Risk and Predictors of Motor-Performance Decline in a Normally Functioning Population-Based Sample of Elderly Subjects: The Italian Longitudinal Study on Aging Marco Inzitari, MD, à Antonio Di Carlo, MD, z Marzia Baldereschi, MD, z Giovanni Pracucci, MD, w Stefania Maggi, MD, § Carlo Gandolfo, MD, k Salvatore Bonaiuto, MD, z Gino Farchi, MSc, # Emanuele Scafato, MD, # Pierugo Carbonin, MD, Ãà and Domenico Inzitari, MD w for the ILSA Working Group OBJECTIVES: To examine risk and predictors of motor- performance (MP) decline targeting subjects performing normally at an initial observation. DESIGN: Cohort study. SETTING: A subsample of the Italian Longitudinal Study on Aging (aged 65–84). PARTICIPANTS: One thousand fifty-two subjects (mean age  standard deviation 5 71  5, 69% men) with normal MP at baseline. MEASUREMENTS: Six tests (standing up from a chair, stepping up, tandem walk, standing on one leg, walking speed, and steps turning 1801) were used to assess MP at baseline and after 3 years. Baseline characteristics were po- tential predictors of MP decline. RESULTS: Of the 1,052 subjects performing normally at baseline, 166 (15.8%) had declined in MP at follow-up. Older age, female sex, lower education, symptoms of distal symmetrical neuropathy, cognitive impairment without de- mentia, parkinsonism, heart failure, anemia, depressive symptoms, worse Mini-Mental State Examination score, and lost activities of daily living and instrumental activities of daily living (IADLs) were significantly associated with MP decline in univariate comparisons. Older age (odds ra- tio (OR) 5 3.84, 95% confidence interval (CI) 5 2.14–6.88 comparing age classes 80 with 65–69), female sex (OR 5 1.50, 95% CI 5 1.03–2.20), distal symmetric neu- ropathy (OR 5 2.00, 95% CI 5 1.03–3.87), depressive symptoms (OR 5 1.85, 95% CI 5 1.17–2.24), and baseline IADLs (OR 5 1.22, 95% CI 5 1.08–1.37 for each lost ac- tivity) independently predicted MP decline after regression analysis. CONCLUSION: In a population-based cohort of elderly people with normal MP, one-sixth declined in 3 years. Age, sex, distal symmetrical neuropathy, depressive symptoms, and baseline IADLs independently predicted this decline. Distal symmetrical neuropathy is underestimated in the clinical and epidemiological evaluation of motor decline in older people. J Am Geriatr Soc 54:318–324, 2006. Key words: aging; normal functioning; motor perform- ance; walking; mobility I n older people, motor-performance (MP) impairment predicts disability, institutionalization, and death. 1–3 Studies of MP decline in older people are scanty, subjects are variably impaired at baseline, and reported risk factors differ. Older age, body mass index, hypertension, diabetes mellitus, depressive symptoms, and anemia were the factors most consistently shown to independently determine this decline. No study has addressed subjects who have normal MP at initial observation. Focusing on subjects with normal MP may provide more accurate information about the fac- tors independently involved in MP decline. The Italian Longitudinal Study on Aging (ILSA) sur- veyed a randomly selected, multicenter, population-based cohort of old people who were followed over 3 years to investigate factors of major functional and clinical impair- ments in older people. The ILSA database was an ideal source of information on MP decline in older people. METHODS Setting Details of the ILSA methods are reported elsewhere. 4 Brief- ly, the ILSA investigates, in a cohort of older Italians, frequency, determinants, and consequent dysfunctions of Address correspondence to Professor Domenico Inzitari, Department of Neurological and Psychiatric Sciences, University of Florence, Viale Morgagni 85, 50134 Florence, Italy. E-mail: inzitari@neuro.unifi.it DOI: 10.1111/j.1532-5415.2005.00584.x From the à Department of Critical Care Medicine and Surgery, Unit of Ger- ontology and Geriatrics, and w Department of Neurological Sciences, Uni- versity of Florence, Florence, Italy; z Institute of Neurosciences, ILSA Study, Italian National Research Council, Florence, Italy; § Center on Aging, Italian National Research Council, Padua, Italy; k Department of Neuroscience, University of Genoa, Genoa, Italy; z INRCA, Fermo, Italy; # Laboratory of Epidemiology and Biostatistics, Istituto Superiore di Sanita ` , Rome, Italy; and Ãà Institute of Internal Medicine and Geriatrics, Universita ` Cattolica del Sacro Cuore, Rome, Italy. JAGS 54:318–324, 2006 r 2006, Copyright the Authors Journal compilation r 2006, The American Geriatrics Society 0002-8614/05/$15.00