Mechanisms of motoric cognitive risk-Hypotheses based on a systematic review and meta-analysis of longitudinal cohort studies of older adults

Motoric cognitive risk syndrome: A review of fall risk assessment and management strategies

The aging global population is driving an increase in dementia, making the early identification of at-risk individuals crucial. Studies have shown that elderly people often exhibit a slowing gait before dementia diagnosis, which is linked to cognitive decline and predicts dementia risk. With 30% of those over 65 years of age experiencing falls annually, managing fall risk is essential. Motoric cognitive risk syndrome (MCR), characterized by subjective memory impairment and slow gait, is a pre-dementia condition that can identify high-risk individuals without extensive evaluation. The prevalence of MCR varies globally and is associated with an increased risk of falls, disability, and death. Early screening and intervention for MCR can delay dementia and improve fall regulation, offering a new perspective on elderly health management. This review synthesizes the current understanding of MCR-related falls, evaluates risk assessment methods, and discusses health strategies to provide a theoretical basis for fall prevention in community-dwelling older adults.

Clinical, biological, and neuroimaging profiles for motoric cognitive risk syndrome in older adults: The MIND-China study

BACKGROUND

Motoric cognitive risk syndrome (MCR) has been associated with dementia, functional dependence, and mortality. We sought to describe the prevalence and distribution of MCR and to explore the clinical, biological, and neuroimaging profiles for MCR in rural-dwelling Chinese older adults.

METHODS

This population-based study included 5021 dementia- and disability-free participants (mean age 70.3 years) in MIND-China. Of these, data were available in 1186 for blood biomarkers of Alzheimer's disease and vascular injury and in 1159 for structural brain magnetic resonance imaging biomarkers. MCR was defined as having both subjective memory complaints and gait speed ≥1 standard deviation below the age- and sex-specific means. Data were analyzed using logistic regression models and voxel-based morphometry methods.

RESULTS

The overall prevalence of MCR was 13.58%, which was higher in females than in males and increased with age. Controlling for demographic and lifestyle factors, obesity, diabetes, dyslipidemia, coronary heart disease, stroke, osteoarthritis, hip fracture, and depressive symptoms were significantly associated with an elevated likelihood of MCR (p < 0.05). MCR was significantly associated with smaller volumes of the total brain tissue, thalamus, hippocampus, cerebellum, insula, supplementary motor area, and inferior frontal gyrus, higher volumes of white matter hyperintensities, and an increased likelihood of lacunes (all p < 0.05), but not with any of the examined blood biomarkers (p > 0.05).

CONCLUSIONS

MCR affects approximately one-seventh of rural-dwelling Chinese older adults. The clinical and neuroimaging profiles for MCR are characterized by cardiometabolic disorders, osteoarthritis, hip fracture, and depressive symptoms as well as global and regional brain atrophy and cerebral microvascular lesions.

Rothman-Keller model for risk prediction of motoric cognitive risk syndrome in older Chinese adults: A proof-of-concept study

OBJECTIVE

The risk factors for motoric cognitive risk syndrome (MCR) remains unclear, and a lack of predictive studies on the risk of developing MCR. This proof-of-concept study aims to investigate the risk factors of MCR, and develop and internally validate a prediction system to assess the risk of MCR in older Chinese adults.

METHODS

Through performing a meta-analysis to obtain the risk factors and pooled risk ratio of MCR, the Rothman-Keller model which could be used to predict risk level of MCR was constructed. A total of 5020 participants from the CHARLS were used to validate discrimination and calibration of model. Predictive performance was assessed using AUC-ROC, accuracy, sensitivity, and specificity.

RESULTS

The pooled prevalence of MCR was 12.0 %. The results of the meta-analysis showed that there are eleven significant risk factors of MCR, including age, sex, marital status, diabetes, stroke, depression, falls, physical inactivity, social isolation, fear responses, and hospitalization, with RRi of 3.00, 1.29, 1.21, 1.53, 2.90, 2.13, 2.95, 1.46, 0.79, 1.55, and 1.31, respectively. Rothman-Keller model performed well to predict MCR risk with an AUC-ROC of 0.631 (95 %CI: 0.610-0.653), and the score was well calibrated (chi-square test for goodness-of-fit = 5.981, P = 0.649).

CONCLUSIONS

MCR is highly prevalent in China, caused by the complex interaction of genetics, comorbidities, and lifestyle factors. This study serves as proof-of-concept that Rothman-Keller model performs a good calibration and fair discrimination, which can be used as a simple, time-saving, and cost-effective mean to assess and monitor the risk level of MCR.

