Weakness and cognitive impairment are independently and jointly associated with functional decline in aging Americans

  • Ryan McGrathEmail author
  • Brenda M. Vincent
  • Kyle J. Hackney
  • Soham Al Snih
  • James Graham
  • Laura Thomas
  • Diane K. Ehlers
  • Brian C. Clark
Original Article



Discovering how certain health factors contribute to functional declines may help to promote successful aging.


To determine the independent and joint associations of handgrip strength (HGS) and cognitive function with instrumental activities of daily living (IADL) and activities of daily living (ADL) disability decline in aging Americans.


Data from 18,391 adults aged 50 years and over who participated in at least one wave of the 2006–2014 waves of the Health and Retirement Study were analyzed. A hand-held dynamometer assessed HGS and cognitive functioning was examined with a modified version of the Telephone Interview of Cognitive Status. IADL and ADL abilities were self-reported. Participants were stratified into four distinct groups based on their HGS and cognitive function status. Separate covariate-adjusted multilevel models were conducted for the analyses.


Participants who were weak, had a cognitive impairment, and had both weakness and a cognitive impairment had 1.70 (95% confidence interval (CI) 1.57–1.84), 1.97 (CI 1.74–2.23), and 3.13 (CI 2.73–3.59) greater odds for IADL disability decline, respectively, and 2.26 (CI 2.03–2.51), 1.26 (CI 1.05–1.51), and 4.48 (CI 3.72–5.39) greater odds for ADL disability decline, respectively.


HGS and cognitive functioning were independently and jointly associated with IADL and ADL disability declines. Individuals with both weakness and cognitive impairment demonstrated substantially higher odds for functional decline than those with either risk factor alone.


Including measures of both HGS and cognitive functioning in routine geriatric assessments may help to identify those at greatest risk for declining functional capacity.


Dementia Epidemiology Geriatrics Muscle strength Nervous system 



RMs effort on this research was partially funded by the College of Human Sciences and Education at North Dakota State University. The authors would like to thank those who anecdotally contributed to this research (TMM).

Compliance with ethical standards

Conflict of interest

BCC has received research funding or consulting fees from the NIH, Regeneron Pharmaceuticals, Astellas Pharma Global Development, RTI Health Solutions, Osteopathic Heritage Foundations, Regeneron Pharmaceuticals, Abbott Laboratories, and the Gerson Lehrman Group. Additionally, BCC is co-founder with equity, and serves as the Chief of Aging Research for AEIOU Scientific. The other authors declare no conflicts of interest.

Statement of human and animal rights

HRS protocols were approved by the university’s Behavioral Sciences Committee Instructional Review Board.

Informed consent

Written informed consent was provided by participants before entering the HRS.

Supplementary material

40520_2019_1351_MOESM1_ESM.docx (18 kb)
Supplementary material 1 (DOCX 17 kb)
40520_2019_1351_MOESM2_ESM.docx (17 kb)
Supplementary material 2 (DOCX 17 kb)


