Layout 1 Thematic Section: Advances in Musculoskeletal and Neuromuscular Rehabilitation Eur J Transl Myol 35 (3) 13726, 2025 doi: 10.4081/ejtm.2025.13726 Dementia is a rapidly increasing global burden, particularly among the aging population. According to the Global Burden of Disease1 estimates, the number of people living with dementia is expected to triple by 2050 due to demographic shifts and an aging global population. Currently, dementia prevalence increases significantly with age, affecting 13.5% to 35.9% of people aged 80-84 and over 90, respectively.2 Dementia is an acquired, chronic syndrome that impairs multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgment.3 Beyond cognitive deficits, dementia also negatively impacts physical function.4 The connection between cognitive decline and physical function is evident in gait speed, often referred to as the “6th vital sign” due to its ability to predict outcomes such as fall risk, mortality, dependency in self-care, disability in Activ- ities of Daily Living (ADLs), and cognitive decline over five years.5 Individuals with slower gait speed are more likely to experience steeper cognitive decline and develop dementia.6 For instance, compared to cognitively intact con- trols, gait speed reduction in people with cognitive impair- ment, mild dementia, and moderate dementia was 0.11 m/s, 0.20 m/s, and 0.41 m/s, respectively.7 Furthermore, func- tional mobility assessed through the timed “Up & Go” test (TUG) in cognitively impaired older adults was found to be an independent risk factor for 12-month mortality.8 Moreover, exercise capacity has been positively associated with memory performance in older adults with Mild Cog- nitive Impairment (MCI).9 Sampaio et al.10 found that car- diorespiratory endurance had the strongest relationship with cognition in older adults, followed by upper body strength, which explained 7.4% and 7.2% of the variance in cognitive function, respectively. Muscle mass may also play a critical role in the devel- opment of dementia. Low appendicular lean mass has been linked to greater cognitive decline over three years in in- dividuals aged 45 to 85 years.11 Similarly, sarcopenia—loss of muscle mass and strength—is associated with an in- creased risk of developing dementia and lower cognitive function.12 Evidence suggests that a 5-kg decrease in Hand- grip Strength (HGS) is associated with a 16% increase in Abstract Cognitive impairment significantly affects physical function in dementia patients, but variations across dementia types and levels of cognitive decline remain unclear. This retrospective cross- sectional study included 874 patients (80.75±8.00 years; 60.4% female) with different dementia types and cognitive impairment levels. Six physical function tests were administered: the De Mor- ton Mobility Index (DEMMI), 6-minute walking test (6MTW), 10-meter walking test (10MWT), hand grip strength (HGS), 30-second chair stand (30sSTS), and the timed “Up & Go” test (TUG). Cognitive function was assessed using the Mini-Mental State Examination (MMSE). The Mild Cognitive Impairement (MCI) group outperformed Alzheimer’s Dementia (AD) and Vascular De- mentia (VaD) on DEMMI, 30sSTS and HGS (p <0.001, η²=0.012 to 0.052). Differences in the 6MWT were significant in ANOVA but disappeared after adjusting for sex and age (p=0.066). Severe cognitive impairment was linked to significantly lower physical performance across all measures (p <0.001, η²=0.037 to 0.064). Physical function profiles vary by dementia type and cognitive decline level, highlighting the need for targeted interventions to address specific physical challenges. Key Words: physical function, cognitive impairment, dementia, geriatric psychiatry, older adults. Eur J Transl Myol 35 (3) 13726, 2025 doi: 10.4081/ejtm.2025.13726 Differences in physical function across dementia subtypes and cognitive decline: a cross-sectional study Kristina Batič,1,2 Žiga Kozinc,2 Polona Rus Prelog3,4 1Rehabilitation Department, University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia; 2Faculty of Health Sciences, University of Primorska, Izola, Slovenia; 3Centre for Clinical Psychiatry, University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia; 4Medical Faculty, University of Ljubljana, Ljubljana, Slovenia. