Motoric cognitive risk syndrome and risk of mortality in older adults

Self-reported motoric cognitive risk syndrome predicts long-term mortality in older adults

OBJECTIVES

Motoric cognitive risk syndrome (MCR) is a pre-dementia syndrome characterized by slow gait and subjective cognitive decline, increasing the risk of adverse clinical events such as dementia and falls in older adults. However, whether self-reported MCR (sMCR) predicts long-term mortality in Chinese older adults remains unknown. This study aimed to explore the role of sMCR in 8-year mortality in community-dwelling older adults.

DESIGN

Longitudinal cohort study.

SETTING

Data were sourced from the Beijing Longitudinal Study of Aging.

PARTICIPANTS

A total of 1,683 community-dwelling individuals aged 65 years and older who were free from disability and dementia at baseline were included.

MEASUREMENTS

sMCR was defined based on the presence of subjective cognitive decline and self-reported slow gait. Mortality data were tracked over the 8-year follow-up period. Cox regression models were used to analyze the association between sMCR and 8-year mortality.

RESULTS

A total of 113 (6.71%) community-dwelling individuals had sMCR. sMCR was associated with female sex, older age, no spouse, living in rural areas, low education level, low monthly income, no work, no tea intake, poor sleep quality, inactivity, poor physical performance, chronic diseases, and frailty. Participants with sMCR had a higher 8-year mortality compared to those without (70.80% vs. 34.52%). Cox regression analysis showed that sMCR predicted 8-year mortality (hazard ratio [HR] = 2.859, 95% confidence interval [CI] 2.260-3.619). This association remained significant even after adjusting for sex, age, area, education level, marital status, chronic diseases, and lifestyle factors (HR = 1.540, 95% CI 1.169-2.028).

CONCLUSIONS

sMCR is a predictor of 8-year mortality in Chinese community-dwelling older adults, which highlights the importance of early identification and intervention for sMCR to reduce adverse clinical outcomes in the aging population.

Motoric Cognitive Risk Syndrome and Risk of Cardiovascular Disease: A Population-Based Study

BACKGROUND

To investigate whether differences between motoric cognitive risk syndrome (MCRS) and mild cognitive impairment (MCI) are of vascular origin, we compared the risk of incident cardiovascular disease in both groups in a population-based study.

METHODS

We included 2710 dementia-free participants of the Rotterdam Study who underwent structured interviews, as well as gait and cognitive assessments. MCRS was defined as subjective cognitive complaints in combination with slow gait speed. MCI was defined as subjective cognitive complaints and objective impairment in one cognitive domain. We used Cox proportional hazards models adjusted for age, sex, and cardiovascular risk factors to obtain hazard ratios (HR) for the composite outcome of cardiovascular disease, including coronary heart disease and stroke.

RESULTS

Of all 2710 participants (mean age 71 years; 58.5% women), 221 (8.2%) had MCRS and 148 (5.5%) had MCI. During a median follow-up of 7.6 years, 298 individuals suffered a cardiovascular event, including 167 with coronary heart disease and 147 with stroke. Compared to individuals with neither MRCS nor MCI, MCRS was associated with increased risk of cardiovascular disease (HR = 1.54; 95% confidence intervals [95% CI] = 1.03-2.29), but this could not be confirmed for MCI (HR = 0.85; 95% CI = 0.46-1.55). Risk of stroke was similar for individuals with MCRS and MCI, whereas associations with coronary heart disease were observed for MCRS only.

CONCLUSIONS

Motoric cognitive risk syndrome, but not MCI, is associated with increased risk of cardiovascular disease, in particular coronary heart disease. These findings are in line with a predominant vascular underpinning of dementia risk attributed to MCRS.

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 of cystatin C kidney function measures with motoric cognitive risk syndrome: evidence from two cohort studies

BACKGROUND

This study aimed to examine the associations of cystatin C, cystatin C estimated glomerular filtration rate (eGFRcys), and the difference between eGFRs (eGFRdiff) using cystatin C and creatinine levels with incident motoric cognitive risk syndrome (MCR).

METHODS

We utilized data from two nationally representative cohort studies, the China Health and Retirement Longitudinal Study (CHARLS, 2011-2015) and the US Health and Retirement Study (HRS, 2010-2018). Baseline serum cystatin C and creatinine levels were measured, and eGFRcys and creatinine estimated GFR (eGFRcr) were calculated. MCR was defined as subjective cognitive complaints plus objectively measured slow gait speed. Multivariable logistic models were used to investigate the longitudinal associations between kidney function measurements and incident MCR.