Association between personality profiles and motoric cognitive risk syndrome in community-dwelling older adults: a person-centered approach

BACKGROUND

Motoric cognitive risk (MCR) syndrome is a predementia syndrome characterized by subjective cognitive complaints and slow gait in the absence of dementia and mobility disability. Although past research has suggested that personality traits could play a significant role in the onset and progression of MCR among older adults, the exact relationships between specific personality profiles and MCR remain unclear. This study aimed to examine the relationship between personality profiles and MCR among community-dwelling older adults.

METHODS

A cross-sectional study was conducted from March 2021 to January 2022. Personality traits, including openness, extraversion, agreeableness, conscientiousness and neuroticism, were measured using the 40-item brief version of the Chinese Big Five Inventory. The Latent profile analysis was used to identify personality profiles among these older adults who shared similar patterns of personality traits. The Lanza, Tan, and Bray's approach was employed to investigate the personality profile-specific differences in MCR prevalence. Furthermore, a stepwise multinomial logistic regression revealed unique population characteristics for different personality profiles.

RESULTS

A total of 538 eligible participants were included in this study. The mean age was 73.25 years (SD = 9.0) and 62.50% were females. This study identified four distinct personality profiles: the resilient, ordinary, reserved, and anti-resilient profiles. The resilient profile exhibited the lowest prevalence of MCR (mean = 6%, SE = 0.024), whereas the anti-resilient profile had the highest (mean = 20.3%, SE = 0.043). The prevalence of MCR differed among personality profiles (overall χ2 = 14.599, p = 0.002). Personality profile membership was characterized by different population characteristics. Notably, the anti-resilient profile was association with symptoms of depression (OR = 28.443, 95%CI = 11.095-72.912), while the reserved profile was linked with advanced age (OR = 1.031, 95%CI = 1.003-1.061). Overall, a low education level and poor sleep quality were the robust attribution factors.

CONCLUSIONS

This study revealed that personality profiles may assist in identifying older adults at greater risk of MCR. Increased awareness and management of personality profiles may contribute to the prevention of MCR.

Subjective motoric cognitive risk syndrome: Preliminary prevalence from an online survey of a German cohort aged 50

The motoric cognitive risk syndrome (MCR) is a novel and clinically relevant pre-dementia syndrome indicating a higher dementia risk (e.g., for Alzheimer's disease). Given that MCR prevalence is unknown in Germany, we conducted a cross-sectional study, in which 208 participants from Germany aged 50 and 82 years answered an online survey including questions to assess subjective MCR (sMCR). The adjusted sMCR prevalence was 25.3%. Adults with sMCR reported more diseases and showed negative associations with physical activity, sedentary behavior, and sleep, suggesting that lifestyle modifications can play a significant role in MCR prevention. Further research is required to complement our preliminary findings on sMCR prevalence in Germany.

Motoric cognitive risk syndrome as a predictive factor of cognitive impairment and dementia - A systematic review and meta-analysis

BACKGROUND

Motoric cognitive risk syndrome (MCR) is defined as the presence of slow gait-speed and subjective cognitive decline in older individuals without mobility disability or dementia. While some studies suggest that MCR is a pre-dementia syndrome and may help predict the risk of cognitive impairment and dementia, not all studies concur. The objective of this study is to comprehensively summarize and synthesize evidence to assess the association between MCR and cognitive impairment and dementia.

METHODS

Following a pre-specified protocol, two authors systematically searched PubMed, Embase, and The Cochrane Library from inception to 19 August 2024 for observational or randomized studies pertaining to the association between MCR and cognitive impairment and dementia. We favoured maximally adjusted hazards and odds ratios to determine the longitudinal and cross-sectional risk of cognitive impairment and dementia. We investigated for potential sources of heterogeneity and also conducted sensitivity and subgroup analyses by continent and the type of cognitive outcome. The quality of evidence was assessed using the Newcastle-Ottawa Scale (NOS) and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework.

RESULTS

We included 20 studies comprising a combined cohort of 1206,782 participants, of which 17 studies were included in the quantitative analysis. The pooled analysis outlined that individuals with MCR exhibited 2.20-fold higher risk of cognitive impairment and dementia, compared to controls (RR=2.20; 95 %CI=1.91-2.53). These findings remained robust across all subgroup analyses, sensitivity analyses and assessments of publication bias.

CONCLUSION

MCR may be considered a predictive factor for long-term cognitive impairment and dementia. This should be taken into consideration when clinically evaluating the risk of cognitive impairment and dementia but further research is required to lend greater clarity to this association.

