later life

Background: Age-related changes in cognitive and balance capabilities are well-established, as is their correlation with one another. Given limited evidence regarding the directionality of associations, we aimed to explore the direction and potential explanations of associations between word memory and one-legged balance performance in mid-later life. / Methods: A total of 3062 participants in the Medical Research Council National Survey of Health and Development, a British birth cohort study, were included. One-legged balance times (eyes closed) were measured at ages 53, 60–64 and 69 years. Word memory was assessed at ages 43, 53, 60–64 and 69 with three 15-item word-recall trials. Autoregressive cross-lagged and dual change score models assessed bidirectional associations between word memory and balance. Random-effects models quantified the extent to which these associations were explained by adjustment for anthropometric, socioeconomic, behavioural and health status indicators. / Results: Autoregressive cross-lagged and dual change score models suggested a unidirectional association between word memory and subsequent balance performance. In a sex-adjusted random-effects model, 1 standard deviation increase in word memory was associated with 9% (7,12%) higher balance performance at age 53. This association decreased with age (−0.4% /year (−0.6,-0.1%). Education partially attenuated the association, although it remained in the fully-adjusted model (3% (0.1,6%)). / Conclusions: There was consistent evidence that word memory is associated with subsequent balance performance but no evidence of the reverse association. Cognitive processing plays an important role in the balance process, with educational attainment providing some contribution. These findings have important implications for understanding cognitive-motor associations and for interventions aimed at improving cognitive and physical capability in the ageing population

Associations Between Factors Across Life and One-Legged Balance Performance in Mid and Later Life: Evidence From a British Birth Cohort Study

INTRODUCTION: Despite its associations with falls, disability, and mortality, balance is an under-recognized and frequently overlooked aspect of aging. Studies investigating associations between factors across life and balance are limited. Understanding the factors related to balance performance could help identify protective factors and appropriate interventions across the life course. This study aimed to: (i) identify socioeconomic, anthropometric, behavioral, health, and cognitive factors that are associated with one-legged balance performance; and (ii) explore how these associations change with age. METHODS: Data came from 3,111 members of the MRC National Survey of Health and Development, a British birth cohort study. Multilevel models examined how one-legged standing balance times (assessed at ages 53, 60–64, and 69) were associated with 15 factors across life: sex, maternal education (4 years), paternal occupation (4 years), own education (26 years), own occupation (53 years), and contemporaneous measures (53, 60–64, 69 years) of height, BMI, physical activity, smoking, diabetes, respiratory symptoms, cardiovascular events, knee pain, depression and verbal memory. Age and sex interactions with each variable were assessed. RESULTS: Men had 18.8% (95%CI: 13.6, 23.9) longer balance times than women at age 53, although this difference decreased with age (11.8% at age 60–64 and 7.6% at age 69). Disadvantaged socioeconomic position in childhood and adulthood, low educational attainment, less healthy behaviors, poor health status, lower cognition, higher body mass index (BMI), and shorter height were associated with poorer balance at all three ages. For example, at age 53, those from the lowest paternal occupational classes had 29.6% (22.2, 38.8) worse balance than those from the highest classes. Associations of balance with socioeconomic indicators, cognition and physical activity became smaller with age, while associations with knee pain and depression became larger. There were no sex differences in these associations. In a combined model, the majority of factors remained associated with balance. DISCUSSION: This study identified numerous risk factors across life that are associated with one-legged balance performance and highlighted diverse patterns of association with age, suggesting that there are opportunities to intervene in early, mid and later life. A multifactorial approach to intervention, at both societal and individual levels, may have more benefit than focusing on a single risk factor

Childhood cognition and age-related change in standing balance performance from mid to later life: findings from a British birth cohort