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License (CC BY-NC 4.0) which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. - 228 - Physical function across dementia subtypes and cognitive decline Eur J Transl Myol 35 (3) 13726, 2025 doi: 10.4081/ejtm.2025.13726 the risk of developing all-cause dementia in men and a 14% increase in women.13 In older adults, greater lower extrem- ity strength has been associated with a 34% reduction in the risk of low cognitive function.14 Changes in physical fitness also affect functional capacity, particularly in performing ADLs among older adults.10 ADL performance in people with dementia is associated with al- terations in gait parameters, including velocity, step length, stride length, and gait quality.15 Better ADL performance is linked to higher health-related quality of life in people with dementia.16 Given the growing evidence, identifying phys- ical function deficits in patients with cognitive decline and dementia is crucial for initiating appropriate treatment strategies that address or prevent these deficits. Most studies have focused on institutionalized10,15-17 and community- dwelling older adults with dementia7,11-14,18 with few con- ducted in clinical settings,8 and none specifically in geriatric psychiatric settings. Additionally, different types of demen- tia exhibit varying cognitive,19 behavioral,20 and motor symptoms.21 Motor impairments are more commonly ob- served in patients with non-Alzheimer’s disease (non-AD) dementias.18,22-24 Most studies have focused on gait dis- orders, consistently finding that patients with Lewy Body Dementia (LBD), Parkinson’s Disease Dementia (PDD),24 Frontotemporal Dementia (FTD)22, and Vascular Dementia (VaD)23 experience greater gait and balance impairments compared to those with Alzheimer’s Dementia (AD). When multiple types of dementia are examined, research often categorizes them broadly as AD and non-AD.23 Beyond gait, previous studies suggest that AD patients tend to have better lower limb muscle strength compared to those with VaD and LBD, whereas no significant differences in hand- grip strength have been found among these groups.18 Dis- tinguishing physical function deficits is crucial for optimizing dementia care. However, the limited available data highlight the need for further research in this area. To our knowledge, this is the first study conducted in a clin- ical geriatric psychiatry setting that investigates physical function differences among different types of dementia. The second aim of this study is to determine physical function differences according to the level of cognitive decline. Un- derstanding these differences that are specific to the under- lying pathophysiology of each dementia type can help tailor therapeutic interventions and management strategies, add- ing importantly to the quality of life. Without this distinc- tion, current treatment approaches that constitute good post diagnostic support may be overly generalized, potentially overlooking critical physical function challenges unique to each dementia subtype. Materials and Methods Participants The study included 874 patients, aged 52 to 99, diagnosed with MCI, AD, VaD, PDD or LBD, and FTD. Participants were required to meet the following inclusion criteria: i) a diagnosis of any type of dementia or MCI and ii) admission to the Gerontopsychiatric Unit at the University Psychiatric Clinic Ljubljana. Patients were not excluded based on the presence of comorbidities. Patient information, including age, Body Mass Index (BMI), Mini Mental State Exami- nation (MMSE) score, and diagnosis, was obtained from the clinic’s database. All data were anonymized to ensure compliance with data protection standards. Study design and procedures A retrospective cross-sectional quantitative study was con- ducted from October 2020 to August 2023. The data were collected as part of an standardized clinical pathway for as- sessing physical functions in individuals with dementia ad- mitted to the Gerontopsychiatric ward. Therefore, no specific consent for data processing was obtained. All col- lected data were anonymized prior to processing. Ethical approval was granted by the Commission for Ethical Issues at the University Psychiatric Clinic Ljubljana (reference number KEV/2023-03). The study was performed in accor- dance with the Declaration of Helsinki and its subsequent amendments. Diagnosis protocol Participants were classified into dementia subtypes—MCI, AD, VaD, PDD/LBD, and FTD—based on