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Brain Volumes, Cognitive Decline, and Physical Activity in Older Inhabitants.

In Reply: We appreciate the attention and comments by Dr Kawada, in relation to our study on the association between brain volumes, white matter volumes, lacunes and general cognitive decline in persons without dementia.1 In addition, we also found associations between specific lobe volumes and scores of the individual cognitive tests. Note that in our current paper we only investigated motor function with respect to fine motor speed, that is scores on the Purdue Pegboard Test. We believe our findings with fine motor speed preclude any general conclusion regarding motor function and gait per se. Separately, we refer to a previous report from our study that studied the relation of gait speed with cognition.2 Yet, that study2 did not take into account the brain volumes. Nevertheless, we completely agree with Dr Kawada that the association between brain volume and gait is an interesting topic to study in a longitudinal population based cohort study, for ascertaining association, especially with interaction of cognition. The biology and the direction of association might require speculation in terms of brain volumes determining the gait speed, possibly mediated via general or specific cognitive domains. While there are studies and meta-analysis to evaluate the association between gait speed and cognitive status,3 the direction of association and its interplay with physical activity and brain volumes, may be dealt with in a study dedicated to such a hypothesis. We welcome this insight, and possibly a study looking at association of physical activity with cognition and brain volume may provide the information.