Effects of Hand Strength and Walking Speed Combined and in Isolation on the Prediction of Cognitive Decline and Dementia in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis

Objective

This review aims to further elucidate the relationship between reduced walking speed and grip function and cognitive decline.

Design

Systematic review and meta-analysis.

Settings and Participants

Adults without dementia.

Methods

Six English databases were searched from inception to January 2025. Longitudinal studies that simultaneously investigate the relationship between a decline in grip strength or walking speed and cognitive impairment or dementia were eligible. The meta-analysis was conducted using Stata 17.0. The Newcastle-Ottawa Scale and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach were used to assess the quality of evidence in the included studies.

Results

A total of 2779 articles were identified through the search strategy. After removing duplicate titles and completing screening, 10 studies were included. Random effects analysis revealed that decreases in physical function [walking speed: hazard ratio (HR), 1.34; 95% CI, 1.13–1.60] and grip strength: HR, 1.30; 95% CI, 1.14–1.49) were significantly associated with decreases in cognitive ability, and this correlation became even more pronounced when pace and grip strength were assessed jointly (HR, 2.72; 95% CI, 1.20-6.17). The results of the subgroup analysis revealed that the study location, follow-up time, cognitive assessment method, sex ratio of the subjects, and other factors affected the results of the study.

Conclusions and Implications

This study suggests that grip strength and walking speed are important predictors of cognitive decline and dementia, and highlights the significance of the comprehensive assessment. Early intervention before middle-aged and older adults enter the clinical stage of dementia is needed, which requires standardized and rigorous assessment.The sequential relationships between hand strength and walking speed in relation to different developmental stages of dementia, as well as how they can be integrated with objective indicators to facilitate diagnosis, need to be further investigated.