comprehensive evaluations conducted by experienced psychiatrists and neurologists. These evaluations included clinical inter- views, neurological examinations, cognitive assessments (primarily MMSE), and neuroimaging (MRI or PET-CT). Diagnoses followed the NIA-AA 2018 framework25 for AD and internationally established guidelines for other demen- tia subtypes, in accordance with the 10th edition of the In- ternational Classification of Diseases (ICD-10).3 For the second analysis, however, we focused solely on dif- ferences in cognitive decline, regardless of the specific dia- gnosis. Cognitive function was assessed using the Slovenian version of the MMSE, which evaluates orienta- tion, attention, memory, language, and visuospatial skills, with a maximum score of 30 points.26 Based on MMSE scores, participants were categorized into three groups: mild cognitive impairment (20-30 points), moderate cognitive impairment (11-19 points), and severe cognitive impair- ment (≤10 points). Given this classification, we included MCI within the mild cognitive impairment group. This ap- proach was justified, as some patients diagnosed with AD, VaD, or PDD/LBD scored higher on the MMSE than those with MCI. It is well established that MMSE scores do not always correlate precisely with the severity of cognitive de- cline, particularly in cases of mild impairment.27 Assessments Eligible participants underwent a series of six physical function tests administered by trained physiotherapists: the De Morton Mobility Index (DEMMI), 6-minute walking test (6MTW), 10-meter walking test (10MWT), hand grip strength (HGS), 30-second chair stand (30sSTS), and the TUG. When administering the tests, adaptations were made as needed, such as simplifying instructions or providing practical demonstrations. In many cases, multiple verbal prompts were used to guide the patient through the entire testing process. Breaks were incorporated whenever nec- - 229 - Physical function across dementia subtypes and cognitive decline Eur J Transl Myol 35 (3) 13726, 2025 doi: 10.4081/ejtm.2025.13726 essary to ensure patient comfort. Each test was administered only once, with no repetitions performed, to avoid causing unnecessary fatigue for the patients. De Morton Mobility Index The DEMMI is a standardized tool for assessing patient mobility, covering 15 items that evaluate aspects such as bed and chair mobility, static and dynamic balance, and am- bulation. Eleven items are rated on a 2-point scale, while the remaining four are rated on a 3-point scale. The raw scores, ranging from 0 to 19, are converted to interval-level DEMMI scores from 0 to 100, with higher scores indicating greater independence in mobility.28 6-minute walking test The 6 MTW measures functional exercise capacity.29 Par- ticipants were asked to walk at a comfortable pace for six minutes along a flat, straight, 25-meter corridor. If required, patients were allowed to use walking aids such as canes or walkers. During the test, patients could stop or slow down as needed and were encouraged to resume walking as soon as possible. The total distance covered was recorded. A 6MWT distance of less than 450 meters reflects impaired functional status.30 Timed 10-meter walk test Gait speed was assessed using the 10MWT. Patients walked a 14-meter corridor at their preferred speed, with the middle 10 meters used to measure time, excluding the first and last 2 meters designated for acceleration and deceleration phases. The test completion time was recorded using a stop- watch. A gait speed of 0.8 m/s is considered a predictor of poor clinical outcomes, while a threshold of 0.6 m/s is used to anticipate further functional decline in older adults who are already impaired.31 Hand grip strength HGS was measured using the Saehan Hydraulic Hand Dy- namometer, set to the second handle position. Standardized protocols were followed: participants were seated with feet flat on the floor, shoulders adducted in neutral rotation, el- bows flexed at 90°, forearms in a neutral position, and wrists in 15°-30° of extension and 0°-15° of ulnar deviation.32 Scores below 25.8 kilograms for men and 17.4 kilograms for women suggest reduced mobility among community-dwelling older adults.33 Sit to stand Lower extremity strength was evaluated using the 30sSTS.34 Participants were seated in a standard chair (height: 45 cm) with their arms crossed over their chest and