Clustering of Behavioral Changes and Their Associations With Cognitive Decline in Older Adults

To examine (1) the clustering of reduced falls-efficacy, social withdrawal, and physical activity withdrawal in Irish adults aged 50 years and older, and (2) the concurrent and prospective associations of these clustered behaviors with cognitive decline.

Longitudinal cohort study.

Data were from 4571 participants (mean age 64.5 ± 8.6, 54.9% women) in The Irish Longitudinal Study on Ageing, a population-based study.

Changes in social and physical activity and falls-efficacy from 2012/2013 to 2014/2015 were used to define the behaviors of social withdrawal, physical activity withdrawal, and reduced falls-efficacy. Patterns of behaviors were associated with concurrent (2012/2013-2014/2015) and prospective (2014/2015-2016/2017) changes in immediate recall, delayed recall, and verbal fluency using random effects mixed models.

Eighty-six percent of participants had social withdrawal, physical activity withdrawal, or reduced falls-efficacy, and 15% had all 3 behaviors. Participants with all 3 behaviors showed the greatest declines in immediate recall (concurrent: B = -0.51, confidence interval [CI] = -0.77 to -0.25; prospective: B = -0.51, CI = -0.78 to -0.25), delayed recall (concurrent: B = -0.40, CI = -0.61 to -0.18; prospective: B = -0.47, CI = -0.69 to -0.25) and verbal fluency (concurrent: B = -1.05, CI = -1.58 to -0.52; prospective: B = -1.29, CI = -1.83 to -0.74).

The clustering of social withdrawal, physical activity withdrawal, and reduced falls-efficacy is common. Presence of multiple behaviors was associated with greater cognitive declines, suggesting a cumulative association of these behaviors with cognitive decline. These findings guide (1) identification of vulnerable groups, (2) intervention design, and (3) care planning for people presenting with 1 or more of these changes in behavior.