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Examining the Association between Life-Space Mobility and Cognitive Function in Older Adults: A Systematic Review

Examining the Association between Life-Space Mobility and Cognitive Function in Older Adults: A... Hindawi Journal of Aging Research Volume 2019, Article ID 3923574, 9 pages https://doi.org/10.1155/2019/3923574 Review Article Examining the Association between Life-Space Mobility and Cognitive Function in Older Adults: A Systematic Review 1 2 3 Nileththi A. De Silva , Michael A. Gregory, Shree S. Venkateshan, 4 2 Chris P. Verschoor , and Ayse Kuspinar Department of Interdisciplinary Sciences, McMaster University, Hamilton, ON, Canada L8S 4L8 School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada L8S 1C7 Department of Psychology, Neuroscience and Behavior, McMaster University, Hamilton, ON, Canada L8S 4L8 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada Correspondence should be addressed to Ayse Kuspinar; kuspinaa@mcmaster.ca Received 23 January 2019; Revised 16 April 2019; Accepted 6 May 2019; Published 2 June 2019 Academic Editor: Barbara Shukitt-Hale Copyright © 2019 Nileththi A. De Silva et al. -is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose. -e purpose of this review is to investigate the relationship between life-space mobility and cognition in older adults. Methods. MEDLINE, Embase, CINAHL, and PsycINFO were searched through December 2018 for studies containing measures of life-space mobility and cognitive function. Two independent reviewers screened studies. Eligible studies were combined using a random-effects model, and heterogeneity was assessed using the I . Results. -irty-five articles were identified for review. A moderate and statistically significant association (pooled r � 0.30, 95% confidence interval 0.19 to 0.40.) was observed between life- space mobility and cognition among nine studies. Life-space mobility demonstrated small-to-moderate associations with domain- specific cognitive functioning, particularly executive function, learning, memory, and processing speed. Furthermore, individuals who had restricted life-space mobility (Life-Space Assessment≤ 40) experienced a steeper decline in cognition (β � 0.56 and p � 0.0471) compared to those who did not (Life-Space Assessment≥ 41). Conclusion. -is review examined the association between life-space mobility and cognitive function in older adults. -e results suggest that a moderate relationship between life- space mobility and cognition exists, whether adjusted or unadjusted for covariates such as sociodemographics, mental health, functional capacity, and comorbidities. spatial environment a person moves through within a 1. Introduction specified time period [5]. LSM not only captures social Mobility is an integrated motion referring to forms of interactions of individuals; as larger life spaces can reveal movement ranging from the use of assistive devices to public higher levels of community engagement [6], it can also be transport [1]. Mobility loss in aging manifests in several representative of real-world applications of functional skills, ways, including the development of gait impairments or which traditional, performance-based mobility tests do not changes in driving behaviour. Mobility has been concep- consider. tualized using a variety of measures. For instance, the Another characteristic of aging is the decline in cognitive spatiotemporal assessment of gait is commonly used for the function, which encompasses executive function, learning, evaluation of mobility impairments in dementia populations memory, attention, visual-spatial ability, and perceptual- [2]. Within rehabilitation research, other scales and mea- motor function. Cognitive impairment is differentially sures of mobility, such as the Elderly Mobility Scale [3] and distributed throughout the aging population [7]. In fact, less Performance-Oriented Mobility Assessment [4], are used. than 40% of those with mild cognitive impairment have been Although these measures have been validated, they fail to reported to progress to dementia and Alzheimer’s disease acknowledge life-space mobility (LSM) which describes the [8]. -ese findings suggest that since the degree of cognitive 2 Journal of Aging Research degeneration varies from person to person, preventative during Level 1 screening were resolved through discussion actions [9, 10] may deter the onset of cognitive impairment, [13]. Data extraction was performed using a prepared data extraction sheet, which included (1) study and population and in turn, conversion to dementia, which is an irreversible condition. characteristics; (2) cognitive outcomes utilized; (3) life-space -e concurrent decline in mobility and cognitive mobility outcome utilized; and (4) the associated results. -e function in aging suggests an association between the two linear relationships and explained variances were inter- variables [11, 12], while the lack of uniformity seen in the preted according to Cohen’s guidelines, where an r value of decline presents an area for active research. 0.10 indicates a small effect, r value of 0.30 indicates a -erefore, the aim of this systematic review is to sum- medium effect, and an r value of 0.50 indicates a large effect 2 2 marize the associations between LSM and cognition (global and R value of 0.02 indicates a small effect, R of 0.13 and specific domains) in older adults. indicates a medium effect, and R of 0.26 indicates a large effect [14]. A forest plot was constructed by MedCalc Statistical 2. Methods Software version 18.6 [15] to combine the correlation co- 2.1. Search Strategy. A systematic literature search of 4 efficient values across applicable studies. For the purpose of electronic databases Ovid MEDLINE (1946 to December this forest plot, weighted averages of r values were taken if a 2018), Embase (1974 to December 2018), CINAHL (1982 to study presented more than one correlation value for the December 2018), and PsycINFO (1806 to December 2018) association between LSM and cognition [16]. -e I statistic was conducted. Please refer to Supplementary Table 1 for a was used to assess heterogeneity, which is the percentage of summary of the databases included and the search terms total variation across studies that is due to between-study used for this review. differences rather than chance [17]. -e I ranges between 0 and 100%, with higher values indicating greater heteroge- neity [17]. A p value of<0.05 and an I value>50% indicated 2.2. Study Selection significant heterogeneity [17]. 2.2.1. Study Design. Randomized controlled trials, retro- spective and prospective cohort studies, case series, case- 2.4. Study Quality Assessment. -e SIGN 50 checklist as control studies, and cross-sectional studies were eligible for shown in Supplementary Table 3 was used to evaluate the inclusion. quality of the included citations [18]. -e SIGN 50 evaluates internal validity across 20-items that fall within four do- 2.2.2. Participants. Studies that sampled community- mains. -e quality of each study was ranked based on the dwelling or nursing/long-term care residents, over the age maximum attained score: (1) 0–50% (low quality), (2) 51– of 65, exhibiting a range of mobility limitations and cog- 74% (moderate quality), and (3) ≥75% (high quality). Two nitive conditions, were considered. reviewers (MG and NAD) performed quality assessments, and any disagreements were addressed through discussion [18]. A third party (SV) adjudicated any persisting dis- 2.2.3. Outcomes of Interest. Studies were considered for agreements [18] to reach a consensus on quality scores, inclusion if they met the following criteria: (1) contained an which are presented in Supplementary Table 4. outcome measure for LSM and cognition and (2) reported a quantitative association between LSM and cognition. 3. Results 2.2.4. Inclusion/Exclusion Criteria. Articles were included if 3.1. Study Descriptions. In total, 207 papers were exported they (1) included older adults over the age of 65 years, (2) from the databases and 173 abstracts were reviewed after measured LSM and cognition using a standard outcome exclusion of duplicates. -irty-five were included in this measure (e.g., Life-Space Assessment and Mini-Mental State review as illustrated in Figure 1. Supplementary Table 4 Examination), and (3) reported a quantitative association summarizes the characterizations of the included studies. Of between LSM and cognition. Manuscripts were excluded if the thirty-five papers, 21 studies employed a cross-sectional they were (1) protocol papers; (2) review articles; (3) un- design [19–39], 13 studies used a longitudinal/prospective published studies, conference abstracts, or dissertations; (4) design [40–52], and 1 study [53] employed a randomized non-peer-reviewed articles; (5) book chapters; (6) manu- control trial design. -ere were 17 studies [19, 27, 29–31, scripts published outside of the English language, and (7) 34, 37–39, 41–43, 49–53], whose primary objective con- manuscripts that did not use a questionnaire to assess LSM cerned cognition, and 18 studies [20–26, 28, 32, 33, 35, (i.e., GPS technologies). 36, 40, 44–48] which assessed cognition but did not identify cognition as a variable of primary interest. -e sample sizes 2.3. Data Extraction and Analysis. Title and abstract ranged from 20 to 3892. screening (Level 1) was performed by two independent An age limit of ≥65 was applied to the electronic da- reviewers (NAD and SV). Both reviewers (NAD and SV) tabase searches; however, two studies with an inclusion performed the full-text review and data extraction for the criteria for age<65 surfaced from the search. Bergland et al. final inclusions. Disagreements between the two reviewers [22] included participants ≥64, while Mortenson et al. [25] Journal of Aging Research 3 Records identified through database search Embase - 102 Ovid MEDLINE - 53 PsycINFO - 27 CINAHL - 25 Total = 207 Duplicates removed n = 34 Abstracts, titles, and full papers (i) No quantitative association between screened n = 173 cognition and life space, n = 36 (ii) No cognitive function or life-space mobility results given or both, n = 31 (iii) Full paper could not be obtained/ abstract/ dissertation, n = 34 (iv) Age of participants does not meet inclusion criteria (≥65 y.o), n = 19 (v) Language of publication not English, n = 10 (vi) Life-space mobility assessed by non questionnaires (GPS technologies), n = 5 (vii) Associations between life space and cognition not quantifiable, n = 3 Full-text articles included in review n = 35 Figure 1: Flow diagram to illustrate study selection. included participants ≥60. -e two studies were deemed 3.2. Assessment of Study Quality. -e quality assessment sufficient for inclusion as the mean ages of their respective results as measured by the SIGN 50 checklist [58] show that samples exceeded 80 years of age. Among the 35 studies 21 studies [19–23, 25–29, 31, 37–39, 41, 44–48, 53] were of included in the review, the mean age of participants ranged moderate quality (i.e., 51–74%), ranging from 57.9% to from 65 to 87.6. 