instructed to stand up and sit down as many times as pos- sible within 30 seconds, starting on the command “go.” The diagnostic cut-off scores for sarcopenia are 15 for females and 17 for males.35 Timed up and go test The TUG assesses overall mobility and balance.36 Partici- pants began in a seated position, stood up, walked 3 meters at their preferred pace, turned around, returned to the chair, and sat down. The time taken to complete the test was recorded in seconds using a stopwatch. Use of walking aids was permitted, if necessary. Older adults who take more than 12 seconds to complete the test are at risk of significant hospitalization associated functional decline.37 Statistical analysis The data are presented as means±standard deviations. The threshold for statistical significance was set at α<0.05, and all analyses were carried out in SPSS statistical software (version 25.0, IBM, USA). Group comparisons were con- ducted with a univariate Analysis Of Variance (ANOVA) with group as single fixed factor. Additionally, an Analysis Of Covariance (ANCOVA) was conducted to control for age and sex. Prior to ANOVA and ANCOVA, assumptions of normality and homogeneity of variance were evaluated using the Shapiro-Wilk test and Levene’s test, respectively. The assumptions for ANCOVA, including linearity and ho- mogeneity of regression slopes, were also assessed and con- firmed. Visual inspections of histograms and scatterplots were performed to further verify data distribution and the absence of outliers.The correlations were interpreted as fol- lows: negligible (r <0.1), weak (r=0.1-0.4), moderate (r=0.4-0.7), strong (r=0.7-0.9), and very strong (r >0.9).38 Results Study population Of the 874 patients included in the study, 346 (39.6%) were male and 528 (60.4%) were female with an average age of 80.75±8.00 years and an average Body Mass Index (BMI) of 25.80±4.94 (BMI data was missing for 82 patients, or 9.4%). Among the participants, 113 (12.9%) had MCI, 497 (56.9%) were diagnosed with AD, 219 (25.1%) had VaD, 37 (4.2%) presented with PDD or LBD, and 8 (0.9%) were diagnosed with FDT. The MMSE was administered to 692 (79.2%) of the patients, revealing an average score of 16.65±7.14 points. Additionally, the degree of cognitive de- cline was determined through clinical examination for another 105 patients (12.0%), while the remaining 77 pa- tients (8.8%) were included based on their clinical dia- gnoses. All participants were included in the comparison based on the level of cognitive decline; however, the 8 par- ticipants diagnosed with FDT were excluded from the de- mentia subtype analysis due to the small sample size. Differences between types of dementia Significant differences in physical performance measures were observed across cognitive impairment and dementia groups. For the dementia subgroups, DEMMI, 30sSTS, and HGS demonstrated statistically significant differences after adjustment for sex and age (p <0.001), with effect sizes ranging from small to moderate (η2=0.012 to 0.052). No- tably, MCI group showed higher performance than AD and VaD. Similarly, 6MWT showed a significant group effect in ANOVA (F=6.24; p <0.001, η2=0.022), but not after ad- - 230 - Physical function across dementia subtypes and cognitive decline Eur J Transl Myol 35 (3) 13726, 2025 doi: 10.4081/ejtm.2025.13726 justing for sex and age (p=0.066). Performance on 10MWT and TUG was not significantly different among groups. These results imply significant differences in performance and function across dementia subtypes, and suggest some outcome measures may be more sensitive to detect these differences (Tables 1 and 2). Differences between levels of cognitive impairment When comparing levels of cognitive impairment, individ- uals with severe cognitive impairment exhibited notably lower performance across all measures compared to those with mild and moderate impairment. DEMMI, 30sSTS, HGS, and TUG were significantly lower in the severe group (p <0.001), with effect sizes ranging from η²=0.037 to 0.064. ANCOVA further confirmed these differences after adjustment for sex and age. In contrast to the first analysis, the 6MWT and 10MWT also showed significant differ- ences both in ANOVA and ANCOVA (p <0.05). These re- sults suggest that there is a progressive decline in physical performance associated with increasing severity of cogni- tive impairment, reflected in decline in all