Summary and clinical relevance Summary and conclusions of this descriptive review will be organised in regard to the original specific aims. The first objective was to discuss research examining the correlation between clinical measures of motor function and cognitive change. This review of research indicates that motor function differs in healthy older adults from those with cognitive impairments. Therefore, declines in both cognitive and motor domains should no longer be dismissed as normal aging, but rather examined over time for cause and potential progression, as well as possible interactive effects with cognitive function. The second objective was to describe research which examines clinical measures of motor function as predictors of conversion to cognitive impairment in healthy older adults and progression of cognitive impairments in people with MCI. Review of the literature revealed that the presence of motor impairments (specifically EPS, fine and gross motor impairments, gait and balance impairments) has been found to be predictors of future cognitive decline in both non-demented older adults and those with MCI. Furthermore, this information can prompt more detailed examination methods aimed at identifying older adults who are at risk of further decline and identify if motor impairments are in fact reversible with appropriate therapeutic interventions. The third objective of this review was to describe findings which examine clinical measures of motor function as predictors of rate of decline in cognitive function in healthy older adults, people with MCI
and those with early AD. Review of the literature showed that the presence of motor impairments over time is associated with a faster rate of cognitive decline. Therefore, information regarding the pre- sence of motor impairments at various stages in the dementia process will allow for more accurate staging of the disease progression as well as aiding physicians in making differential diagnoses. Several clinical applications have emerged based on the research findings regarding the relationship between cognitive and motor changes in older adults: (1) physical therapists may be the first practitioners to identify motor dysfunctions in older adults, which may prompt a referral for a neurological work-up. The recognition of those older adults at risk for cognitive decline could lead to more appropriate early interventions. For example, research has shown that exercise is related to reduced risk of incident dementia in adults over the age of 65 years old.60 Furthermore, medical interventions to address early AD are being utilised and those to address MCI are under investigation; (2) motor impairments are associated with functional impairments in ADL and disability. Early identification of motor and cognitive impairments can help caregivers prepare for the possibility of progressive functional changes in terms of personal and environmental adaptations; (3) the addition of a motor assessment to typical cognitive assessment batteries may add to the prognostic ability of the examination. This is particularly helpful since motor characteristics are not likely to be influenced by education or other demographic variables, unlike measures of cognitive function. Collaborations between psychologists or neurologists and physical therapists may provide optimal prognostic informa- tion for patients at risk of cognitive decline. The literature associating physical and cognitive impairments will continue to expand as clinicians attempt to identify predictors of future function in older adults of all cognitive levels. The findings presented in this paper provide foundational support for the need for objective examination of fine and gross motor function in older adults across the spectrum of health and function.