73.3%, and 14 studies [24, 30, 32–36, 40, 42, 43, 49–52] were Twenty-six studies [21–27, 31, 33–43, 46–51, 53] in the of high quality (i.e., ≥75%), ranging from 75.0% to 86.7%. review had a predominately female sample (>50% females). Fifteen studies [19, 24, 26, 28–31, 33, 35, 37, 48, 50–53] 3.3. Outcome Measures Used in Studies. A summary of the included participants whose average years of education were cognitive tests used in this review are shown in Supple- less than 13, while six studies [27, 41–45] had a population mentary Table 2. Global cognitive functioning (i.e., evaluated whose mean years of education exceeded 13 years. Nine via the MMSE or Montreal Cognitive Assessment (MoCA)) studies [21, 23, 26, 27, 41–43, 45, 46] had a primarily was most commonly assessed (n � 27/34 studies) Caucasian population (>50% Caucasian vs other races), [19–26, 29–34, 36, 38, 39, 41–44, 47–52]. Domain-specific three studies [24, 28, 50] assessed a Hispanic or Latin cognitive functions, including attention, executive function, population (Mexican, Colombian, and Brazilian), and 5 learning, memory, language, processing speed, perceptual studies [29–32, 53] evaluated an East Asian sample (Chinese speed, and visuospatial abilities, were evaluated in twelve of and Japanese). While the majority of the studies included a the included studies [21, 27, 29–32, 37, 40, 43, 49, 51, 53]. sample of community-dwelling older adults, three studies -e life-space measures’ descriptions and frequencies [22, 25, 35] exclusively assessed subjects residing in long- can be found in Table 1. Within the included citations, 27 term care and nursing homes. [19, 20, 24–26, 28–34, 36–41, 45–53] used the University of Twenty-six percent of studies [21, 27–29, 32, 43, 44, Alabama at Birmingham Life-Space Assessment (LSA), 3 50, 53] included individuals with healthy cognitive func- studies employed a modified Life-Space Assessment for tion (i.e., Mini-Mental State Examination (MMSE) score cognitively impaired patients [34, 38, 39], 5 studies >25 and Legane´s cognitive test (LCT) scores>22) [54]. Of [21, 27, 42–44] administered the Life-Space Questionnaire the remaining studies, 6 [22, 25, 34, 38, 39, 46] included a (LSQ), 3 [21, 43, 44] used a modified LSQ, and 3 [22, 25, 35] mild to moderate (i.e., MMSE 17–26) [55] and severe used the Nursing Home Life-Space Diameter (NHLSD). cognitive impairment (MMSE scores <24 [56] and Mod- ified Mini-Mental State (3MS) Examination scores <77/78 3.4. Association between LSM and Cognition. Only nine [57]) and 4 studies [35, 40, 45, 46] included dementia patients. studies [19, 22, 25, 27, 30, 32, 34, 40, 41] assessed the 4 Journal of Aging Research Table 1: Summary of life-space mobility measures. No. of Administration time Maximal Life-space mobility test Criteria Scoring questions frame score Life space zones [59]: (i) Bedroom (ii) Outside bedroom UAB Life-Space (iii) Outside the home Assessment (iv) Neighbourhood (UAB LSA) (i) Life-space zone scored (v) Beyond neighbourhood [19, 20, 24–26, 28–33, 36, LSA: last 4 weeks 1–5 Frequency: 37, 40, 41, 45–51, 53] 15 LSA-CI: past week (ii) Frequency scored 1–4 120 (i) Less than once/week Life-Space Assessment (iii) Assistance scored 1- (ii) 1–3 times/week adapted for cognitive 2 [59] (iii) 4–6 times/week impairment (LSA-CI) (iv) Daily [34, 38, 52] Assistance required [59]: (i) Person (ii) Device Life space zones: [60] (i) Bedroom (ii) Area immediately outside the home (iii) Area outside of home (i) “Yes” responses (iv) Areas in immediate (i) 9 Life space Questionnaire scored 1 9 Last 3 days neighbourhood (ii) Modified [21, 27, 42–44] (ii) “No” responses (v) Area outside of LSQ out of 6 scored 0 [60] neighbourhood (vi) Areas outside of county/city (vii) Area outside of state/ province (viii) Area outside of country Life space diameters: [61] (i) Diameter 1: bedroom (i) 1 (diameter (ii) Diameter 2: outside the room 1 × frequency 1) (iii) Diameter 3: outside the unit (ii) 2 (diameter (iv) Diameter 4: outside the 2 × frequency 2) facility Past 2 weeks (can be (iii) 3 (diameter Frequency [61]: Nursing home life-space completed by 3 × frequency 3) 9 (i) 5, >3 times/day 100 diameter [22, 25, 35] nursing (iv) 4 (diameter (ii) 4, 1–3 times/day home staff) [61] 4 × frequency 4) (iii) 3, >2 times/day (v) Score × 2, if (iv) 2, weekly independent mobility, (v) 1, less than weekly done without human (vi) 0, never assistance [61] Assistance (optional) [61]: (i) Human assistance correlation between LSM and cognition. As shown in Fig- function, longitudinal analyses demonstrated that poor ure 2, the random-effect pooled correlation was 0.30 (95% CI performance on the Trail Making Tests (i.e.,≥240 seconds to 0.19 to 0.40) (Cohen’s medium effect size), which is sig- complete or ≥4 mistakes) significantly predicted lower life- nificant as the confidence interval excludes zero. High space mobility scores (β �−11.03, p � 0.006) [51] while good heterogeneity (I � 93.9%) was found across the nine studies. performance (i.e.,<60 seconds) was found to predict higher life-space scores (β � 3.81, p � 0.012) [49]. Certain studies [19, 20, 24, 27, 34, 35, 41, 43] assessed the relationship between LSM and cognition using multiple re- 3.5. Summary of Cognitive Domain Results. -e correlation coefficients obtained for the relationship between learning gression analyses. -ese regression models included variables and memory and LSM ranged from 0.22 to 0.23 [27, 32] such as sociodemographics, mental health, general health, fear (Cohen’s small effect size) and −0.19 to 0.37 [27, 30] per- of falling, instrumental activities of daily living, physical ceptual speed/processing speed/visuospatial processing activity/performance, transportation difficulty, social activities, speed (Cohen’s small-to-medium effect size). -e correla- living situation, comorbidity, and vascular risk factors. Table 2 tion coefficients obtained for the relationship between ex- presents the numerical associations for a mixed sample of ecutive function and LSM ranged from 0.13 to 0.26 [27, 40] older adults harbouring a range of cognitive conditions. -e R (Cohen’s small effect size). Furthermore, for executive values for the association between LSM and cognitive function Journal of Aging Research 5 Correlation meta-analysis plot Peel et al. [19] Bergland et al. [22] Ben Mortenson et al. [25] Sartori et al. [27] Uemura et al. [30] Ji et al. [30] Ullrich et al. [34] Allman et al. [40] Crowe et al. [41] Total (random effects) 0.0 0.1 0.2 0.3 0.4 0.5 0.6 Correlation (95% confidence interval) Figure 2: Forest plot with correlation coefficient values (r) for the association between life-space mobility and cognition. in these studies ranged from 0.11 to 0.59 [19, 20, 27, 30, Table 2: Associations between life-space mobility and cognition. 34, 35, 41] (Cohen’s small to large effect size). 2 2 R cognition as R LS as Cognitive domain/assessment exposure exposure Clinical dementia 0.12–0.14 (R change No data 3.6. LSM Category Results. As shown in Table 3, cognitive rating scale [35] not available) function results varied by the level of LSM. When com- 0.12 (R change Executive function [27] No data paring cognition between those restricted to the household 0.009) and those who regularly travel beyond the town, it is ap- 0.12 (R change Learning and memory [27] No data parent that the prevalence of cognitive impairment is much 0.006) Perceptual motor/processing higher among older adults with lower life space. Longi- 0.11 (R change 0.03) speed/visuospatial ability No data tudinal analyses [43, 47, 50] found that individuals who are to 0.37 [27, 30] restricted to the home versus those who are not have a Mini-Mental State Examination 0.42 to 0.59 higher risk of developing mild cognitive impairment 0.14 (MMSE) [19, 20, 34, 41] (R change 0.07) (HR � 1.17 (95% CI 1.06 to 1.28)) [43] and Alzheimer’s R values are derived from multiple regression models including other disease (HR � 1.21 (95% CI 1.08 to 1.36)) [43] and covariates. -e increment change in R after cognition added to the multiple accelerated decline in global cognitive function [50]. Global regression model is reported in brackets. cognition was also significantly higher for participants with maintained and early-decline LSM (life space declined>10 3.7. Association between LSM and Cognition in Individuals points but remained stable after the 2nd follow-up) versus with Mild to Moderate Cognitive Impairment. Six studies those with constricted or late-decline LSM (life space [30, 31, 34, 38, 39, 42] included participants with known remained stable at the 1st follow-up then decreased >10 mild to moderate cognitive impairment at baseline as points by the 2nd follow-up) (p � 0.023) [48]. -e majority diagnosed by a physician, determined by a psychometric of the studies included in the review suggest that con- algorithm, meeting Peterson’s internationally accepted stricted LSM may be associated with cognitive impairment. criteria [62] or having MMSE scores between 17 and 26 However, in a recent cohort study involving community- [63]. In these studies, amnestic mild cognitive impair- dwelling older adults, decline in LSM was not observed to ment was not significantly associated with life space. significantly depend on a change in global cognition over a Longitudinally, having amnestic and nonamnestic mild period of two years [52]. cognitive impairment was found to have negative effects Cross-sectional studies found restricted life space on driving frequency, but not on life space over a five year (i.e., LSM <60) at baseline was associated with lower global period as measured by the Life-Space Questionnaire [42]. cognition compared to unrestricted life space (p � 0.002, Likewise, further analyses showed that life space did p< 0.001) [33, 44]. In separate cross-sectional studies, an not significantly vary between controls and those with increase in cognition was found to reduce the odds of being mild cognitive impairment in a cross-sectional study restricted to the home (OR � 0.40 (95% CI 0.23 to 0.69)) [21] (p � 0.128) [31]. Studies that performed sensitivity ana- and neighbourhood (OR � 0.97 (95% CI 0.87 to 1.07); lyses to identify a cutoff value between low and high OR � 0.40 (95% CI 0.21 to 0.75)) [21, 28]. However, contrary LSM found that cognitively impaired subjects have to these studies, a recent cross-sectional study reported that a substantially lower value (LSA � 26.8) [38] compared older adults who travelled out of the home on a daily basis to samples of cognitively healthier adults (LSA � 52.3) did not have significantly higher global cognition [47]. (p � 0.502) [36]. 6 Journal of Aging Research Table 3: Cognitive results based on life-space categorizations. Life-space category: Life-space category: Life-space category: restricted to house and household vicinity Scores neighbourhood level out of town Modified LSQ< 1 LSA≤ 40 LSA≤ 52.3 LSA 41–60 LSA≥ 61 Older adults in this category were Older adults in this Older adults in this Older adults in this at a higher risk of developing MCI category had a higher category had lower category had lowest Older adults in this compared to individuals who travel rate of cognitive rate of global rate of global category had lower beyond the town (HR � 1.17 (95% decline over 5 years cognitive decline cognitive decline over cognitive function CI 1.06 to 1.28)) [43] (β � 0.56, p � 0.0471) (β � 0.85, p � 0.0026) 5 years (β �1.03, Results than those with Older adults in this category were compared to people over 5 years p � 0.0004) higher scores at a higher risk of developing AD who visited the compared to those compared to those (LSA> 52.3) compared to individuals who travel neighbourhood and who were constricted with neighbourhood (p< 0.001) [47] beyond the town (HR � 1.21 (95% beyond (LSA≥ 41) to their home life space (LSA CI 1.08 to 1.36)) [43] [50] (LSA≤ 40) [50] 41–60) [50] 3.8. Association between LSM and Cognition in Individuals cohorts and found that physical functioning as defined by with Dementia. Four studies [35, 40, 45, 46] targeted in- measures like grip strength and walking speed were sig- dividuals with dementia. -e collective results of the studies nificantly associated with changes in cognitive function. were largely in agreement with one another; as life space Our study extends these findings to the broader in- increased, the proportion of men and women with dementia volvement of the spatiotemporal environment, which can decreased (p< 0.001) [45, 46]. While nursing home residents only be captured by measures of LSM. For example, when with dementia had a significantly wider LSM than