outcome meas- ures in this study (Tables 3 and 4). - 231 - Table 1. Descriptive statistics by dementia type and results of ANOVA. Variable Mild cognitive Alzheimer’s Vascular Parkinson’s/ Analysis of variance impairment dementia dementia lewy body (ANOVA) [M±SD] [M±SD] [M±SD] dementia F p Eta2 [M±SD] DEMMI [points] 67.27±21.32 56.01±22.38 57.19±20.76 57.69±25.52 8.151 <0.001* 0.022 30sSTS [stands] 6.12±4.66 4.00±4.19 3.94±4.30 5.29±5.50 8.505 <0.001* 0.029 HGS [kg] 19.65±10.89 12.92±8.97 14.77±9.68 16.35±8.74 14.800 <0.001* 0.052 6 MWT [m] 229.5±145.74 177.36±132.10 173.25±124.85 226.00±158.74 6.249 <0.001* 0.022 10 MWT [s] 18.03±13.42 23.21 ±18.68 25.18±30.66 27.93±63.51 2.394 0.067 0.009 TUG [s] 22.61±8.59 28.53±22.34 29.84±23.52 30.85±38.06 2.562 0.054 0.010 DEMMI, de Morton mobility index; 30sSTS, 30 second sit to stand HGS, hand grip strength; 6MWT, 6 minute walking test; 10MWT, 10 meter walking test; TUG, timed up and go test; M, mean; SD, standard deviation. Table 2. Descriptive statistics by dementia type and results of ANCOVA. Variable Mild cognitive Alzheimer’s Vascular Parkinson’s/ Adjusted for sex and age impairment dementia dementia lewy body (ANCOVA) [M±SD] [M±SD] [M±SD] dementia F p Eta2 [M±SD] DEMMI [points] 67.27±21.32 56.01±22.38 57.19±20.76 57.69±25.52 3.448 0.016* 0.012 30sSTS [stands] 6.12±4.66 4.00±4.19 3.94±4.30 5.29±5.50 4.513 0.004* 0.016 HGS [kg] 19.65±10.89 12.92±8.97 14.77±9.68 16.35±8.74 6.998 <0.001* 0.025 6 MWT [m] 229.5±145.74 177.36±132.10 173.25±124.85 226.00±158.74 2.404 0.066 0.009 10 MWT [s] 18.03±13.42 23.21 ±18.68 25.18±30.66 27.93±63.51 1.884 0.138 0.007 TUG [s] 22.61±8.59 28.53±22.34 29.84±23.52 30.85±38.06 1.418 0.236 0.006 DEMMI, de Morton mobility index; 30sSTS, 30 second sit to stand; HGS, hand grip strength; 6MWT, 6 minute walk- ing test; 10MWT, 10 meter walking test; TUG, timed up and go test; M, mean; SD, standard deviation. Physical function across dementia subtypes and cognitive decline Eur J Transl Myol 35 (3) 13726, 2025 doi: 10.4081/ejtm.2025.13726 Discussion The aim of this study was to examine physical function dif- ferences among patients with MCI, AD, VaD, and PPD or LBD in a clinical geriatric psychiatry setting. Additionally, we investigated physical function differences across vary- ing levels of cognitive impairment, including mild, mod- erate, and severe cognitive impairment. As physical function is a multi-faceted concept it was assessed using a comprehensive battery of six physical tests: DEMMI, 30sSTS, HGS, 6MWT, 10MWT, and TUG, which collec- tively measure six primary domains of physical function: general mobility, lower extremity strength, upper extremity strength, cardiorespiratory endurance, gait speed, and func- tional mobility. Our findings reveal distinct physical func- tion patterns among the different types and severities of de- mentia. Specifically, patients with AD and VaD showed greater physical function deficits compared to those with MCI, particularly in the domains of general mobility, car- diorespiratory endurance, and upper and lower extremity strength. Conversely, no significant physical function dif- ferences were found in patients with PDD or LBD com- pared to the other dementia types. As hypothesized, when comparing severity of cognitive impairment, it showed a clear trend of reduced physical function as cognitive im- pairment progressed, affecting all six domains. Previous longitudinal evidence suggests a steeper decline in mobility in individuals with both AD and non-AD com- - 232 - Table 3. Descriptive statistics by levels of cognitive decline and results of ANOVA. Variable Mild cognitive Moderate cognitive Severe cognitive Analysis of variance impairment impairment impariment (ANOVA) [M±SD] [M±SD] [M±SD] F p Eta2 DEMMI [points] 63.87±23.06 60.48±20.06 51.16±22.25 19.988 <0.001* 0.046 30sSTS [stands] 5.82±4.77 4.62±4.35 2.91±3.69 22.624 <0.001* 0.052 HGS [kg] 17.97±10.16 14.81±9.30 11.27±8.78 23.33 <0.001* 0.056 6 MWT [m] 219.60±149.92 192.07±130.88 160.75±121.35 9.263 <0.001* 0.022 10 MWT [s] 19.02±16.35 22.35±24.01 27.57±31.02 5.486 0.004* 0.014 TUG [s] 21.52±18.91 27.69±21.97 33.38±25.95 11.722 <0.001* 0.030 DEMMI, de Morton mobility index; 30sSTS, 30 second sit to stand; HGS, hand grip strength; 6MWT, 6 minute walking test; 10MWT, 10 meter walking test; TUG, timed up and go test; M, mean; SD, standard deviation. Table 4. Descriptive statistics by levels of