Background/Purpose: While osteoarthritis (OA) is associated with an increased risk of dementia,¹ the frequency of milder cognitive impairment is unknown. Mild to moderate cognitive impairment is potentially addressable through physical activity (PA),² however many do not meet PA guidelines. To explore potential associations between cognitive impairment and PA in OA, we used baseline data from the Johnston County Health Study (JoCoHS), an actively enrolling community-based study of Black, Hispanic, and White men and women 35-70 years of age in Johnston County, North Carolina. In this preliminary cross-sectional analysis, we sought to: 1) explore the potential association between cognitive impairment and lower extremity symptomatic OA (sxOA; hip, knee, ankle, foot) and 2) determine whether this association is mitigated among those achieving higher levels of daily PA.

Methods: Cognitive impairment was defined as a score < 18 on the Montreal Cognitive Assessment (MoCA)-Blind. Pain, aching, or stiffness in the lower extremity (yes/no) was assessed by the question: “On most days, do you have pain, aching or stiffness in your left/right hip/knee/ankle/foot?” SxOA was defined as pain, aching, or stiffness in a lower extremity joint, along with radiographic OA, defined as Kellgren-Lawrence grade ³ 2 in the respective joint. PA was measured using the International Physical Activity Questionnaire with categories of high, moderate, and low PA levels. Logistic regression was used to examine associations of cognitive impairment with sxOA, adjusting for age, sex, race/ethnicity, body mass index (BMI), and years of education, overall and by PA level.

Results: Complete data were available for 343 of the first 455 consecutively enrolled participants (mean age 54.8 ± 8.4 years, 68.6% women, 18.1% Black, 8.5% Hispanic, mean BMI 33.0 ± 7.9 kg/m2, 19.8% high school education or less). Eighty-three (24.2%) participants showed cognitive impairment (mean age 58 ± 8 years, mean MoCA-Blind score 18.8 ± 2.4). In the past 7 days, 26.5% and 28.6% engaged in moderate or high PA, respectively. The odds of cognitive impairment were 56% higher among those with sxOA (unadjusted odds ratio [OR] 1.56, 95% confidence interval [CI] 0.95, 2.57), but were attenuated after adjustment (OR 0.96, 95%CI 0.52, 1.78). Although not statistically significant, those with low levels of PA had a higher estimate of the cognitive impairment-sxOA association (unadjusted OR 1.89, 95% CI 0.92, 3.85) than was observed among those with moderate (OR 1.63, 95%CI 0.60, 4.43) or high PA levels (OR 1.06, 95% CI 0.39, 2.84).

Conclusion: In this preliminary analysis, sxOA was associated with higher odds of cognitive impairment. There was a trend towards an association between higher PA and lower odds among those with OA. The small sample size precluded analysis of other potential covariates such as pain severity and depression. However, given the nearly 1 in 4 prevalence of cognitive impairment, this “first look” analysis demonstrates that cognitive impairment and its interaction with PA in sxOA warrants further study.

References: 1. Weber et al., 2019. Medicine 98:e14355.; 2. Erickson et al., 2019. Med Sci Sports Exerc 51:1242–51.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-of-cognitive-impairment-and-symptomatic-lower-extremity-osteoarthritis-by-level-of-physical-activity-preliminary-data-from-the-johnston-county-health-study/