subjects low physical fitness and cognitive function limit the ability without (p � 0.003), healthy cognitively functioning older to ambulate, acquire information, or make decisions, the residents exhibited more dependency on others or equip- attainment of higher life spaces also become hindered, ment to achieve mobility compared to the cognitively im- further depriving older adults of enriching auditory, visual, paired residents (p � 0.013) [35]. and tactile stimuli. -erefore, it is important to consider environmental fluctuations (i.e., transition from home to nursing home, hospitalization, or driving cessation) that 4. Discussion occur in the course of aging in tandem with mobility and -e goal of this review was to discern the relative association cognitive declines. between LSM and cognitive function in older adults. -e key -e findings of the current review also found that results reported herein suggest that a moderate relationship mobility outcomes were not uniformly linked with all between LSM and cognition exists, whether or not adjusted cognitive domains as was also revealed by Demnitz et al. [64] for covariates such as sociodemographics, mental health, and Clouston et al. [65]. For example, when considering functional capacity, and comorbidities. Longitudinal studies specific cognitive domains, the review found that processing suggest that restriction to the house and areas immediately speed presented the largest range of small–to-moderate proximate to the household (i.e., equivalent to an LSA score mixed associations with LSM, while executive function ≤40 and LSQ<4) increases the risk for developing cognitive and learning and memory showed small positive associa- impairment in good cognitively functioning seniors. tions with LSM. Global cognitive function also exhibited a -e pooled association across nine studies was moderate moderate association with LSM. Additionally, processing in magnitude and statistically significant. However, this speed played a more significant role in determining life space value must be interpreted with caution as the heterogeneity among amnestic mild cognitively impaired older adults [30] (I ) was substantially large (93.9%). -e high heterogeneity while reasoning emerged as a strong predictor of life space may be attributed to variations in population characteristics among subjects with healthy cognition [27]. such as the inclusion of dementia and the different LSM and cognitive measures used in the studies. 4.1. Limitations. -e majority of the studies contained a Previous reviews have described the relationship be- tween mobility and cognition; however, they quantified high proportion of Caucasians and females, limiting the generalizability of our results and consideration of the in- mobility within the realm of physiological and bio- mechanical functions and omitted the consideration of fluence of cultural and racial differences on the LSM and cognition relationship. Also, many of the studies measured mobility with respect to life-space utilization across diverse populations. For example, Demnitz et al. [64] conducted a cognitive function using the MMSE, which has an un- systematic review of cross-sectional studies analysing cog- derrepresentation of executive function with the majority of nition and mobility among healthy older adults and dis- the scoring items evaluating orientation and language [66]. covered that features of mobility including gait, lower -us, despite the MMSE being regarded as a tool to screen extremity function, and balance, yielded small effect sizes for for cognitive impairment, its capacity to test global cognitive their association with cognitive function. function is limited and may not be suitable to assess change in cognition over time, as was done in seven of the included Similarly, Clouston et al. [65] conducted a systematic review of physical and cognitive function changes in older studies [19, 23, 24, 34, 41, 49, 50]. Journal of Aging Research 7 4.2. Implications. -e findings of this review expand on the Conflicts of Interest theoretical connections between environmental factors and -e authors declare that they have no conflicts of interest. cognitive function. As postulated by the Environmental Complexity -eory, exposure to cognitive stimulation in diverse and heterogeneous spaces during the earlier decades Acknowledgments of aging may reinforce the cognitive reserves of executive -is work was supported by the Labarge Centre for Mobility function, learning, memory, and processing speed, which in Aging within the McMaster Institute for Research on subsequently contributes to the effective utilization of Aging at McMaster University. mobility in later life [67]. -is proposition may explain why weakened global cognition increases the likelihood of re- Supplementary Materials stricted LSM, which then increases the risk of dementia. -e Scaffolding -eory of Aging and Cognition similarly pro- Supplementary Table 1: Ovid MEDLINE search terms poses that external lifestyle influences may contribute to the modified for Embase, CINAHL, and PsycINFO (from No- brain’s neural and functional capacity to adapt and com- vember to December 2017). Supplementary Table 2: summary pensate for age-related changes [68]. Some of the external of cognitive tests administered in studies. Supplementary interventions advocated by the authors Reuter-Lorenz and Table 3: SIGN 50 adapted for prospective, randomized Park to boost the brain’s compensatory mechanisms include controlled trial, and cross-sectional studies. Supplementary exercise, intellectual engagement, social activity, and cog- Table 4: descriptive information for each study included in the nitive training [68]. -e findings of this review suggest that systematic review. (Supplementary Materials) higher life spaces provide opportunities for intellectual and social engagement, thereby facilitating the compensatory References scaffolding of the brain to impose a protective barrier against cognitive decline. [1] W. A. Satariano, J. M. Guralnik, R. J. Jackson, R. A. Marottoli, -is review also demonstrated that most nursing and E. A. Phelan, and T. R. Prohaska, “Mobility and aging: new long-term care residents possess substantially lower LSM directions for public health action,” American Journal of and cognition compared to community-dwelling older Public Health, vol. 102, no. 8, pp. 1508–1515, 2012. adults. Cognitive and mobility impairments are common [2] O. Beauchet, G. Allali, G. Berrut, C. Hommet, V. Dubost, and reasons for admission into long-term care or nursing homes F. Assal, “Gait analysis in demented subjects: interests and perspectives,” Neuropsychiatric Disease and Treatment, vol. 4, [69, 70]. However, exposure to heterogeneous spaces within no. 1, pp. 155–160, 2008. these institutions is particularly limited as there are fewer [3] V. Rajendran and D. Jeevanantham, “-e elderly mobility opportunities for activity engagement [71]. Jansen et al.’s scale,” Journal of Acute Care Physical 5erapy, vol. 7, no. 1, study of movement within nursing homes found that while pp. 3-4, 2016. meal times were associated with higher transits out of the [4] M. E. Tinetti, “Performance-oriented assessment of mobility room, residents remain largely confined to their rooms problems in elderly patients,” Journal of the American Geri- during their free time [72]. -erefore, there is a need to atrics Society, vol. 34, no. 2, pp. 119–126, 1986. incorporate social and physical activities into institutional [5] D. May, U. S. L. Nayak, and B. Isaacs, “-e life-space diary: a schedules that encourage excursions outside of the room, measure of mobility in old people at home,” International unit, and facility for older adults. Rehabilitation Medicine, vol. 7, no. 4, pp. 182–186, 1985. [6] S. C. Webber, M. M. Porter, and V. H. Menec, “Mobility in -is study did not delineate the temporal ordering of older adults: a comprehensive framework,” 5e Gerontologist, mobility and cognitive decline; however, it suggests that both vol. 50, no. 4, pp. 443–450, 2010. LSM and cognition can play predictive roles in the trajectory [7] E. L. Glisky, “Changes in cognitive function in human aging,” of these declines. While it is unclear whether or not LSM in Brain Aging Models, Methods, and Mechanisms, restrictions precede cognitive dysfunction, it is important to D. R. Riddle, Ed., CRC Press/Taylor & Francis, Boca Raton, recognise that LSM may be a more discernible outcome to FL, USA, 2007. measure compared to cognitive function, due to the ob- [8] A. J. Mitchell and M. Shiri-Feshki, “Rate of progression of servability of the contributing factors to life space such as the mild cognitive impairment to dementia—meta-analysis of 41 frequency and duration of movement as well as size of social robust inception cohort studies,” Acta Psychiatrica Scandi- networks. -us, LSM may be a more practical initial target navica, vol. 119, no. 4, pp. 252–265, 2009. for early aging interventions. Furthermore, research on the [9] D. S. Sherman, J. Mauser, M. Nuno, and D. Sherzai, “-e efficacy of cognitive intervention in mild cognitive impair- combined effects of cognitive training and life-space en- ment (MCI): a meta-analysis of outcomes on neuro- hancing activities such as building relationships outside of psychological measures,” Neuropsychology Review, vol. 27, the home through explorative community engagements is no. 4, pp. 440–484, 2017. yet to be explored. [10] L. Mowszowski, J. Batchelor, and S. L. Naismith, “Early in- tervention for cognitive decline: can cognitive training be used Disclosure as a selective prevention technique?,” International Psycho- geriatrics, vol. 22, no. 4, pp. 537–548, 2010. An earlier version of this work was presented at the Ge- [11] Q. Tian, Y. An, S. M. Resnick, and S. Studenski, “-e relative rontological Society of America 2018 Annual Scientific temporal sequence of decline in mobility and cognition Meeting. among initially unimpaired older adults: results from the 8 Journal of Aging Research Baltimore Longitudinal Study of Aging,” Age and Ageing, men,” Aging Clinical and Experimental Research, vol. 25, no. 5, vol. 46, no. 3, pp. 445–451, 2017. pp. 553–560, 2013. [12] M. I. Tolea and J. E. Galvin, “-e relationship between mo- [29] H. Makizako, T. Doi, H. Shimada et al., “Relationship between going outdoors daily and activation of the prefrontal cortex bility dysfunction staging and global cognitive performance,” Alzheimer Disease & Associated Disorders, vol. 30, no. 3, during verbal fluency tasks (VFTs) among older adults: a near- pp. 230–236, 2016. infrared spectroscopy study,” Archives of Gerontology and [13] J. P. Higgins and S. Green, Cochrane Handbook for Systematic Geriatrics, vol. 56, no. 1, pp. 118–123, 2013. Reviews of Interventions, John Wiley & Sons, Chichester, UK, [30] K. Uemura, H. Shimada, H. Makizako et al., “Factors asso- 2008. ciated with life-space in older adults with amnestic mild [14] J. Cohen, Statistical Power Analysis for the Behavioral Sciences, cognitive impairment,” Geriatrics & Gerontology In- Routledge, New York, NY, USA, 1st edition, 1977. ternational, vol. 13, no. 1, pp. 161–166, 2013. [15] MedCalc, MedCalc Statistical Software, MedCalc, Ostend, [31] Y. Maki, T. Yamaguchi, T. Yamagami et al., “-e impact of Belgium, 2018. subjective memory complaints on quality of life in [16] A. J. Faller, “An average correlation coefficient,” Journal of community-dwelling older adults,” Psychogeriatrics, vol. 14, Applied Meteorology and Climatology, vol. 20, no. 2, no. 3, pp. 175–181, 2014. pp. 203–205, 1981. [32] M. Ji, Y. Zhou, J. Liao, and F. Feng, “Pilot study on the Chinese version of the Life Space Assessment among community- [17] J. P. T. Higgins, S. G. -ompson, J. J. Deeks, and D. G. Altman, “Measuring inconsistency in meta-analyses,” BMJ, vol. 327, dwelling elderly,” Archives of Gerontology and Geriatrics, no. 