Association between Motoric Cognitive Risk Syndrome and Indicators of Reflecting Independent Living among Community-Dwelling Older Adults in Japan: A Cross-Sectional Study

The purpose of this study was to examine whether motoric cognitive risk syndrome (MCR) is associated with various indicators of independent living among community-dwelling older adults in Japan. The study design was a cross-sectional study, and the participants were 107 community-dwelling older adults (mean age 79 ± 7 years) who were living independently. The participants were administered the Questionnaire for Medical Checkup of Old-Old (QMCOO) as an indicator of health status and the Japan Science and Technology Agency Index of Competence (JST-IC) as an indicator of higher levels of functioning capacity, among others. In addition, we assessed physical frailty (J-CHS), sarcopenia (AWGS2019), and MCR (slow gait + subjective memory complaints), which are predictors of adverse events in the elderly. Multiple regression analysis with QMCOO as the response variable showed that MCR (p = 0.01, β: 0.25) and physical frailty (p < 0.01, β: 0.43) were significantly associated. In addition, analysis with JST-IC as the response variable showed that MCR (p = 0.03, β: -0.20), physical frailty (p = 0.01, β: -0.24) and age (p = 0.02, β: -0.21) were significantly associated. In conclusion, MCR was found to be similarly associated with QMCOO and JST-IC as physical frailty. It is expected that the MCR will be used as an initial screening tool to identify signs of risk in community-dwelling older people, as it is easy to diagnose.

Non-literacy biased, culturally fair cognitive detection tool in primary care patients with cognitive concerns: a randomized controlled trial

Dementia is often undiagnosed in primary care, and even when diagnosed, untreated. The 5-Cog paradigm, a brief, culturally adept, cognitive detection tool paired with a clinical decision support may reduce barriers to improving dementia diagnosis and care. We performed a randomized controlled trial in primary care patients experiencing health disparities (racial/ethnic minorities and socioeconomically disadvantaged). Older adults with cognitive concerns were assigned in a 1:1 ratio to the 5-Cog paradigm or control. Primary outcome was improved dementia care actions defined as any of the following endpoints within 90 days: new mild cognitive impairment syndrome or dementia diagnoses as well as investigations, medications or specialist referrals ordered for cognitive indications. Groups were compared using intention-to-treat principles with multivariable logistic regression. Overall, 1,201 patients (mean age 72.8 years, 72% women and 94% Black, Hispanic or Latino) were enrolled and 599 were assigned to 5-Cog and 602 to the control. The 5-Cog paradigm demonstrated threefold odds of improvement in dementia care actions over control (odds ratio 3.43, 95% confidence interval 2.32-5.07). No serious intervention-related adverse events were reported. The 5-Cog paradigm improved diagnosis and management in patients with cognitive concerns and provides evidence to promote practice change to improve dementia care actions in primary care.ClinicalTrials.gov: NCT03816644 .

The Best of Two Worlds to Promote Healthy Cognitive Aging: Definition and Classification Approach of Hybrid Physical Training Interventions

A healthy lifestyle can be an important prerequisite to prevent or at least delay the onset of dementia. However, the large number of physically inactive adults underscores the need for developing and evaluating intervention approaches aimed at improving adherence to a physically active lifestyle. In this regard, hybrid physical training, which usually combines center- and home-based physical exercise sessions and has proven successful in rehabilitative settings, could offer a promising approach to preserving cognitive health in the aging population. Despite its potential, research in this area is limited as hybrid physical training interventions have been underused in promoting healthy cognitive aging. Furthermore, the absence of a universally accepted definition or a classification framework for hybrid physical training interventions poses a challenge to future progress in this direction. To address this gap, this article informs the reader about hybrid physical training by providing a definition and classification approach of different types, discussing their specific advantages and disadvantages, and offering recommendations for future research. Specifically, we focus on applying digital technologies to deliver home-based exercises, as their use holds significant potential for reaching underserved and marginalized groups, such as older adults with mobility impairments living in rural areas.

Development and validation of a risk prediction model for motoric cognitive risk syndrome in older adults

OBJECTIVE

The objective of this study was to develop a risk prediction model for motoric cognitive risk syndrome (MCR) in older adults.

METHODS

Participants were selected from the 2015 China Health and Retirement Longitudinal Study database and randomly assigned to the training group and the validation group, with proportions of 70% and 30%, respectively. LASSO regression analysis was used to screen the predictors. Then, identified predictors were included in multivariate logistic regression analysis and used to construct model nomogram. The performance of the model was evaluated by area under the receiver operating characteristic (ROC) curve (AUC), calibration curves and decision curve analysis (DCA).

RESULTS

528 out of 3962 participants (13.3%) developed MCR. Multivariate logistic regression analysis showed that weakness, chronic pain, limb dysfunction score, visual acuity score and Five-Times-Sit-To-Stand test were predictors of MCR in older adults. Using these factors, a nomogram model was constructed. The AUC values for the training and validation sets of the predictive model were 0.735 (95% CI = 0.708-0.763) and 0.745 (95% CI = 0.705-0.785), respectively.