  1. 1.
    McGrath RP, Kraemer WJ, Al Snih S et al (2018) Handgrip strength and health in aging adults. Sports Med 48:1993–2000CrossRefGoogle Scholar
  2. 2.
    Carson RG (2018) Get a grip: individual variations in grip strength are a marker of brain health. Neurobiol Aging 71:189–222CrossRefGoogle Scholar
  3. 3.
    Clark BC (2018) Neuromuscular changes with aging and sarcopenia. J Frailty Aging 8:7–9Google Scholar
  4. 4.
    Ohtsuki T (1981) Inhibition of individual fingers during grip strength exertion. Ergonomics 24:21–36CrossRefGoogle Scholar
  5. 5.
    Firth J, Stubbs B, Vancampfort D et al (2018) Grip strength is associated with cognitive performance in schizophrenia and the general population: a UK biobank study of 476559 participants. Schizophr Bull 44:728–736CrossRefGoogle Scholar
  6. 6.
    McGrath R, Robinson-Lane SG, Cook S et al (2019) Handgrip strength is associated with poorer cognitive functioning in aging americans. J Alzheimers Dis 70:1187–1196CrossRefGoogle Scholar
  7. 7.
    Duchowny K (2019) Do nationally representative cutpoints for clinical muscle weakness predict mortality? Results from 9 years of follow-up in the health and retirement study. J Gerontol A Biol Sci Med Sci 74:1070–1075Google Scholar
  8. 8.
    Shavelle RM, Paculdo DR, Strauss DJ et al (2009) Cognitive impairment and mortality in the Cardiovascular Health Study. J Insur Med 41:110–116Google Scholar
  9. 9.
    Liang Y, Welmer A-K, Möller J et al (2017) Trends in disability of instrumental activities of daily living among older Chinese adults, 1997–2006: population based study. BMJ Open 7:e016996CrossRefGoogle Scholar
  10. 10.
    Mlinac ME, Feng MC (2016) Assessment of activities of daily living, self-care, and independence. Arch Clin Neuropsychol 31:506–516CrossRefGoogle Scholar
  11. 11.
    South-Paul J, Matheny S, Lewis E (2010) Current diagnosis & treatment in family medicine, 4th edn. McGraw Hill, New YorkGoogle Scholar
  12. 12.
    Gobbens RJ (2018) Associations of ADL and IADL disability with physical and mental dimensions of quality of life in people aged 75 years and older. Peer J 6:e5425CrossRefGoogle Scholar
  13. 13.
    McGrath RP, Clark BC, Erlandson KM et al (2018) Impairments in individual autonomous living tasks and time to self-care disability in middle-aged and older adults. J Am Med Dir Assoc (ppi:1525-8610(18)30587-5)Google Scholar
  14. 14.
    McGrath RP, Vincent BM, Lee I-M et al (2018) Handgrip strength, function, and mortality in older adults: a time-varying approach. Med Sci Sports Exerc 50:2259–2266CrossRefGoogle Scholar
  15. 15.
    McGrath R, Robinson-Lane SG, Peterson MD et al (2018) Muscle strength and functional limitations: preserving function in older Mexican Americans. J Am Med Dir Assoc 19:391–398CrossRefGoogle Scholar
  16. 16.
    Orellano E, Colón WI, Arbesman MJ (2012) Effect of occupation-and activity-based interventions on instrumental activities of daily living performance among community-dwelling older adults: a systematic review. Am J Occup Ther 66:292–300CrossRefGoogle Scholar
  17. 17.
    Health and Retirement Study (2019) HRS data products. Accessed 16 Jun 2019
  18. 18.
    Sonnega A, Faul JD, Ofstedal MB et al (2014) Cohort profile: the health and retirement study (HRS). Int J Epidemiol 43:576–585CrossRefGoogle Scholar
  19. 19.
    Health and Retirement Study (2019) HRS data book. Accessed 16 Jun 2019
  20. 20.
    Plassman BL, Newman TT, Welsh KA et al (1994) Application in epidemiological and longitudinal studies. Cogn Behav Neurol 7:235–241Google Scholar
  21. 21.
    Crimmins EM, Kim JK, Langa KM et al (2011) Assessment of cognition using surveys and neuropsychological assessment: the health and retirement study and the aging, demographics, and memory study. J Gerontol B Psychol Sci Soc Sci 66:i162–i171CrossRefGoogle Scholar
  22. 22.
    Langa KM, Larson EB, Karlawish JH et al (2008) Trends in the prevalence and mortality of cognitive impairment in the United States: is there evidence of a compression of cognitive morbidity? Alzheimers Dement. 4:134–144CrossRefGoogle Scholar
  23. 23.
    Duchowny KA, Peterson MD, Clarke PJ (2017) Cut points for clinical muscle weakness among older Americans. Am J Prev Med 53:63–69CrossRefGoogle Scholar
  24. 24.
    HRS Documentation Report (2019) Documentation of physical measures, anthropometrics and blood pressure in the health and retirement study. Accessed 16 Jun 2019
  25. 25.
    Turvey CL, Wallace RB, Herzog R (1999) A revised CES-D measure of depressive symptoms and a DSM-based measure of major depressive episodes in the elderly. Int Psychogeriatr 11:139–148CrossRefGoogle Scholar
  26. 26.
    Rosanbalm S (2019) Getting Sankey with bar charts. Getting Sankey with bar charts. Accessed 16 Jun 2019
  27. 27.
    Liu C-J, Jones LY, Formyduval AR et al (2016) Task-oriented exercise to reduce activities of daily living disability in vulnerable older adults: a feasibility study of the 3-step workout for life. J Aging Phys Act. 24:384–392CrossRefGoogle Scholar
  28. 28.
    Giebel CM, Sutcliffe C, Challis D (2015) Activities of daily living and quality of life across different stages of dementia: a UK study. Aging Ment Health. 19:63–71CrossRefGoogle Scholar
  29. 29.
    Liu C-J, Shiroy DM, Jones LY et al (2014) Systematic review of functional training on muscle strength, physical functioning, and activities of daily living in older adults. Eur Rev Aging Phys Act. 11:95CrossRefGoogle Scholar
  30. 30.
    Blankevoort CG, Van Heuvelen MJ, Boersma F et al (2010) Review of effects of physical activity on strength, balance, mobility and ADL performance in elderly subjects with dementia. Dement Geriatr Cogn Disord 30:392–402CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ryan McGrath
    • 1
    Email author
  • Brenda M. Vincent
    • 2
  • Kyle J. Hackney
    • 1
  • Soham Al Snih
    • 3
  • James Graham
    • 4
  • Laura Thomas
    • 5
  • Diane K. Ehlers
    • 6
  • Brian C. Clark
    • 7
    • 8
    • 9
  1. 1.Department of Health, Nutrition, and Exercise SciencesNorth Dakota State UniversityFargoUSA
  2. 2.Department of StatisticsNorth Dakota State UniversityFargoUSA
  3. 3.Division of Rehabilitation SciencesUniversity of Texas Medical BranchGalvestonUSA
  4. 4.Department of Occupational TherapyColorado State UniversityFort CollinsUSA
  5. 5.Department of PsychologyNorth Dakota State UniversityFargoUSA
  6. 6.Department of Neurological SciencesUniversity of Nebraska Medical CenterOmahaUSA
  7. 7.Ohio Musculoskeletal and Neurological InstituteOhio UniversityAthensUSA
  8. 8.Department of Geriatric MedicineOhio UniversityAthensUSA
  9. 9.Department of Biomedical SciencesOhio UniversityAthensUSA

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