Gait speed in old age is a window into brain health
STUDY: Jayakody O et al, Neurology 2026
STUDY TYPE: Cohort study (pooled analysis of five international cohorts plus two independent longitudinal samples)
FUNDING: National Institutes of Health
Background
Slow gait in older adults is a well-known warning sign for cognitive decline, but what about fast gait? This study defines “super movers” as adults 80 and older whose walking speed sits far above their age and sex norms, and asks whether they age more slowly, cognitively and structurally.
The Study
- Nearly 4,000 adults 80 and older from five international aging cohorts (United States, England, Europe, China, Mexico), plus separate longitudinal samples from the LonGenity study (197 adults) and the RUSH Memory and Aging Project (692 adults with autopsy data).
- Super movers (gait speed 1.5 SD above age- and sex-adjusted norms) were compared with everyone else.
- Follow-up ranged from about 3 to 15 years depending on the cohort, tracking cognitive test scores, brain MRI measures, and dementia pathology at autopsy.
Results
Across the pooled international cohorts, super movers had about half the risk of developing cognitive impairment compared with their peers (hazard ratio 0.49). They also had a lower rate of self-reported Alzheimer’s or dementia diagnosis (hazard ratio 0.40).
In the LonGenity cohort, super movers declined more slowly on memory testing and on tests of processing speed and executive function, and had larger hippocampal volume on MRI, particularly in subfields tied to memory and movement. But in the autopsy cohort, super movers had no less Alzheimer’s pathology on the brain than anyone else, despite having better cognition while alive. Cortical thickness didn’t differ either.
Limitations
This doesn’t show that walking faster reduces cognitive decline. Rather, that it’s a sign of cognitive health (correlation, not causation).
The imaging sample was small (just 64 participants, only 6 of them super movers), and the age-80 cutoff for defining a super mover is somewhat arbitrary.
Practice Implications
- Watch your patients as they walk into the office. A drop in speed in an older adults should prompt concern, and perhaps screening for cognitive health.
Veterinary Implications
- What’s true for humans is true for dogs, as a study published the same week shows.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