cognitive decline and results of ANCOVA. Variable Mild cognitive Moderate cognitive Severe cognitive Adjusted for sex and age impairment impairment impariment (ANCOVA) [M±SD] [M±SD] [M±SD] F p Eta2 DEMMI [points] 63.87±23.06 60.48±20.06 51.16±22.25 16.077 <0.001* 0.037 30sSTS [stands] 5.82±4.77 4.62±4.35 2.91±3.69 18.894 <0.001* 0.016 HGS [kg] 17.97±10.16 14.81±9.30 11.27±8.78 26.618 <0.001* 0.064 6 MWT [m] 219.60±149.92 192.07±130.88 160.75±121.35 2.404 0.003* 0.014 10 MWT [s] 19.02±16.35 22.35±24.01 27.57±31.02 4.548 0.011* 0.012 TUG [s] 21.52±18.91 27.69±21.97 33.38±25.95 9.098 <0.001* 0.024 DEMMI, de Morton mobility index; 30sSTS, 30 second sit to stand; HGS, hand grip strength; 6MWT, 6 minute walking test; 10MWT, 10 meter walking test; TUG, timed up and go test; M, mean; SD, standard deviation. Physical function across dementia subtypes and cognitive decline Eur J Transl Myol 35 (3) 13726, 2025 doi: 10.4081/ejtm.2025.13726 pared to those who remained cognitively healthy.4 In ad- dition, functional impairment, as measured through inform- ant reports of ADLs, is more severe in people with dementia than in those with MCI.39 Our study demonstrates notable differences in general mobility between patients with AD and VaD compared to those with MCI, using the DEMMI which assesses bed and chair mobility, ambulation, and static and dynamic balance,28 which are critical components for performing ADLs. People with mild AD often require assistance with ADLs, while those with MCI generally do not, despite some difficulties in performing these tasks40 However, when comparing patients with AD to those with VaD, greater limitations in ADL performance have been ob- served in patients with VaD.41 In our study, we did not find significant differences in general mobility between demen- tias, which could be attributed to varying levels of cognitive impairment as measured by MMSE scores. Improvements in cardiorespiratory fitness have been shown to positively impact brain structure and function, such as increases in hippocampal volume and white matter inte- grity,42 and midlife fitness is associated with a lower risk of dementia later in life.43 Our results suggest that patients with less severe cognitive impairment exhibited better cardio- respiratory endurance than those with moderate or severe cognitive impairment, underscoring the close relationship between cardiorespiratory endurance and cognitive function observed in prior studies.9,10 However, no significant differ- ences in cardiorespiratory endurance were observed across different types of dementia, suggesting that the relationship may be more closely tied to the severity of cognitive im- pairment rather than the type of dementia. This lack of vari- ation between dementia types could be attributed to a predominantly sedentary lifestyle prior to hospitalization. In fact, previous studies have shown that older adults typi- cally spend an average of 7.7 to 9.0 hours per day engaged in sedentary activities.44 Therefore, our findings highlight the potential value of cardiorespiratory exercise as a mod- ifiable factor in maintaining cognitive health, in particular for the patients with higher levels of cognitive decline. The prevalence of sarcopenia among patients with dementia is as high as 65%45 and is associated with the severity of cognitive impairment12 indicating that muscle mass and muscle strength play a significant role in cognitive impair- ment. Our study found that patients with MCI had signifi- cantly greater upper and lower extremity strength than those with AD or VaD. When comparing across levels of cogni- tive impairment, we observed that greater muscle strength was consistently found in those with milder impairment, suggesting that muscle strength may be an important indi- cator of physical function in relation to cognitive health. This aligns with findings from a large cohort study indicat- ing that lower extremity strength is associated with better global cognitive performance among community-dwelling older women.46 Additionally, the authors established that the «five-times sit-to-stand» test can serve as a screening tool for cognitive decline, where completing the test in under 15 seconds made the presence of moderate cognitive impairment unlikely. Similarly, previous studies have em- phasized the significance of HGS as a valuable screening tool, as it may serve as an early, non-cognitive