7414, pp. 557–560, 2003. vol. 61, no. 2, pp. 301–306, 2015. [18] A. Bai, V. Shukla, and G. Wells, Quality Assessment Tools [33] M. Rantakokko, S. Iwarsson, E. Portegijs, A. Viljanen, and Project Report, Canadian Agency for Drugs and Technologies T. Rantanen, “Associations between environmental charac- in Health, Ottawa, ON, Canada, 2012. teristics and life-space mobility in community-dwelling older [19] C. Peel, P. Sawyer Baker, D. L. Roth, C. J. Brown, people,” Journal of Aging and Health, vol. 27, no. 4, E. V. Brodner, and R. M. Allman, “Assessing mobility in older pp. 606–621, 2015. adults: the UAB study of aging life-space assessment,” Physical [34] P. Ullrich, T. Eckert, M. Bongartz et al., “Life-space mobility in 5erapy, vol. 85, no. 10, pp. 1008–1119, 2005. older persons with cognitive impairment after discharge from [20] R. M. Allman, P. Sawyer, and J. M. Roseman, “-e UAB Study geriatric rehabilitation,” Archives of Gerontology and Geri- of Aging: background and insights into life-space mobility atrics, vol. 81, pp. 192–200, 2018. among older Americans in rural and urban settings,” Aging [35] K. Sverdrup, S. Bergh, G. Selbæk, I. Røen, and Ø. Kirkevold, G. G. Tangen, Mobility and cognition at admission to the Health, vol. 2, no. 3, pp. 417–429, 2006. [21] L. L. Barnes, R. S. Wilson, J. L. Bienias et al., “Correlates of life nursing home—a cross-sectional study,” BMC Geriatrics, space in a volunteer cohort of older adults,” Experimental vol. 18, no. 1, p. 30, 2018. Aging Research, vol. 33, no. 1, pp. 77–93, 2007. [36] E. Portegijs, M. Rantakokko, A. Viljanen, T. Rantanen, and [22] A. Bergland, I. Narum, H. Gronstedt ¨ et al., “Evaluating the S. Iwarsson, “Perceived and objective entrance-related envi- feasibility and intercorrelation of measurements on the ronmental barriers and daily out-of-home mobility in functioning of residents living in Scandinavian nursing community-dwelling older people,” Archives of Gerontology homes,” Physical & Occupational 5erapy in Geriatrics, and Geriatrics, vol. 69, pp. 69–76, 2017. vol. 28, no. 2, pp. 154–169, 2010. [37] C. Poletti, R. Sleimen-Malkoun, L. M. Decker, F. Retornaz, [23] M. L. Popescu, H. Boisjoly, H. Schmaltz et al., “Age-related eye P. Lemaire, and J. J. Temprado, “Strategic variations in Fitts’ disease and mobility limitations in older adults,” Investigative task: comparison of healthy older adults and cognitively impaired patients,” Frontiers in Aging Neuroscience, vol. 8, Opthalmology & Visual Science, vol. 52, no. 10, pp. 7168–7174, 2011. p. 334, 2017. [24] S. Al Snih, K. M. Peek, P. Sawyer, K. S. Markides, [38] P. Ullrich, C. Werner, T. Eckert et al., “Cut-off for the life- R. M. Allman, and K. J. Ottenbacher, “Life-space mobility in space assessment in persons with cognitive impairment,” Mexican Americans aged 75 and older,” Journal of the Aging Clinical and Experimental Research, pp. 1–5, 2018. American Geriatrics Society, vol. 60, no. 3, pp. 532–537, 2012. [39] P. Ullrich, C. Werner, M. Bongartz, R. Kiss, J. Bauer, and [25] W. Ben Mortenson, W. C. Miller, C. L. Backman, and K. Hauer, “Validation of a modified life-space assessment in J. L. Oliffe, “Association between mobility, participation, and multimorbid older persons with cognitive impairment,” 5e wheelchair-related factors in long-term care residents who use Gerontologist, vol. 59, no. 2, pp. e66–e75, 2019. wheelchairs as their primary means of mobility,” Journal of [40] R. M. Allman, P. S. Baker, R. M. Maisiak, R. V. Sims, and the American Geriatrics Society, vol. 60, no. 7, pp. 1310–1315, J. M. Roseman, “Racial similarities and differences in predictors 2012. of mobility change over eighteen months,” Journal of General [26] M. L. Popescu, H. Boisjoly, H. Schmaltz et al., “Explaining the Internal Medicine, vol. 19, no. 11, pp. 1118–1126, 2004. [41] M. Crowe, R. Andel, V. G. Wadley, O. C. Okonkwo, relationship between three eye diseases and depressive symptoms in older adults,” Investigative Opthalmology & P. Sawyer, and R. M. Allman, “Life-space and cognitive de- Visual Science, vol. 53, no. 4, pp. 2308–2313, 2012. cline in a community-based sample of African American and [27] A. C. Sartori, V. G. Wadley, O. J. Clay, J. M. Parisi, Caucasian older adults,” Journals of Gerontology Series A: G. W. Rebok, and M. Crowe, “-e relationship between Biological Sciences and Medical Sciences, vol. 63, no. 11, cognitive function and life space: the potential role of personal pp. 1241–1245, 2008. control beliefs,” Psychology and Aging, vol. 27, no. 2, [42] M. L. O’Connor, J. D. Edwards, V. G. Wadley, and M. Crowe, pp. 364–374, 2012. “Changes in mobility among older adults with psychomet- [28] C.-L. Curcio, B. E. Alvarado, F. Gomez, R. Guerra, J. Guralnik, rically defined mild cognitive impairment,” Journals of Ger- and M. V. Zunzunegui, “Life-space assessment scale to assess ontology Series B: Psychological Sciences and Social Sciences, mobility: validation in Latin American older women and vol. 65B, no. 3, pp. 306–316, 2010. Journal of Aging Research 9 [43] B. D. James, P. A. Boyle, A. S. Buchman, L. L. Barnes, and [56] T. N. Tombaugh and N. J. McIntyre, “-e mini-mental state D. A. Bennett, “Life space and risk of Alzheimer disease, mild examination: a comprehensive review,” Journal of the cognitive impairment, and cognitive decline in old age,” American Geriatrics Society, vol. 40, no. 9, pp. 922–935, 1992. [57] R. C. Bland and S. C. Newman, “Mild dementia or cognitive American Journal of Geriatric Psychiatry, vol. 19, no. 11, pp. 961–969, 2011. impairment: the modified mini-mental state examination [44] R. C. Shah, K. Maitra, L. L. Barnes, B. D. James, S. Leurgans, (3MS) as a screen for dementia,” Canadian Journal of Psy- and D. A. Bennett, “Relation of driving status to incident life chiatry, vol. 46, no. 6, pp. 506–510, 2001. space constriction in community-dwelling older persons: a [58] SIGN 50, A Guideline Developer’s Handbook, Scottish In- prospective cohort study,” 5e Journals of Gerontology Series tercollegiate Guidelines Network (SIGN), Edinburgh, A: Biological Sciences and Medical Sciences, vol. 67, no. 9, Scotland, 2015. pp. 984–989, 2012. [59] E. Portegijs, S. Iwarsson, M. Rantakokko, A. Viljanen, and [45] D. C. Mackey, J. A. Cauley, E. Barrett-Connor et al., “Life- T. Rantanen, “Life-space mobility assessment in older people space mobility and mortality in older men: a prospective in Finland; measurement properties in winter and spring,” cohort study,” Journal of the American Geriatrics Society, BMC Research Notes, vol. 7, no. 1, p. 323, 2014. vol. 62, no. 7, pp. 1288–1296, 2014. [60] B. T. Stalvey, C. Owsley, M. E. Sloane, and K. Ball, “-e life [46] D. C. Mackey, L.-Y. Lui, P. M. Cawthon, K. Ensrud, K. Yaffe, space questionnaire: a measure of the extent of mobility of older adults,” Journal of Applied Gerontology, vol. 18, no. 4, and S. R. Cummings, “Life-space mobility and mortality in older women: prospective results from the study of osteo- pp. 460–478, 1999. porotic fractures,” Journal of the American Geriatrics Society, [61] M. E. Tinetti and S. F. Ginter, “-e nursing home life-space vol. 64, no. 11, pp. 2226–2234, 2016. diameter,” Journal of the American Geriatrics Society, vol. 38, [47] E. Portegijs, M. Rantakokko, A. Viljanen, S. Sipila, ¨ and no. 12, pp. 1311–1315, 1990. T. Rantanen, “Identification of older people at risk of ADL [62] R. C. Petersen and J. C. Morris, “Mild cognitive impairment as disability using the life-space assessment: a longitudinal co- a clinical entity and treatment target,” Archives of Neurology, hort study,” Journal of the American Medical Directors As- vol. 62, no. 7, pp. 1160–1163, 2005. sociation, vol. 17, no. 5, pp. 410–414, 2016. [63] A. U. Monsch, N. S. Foldi, D. E. Ermini-Funfschilling ¨ et al., [48] M. Rantakokko, E. Portegijs, A. Viljanen, S. Iwarsson, “Improving the diagnostic accuracy of the Mini-Mental State M. Kauppinen, and T. Rantanen, “Changes in life-space Examination,” Acta Neurologica Scandinavica, vol. 92, no. 2, mobility and quality of life among community-dwelling pp. 145–150, 1995. older people: a 2-year follow-up study,” Quality of Life Re- [64] N. Demnitz, P. Esser, H. Dawes et al., “A systematic review and meta-analysis of cross-sectional studies examining the search, vol. 25, no. 5, pp. 1189–1197, 2016. [49] T. Poranen-Clark, M. B. von Bonsdorff, E. Portegijs et al., “-e relationship between mobility and cognition in healthy older temporal association between executive function and life- adults,” Gait & Posture, vol. 50, pp. 164–174, 2016. space mobility in old age,” Journals of Gerontology: Series [65] S. A. P. Clouston, P. Brewster, D. Kuh et al., “-e dynamic A, vol. 73, no. 6, pp. 835–839, 2018. relationship between physical function and cognition in [50] S. Silberschmidt, A. Kumar, M. M. Raji, K. Markides, longitudinal aging cohorts,” Epidemiologic Reviews, vol. 35, K. J. Ottenbacher, and S. Al Snih, “Life-space mobility and no. 1, pp. 33–50, 2013. cognitive decline among Mexican Americans aged 75 years [66] C. Proust-Lima, H. Amieva, J.-F. Dartigues, and H. Jacqmin- and older,” Journal of the American Geriatrics Society, vol. 65, Gadda, “Sensitivity of four psychometric tests to measure cog- no. 7, pp. 1514–1520, 2017. nitive changes in brain aging-population-based studies,” Amer- [51] T. Poranen-Clark, M. B. von Bonsdorff, M. Rantakokko et al., ican Journal of Epidemiology, vol. 165, no. 3, pp. 344–350, 2006. [67] P. Godfrey-Smith, “Environmental complexity and the evo- “Executive function and life-space mobility in old age,” Aging Clinical and Experimental Research, vol. 30, no. 2, pp. 145– lution of cognition,” in 5e Evolution of Intelligence, 151, 2018. R. Sternberg and J. Kaufman, Eds., pp. 233–249, Lawrence [52] F. Be´land, D. Julien, N. Bier, J. Desrosiers, M. J. Kergoat, and Erlbaum, Mahwah, NJ, USA, 2002. L. Demers, “Association between cognitive function and life- [68] P. A. Reuter-Lorenz and D. C. Park, “How does it STAC up? space mobility in older adults: results from the FRe´LE Revisiting the scaffolding theory of aging and cognition,” longitudinal study,” BMC Geriatrics, vol. 18, no. 1, p. 227, Neuropsychology Review, vol. 24, no. 3, pp. 355–370, 2014. 2018. [69] K. D. Sheppard, P. Sawyer, C. S. Ritchie, R. M. Allman, and [53] Y. Maki, C. Ura, T. Yamaguchi et al., “Effects of intervention C. J. Brown, “Life-space mobility predicts nursing home using a community-based walking program for prevention admission over 6 years,” Journal of Aging and Health, vol. 25, of mental decline: a randomized controlled trial,” Journal of no. 6, pp. 907–920, 2013. the American Geriatrics Society, vol. 60, no. 3, pp. 505–510, [70] J. E. Gaugler, S. Duval, K. A. Anderson, and R. L. Kane, 2012. “Predicting nursing home admission in the U.S: a meta- ´ analysis,” BMC Geriatrics, vol. 7, no. 1, p. 13, 2007. [54] M. J. G. de Yebenes, A. Otero, M. V. Zunzunegui, A. Rodr´ıguez-Laso, F. Sanchez-S ´ anchez, ´ and T. Del Ser, [71] S. H. Tak, S. Kedia, T. M. Tongumpun, and S. H. Hong, “Validation of a short cognitive tool for the screening of “Activity engagement: perspectives from nursing home res- dementia in elderly people with low educational level,” In- idents with dementia,” Educational Gerontology, vol. 41, no. 3, ternational Journal of Geriatric Psychiatry, vol. 18, no. 10, pp. 182–192, 2015. pp. 925–936, 2003. [72] C.-P. Jansen, M. Diegelmann, E.-L. Schnabel, and [55] M. F. Folstein, S. E. Folstein, and P. R. McHugh, “Mini-mental H. W. Wahl, K. Hauer, Life-space and movement behavior in state: a practical method for grading the cognitive state of nursing home residents: results of a new sensor-based as- patients for the clinician,” Journal of Psychiatric Research, sessment and associated factors,” BMC Geriatrics, vol. 17, vol. 12, no. 3, pp. 189–198, 1975. no. 1, p. 36, 2017. 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Examining the Association between Life-Space Mobility and Cognitive Function in Older Adults: A Systematic Review