CONCLUSION

The nomogram constructed in this study is a useful tool for assessing the risk of MCR in older adults, which can help clinicians identify individuals at high risk.

Motoric Cognitive Risk Syndrome as a Predictor of Adverse Health Outcomes: A Systematic Review and Meta-Analysis

INTRODUCTION

Motoric cognitive risk syndrome (MCR) is a newly proposed pre-dementia syndrome characterized by subjective cognitive complaints (SCCs) and slow gait (SG). Increasing evidence links MCR to several adverse health outcomes, but the specific relationship between MCR and the risk of frailty, Alzheimer's disease (AD), and vascular dementia (VaD) remains unclear. Additionally, literature lacks analysis of MCR's components and associated health outcomes, complicating risk identification. This systematic review and meta-analysis aimed to provide a comprehensive overview of MCR's predictive value for adverse health outcomes.

METHODS

Relevant cross-sectional, cohort, and longitudinal studies examining the association between MCR and adverse health outcomes were extracted from ten electronic databases. The Newcastle-Ottawa Scale (NOS) and modified NOS were used to assess the risk of bias in studies included in the analysis. Relative ratios (RRs) and 95% confidence intervals (CIs) were pooled for outcomes associated with MCR.

RESULTS

Twenty-eight longitudinal or cohort studies and four cross-sectional studies with 1,224,569 participants were included in the final analysis. The risk of bias in all included studies was rated as low or moderate. Pooled analysis of RR indicated that MCR had a greater probability of increased the risk of dementia (adjusted RR = 2.02; 95% CI = 1.94-2.11), cognitive impairment (adjusted RR = 1.72; 95% CI = 1.49-1.99), falls (adjusted RR = 1.32; 95% CI = 1.17-1.50), mortality (adjusted RR = 1.66; 95% CI = 1.32-2.10), and hospitalization (adjusted RR = 1.46; 95% CI = 1.16-1.84); MCR had more prominent predictive efficacy for AD (adjusted RR = 2.23; 95% CI = 1.81-2.76) compared to VaD (adjusted RR = 3.78; 95% CI = 0.49-28.95), while excluding analyses from the study that utilized the timed-up-and-go test and one-leg-standing to evaluate gait speed. One study examined the association between MCR and disability (hazard ratios [HR] = 1.69; 95% CI = 1.08-2.02) and frailty (OR = 5.53; 95% CI = 1.46-20.89). SG was a stronger predictor of the risk for dementia and falls than SCC (adjusted RR = 1.22; 95% CI = 1.11-1.34 vs. adjusted RR = 1.19; 95% CI = 1.03-1.38).

CONCLUSION

MCR increases the risk of developing any discussed adverse health outcomes, and the predictive value for AD is superior to VaD. Additionally, SG is a stronger predictor of dementia and falls than SCC. Therefore, MCR should be routinely assessed among adults to prevent poor prognosis and provide evidence to support future targeted interventions.

Social frailty and the incidence of motoric cognitive risk syndrome in older adults

INTRODUCTION

Various associations between social factors and motoric cognitive risk syndrome (MCR) have been reported. However, whether social frailty (integrated from multiple social factors) is associated with MCR is still unclear.

METHODS

We included 4657 individuals without MCR at Round 1 of the NHATS as the discovery sample, and 3075 newly recruited individuals from Round 5 of the NHATS as the independent validation sample. Social frailty was assessed by five social items. MCR was defined as the presence of both subjective cognitive complaints and slow gait speed in individuals without dementia or mobility disability.

RESULTS

Compared with normal individuals, those with social frailty had higher risk of incident MCR (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.34-1.84). Each additional unfavorable social item was associated with an increased risk of MCR (HR: 1.32, 95% CI: 1.22-1.43).

DISCUSSION

Social frailty was associated with an increased risk of incident MCR in older adults.

HIGHLIGHTS

Various associations between social factors and motoric cognitive risk syndrome (MCR) have been reported. Social frailty that integrated from multiple social factors was associated with an increased risk of incident MCR. Social frailty should be included in the early screening of individuals to identify those at higher risk of MCR.

Biological and Physical Performance Markers for Early Detection of Cognitive Impairment in Older Adults

Dementia is a major cause of poor quality of life, disability, and mortality in old age. According to the geroscience paradigm, the mechanisms that drive the aging process are also involved in the pathogenesis of chronic degenerative diseases, including dementia. The dissection of such mechanisms is therefore instrumental in providing biological targets for interventions and new sources for biomarkers. Within the geroscience paradigm, several biomarkers have been discovered that can be measured in blood and that allow early identification of individuals at risk of cognitive impairment. Examples of such markers include inflammatory biomolecules, markers of neuroaxonal damage, extracellular vesicles, and DNA methylation. Furthermore, gait speed, measured at a usual and fast pace and as part of a dual task, has been shown to detect individuals at risk of future dementia. Here, we provide an overview of available biomarkers that may be used to gauge the risk of cognitive impairment in apparently healthy older adults. Further research should establish which combination of biomarkers possesses the highest predictive accuracy toward incident dementia. The implementation of currently available markers may allow the identification of a large share of at-risk individuals in whom preventive interventions should be implemented to maintain or increase cognitive reserves, thereby reducing the risk of progression to dementia.

