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Cognitive and physical aspects of functionality are closely related. However, whether physical decline differs by dementia type and progression rate is debatable. To address these issues, we conducted a longitudinal study of 766 older adults whose physical performance and cognitive status were assessed annually with standard assessment tools [eg, Physical Performance Test, Clinical Dementia Rate (CDR)] for 8 years. Compared with participants who remained cognitively normal, those progressing to later-stage dementia (CDR=1) declined in their mobility by a factor of 2.82 (P<0.001), followed by those who maintained a later-stage diagnosis (slope=-1.84, P<0.001), those progressing from early-stage to later-stage (CDR=0.5 to CDR=1) dementia (slope=-1.20, P<0.001), and those who progressed to early-stage dementia (slope=-0.39, P=0.038) suggesting a steeper physical decline with dementia progression, particularly in those with the fastest disease progression. Although all types of dementia experienced mobility decline, those progressing to non-Alzheimer disease (AD) dementias, especially vascular dementia declined faster than those who remained normal (slope=-2.70, P<0.001) or progressed to AD (slope=-2.18, P<0.001). These associations were better captured by the gait/balance component of physical functionality. Our findings suggest that rapidly progressing dementia patients particularly those with non-AD subtypes should be targeted for interventions to maintain or improve gait/balance and prevent functional decline and disability although AD patients may also benefit.

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