BACKGROUND: Cognitive processing plays a crucial role in the integration of sensory input and motor output that facilitates balance. However, whether balance ability in adulthood is influenced by cognitive pathways established in childhood is unclear, especially as no study has examined if these relationships change with age. We aimed to investigate associations between childhood cognition and age-related change in standing balance between mid and later life. METHODS: Data on 2380 participants from the MRC National Survey of Health and Development were included in analyses. Repeated measures multilevel models estimated the association between childhood cognition, assessed at age 15, and log-transformed balance time, assessed at ages 53, 60–64 and 69 using the one-legged stand with eyes closed. Adjustments were made for sex, death, attrition, anthropometric measures, health conditions, health behaviours, education, other indicators of socioeconomic position (SEP) and adult verbal memory. RESULTS: In a sex-adjusted model, one standard deviation increase in childhood cognition was associated with a 13% (95%CI:10,16%;p<0.001) increase in balance time at age 53, and this association got smaller with age (cognition*age interaction:p<0.001). Adjustments for education, adult verbal memory and SEP largely explained these associations. CONCLUSIONS: Higher childhood cognition was associated with better balance performance in midlife, with diminishing associations with increasing age. The impact of adjustment for education, cognition and other indicators of SEP suggested a common pathway through which cognition is associated with balance across life. Further research is needed to understand underlying mechanisms, which may have important implications for falls risk and maintenance of physical capability

Fertility Desire and Intention of People Living with HIV/AIDS in Tanzania: A call for Restructuring Care and Treatment Services.

Scaling up of antiretroviral therapy (ART) is currently underway in sub-Saharan Africa including, Tanzania, increasing survival of people living with HIV/AIDS (PLWHA). Programmes pay little attention to PLWHA's reproductive health needs. Information on fertility desire and intention would assist in the integration of sexual and reproductive health in routine care and treatment clinics. A cross-sectional study of all PLWHA aged 15--49 residing in Kahe ward in rural Kilimanjaro Tanzania was conducted. Participants were recruited from the community and a local counselling centre located in the ward. Data on socio-demographic, medical and reproductive characteristics were collected through face-to-face interviews. Data were entered and analysed using STATA statistical software. A total of 410 PLWHA with a mean age of 34.2 and constituting 264 (64.4%) females participated. Fifty-one per cent reported to be married/cohabiting, 73.9% lived with their partners and 60.5% were sexually active. The rate of unprotected sex was 69.0% with 12.5% of women reporting to be pregnant at the time of the survey. Further biological children were desired by 37.1% of the participants and lifetime fertility intention was 2.4 children. Increased fertility desire was associated with living and having sex with a partner, HIV disclosure, good perceived health status and CD4 count >=200 cells for both sexes. Reduced desire was associated with havingmore than 2 children among females, divorce or separation, and having a child with the current partner among both males and females. Fertility desire and intention of PLWHA was substantially high though lower than that of the general population in Tanzania. Practice of unprotected sexual intercourse with higher pregnancy rate was observed. Fertility desire was determined by individual perceived health and socio-family related factors. With increasing ART coverage and subsequent improved quality of life of PLWHA, these findings underscore the importance of integrating reproductive health services in the routine care and treatment of HIV/AIDS worldwide. The results also highlight a group of PLWHA with potentially high desire for children who need to be targeted during care

Early-life socioeconomic position and the accumulation of health-related deficits by midlife in the 1958 British birth cohort study

Reducing population levels of frailty is an important goal and preventing its development in mid-adulthood could be pivotal. There is limited evidence on associations between childhood socioeconomic position (SEP) and frailty. Using 1958 British birth cohort data (followed from 1958 to 2016; N=8711), we aimed to: (i) establish the utility of measuring frailty in mid-life, by examining associations between a 34-item frailty index at 50y (FI50y) and mortality (50-58y) and, (ii) examine associations between early-life SEP and FI50y, and investigate whether these associations were explained by adult SEP. Hazard ratios (HRs) for mortality increased with increasing frailty, e.g., HRsex-adjusted was 4.07(95% CI:2.64,6.25) for highest vs. lowest fifth of FI50y. Lower early-life SEP was associated with higher FI50y. Compared with participants born in the highest social class, the estimated total effect on FI50y was 42.0%(35.5%,48.4%) for participants born in the lowest class, with the proportion mediated by adult SEP being 0.45(0.35,0.55). Mediation by adult SEP was negligible, for other early-life SEP classes. Findings suggest that early-life SEP is associated with frailty and that adult SEP only partially explains this association. Results highlight the importance of improving socioeconomic circumstances across the life course to reduce inequalities in mid-life frailty