Predictors of progression from subjective cognitive decline to objective cognitive impairment: A systematic review and meta-analysis of longitudinal studies

BACKGROUND

Subjective cognitive decline is one of the first symptoms of dementia. With increasing awareness of brain health and a rising prevalence of dementia, a growing number of individuals seek medical assistance for purely subjective cognitive decline. However, only individuals with specific characteristics tend to experience clinical progression.

OBJECTIVES

This study aims to summarize the predictors of objective cognitive impairment in individuals with subjective cognitive decline and to identify those at higher risk of clinical progression.

DESIGN

Systematic review and meta-analysis.

METHODS

We systematically searched 11 electronic databases from inception to February 1, 2023, for longitudinal studies investigating factors associated with the clinical progression of subjective cognitive decline. Effect sizes were pooled using fixed-effects and random-effects models. Leveraging the results of the meta-analysis, we developed two risk prediction models for objective cognitive impairment.

RESULTS

Forty-six cohort studies were included in the systematic review, of which 28 met the meta-analysis criteria. Fifteen predictors were identified, including 4 biomarkers (amyloid β deposition, lower Hulstaert Formula scores, apolipoprotein e4, and hippocampus atrophy), four epidemiological factors (older age at baseline, impaired instrumental activity of daily living, depression, and anxiety), and seven neuropsychological factors (participants in clinical settings, older age at onset, stable symptom, concerns, cognitive decline confirmed by informant, severe symptoms, and poor performance on Trail Making Test B). Based on the meta-analysis results, we developed two risk prediction models. The first model (Model1) incorporates epidemiological and neuropsychological factors, distinguishing individuals with low and medium risk. The second model (Model2) includes additional biomarkers to enhance predictive performance and identify individuals at high risk.

CONCLUSIONS

This study provides a comprehensive characterization of individuals undergoing clinical progression from subjective cognitive decline to mild cognitive impairment or dementia. The developed models support the prediction of progression risk in both memory clinic and community settings, aiding in the early identification of individuals at risk of disease conversion and facilitating the translation of evidence into clinical practice.

REGISTRATION

The systematic review and meta-analysis have been registered in PROSPERO (CRD 42023392476).

TWEETABLE ABSTRACT

Factors for predicting progression from subjective cognitive decline to objective cognitive impairment: evidence from longitudinal studies.

Predictors of cognitive deterioration in subjective cognitive decline: evidence from longitudinal studies and implications for SCD-plus criteria

BACKGROUND

Subjective cognitive decline (SCD) is an early manifestation of cognitive deterioration (CD) in some individuals. Therefore, it is worthwhile to conduct a systematic review and meta-analysis to summarise predictors of CD among individuals with SCD.

METHOD

PubMed, Embase, and Cochrane Library were searched until May 2022. Longitudinal studies that assessed factors associated with CD in SCD population were included. Multivariable-adjusted effect estimates were pooled using random-effects models. The credibility of evidence was assessed. The study protocol was registered with PROSPERO.

RESULTS

A total of 69 longitudinal studies were identified for systematic review, of which 37 were included for the meta-analysis. The mean conversion rate of SCD to any CD was 19.8%, including all-cause dementia (7.3%) and Alzheimer's disease (4.9%). Sixteen factors (66.67%) were found as predictors, including 5 SCD features (older age at onset, stable SCD, both self- and informant-reported SCD, worry and SCD in the memory clinic), 4 biomarkers (cerebral amyloid β-protein deposition, lower scores of Hulstaert formula, higher total tau in the cerebrospinal fluid and hippocampus atrophy), 4 modifiable factors (lower education, depression, anxiety and current smoking), 2 unmodifiable factors (apolipoprotein E4 and older age) and worse performance on Trail Making Test B. The robustness of overall evidence was impaired by risk of bias and heterogeneity.

CONCLUSION

This study constructed a risk factor profile for SCD to CD conversion, supporting and supplementing the existing list of features for identifying SCD populations at high risk of objective cognitive decline or dementia. These findings could promote early identification and management of high-risk populations to delay dementia onset.

PROSPERO REGISTRATION NUMBER

CRD42021281757.

[Motoric cognitive risk syndrome-Setting the course for dementia prevention?]