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Copyright © 2019 Nileththi A. De Silva et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Hindawi Journal of Aging Research Volume 2019, Article ID 3923574, 9 pages https://doi.org/10.1155/2019/3923574 Review Article Examining the Association between Life-Space Mobility and Cognitive Function in Older Adults: A Systematic Review 1 2 3 Nileththi A. De Silva , Michael A. Gregory, Shree S. Venkateshan, 4 2 Chris P. Verschoor , and Ayse Kuspinar Department of Interdisciplinary Sciences, McMaster University, Hamilton, ON, Canada L8S 4L8 School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada L8S 1C7 Department of Psychology, Neuroscience and Behavior, McMaster University, Hamilton, ON, Canada L8S 4L8 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada Correspondence should be addressed to Ayse Kuspinar; kuspinaa@mcmaster.ca Received 23 January 2019; Revised 16 April 2019; Accepted 6 May 2019; Published 2 June 2019 Academic Editor: Barbara Shukitt-Hale Copyright © 2019 Nileththi A. De Silva et al. -is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose. -e purpose of this review is to investigate the relationship between life-space mobility and cognition in older adults. Methods. MEDLINE, Embase, CINAHL, and PsycINFO were searched through December 2018 for studies containing measures of life-space mobility and cognitive function. Two independent reviewers screened studies. Eligible studies were combined using a random-effects model, and heterogeneity was assessed using the I . Results. -irty-five articles were identified for review. A moderate and statistically significant association (pooled r � 0.30, 95% confidence interval 0.19 to 0.40.) was observed between life- space mobility and cognition among nine studies. Life-space mobility demonstrated small-to-moderate associations with domain- specific cognitive functioning, particularly executive function, learning, memory, and processing speed. Furthermore, individuals who had restricted life-space mobility (Life-Space Assessment≤ 40) experienced a steeper decline in cognition (β � 0.56 and p � 0.0471) compared to those who did not (Life-Space Assessment≥ 41). Conclusion. -is review examined the association between life-space mobility and cognitive function in older adults. -e results suggest that a moderate relationship between life- space mobility and cognition exists, whether adjusted or unadjusted for covariates such as sociodemographics, mental health, functional capacity, and comorbidities. spatial environment a person moves through within a 1. Introduction specified time period [5]. LSM not only captures social Mobility is an integrated motion referring to forms of interactions of individuals; as larger life spaces can reveal movement ranging from the use of assistive devices to public higher levels of community engagement [6], it can also be transport [1]. Mobility loss in aging manifests in several representative of real-world applications of functional skills, ways, including the development of gait impairments or which traditional, performance-based mobility tests do not changes in driving behaviour. Mobility has been concep- consider. tualized using a variety of measures. For instance, the Another characteristic of aging is the decline in cognitive spatiotemporal assessment of gait is commonly used for the function, which encompasses executive function, learning, evaluation of mobility impairments in dementia populations memory, attention, visual-spatial ability, and perceptual- [2]. Within rehabilitation research, other scales and mea- motor function. Cognitive impairment is differentially sures of mobility, such as the Elderly Mobility Scale [3] and distributed throughout the aging population [7]. In fact, less Performance-Oriented Mobility Assessment [4], are used. than 40% of those with mild cognitive impairment have been Although these measures have been validated, they fail to reported to progress to dementia and Alzheimer’s disease acknowledge life-space mobility (LSM) which describes the [8]. -ese findings suggest that since the degree of cognitive 2 Journal of Aging Research degeneration varies from person to person, preventative during Level 1 screening were resolved through discussion actions [9, 10] may deter the onset of cognitive impairment, [13]. Data extraction was performed using a prepared data extraction sheet, which included (1) study and population and in turn, conversion to dementia, which is an irreversible condition. characteristics; (2) cognitive outcomes utilized; (3) life-space -e concurrent decline in mobility and cognitive mobility outcome utilized; and (4) the associated results. -e function in aging suggests an association between the two linear relationships and explained variances were inter- variables [11, 12], while the lack of uniformity seen in the preted according to Cohen’s guidelines, where an r value of decline presents an area for active research. 0.10 indicates a small effect, r value of 0.30 indicates a -erefore, the aim of this systematic review is to sum- medium effect, and an r value of 0.50 indicates a large effect 2 2 marize the associations between LSM and cognition (global and R value of 0.02 indicates a small effect, R of 0.13 and specific domains) in older adults. indicates a medium effect, and R of 0.26 indicates a large effect [14]. A forest plot was constructed by MedCalc Statistical 2. Methods Software version 18.6 [15] to combine the correlation co- 2.1. Search Strategy. A systematic literature search of 4 efficient values across applicable studies. For the purpose of electronic databases Ovid MEDLINE (1946 to December this forest plot, weighted averages of r values were taken if a 2018), Embase (1974 to December 2018), CINAHL (1982 to study presented more than one correlation value for the December 2018), and PsycINFO (1806 to December 2018) association between LSM and cognition [16]. -e I statistic was conducted. Please refer to Supplementary Table 1 for a was used to assess heterogeneity, which is the percentage of summary of the databases included and the search terms total variation across studies that is due to between-study used for this review. differences rather than chance [17]. -e I ranges between 0 and 100%, with higher values indicating greater heteroge- neity [17]. A p value of<0.05 and an I value>50% indicated 2.2. Study Selection significant heterogeneity [17]. 2.2.1. Study Design. Randomized controlled trials, retro- spective and prospective cohort studies, case series, case- 2.4. Study Quality Assessment. -e SIGN 50 checklist as control studies, and cross-sectional studies were eligible for shown in Supplementary Table 3 was used to evaluate the inclusion. quality of the included citations [18]. -e SIGN 50 evaluates internal validity across 20-items that fall within four do- 2.2.2. Participants. Studies that sampled community- mains. -e quality of each study was ranked based on the dwelling or nursing/long-term care residents, over the age maximum attained score: (1) 0–50% (low quality), (2) 51– of 65, exhibiting a range of mobility limitations and cog- 74% (moderate quality), and (3) ≥75% (high quality). Two nitive conditions, were considered. reviewers (MG and NAD) performed quality assessments, and any disagreements were addressed through discussion [18]. A third party (SV) adjudicated any persisting dis- 2.2.3. Outcomes of Interest. Studies were considered for agreements [18] to reach a consensus on quality scores, inclusion if they met the following criteria: (1) contained an which are presented in Supplementary Table 4. outcome measure for LSM and cognition and (2) reported a quantitative association between LSM and cognition. 3. Results 2.2.4. Inclusion/Exclusion Criteria. Articles were included if 3.1. Study Descriptions. In total, 207 papers were exported they (1) included older adults over the age of 65 years, (2) from the databases and 173 abstracts were reviewed after measured LSM and cognition using a standard outcome exclusion of duplicates. -irty-five were included in this measure (e.g., Life-Space Assessment and Mini-Mental State review as illustrated in Figure 1. Supplementary Table 4 Examination), and (3) reported a quantitative association summarizes the characterizations of the included studies. Of between LSM and cognition. Manuscripts were excluded if the thirty-five papers, 21 studies employed a cross-sectional they were (1) protocol papers; (2) review articles; (3) un- design [19–39], 13 studies used a longitudinal/prospective published studies, conference abstracts, or dissertations; (4) design [40–52], and 1 study [53] employed a randomized non-peer-reviewed articles; (5) book chapters; (6) manu- control trial design. -ere were 17 studies [19, 27, 29–31, scripts published outside of the English language, and (7) 34, 37–39, 41–43, 49–53], whose primary objective con- manuscripts that did not use a questionnaire to assess LSM cerned cognition, and 18 studies [20–26, 28, 32, 33, 35, (i.e., GPS technologies). 36, 40, 44–48] which assessed cognition but did not identify cognition as a variable of primary interest. -e sample sizes 2.3. Data Extraction and Analysis. Title and abstract ranged from 20 to 3892. screening (Level 1) was performed by two independent An age limit of ≥65 was applied to the electronic da- reviewers (NAD and SV). Both reviewers (NAD and SV) tabase searches; however, two studies with an inclusion performed the full-text review and data extraction for the criteria for age<65 surfaced from the search. Bergland et al. final inclusions. Disagreements between the two reviewers [22] included participants ≥64, while Mortenson et al. [25] Journal of Aging Research 3 Records identified through database search Embase - 102 Ovid MEDLINE - 53 PsycINFO - 27 CINAHL - 25 Total = 207 Duplicates removed n = 34 Abstracts, titles, and full papers (i) No quantitative association between screened n = 173 cognition and life space, n = 36 (ii) No cognitive function or life-space mobility results given or both, n = 31 (iii) Full paper could not be obtained/ abstract/ dissertation, n = 34 (iv) Age of participants does not meet inclusion criteria (≥65 y.o), n = 19 (v) Language of publication not English, n = 10 (vi) Life-space mobility assessed by non questionnaires (GPS technologies), n = 5 (vii) Associations between life space and cognition not quantifiable, n = 3 Full-text articles included in review n = 35 Figure 1: Flow diagram to illustrate study selection. included participants ≥60. -e two studies were deemed 3.2. Assessment of Study Quality. -e quality assessment sufficient for inclusion as the mean ages of their respective results as measured by the SIGN 50 checklist [58] show that samples exceeded 80 years of age. Among the 35 studies 21 studies [19–23, 25–29, 31, 37–39, 41, 44–48, 53] were of included in the review, the mean age of participants ranged moderate quality (i.e., 51–74%), ranging from 57.9% to from 65 to 87.6. 