marker of cognitive decline or dementia.47 A combination of low HGS and a slow walking pace has been found to correlate with the highest risk of developing dementia, even when adjust- ing for several potential confounders such as physical ac- tivity, dietary patterns, hypertension, depression, diabetes, and a family history of dementia.48 Our findings contribute to this growing body of evidence by highlighting the im- portance of assessing muscle strength in dementia care. Our results also emphasize the need for individually-tailored strength-based interventions that address the unique phys- ical challenges associated with each dementia subtype. Regarding gait speed, previous research has found that gait speed and increased gait variability are strongly associated with lower Montreal Cognitive Assessment test scores in both single-task and dual-task conditions, indicating a sig- nificant relationship between gait and cognitive function in older adults.49 Furthermore, slower gait speed is linked to a steeper cognitive decline over time.6 Similarly, poorer per- formance on the TUG has been shown to increase the risk of developing dementia by 1.34-fold.50 In our study, we ob- served that patients with severe cognitive impairment took longer to complete both the 10MWT and the TUG com- pared to those with mild cognitive impairment. However, when comparing patients with moderate and severe cogni- tive impairment, differences were only found for the TUG, not the 10MWT. This discrepancy can likely be attributed to the complexity of the TUG, which involves multiple components such as standing, walking, and turning, proved to be a more complex task compared to a straightforward 10MWT. Supporting this, a functional magnetic resonance imaging study demonstrated that prefrontal brain activation correlated with TUG performance, but not with simple walking.51 When evaluating performance on the 10MWT and TUG among different types of dementia, we did not observe significant differences. Previous studies suggest that patients with non-amnestic MCI and non-AD experi- ence greater gait decline than patients with amnestic MCI and AD.52 This inconsistency between our results and pre- vious studies may be due to differences in the study sample, specific dementia subtypes and variations in disease pro- gression among participants. Moreover, the sensitivity of these tests can be influenced by cognitive impairment and the adjustments made during their administration, such as offering practical demonstrations and providing multiple verbal prompts to guide the patient throughout the testing process.53 Overall, our study’s strengths include the use of multiple quantitative physical function measures in a large sample of patients with varying types of dementias and severities of cognitive impairment. However, several limitations must be noted. First, the study’s cross-sectional design limits the abil- ity to infer causal relationships or track physical function changes over time. Second, the retrospective nature of data collection resulted in some missing information, such as BMI and MMSE scores. Moreover, potential confounding variables, such as medication use, comorbidities, and life- style factors, were not controlled for, which may have in- fluenced the results and limited the robustness of the conclusions. Another limitation lies in the generalizability of the findings, as the study focused on individuals admitted to - 233 - Physical function across dementia subtypes and cognitive decline Eur J Transl Myol 35 (3) 13726, 2025 doi: 10.4081/ejtm.2025.13726 a single hospital, which may not fully represent the broader population of patients with dementia. However, the clinic is the largest in the country, covering ¼ of its geographic terri- tory. Lastly, while some observed group differences were statistically significant, the small effect sizes highlight that the clinical relevance of these differences might be minimal. Future studies addressing these limitations, such as using longitudinal designs, larger and more diverse populations, and controlling for confounding variables, are necessary to validate and expand upon these findings. Conclusions In conclusion, this study highlights significant differences in physical function among patients with various types and stages of dementia, emphasizing the complex relationship between cognitive function and physical performance. The