BACKGROUND

The predicted increase in adults with dementia will pose a major challenge for the German healthcare system. To mitigate this challenge, the early detection of adults with an increased risk of dementia is crucial. In this context, the concept of motoric cognitive risk (MCR) syndrome has been introduced into the English literature but is currently relatively unknown in German-speaking countries.

OBJECTIVE

What are the characteristics and diagnostic criteria of MCR? What is the impact of MCR on health-related parameters? What is the current state of evidence regarding the risk factors and prevention of the MCR?

MATERIAL AND METHODS

We reviewed the English language literature concerning MCR, the associated risk factors, and protective factors, similarities or differences with the concept of mild cognitive impairment (MCI), and its influence on the central nervous system.

RESULTS

The MCR syndrome is characterized by subjective cognitive impairment and a slower gait speed. Compared to healthy adults, adults with the MCR have a higher risk of dementia, falls, and mortality. Modifiable risk factors provide a starting point for specific multimodal lifestyle-related preventive interventions.

CONCLUSION

As MCR can be easily diagnosed in practical settings, it could become an important concept for the early detection of adults with an increased risk of dementia in German-speaking countries, although further research is necessary to empirically confirm this assumption.

Association of cardiometabolic multimorbidity with motoric cognitive risk syndrome in older adults

INTRODUCTION

Motoric cognitive risk syndrome (MCR) is a predementia syndrome that is characterized by cognitive complaints and slow gait. Cardiometabolic multimorbidity (CMM) is associated with an increased risk of dementia. However, the relationship between CMM and MCR is still unclear.

METHODS

We included 4744 participants (aged 65+ years) without MCR at baseline from the National Health and Aging Trends Study (NHATS), who were followed-up from 2011 to 2018. CMM was defined as the presence of two or more cardiometabolic diseases (including diabetes mellitus, heart disease, and stroke).

RESULTS

CMM was significantly associated with an increased risk of MCR (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.13-1.75) in fully adjusted models. Consistent results were observed from stratified analyses of different subgroups. Increasing numbers of cardiometabolic diseases were dose-dependently associated with increased MCR risk (HR 1.33, 95% CI 1.20-1.48).

DISCUSSION

CMM is associated with an increased risk of MCR in older adults.

HIGHLIGHTS

Motoric cognitive risk syndrome (MCR) is a predementia syndrome characterized by slow gait speed and cognitive complaints.Cardiometabolic multimorbidity was associated with an increased MCR risk.An increased number of cardiometabolic diseases were dose-dependently associated with increased MCR risk.

Motoric cognitive risk syndrome trajectories and incident dementia over 10 years

Background

Motoric Cognitive Risk (MCR) syndrome is a high-risk state for adverse health outcomes in older adults characterised by measured slow gait speed and self-reported cognitive complaints. The recent addition to the Lothian Birth Cohort 1936 of robust dementia outcomes enabled us to assess the prognostic value of MCR for dementia and explore the various trajectories of participants diagnosed with MCR.

Methods

We classified 680 community-dwelling participants free from dementia into non-MCR or MCR groups at mean [SD] age 76.3 [0.8] years. We used Cox and competing risk regression methods, adjusted for potential confounders, to evaluate the risk of developing all-cause incident dementia over 10 years of follow-up. Secondarily, we followed the trajectories for individuals with and without MCR at baseline and categorised them into subgroups based on whether MCR was still present at the next research wave, three years later.

Results

The presence of MCR increased the risk of incident dementia (adjusted HR 2.34, 95%CI 1.14-4.78, p = 0.020), as did fewer years of education and higher depression symptoms. However, MCR has a heterogenous progression trajectory. The MCR progression subgroups each have different prognostic values for incident dementia.

Conclusion

MCR showed similar prognostic ability for dementia in a Scottish cohort as for other populations. MCR could identify a target group for early interventions of modifiable risk factors to prevent incident dementia. This study illustrates the heterogeneous nature of MCR progression. Exploring the underlying reasons will be important work in future work.

Biological Age Acceleration and Motoric Cognitive Risk Syndrome

OBJECTIVE

Motoric cognitive risk (MCR) syndrome, a predementia syndrome characterized by slow gait and subjective cognitive concerns, is associated with multiple age-related risk factors. We hypothesized that MCR is associated with biological age acceleration. We examined the associations of biological age acceleration with MCR, and mortality risk in MCR cases.

METHODS

Biological age was determined using proteomic and epigenetic clocks in participants aged 65 years and older in the LonGenity study (N = 700, females = 57.9%) and Health and Retirement Study (HRS; N = 1,043, females = 57.1%) cohorts. Age acceleration (AgeAccel) was operationally defined as the residual from regressing predicted biological age (from both clocks separately) on chronological age. Association of AgeAccel with incident MCR in the overall sample as well as with mortality risk in MCR cases was examined using Cox models and reported as hazard ratios (HRs).