73.3%, and 14 studies [24, 30, 32–36, 40, 42, 43, 49–52] were Twenty-six studies [21–27, 31, 33–43, 46–51, 53] in the of high quality (i.e., ≥75%), ranging from 75.0% to 86.7%. review had a predominately female sample (>50% females). Fifteen studies [19, 24, 26, 28–31, 33, 35, 37, 48, 50–53] 3.3. Outcome Measures Used in Studies. A summary of the included participants whose average years of education were cognitive tests used in this review are shown in Supple- less than 13, while six studies [27, 41–45] had a population mentary Table 2. Global cognitive functioning (i.e., evaluated whose mean years of education exceeded 13 years. Nine via the MMSE or Montreal Cognitive Assessment (MoCA)) studies [21, 23, 26, 27, 41–43, 45, 46] had a primarily was most commonly assessed (n � 27/34 studies) Caucasian population (>50% Caucasian vs other races), [19–26, 29–34, 36, 38, 39, 41–44, 47–52]. Domain-specific three studies [24, 28, 50] assessed a Hispanic or Latin cognitive functions, including attention, executive function, population (Mexican, Colombian, and Brazilian), and 5 learning, memory, language, processing speed, perceptual studies [29–32, 53] evaluated an East Asian sample (Chinese speed, and visuospatial abilities, were evaluated in twelve of and Japanese). While the majority of the studies included a the included studies [21, 27, 29–32, 37, 40, 43, 49, 51, 53]. sample of community-dwelling older adults, three studies -e life-space measures’ descriptions and frequencies [22, 25, 35] exclusively assessed subjects residing in long- can be found in Table 1. Within the included citations, 27 term care and nursing homes. [19, 20, 24–26, 28–34, 36–41, 45–53] used the University of Twenty-six percent of studies [21, 27–29, 32, 43, 44, Alabama at Birmingham Life-Space Assessment (LSA), 3 50, 53] included individuals with healthy cognitive func- studies employed a modified Life-Space Assessment for tion (i.e., Mini-Mental State Examination (MMSE) score cognitively impaired patients [34, 38, 39], 5 studies >25 and Legane´s cognitive test (LCT) scores>22) [54]. Of [21, 27, 42–44] administered the Life-Space Questionnaire the remaining studies, 6 [22, 25, 34, 38, 39, 46] included a (LSQ), 3 [21, 43, 44] used a modified LSQ, and 3 [22, 25, 35] mild to moderate (i.e., MMSE 17–26) [55] and severe used the Nursing Home Life-Space Diameter (NHLSD). cognitive impairment (MMSE scores <24 [56] and Mod- ified Mini-Mental State (3MS) Examination scores <77/78 3.4. Association between LSM and Cognition. Only nine [57]) and 4 studies [35, 40, 45, 46] included dementia patients. studies [19, 22, 25, 27, 30, 32, 34, 40, 41] assessed the 4 Journal of Aging Research Table 1: Summary of life-space mobility measures. No. of Administration time Maximal Life-space mobility test Criteria Scoring questions frame score Life space zones [59]: (i) Bedroom (ii) Outside bedroom UAB Life-Space (iii) Outside the home Assessment (iv) Neighbourhood (UAB LSA) (i) Life-space zone scored (v) Beyond neighbourhood [19, 20, 24–26, 28–33, 36, LSA: last 4 weeks 1–5 Frequency: 37, 40, 41, 45–51, 53] 15 LSA-CI: past week (ii) Frequency scored 1–4 120 (i) Less than once/week Life-Space Assessment (iii) Assistance scored 1- (ii) 1–3 times/week adapted for cognitive 2 [59] (iii) 4–6 times/week impairment (LSA-CI) (iv) Daily [34, 38, 52] Assistance required [59]: (i) Person (ii) Device Life space zones: [60] (i) Bedroom (ii) Area immediately outside the home (iii) Area outside of home (i) “Yes” responses (iv) Areas in immediate (i) 9 Life space Questionnaire scored 1 9 Last 3 days neighbourhood (ii) Modified [21, 27, 42–44] (ii) “No” responses (v) Area outside of LSQ out of 6 scored 0 [60] neighbourhood (vi) Areas outside of county/city (vii) Area outside of state/ province (viii) Area outside of country Life space diameters: [61] (i) Diameter 1: bedroom (i) 1 (diameter (ii) Diameter 2: outside the room 1 × frequency 1) (iii) Diameter 3: outside the unit (ii) 2 (diameter (iv) Diameter 4: outside the 2 × frequency 2) facility Past 2 weeks (can be (iii) 3 (diameter Frequency [61]: Nursing home life-space completed by 3 × frequency 3) 9 (i) 5, >3 times/day 100 diameter [22, 25, 35] nursing (iv) 4 (diameter (ii) 4, 1–3 times/day home staff) [61] 4 × frequency 4) (iii) 3, >2 times/day (v) Score × 2, if (iv) 2, weekly independent mobility, (v) 1, less than weekly done without human (vi) 0, never assistance [61] Assistance (optional) [61]: (i) Human assistance correlation between LSM and cognition. As shown in Fig- function, longitudinal analyses demonstrated that poor ure 2, the random-effect pooled correlation was 0.30 (95% CI performance on the Trail Making Tests (i.e.,≥240 seconds to 0.19 to 0.40) (Cohen’s medium effect size), which is sig- complete or ≥4 mistakes) significantly predicted lower life- nificant as the confidence interval excludes zero. High space mobility scores (β �−11.03, p � 0.006) [51] while good heterogeneity (I � 93.9%) was found across the nine studies. performance (i.e.,<60 seconds) was found to predict higher life-space scores (β � 3.81, p � 0.012) [49]. Certain studies [19, 20, 24, 27, 34, 35, 41, 43] assessed the relationship between LSM and cognition using multiple re- 3.5. Summary of Cognitive Domain Results. -e correlation coefficients obtained for the relationship between learning gression analyses. -ese regression models included variables and memory and LSM ranged from 0.22 to 0.23 [27, 32] such as sociodemographics, mental health, general health, fear (Cohen’s small effect size) and −0.19 to 0.37 [27, 30] per- of falling, instrumental activities of daily living, physical ceptual speed/processing speed/visuospatial processing activity/performance, transportation difficulty, social activities, speed (Cohen’s small-to-medium effect size). -e correla- living situation, comorbidity, and vascular risk factors. Table 2 tion coefficients obtained for the relationship between ex- presents the numerical associations for a mixed sample of ecutive function and LSM ranged from 0.13 to 0.26 [27, 40] older adults harbouring a range of cognitive conditions. -e R (Cohen’s small effect size). Furthermore, for executive values for the association between LSM and cognitive function Journal of Aging Research 5 Correlation meta-analysis plot Peel et al. [19] Bergland et al. [22] Ben Mortenson et al. [25] Sartori et al. [27] Uemura et al. [30] Ji et al. [30] Ullrich et al. [34] Allman et al. [40] Crowe et al. [41] Total (random effects) 0.0 0.1 0.2 0.3 0.4 0.5 0.6 Correlation (95% confidence interval) Figure 2: Forest plot with correlation coefficient values (r) for the association between life-space mobility and cognition. in these studies ranged from 0.11 to 0.59 [19, 20, 27, 30, Table 2: Associations between life-space mobility and cognition. 34, 35, 41] (Cohen’s small to large effect size). 2 2 R cognition as R LS as Cognitive domain/assessment exposure exposure Clinical dementia 0.12–0.14 (R change No data 3.6. LSM Category Results. As shown in Table 3, cognitive rating scale [35] not available) function results varied by the level of LSM. When com- 0.12 (R change Executive function [27] No data paring cognition between those restricted to the household 0.009) and those who regularly travel beyond the town, it is ap- 0.12 (R change Learning and memory [27] No data parent that the prevalence of cognitive impairment is much 0.006) Perceptual motor/processing higher among older adults with lower life space. Longi- 0.11 (R change 0.03) speed/visuospatial ability No data tudinal analyses [43, 47, 50] found that individuals who are to 0.37 [27, 30] restricted to the home versus those who are not have a Mini-Mental State Examination 0.42 to 0.59 higher risk of developing mild cognitive impairment 0.14 (MMSE) [19, 20, 34, 41] (R change 0.07) (HR � 1.17 (95% CI 1.06 to 1.28)) [43] and Alzheimer’s R values are derived from multiple regression models including other disease (HR � 1.21 (95% CI 1.08 to 1.36)) [43] and covariates. -e increment change in R after cognition added to the multiple accelerated decline in global cognitive function [50]. Global regression model is reported in brackets. cognition was also significantly higher for participants with maintained and early-decline LSM (life space declined>10 3.7. Association between LSM and Cognition in Individuals points but remained stable after the 2nd follow-up) versus with Mild to Moderate Cognitive Impairment. Six studies those with constricted or late-decline LSM (life space [30, 31, 34, 38, 39, 42] included participants with known remained stable at the 1st follow-up then decreased >10 mild to moderate cognitive impairment at baseline as points by the 2nd follow-up) (p � 0.023) [48]. -e majority diagnosed by a physician, determined by a psychometric of the studies included in the review suggest that con- algorithm, meeting Peterson’s internationally accepted stricted LSM may be associated with cognitive impairment. criteria [62] or having MMSE scores between 17 and 26 However, in a recent cohort study involving community- [63]. In these studies, amnestic mild cognitive impair- dwelling older adults, decline in LSM was not observed to ment was not significantly associated with life space. significantly depend on a change in global cognition over a Longitudinally, having amnestic and nonamnestic mild period of two years [52]. cognitive impairment was found to have negative effects Cross-sectional studies found restricted life space on driving frequency, but not on life space over a five year (i.e., LSM <60) at baseline was associated with lower global period as measured by the Life-Space Questionnaire [42]. cognition compared to unrestricted life space (p � 0.002, Likewise, further analyses showed that life space did p< 0.001) [33, 44]. In separate cross-sectional studies, an not significantly vary between controls and those with increase in cognition was found to reduce the odds of being mild cognitive impairment in a cross-sectional study restricted to the home (OR � 0.40 (95% CI 0.23 to 0.69)) [21] (p � 0.128) [31]. Studies that performed sensitivity ana- and neighbourhood (OR � 0.97 (95% CI 0.87 to 1.07); lyses to identify a cutoff value between low and high OR � 0.40 (95% CI 0.21 to 0.75)) [21, 28]. However, contrary LSM found that cognitively impaired subjects have to these studies, a recent cross-sectional study reported that a substantially lower value (LSA � 26.8) [38] compared older adults who travelled out of the home on a daily basis to samples of cognitively healthier adults (LSA � 52.3) did not have significantly higher global cognition [47]. (p � 0.502) [36]. 6 Journal of Aging Research Table 3: Cognitive results based on life-space categorizations. Life-space category: Life-space category: Life-space category: restricted to house and household vicinity Scores neighbourhood level out of town Modified LSQ< 1 LSA≤ 40 LSA≤ 52.3 LSA 41–60 LSA≥ 61 Older adults in this category were Older adults in this Older adults in this Older adults in this at a higher risk of developing MCI category had a higher category had lower category had lowest Older adults in this compared to individuals who travel rate of cognitive rate of global rate of global category had lower beyond the town (HR � 1.17 (95% decline over 5 years cognitive decline cognitive decline over cognitive function CI 1.06 to 1.28)) [43] (β � 0.56, p � 0.0471) (β � 0.85, p � 0.0026) 5 years (β �1.03, Results than those with Older adults in this category were compared to people over 5 years p � 0.0004) higher scores at a higher risk of developing AD who visited the compared to those compared to those (LSA> 52.3) compared to individuals who travel neighbourhood and who were constricted with neighbourhood (p< 0.001) [47] beyond the town (HR � 1.21 (95% beyond (LSA≥ 41) to their home life space (LSA CI 1.08 to 1.36)) [43] [50] (LSA≤ 40) [50] 41–60) [50] 3.8. Association between LSM and Cognition in Individuals cohorts and found that physical functioning as defined by with Dementia. Four studies [35, 40, 45, 46] targeted in- measures like grip strength and walking speed were sig- dividuals with dementia. -e collective results of the studies nificantly associated with changes in cognitive function. were largely in agreement with one another; as life space Our study extends these findings to the broader in- increased, the proportion of men and women with dementia volvement of the spatiotemporal environment, which can decreased (p< 0.001) [45, 46]. While nursing home residents only be captured by measures of LSM. For example, when with dementia had a significantly wider LSM than subjects