findings reveal that individuals with AD and VaD face greater physical function deficits compared to those with mild cognitive impairment, underscoring the importance of incorporating physical function evaluations into com- prehensive dementia care. Future research should focus on longitudinal studies to track changes in physical func- tion over time and identify specific interventions that can help mitigate physical decline in dementia patients. Fur- thermore, investigating the effectiveness of targeted exer- cise programs tailored to the diverse needs of dementia patients holds promise for improving functional outcomes. From a practical perspective, incorporating routine phys- ical function assessments into dementia care plans is cru- cial to addressing both cognitive and physical aspects of the condition. Developing and implementing rehabilita- tion programs customized to the specific needs of patients with different types of dementia represents a vital step for- ward. Such programs, including targeted exercise inter- ventions that address the unique physical challenges of AD, VaD, or other dementia types, have the potential to enhance functional outcomes, slow physical decline, and improve overall quality of life. Additionally, these efforts may reduce the risk of complications related to immobil- ity. Achieving these goals will require interdisciplinary collaboration among geriatricians, physiotherapists, and occupational therapists to create personalized care strategies that prioritize both cognitive and physical well- being in the holistic management of dementia. List of abbreviations ADLs, activities of daily living HGS, handgirp strength MMSE, Mini Mental State Examination MCI, mild cognitive impairment AD, Alzheimer’s disease VaD, Vascular Dementia PDD, Dementia in Parkinson’s disease LBD, Lewy Body Dementia FTD, Fronto-temporal dementia non-AD, non Alzheimer’s demenita DEMMI, De Morton Mobility Index 6MTW, 6-minute walking test 10MWT, 10-meter walking test 30sSTS, 30-second chair stand TUG, timed up and go test Contributions The authors confirm contribution to the paper as follows: study conception and design: KB, ZK, PRP; data collection: KB; analysis and interpretation of results: KB and ZK; draft manuscript preparation: KB, ZK, PRP. All authors reviewed the results and approved the final version of the manuscript. Funding Žiga Kozinc was supported by the Slovenian Research Agency through research program KINSPO - Kinesiology for the effectiveness and prevention of musculoskeletal in- juries in sports (P5-0443). The funder had no role in study conceptualization, data collection, manuscript writing nor decision to publish. Conflict of interests The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Ethical approval Ethical approval was granted by the Commission for Ethi- cal Issues at the University Psychiatric Clinic Ljubljana (reference number KEV/2023-03). The study was per- formed in accordance with the Declaration of Helsinki and its subsequent amendments. Data availabilty All collected data are included in the manuscript. Raw data is available upon reasonable request to the corresponding author. Corresponding author Žiga Kozinc, Faculty of Health Sciences, University of Pri- morska, Polje 42, 6310 Izola, Slovenia. ORCID ID: 0000-0003-3555-8680 E-mail: ziga.kozinc@fvz.upr.si Co-authors Kristina Batič ORCID ID: 0009-0004-6367-8836 E-mail: kristina.batic@psih-klinika.si Polona Rus Prelog ORCID ID: 0000-0002-9328-0915 E-mail: polona.rus@psih-klinika.si - 234 - mailto:kristina.batic@psih-klinika.si mailto:polona.rus@psih-klinika.si Physical function across dementia subtypes and cognitive decline Eur J Transl Myol 35 (3) 13726, 2025 doi: 10.4081/ejtm.2025.13726 References 1. Nichols E, Steinmetz JD, Vollset SE, et al. Estimation of the global prevalence of dementia in 2019 and fore- casted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health 2022;7:e105-25. 2. Global Status Report on the Public Health Response to Dementia. 1st ed. Geneva: World Health Organization; 2021. 3. World Health Organization. International statistical classification of diseases and related health problems. 11th ed. 2019. Available from: https://icd.who.int/ 4. 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Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. Submitted: 12 February 2025. Accepted: 19 March 2025. Early access: 29 May 2025. - 236 -