RESULTS

AgeAccel scores derived from a proteomic clock were associated with prevalent MCR (odds ratio adjusted for age, gender, education years, and chronic illnesses [aOR] = 1.36, 95% confidence interval [CI] = 1.09-1.71) as well as predicted incident MCR (HR = 1.19, 95% CI = 1.00-1.41) in the LonGenity cohort. In HRS, the association of AgeAccel using an epigenetic clock with prevalent MCR was confirmed (aOR = 1.47, 95% CI = 1.16-1.85). Participants with MCR and accelerated aging (positive AgeAccel score) were at the highest risk for mortality in both LonGenity (HR = 3.38, 95% CI = 2.01-5.69) and HRS (HR = 2.47, 95% CI = 1.20-5.10).

INTERPRETATION

Accelerated aging predicts risk for MCR, and is associated with higher mortality in MCR patients. ANN NEUROL 2023;93:1187-1197.

Socioeconomic status as a risk factor for motoric cognitive risk syndrome in a community-dwelling population: A longitudinal observational study

BACKGROUND

Motoric cognitive risk (MCR) is a syndrome characterised by measured slow gait speed and self-reported cognitive complaints. MCR is a high-risk state for adverse health outcomes in older adults, particularly cognitive impairment and dementia. Previous studies have identified risk factors for MCR, but the effect of socioeconomic status has, to date, been insufficiently examined. This study explored the association between MCR and socioeconomic status, as determined by occupational social class and years of education.

METHODS

Some 692 community-based adults of the Lothian Birth Cohort 1936 (LBC1936), aged 70 years at baseline, were followed up after 6 years and classified into non-MCR and MCR groups. We applied logistic regression analyses adjusting for demographic, lifestyle, and health covariates to investigate the association between MCR and years of education and occupational social class, categorised into manual versus non-manual occupations.

RESULTS

MCR prevalence at age 76 years was 5.6% (95% CI 4.0-7.6). After multivariate adjustment, participants of lower socioeconomic status (manual occupation) had a greater than three-fold increased likelihood of MCR (adjusted odds ratio 3.55, 95% CI 1.46-8.74; p = 0.005) compared with those of higher socioeconomic status (non-manual occupation).

CONCLUSIONS

Working in a manual job earlier in life triples the risk of MCR later in life, regardless of education. Unravelling this association will likely reveal important pathophysiological mechanisms underlying MCR and may unearth modifiable risk factors which could be targeted to reduce the incidence of MCR and, ultimately, dementia. Policy and healthcare practice addressing dementia risks such as MCR in their social context and early in the lifecourse could be effective strategies for reducing health inequalities in older age.

Association between positive control in self-perceptions of aging and motoric cognitive risk syndrome among Chinese community-dwelling older adults: a cross-sectional study

BACKGROUND

Self-perceptions of aging (SPA) are important psychosocial factors that lead to a wide range of outcomes including dementia. However, the relationships between positive SPA and motoric cognitive risk syndrome (MCR) which is a predementia syndrome are still unknown. This study aimed to reveal the associations of positive control and aging awareness of SPA with the risk of MCR and its components.

METHODS

A cross-sectional design was conducted among 1137 Chinese community-dwelling older adults. Positive control and aging awareness were defined by two dimensions of SPA (Positive control and Timeline chronic). MCR was determined according to definition. Multivariable logistic regression was used to examine the associations.

RESULTS

The overall prevalence of MCR was 11.5% (mean age = 71.62 ± 5.22). After adjusting for depression, anxiety, and cognitive function, positive control was associated with reduced risk of MCR (OR = 0.624, 95% CI 0.402-0.969, P = 0.036), subjective cognitive complaints (SCC) (OR = 0.687, 95% CI 0.492-0.959, P = 0.027), and gait speed (GS) (OR = 0.377, 95% CI 0.197-0.720, P = 0.003), respectively. Aging awareness was merely related to increased risk of MCR (OR = 1.386, 95% CI 1.062-1.810, P = 0.016).

CONCLUSIONS

This study highlights the crucial associations of positive control and aging awareness with MCR and its components. Our results emphasize that positive belief in control and adaptive aging awareness might be promising targets for preventing MCR.

New onset, transient and stable motoric cognitive risk syndrome: Clinical characteristics and association with incidence of probable dementia in the NuAge cohort

Background

Motoric cognitive risk syndrome (MCR) is a pre-dementia stage. The existence of stable and transient MCR, their related clinical characteristics and their association with incident dementia is a matter of debate.

Objective

This study aims to examine the clinical characteristics and the time course associated with new onset, transient and stable MCR, and their association with incidence of probable dementia in community-dwelling older adults living in the province of Quebec (Canada).