low physical fitness and cognitive function limit the ability without (p � 0.003), healthy cognitively functioning older to ambulate, acquire information, or make decisions, the residents exhibited more dependency on others or equip- attainment of higher life spaces also become hindered, ment to achieve mobility compared to the cognitively im- further depriving older adults of enriching auditory, visual, paired residents (p � 0.013) [35]. and tactile stimuli. -erefore, it is important to consider environmental fluctuations (i.e., transition from home to nursing home, hospitalization, or driving cessation) that 4. Discussion occur in the course of aging in tandem with mobility and -e goal of this review was to discern the relative association cognitive declines. between LSM and cognitive function in older adults. -e key -e findings of the current review also found that results reported herein suggest that a moderate relationship mobility outcomes were not uniformly linked with all between LSM and cognition exists, whether or not adjusted cognitive domains as was also revealed by Demnitz et al. [64] for covariates such as sociodemographics, mental health, and Clouston et al. [65]. For example, when considering functional capacity, and comorbidities. Longitudinal studies specific cognitive domains, the review found that processing suggest that restriction to the house and areas immediately speed presented the largest range of small–to-moderate proximate to the household (i.e., equivalent to an LSA score mixed associations with LSM, while executive function ≤40 and LSQ<4) increases the risk for developing cognitive and learning and memory showed small positive associa- impairment in good cognitively functioning seniors. tions with LSM. Global cognitive function also exhibited a -e pooled association across nine studies was moderate moderate association with LSM. Additionally, processing in magnitude and statistically significant. However, this speed played a more significant role in determining life space value must be interpreted with caution as the heterogeneity among amnestic mild cognitively impaired older adults [30] (I ) was substantially large (93.9%). -e high heterogeneity while reasoning emerged as a strong predictor of life space may be attributed to variations in population characteristics among subjects with healthy cognition [27]. such as the inclusion of dementia and the different LSM and cognitive measures used in the studies. 4.1. Limitations. -e majority of the studies contained a Previous reviews have described the relationship be- tween mobility and cognition; however, they quantified high proportion of Caucasians and females, limiting the generalizability of our results and consideration of the in- mobility within the realm of physiological and bio- mechanical functions and omitted the consideration of fluence of cultural and racial differences on the LSM and cognition relationship. Also, many of the studies measured mobility with respect to life-space utilization across diverse populations. For example, Demnitz et al. [64] conducted a cognitive function using the MMSE, which has an un- systematic review of cross-sectional studies analysing cog- derrepresentation of executive function with the majority of nition and mobility among healthy older adults and dis- the scoring items evaluating orientation and language [66]. covered that features of mobility including gait, lower -us, despite the MMSE being regarded as a tool to screen extremity function, and balance, yielded small effect sizes for for cognitive impairment, its capacity to test global cognitive their association with cognitive function. function is limited and may not be suitable to assess change in cognition over time, as was done in seven of the included Similarly, Clouston et al. [65] conducted a systematic review of physical and cognitive function changes in older studies [19, 23, 24, 34, 41, 49, 50]. Journal of Aging Research 7 4.2. Implications. -e findings of this review expand on the Conflicts of Interest theoretical connections between environmental factors and -e authors declare that they have no conflicts of interest. cognitive function. As postulated by the Environmental Complexity -eory, exposure to cognitive stimulation in diverse and heterogeneous spaces during the earlier decades Acknowledgments of aging may reinforce the cognitive reserves of executive -is work was supported by the Labarge Centre for Mobility function, learning, memory, and processing speed, which in Aging within the McMaster Institute for Research on subsequently contributes to the effective utilization of Aging at McMaster University. mobility in later life [67]. -is proposition may explain why weakened global cognition increases the likelihood of re- Supplementary Materials stricted LSM, which then increases the risk of dementia. -e Scaffolding -eory of Aging and Cognition similarly pro- Supplementary Table 1: Ovid MEDLINE search terms poses that external lifestyle influences may contribute to the modified for Embase, CINAHL, and PsycINFO (from No- brain’s neural and functional capacity to adapt and com- vember to December 2017). Supplementary Table 2: summary pensate for age-related changes [68]. Some of the external of cognitive tests administered in studies. Supplementary interventions advocated by the authors Reuter-Lorenz and Table 3: SIGN 50 adapted for prospective, randomized Park to boost the brain’s compensatory mechanisms include controlled trial, and cross-sectional studies. Supplementary exercise, intellectual engagement, social activity, and cog- Table 4: descriptive information for each study included in the nitive training [68]. -e findings of this review suggest that systematic review. (Supplementary Materials) higher life spaces provide opportunities for intellectual and social engagement, thereby facilitating the compensatory References scaffolding of the brain to impose a protective barrier against cognitive decline. [1] W. A. Satariano, J. M. Guralnik, R. J. Jackson, R. A. Marottoli, -is review also demonstrated that most nursing and E. A. Phelan, and T. R. Prohaska, “Mobility and aging: new long-term care residents possess substantially lower LSM directions for public health action,” American Journal of and cognition compared to community-dwelling older Public Health, vol. 102, no. 8, pp. 1508–1515, 2012. adults. Cognitive and mobility impairments are common [2] O. Beauchet, G. Allali, G. Berrut, C. Hommet, V. Dubost, and reasons for admission into long-term care or nursing homes F. Assal, “Gait analysis in demented subjects: interests and perspectives,” Neuropsychiatric Disease and Treatment, vol. 4, [69, 70]. However, exposure to heterogeneous spaces within no. 1, pp. 155–160, 2008. these institutions is particularly limited as there are fewer [3] V. Rajendran and D. Jeevanantham, “-e elderly mobility opportunities for activity engagement [71]. Jansen et al.’s scale,” Journal of Acute Care Physical 5erapy, vol. 7, no. 1, study of movement within nursing homes found that while pp. 3-4, 2016. meal times were associated with higher transits out of the [4] M. E. Tinetti, “Performance-oriented assessment of mobility room, residents remain largely confined to their rooms problems in elderly patients,” Journal of the American Geri- during their free time [72]. -erefore, there is a need to atrics Society, vol. 34, no. 2, pp. 119–126, 1986. incorporate social and physical activities into institutional [5] D. May, U. S. L. Nayak, and B. Isaacs, “-e life-space diary: a schedules that encourage excursions outside of the room, measure of mobility in old people at home,” International unit, and facility for older adults. Rehabilitation Medicine, vol. 7, no. 4, pp. 182–186, 1985. [6] S. C. Webber, M. M. Porter, and V. H. Menec, “Mobility in -is study did not delineate the temporal ordering of older adults: a comprehensive framework,” 5e Gerontologist, mobility and cognitive decline; however, it suggests that both vol. 50, no. 4, pp. 443–450, 2010. LSM and cognition can play predictive roles in the trajectory [7] E. L. Glisky, “Changes in cognitive function in human aging,” of these declines. While it is unclear whether or not LSM in Brain Aging Models, Methods, and Mechanisms, restrictions precede cognitive dysfunction, it is important to D. R. Riddle, Ed., CRC Press/Taylor & Francis, Boca Raton, recognise that LSM may be a more discernible outcome to FL, USA, 2007. measure compared to cognitive function, due to the ob- [8] A. J. Mitchell and M. Shiri-Feshki, “Rate of progression of servability of the contributing factors to life space such as the mild cognitive impairment to dementia—meta-analysis of 41 frequency and duration of movement as well as size of social robust inception cohort studies,” Acta Psychiatrica Scandi- networks. -us, LSM may be a more practical initial target navica, vol. 119, no. 4, pp. 252–265, 2009. for early aging interventions. Furthermore, research on the [9] D. S. Sherman, J. Mauser, M. Nuno, and D. Sherzai, “-e efficacy of cognitive intervention in mild cognitive impair- combined effects of cognitive training and life-space en- ment (MCI): a meta-analysis of outcomes on neuro- hancing activities such as building relationships outside of psychological measures,” Neuropsychology Review, vol. 27, the home through explorative community engagements is no. 4, pp. 440–484, 2017. yet to be explored. [10] L. Mowszowski, J. Batchelor, and S. L. Naismith, “Early in- tervention for cognitive decline: can cognitive training be used Disclosure as a selective prevention technique?,” International Psycho- geriatrics, vol. 22, no. 4, pp. 537–548, 2010. An earlier version of this work was presented at the Ge- [11] Q. Tian, Y. An, S. M. Resnick, and S. Studenski, “-e relative rontological Society of America 2018 Annual Scientific temporal sequence of decline in mobility and cognition Meeting. among initially unimpaired older adults: results from the 8 Journal of Aging Research Baltimore Longitudinal Study of Aging,” Age and Ageing, men,” Aging Clinical and Experimental Research, vol. 25, no. 5, vol. 46, no. 3, pp. 445–451, 2017. pp. 553–560, 2013. [12] M. I. Tolea and J. E. Galvin, “-e relationship between mo- [29] H. Makizako, T. Doi, H. Shimada et al., “Relationship between going outdoors daily and activation of the prefrontal cortex bility dysfunction staging and global cognitive performance,” Alzheimer Disease & Associated Disorders, vol. 30, no. 3, during verbal fluency tasks (VFTs) among older adults: a near- pp. 230–236, 2016. infrared spectroscopy study,” Archives of Gerontology and [13] J. P. Higgins and S. Green, Cochrane Handbook for Systematic Geriatrics, vol. 56, no. 1, pp. 118–123, 2013. Reviews of Interventions, John Wiley & Sons, Chichester, UK, [30] K. Uemura, H. Shimada, H. Makizako et al., “Factors asso- 2008. ciated with life-space in older adults with amnestic mild [14] J. Cohen, Statistical Power Analysis for the Behavioral Sciences, cognitive impairment,” Geriatrics & Gerontology In- Routledge, New York, NY, USA, 1st edition, 1977. ternational, vol. 13, no. 1, pp. 161–166, 2013. [15] MedCalc, MedCalc Statistical Software, MedCalc, Ostend, [31] Y. Maki, T. Yamaguchi, T. Yamagami et al., “-e impact of Belgium, 2018. subjective memory complaints on quality of life in [16] A. J. Faller, “An average correlation coefficient,” Journal of community-dwelling older adults,” Psychogeriatrics, vol. 14, Applied Meteorology and Climatology, vol. 20, no. 2, no. 3, pp. 175–181, 2014. pp. 203–205, 1981. [32] M. Ji, Y. Zhou, J. Liao, and F. Feng, “Pilot study on the Chinese version of the Life Space Assessment among community- [17] J. P. T. Higgins, S. G. -ompson, J. J. Deeks, and D. G. Altman, “Measuring inconsistency in meta-analyses,” BMJ, vol. 327, dwelling elderly,” Archives of Gerontology and Geriatrics, no. 