Design

Quebec elderly population-based observational cohort study with 3 years of follow-up.

Setting

Community dwellers.

Subjects

A subset of participants (n = 1,113) from the “Quebec Longitudinal Study on Nutrition and Successful Aging” (NuAge) cohort.

Methods

Participants with MCR were identified at baseline and after 1 year of follow-up. Socio-demographic characteristics, 30-item Geriatric depression scale (GDS) score, cardiovascular risk factors and diseases were recorded at baseline. Incidence of probable dementia was measured at annual follow-up visits over a 3-year period.

Results

Over the period of the first year of follow-up, the prevalence of MCR was 8.5% with 4.3% having new onset MCR, 2.8% transient MCR and 1.4% stable MCR. A higher 30-item GDS score was reported with new onset and transient MCR, and the highest prevalence of cerebrovascular diseases was shown with stable MCR compared to non-MCR participants (p &lt; 0.05). MCR was associated with overall incidence of probable dementia, regardless of its status (Hazard Ratio ≥ 1.86, p ≤ 0.034).

Conclusion

Greater prevalence of depressive symptoms and cerebrovascular diseases were reported, respectively, with new onset and transient MCR, and stable MCR. The association of MCR with incidence of probable dementia remains significant, regardless of MCR subtypes.

Prevalence and predictors of Motoric Cognitive Risk syndrome in a community-dwelling older Scottish population: A longitudinal observational study

OBJECTIVES

Motoric Cognitive Risk (MCR) is a gait-based predementia syndrome that is easy to measure and prognostic of dementia and falls. We aimed to examine the prevalence and risk factors for MCR, and assess its overlap with Mild Cognitive Impairment, Prefrailty, and Frailty, in a cohort of older Scottish adults without dementia.

METHODS

In this longitudinal prospective study, we classified 690 participants (mean [SD] age 76.3 [0.8] years; wave 3) of the Lothian Birth Cohort 1936 (LBC1936) into non-MCR or MCR groups. We examined their baseline (age 69.5 [0.8] years; wave 1) risk factors for MCR at waves 3, 4, and 5 (6, 9, and 12 years later respectively).

RESULTS

MCR prevalence rate ranged from 5.3% to 5.7% across the three waves. The presence of MCR was associated with older baseline age (6 and 9 years later), lower occupational socioeconomic status (6 years later), and worse scores in a range of tests of executive function (6, 9 and 12 years later). Approximately 46% of the MCR group also had Mild Cognitive Impairment, and almost everyone in the MCR group had either Prefrailty or Frailty.

CONCLUSIONS

The prevalence of MCR in this Scottish cohort is lower than the pooled global average, possibly reflecting the general good health of the LBC cohort. However, it is higher than the prevalence in two neighbouring countries' cohorts, which may reflect the younger average ages of those cohorts. Future LBC1936 research should assess the risk factors associated with MCR to validate previous findings and analyse novel predictive factors, particularly socioeconomic status.

Using Interaction between Cognitive and Motor Impairment for Risk Screening of Major Neurocognitive Disorders: Results of the EPIDOS Observational Cohort Study

BACKGROUND AND PURPOSE

Cognitive and motor impairments are risk factors of major neurocognitive disorders (MNCD). Inability to name the date and use of a walking aid and/or history of falls are two items which are surrogate measures of cognitive and motor impairments. This study aims to examine the association of inability to name the date (i.e., cognitive impairment), use of a walking aid and/or history of falls (i.e., motor impairment) and their combination with incident MNCD in community-dwelling older adults.

METHODS

A total of 709 participants (mean age 79.8 ± 3.7; 100% female) of the EPIDémiologie de l'OStéoporose (EPIDOS) study recruited in Toulouse (France) were selected for this study. EPIDOS is an observational population-based cohort study with a 7-year follow-up period for Toulouse participants. Inability to name the date and use of a walking aid and/or history of falls were collected at baseline. Incident MNCD and their type (i.e., Alzheimer's disease (AD) and non-AD) were diagnosed at the end of the 7-year follow-up.

RESULTS

Overall incidence of MNCD was 29.1%. Cox regressions revealed that inability to name the date and its combination with use of a walking aid and/or history of falls was associated with a significant increased incidence of MNCD (hazard ratio (HR) = 1.10 with p = 0.003 and HR = 1.81 with p = 0.011, respectively) and AD (HR =1.13 with p = 0.003 and HR = 2.80 with p = 0.016, respectively).

CONCLUSIONS

Increased incident MNCD was reported when inability to name the date and use of a walking aid and/or history of falls were combined, suggesting that this combination of items may be used for risk screening of MNCD in the older population, especially for incident AD.