7414, pp. 557–560, 2003. vol. 61, no. 2, pp. 301–306, 2015. [18] A. Bai, V. Shukla, and G. Wells, Quality Assessment Tools [33] M. Rantakokko, S. Iwarsson, E. Portegijs, A. Viljanen, and Project Report, Canadian Agency for Drugs and Technologies T. Rantanen, “Associations between environmental charac- in Health, Ottawa, ON, Canada, 2012. teristics and life-space mobility in community-dwelling older [19] C. Peel, P. Sawyer Baker, D. L. Roth, C. J. Brown, people,” Journal of Aging and Health, vol. 27, no. 4, E. V. Brodner, and R. M. Allman, “Assessing mobility in older pp. 606–621, 2015. adults: the UAB study of aging life-space assessment,” Physical [34] P. Ullrich, T. Eckert, M. Bongartz et al., “Life-space mobility in 5erapy, vol. 85, no. 10, pp. 1008–1119, 2005. older persons with cognitive impairment after discharge from [20] R. M. Allman, P. Sawyer, and J. M. Roseman, “-e UAB Study geriatric rehabilitation,” Archives of Gerontology and Geri- of Aging: background and insights into life-space mobility atrics, vol. 81, pp. 192–200, 2018. among older Americans in rural and urban settings,” Aging [35] K. Sverdrup, S. Bergh, G. Selbæk, I. Røen, and Ø. Kirkevold, G. G. Tangen, Mobility and cognition at admission to the Health, vol. 2, no. 3, pp. 417–429, 2006. [21] L. L. Barnes, R. S. Wilson, J. L. Bienias et al., “Correlates of life nursing home—a cross-sectional study,” BMC Geriatrics, space in a volunteer cohort of older adults,” Experimental vol. 18, no. 1, p. 30, 2018. Aging Research, vol. 33, no. 1, pp. 77–93, 2007. [36] E. Portegijs, M. Rantakokko, A. Viljanen, T. Rantanen, and [22] A. Bergland, I. Narum, H. Gronstedt ¨ et al., “Evaluating the S. Iwarsson, “Perceived and objective entrance-related envi- feasibility and intercorrelation of measurements on the ronmental barriers and daily out-of-home mobility in functioning of residents living in Scandinavian nursing community-dwelling older people,” Archives of Gerontology homes,” Physical & Occupational 5erapy in Geriatrics, and Geriatrics, vol. 69, pp. 69–76, 2017. vol. 28, no. 2, pp. 154–169, 2010. [37] C. Poletti, R. Sleimen-Malkoun, L. M. Decker, F. Retornaz, [23] M. L. Popescu, H. Boisjoly, H. Schmaltz et al., “Age-related eye P. Lemaire, and J. J. Temprado, “Strategic variations in Fitts’ disease and mobility limitations in older adults,” Investigative task: comparison of healthy older adults and cognitively impaired patients,” Frontiers in Aging Neuroscience, vol. 8, Opthalmology & Visual Science, vol. 52, no. 10, pp. 7168–7174, 2011. p. 334, 2017. [24] S. Al Snih, K. M. Peek, P. Sawyer, K. S. Markides, [38] P. Ullrich, C. Werner, T. Eckert et al., “Cut-off for the life- R. M. Allman, and K. J. Ottenbacher, “Life-space mobility in space assessment in persons with cognitive impairment,” Mexican Americans aged 75 and older,” Journal of the Aging Clinical and Experimental Research, pp. 1–5, 2018. American Geriatrics Society, vol. 60, no. 3, pp. 532–537, 2012. [39] P. Ullrich, C. Werner, M. Bongartz, R. Kiss, J. Bauer, and [25] W. Ben Mortenson, W. C. Miller, C. L. Backman, and K. Hauer, “Validation of a modified life-space assessment in J. L. Oliffe, “Association between mobility, participation, and multimorbid older persons with cognitive impairment,” 5e wheelchair-related factors in long-term care residents who use Gerontologist, vol. 59, no. 2, pp. e66–e75, 2019. wheelchairs as their primary means of mobility,” Journal of [40] R. M. Allman, P. S. Baker, R. M. Maisiak, R. V. Sims, and the American Geriatrics Society, vol. 60, no. 7, pp. 1310–1315, J. M. Roseman, “Racial similarities and differences in predictors 2012. of mobility change over eighteen months,” Journal of General [26] M. L. Popescu, H. Boisjoly, H. Schmaltz et al., “Explaining the Internal Medicine, vol. 19, no. 11, pp. 1118–1126, 2004. [41] M. Crowe, R. Andel, V. G. Wadley, O. C. Okonkwo, relationship between three eye diseases and depressive symptoms in older adults,” Investigative Opthalmology & P. Sawyer, and R. M. Allman, “Life-space and cognitive de- Visual Science, vol. 53, no. 4, pp. 2308–2313, 2012. cline in a community-based sample of African American and [27] A. C. Sartori, V. G. Wadley, O. J. Clay, J. M. Parisi, Caucasian older adults,” Journals of Gerontology Series A: G. W. Rebok, and M. Crowe, “-e relationship between Biological Sciences and Medical Sciences, vol. 63, no. 11, cognitive function and life space: the potential role of personal pp. 1241–1245, 2008. control beliefs,” Psychology and Aging, vol. 27, no. 2, [42] M. L. O’Connor, J. D. Edwards, V. G. Wadley, and M. Crowe, pp. 364–374, 2012. “Changes in mobility among older adults with psychomet- [28] C.-L. Curcio, B. E. Alvarado, F. Gomez, R. Guerra, J. Guralnik, rically defined mild cognitive impairment,” Journals of Ger- and M. V. Zunzunegui, “Life-space assessment scale to assess ontology Series B: Psychological Sciences and Social Sciences, mobility: validation in Latin American older women and vol. 65B, no. 3, pp. 306–316, 2010. Journal of Aging Research 9 [43] B. D. James, P. A. Boyle, A. S. Buchman, L. L. Barnes, and [56] T. N. Tombaugh and N. J. McIntyre, “-e mini-mental state D. A. Bennett, “Life space and risk of Alzheimer disease, mild examination: a comprehensive review,” Journal of the cognitive impairment, and cognitive decline in old age,” American Geriatrics Society, vol. 40, no. 9, pp. 922–935, 1992. [57] R. C. Bland and S. C. Newman, “Mild dementia or cognitive American Journal of Geriatric Psychiatry, vol. 19, no. 11, pp. 961–969, 2011. impairment: the modified mini-mental state examination [44] R. C. Shah, K. Maitra, L. L. Barnes, B. D. James, S. Leurgans, (3MS) as a screen for dementia,” Canadian Journal of Psy- and D. A. Bennett, “Relation of driving status to incident life chiatry, vol. 46, no. 6, pp. 506–510, 2001. space constriction in community-dwelling older persons: a [58] SIGN 50, A Guideline Developer’s Handbook, Scottish In- prospective cohort study,” 5e Journals of Gerontology Series tercollegiate Guidelines Network (SIGN), Edinburgh, A: Biological Sciences and Medical Sciences, vol. 67, no. 9, Scotland, 2015. pp. 984–989, 2012. [59] E. Portegijs, S. Iwarsson, M. Rantakokko, A. Viljanen, and [45] D. C. Mackey, J. A. Cauley, E. Barrett-Connor et al., “Life- T. Rantanen, “Life-space mobility assessment in older people space mobility and mortality in older men: a prospective in Finland; measurement properties in winter and spring,” cohort study,” Journal of the American Geriatrics Society, BMC Research Notes, vol. 7, no. 1, p. 323, 2014. vol. 62, no. 7, pp. 1288–1296, 2014. [60] B. T. Stalvey, C. Owsley, M. E. Sloane, and K. Ball, “-e life [46] D. C. Mackey, L.-Y. Lui, P. M. Cawthon, K. Ensrud, K. Yaffe, space questionnaire: a measure of the extent of mobility of older adults,” Journal of Applied Gerontology, vol. 18, no. 4, and S. R. Cummings, “Life-space mobility and mortality in older women: prospective results from the study of osteo- pp. 460–478, 1999. porotic fractures,” Journal of the American Geriatrics Society, [61] M. E. Tinetti and S. F. Ginter, “-e nursing home life-space vol. 64, no. 11, pp. 2226–2234, 2016. diameter,” Journal of the American Geriatrics Society, vol. 38, [47] E. Portegijs, M. Rantakokko, A. Viljanen, S. Sipila, ¨ and no. 12, pp. 1311–1315, 1990. T. Rantanen, “Identification of older people at risk of ADL [62] R. C. Petersen and J. C. Morris, “Mild cognitive impairment as disability using the life-space assessment: a longitudinal co- a clinical entity and treatment target,” Archives of Neurology, hort study,” Journal of the American Medical Directors As- vol. 62, no. 7, pp. 1160–1163, 2005. sociation, vol. 17, no. 5, pp. 410–414, 2016. [63] A. U. Monsch, N. S. Foldi, D. E. Ermini-Funfschilling ¨ et al., [48] M. Rantakokko, E. Portegijs, A. Viljanen, S. Iwarsson, “Improving the diagnostic accuracy of the Mini-Mental State M. Kauppinen, and T. Rantanen, “Changes in life-space Examination,” Acta Neurologica Scandinavica, vol. 92, no. 2, mobility and quality of life among community-dwelling pp. 145–150, 1995. older people: a 2-year follow-up study,” Quality of Life Re- [64] N. Demnitz, P. Esser, H. Dawes et al., “A systematic review and meta-analysis of cross-sectional studies examining the search, vol. 25, no. 5, pp. 1189–1197, 2016. [49] T. Poranen-Clark, M. B. von Bonsdorff, E. Portegijs et al., “-e relationship between mobility and cognition in healthy older temporal association between executive function and life- adults,” Gait & Posture, vol. 50, pp. 164–174, 2016. space mobility in old age,” Journals of Gerontology: Series [65] S. A. P. Clouston, P. Brewster, D. Kuh et al., “-e dynamic A, vol. 73, no. 6, pp. 835–839, 2018. relationship between physical function and cognition in [50] S. Silberschmidt, A. Kumar, M. M. Raji, K. Markides, longitudinal aging cohorts,” Epidemiologic Reviews, vol. 35, K. J. Ottenbacher, and S. Al Snih, “Life-space mobility and no. 1, pp. 33–50, 2013. cognitive decline among Mexican Americans aged 75 years [66] C. Proust-Lima, H. Amieva, J.-F. Dartigues, and H. Jacqmin- and older,” Journal of the American Geriatrics Society, vol. 65, Gadda, “Sensitivity of four psychometric tests to measure cog- no. 7, pp. 1514–1520, 2017. nitive changes in brain aging-population-based studies,” Amer- [51] T. Poranen-Clark, M. B. von Bonsdorff, M. Rantakokko et al., ican Journal of Epidemiology, vol. 165, no. 3, pp. 344–350, 2006. [67] P. Godfrey-Smith, “Environmental complexity and the evo- “Executive function and life-space mobility in old age,” Aging Clinical and Experimental Research, vol. 30, no. 2, pp. 145– lution of cognition,” in 5e Evolution of Intelligence, 151, 2018. R. Sternberg and J. Kaufman, Eds., pp. 233–249, Lawrence [52] F. Be´land, D. Julien, N. Bier, J. Desrosiers, M. J. Kergoat, and Erlbaum, Mahwah, NJ, USA, 2002. L. Demers, “Association between cognitive function and life- [68] P. A. Reuter-Lorenz and D. C. Park, “How does it STAC up? space mobility in older adults: results from the FRe´LE Revisiting the scaffolding theory of aging and cognition,” longitudinal study,” BMC Geriatrics, vol. 18, no. 1, p. 227, Neuropsychology Review, vol. 24, no. 3, pp. 355–370, 2014. 2018. [69] K. D. Sheppard, P. Sawyer, C. S. Ritchie, R. M. Allman, and [53] Y. Maki, C. Ura, T. Yamaguchi et al., “Effects of intervention C. J. Brown, “Life-space mobility predicts nursing home using a community-based walking program for prevention admission over 6 years,” Journal of Aging and Health, vol. 25, of mental decline: a randomized controlled trial,” Journal of no. 6, pp. 907–920, 2013. the American Geriatrics Society, vol. 60, no. 3, pp. 505–510, [70] J. E. Gaugler, S. Duval, K. A. Anderson, and R. L. Kane, 2012. “Predicting nursing home admission in the U.S: a meta- ´ analysis,” BMC Geriatrics, vol. 7, no. 1, p. 13, 2007. [54] M. J. G. de Yebenes, A. Otero, M. V. Zunzunegui, A. Rodr´ıguez-Laso, F. Sanchez-S ´ anchez, ´ and T. Del Ser, [71] S. H. Tak, S. Kedia, T. M. Tongumpun, and S. H. Hong, “Validation of a short cognitive tool for the screening of “Activity engagement: perspectives from nursing home res- dementia in elderly people with low educational level,” In- idents with dementia,” Educational Gerontology, vol. 41, no. 3, ternational Journal of Geriatric Psychiatry, vol. 18, no. 10, pp. 182–192, 2015. pp. 925–936, 2003. [72] C.-P. Jansen, M. Diegelmann, E.-L. Schnabel, and [55] M. F. Folstein, S. E. Folstein, and P. R. McHugh, “Mini-mental H. W. Wahl, K. Hauer, Life-space and movement behavior in state: a practical method for grading the cognitive state of nursing home residents: results of a new sensor-based as- patients for the clinician,” Journal of Psychiatric Research, sessment and associated factors,” BMC Geriatrics, vol. 17, vol. 12, no. 3, pp. 189–198, 1975. no. 1, p. 36, 2017. 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