RESULTS

In CHARLS (N = 2,085) and HRS (N = 1,240) cohorts, 7.4% and 7.2% developed MCR over follow-up. Each SD increment in serum cystatin C level was associated with elevated incident MCR odds, and an inverse association of eGFRcys with incident MCR was observed in both cohorts after multivariable adjustment and meta-analyses. The association between serum cystatin C and incident MCR remained significant even after adjusting for serum creatinine, suggesting that cystatin C is independently associated with MCR, regardless of kidney function levels. Additionally, each SD decrease in the absolute value of eGFRdiff was associated with lower odds of incident MCR among CHARLS participants.

CONCLUSIONS

Cystatin C and eGFRcys were correlated with an elevated MCR risk in two distinct populations. Specifically, eGFRdiff also related to incident MCR among Chinese older adults. Monitoring cystatin C-based kidney function could have significant clinical utility for identifying incident MCR risk, and represents a potential intervention target for healthier cognitive aging.

Prevalence of motoric cognitive risk syndrome among older adults in Brazil and evaluation of effect modification by race

BACKGROUND

Motoric cognitive risk syndrome (MCRS) is a pre-dementia syndrome of growing interest, yet it remains understudied in Latin America with a significant lack of information on the interaction between its risk factors and race.

OBJECTIVE

To estimate the prevalence of MCRS among older adults in Brazil, investigate its association with various clinical and sociodemographic variables, and explore the potential of effect modification by race.

METHODS

This cross-sectional, population-based study was conducted among community-dwelling older adults in Brazil, with data collected between 2015 and 2016. The diagnosis of MCRS was established following the standard recommended by the original study that first described it. We used Poisson regression models to analyze the association between MCRS and a list of 21 variables identified from a systematic review.

RESULTS

A total of 4677 participants aged 60 years and older were included. The prevalence of MCRS in the Brazilian population of older adults was 4.34% (95% CI: 3.20%-5.48%). Higher levels of education and physical activity showed protective associations with MCRS, while depression and stroke demonstrated risk associations. A significant cross-over interaction between race and depression regarding MCRS was observed, such that the association of depression with MCRS was approximately three times higher among White individuals than Black individuals.

CONCLUSIONS

Our results challenge previous estimates that Latin America is the region with the highest prevalence of MCRS among older adults and signal the need for further studies to better investigate the modification of effect of the association between depression and MCRS by race.

Comparison of 3 Aging Metrics in Dual Declines to Capture All-Cause Dementia and Mortality Risk: Cohort Study

Background

The utility of aging metrics that incorporate cognitive and physical function is not fully understood.

Objective

We aim to compare the predictive capacities of 3 distinct aging metrics-motoric cognitive risk syndrome (MCR), physio-cognitive decline syndrome (PCDS), and cognitive frailty (CF)-for incident dementia and all-cause mortality among community-dwelling older adults.

Methods

We used longitudinal data from waves 10-15 of the Health and Retirement Study. Cox proportional hazards regression analysis was employed to evaluate the effects of MCR, PCDS, and CF on incident all-cause dementia and mortality, controlling for socioeconomic and lifestyle factors, as well as medical comorbidities. Discrimination analysis was conducted to assess and compare the predictive accuracy of the 3 aging metrics.

Results

A total of 2367 older individuals aged 65 years and older, with no baseline prevalence of dementia or disability, were ultimately included. The prevalence rates of MCR, PCDS, and CF were 5.4%, 6.3%, and 1.3%, respectively. Over a decade-long follow-up period, 341 cases of dementia and 573 deaths were recorded. All 3 metrics were predictive of incident all-cause dementia and mortality when adjusting for multiple confounders, with variations in the strength of their associations (incident dementia: MCR odds ratio [OR] 1.90, 95% CI 1.30-2.78; CF 5.06, 95% CI 2.87-8.92; PCDS 3.35, 95% CI 2.44-4.58; mortality: MCR 1.60, 95% CI 1.17-2.19; CF 3.26, 95% CI 1.99-5.33; and PCDS 1.58, 95% CI 1.17-2.13). The C-index indicated that PCDS and MCR had the highest discriminatory accuracy for all-cause dementia and mortality, respectively.

Conclusions

Despite the inherent differences among the aging metrics that integrate cognitive and physical functions, they consistently identified risks of dementia and mortality. This underscores the importance of implementing targeted preventive strategies and intervention programs based on these metrics to enhance the overall quality of life and reduce premature deaths in aging populations.

Measurement Practice of Slow Gait Speed for Motoric Cognitive Risk Syndrome: A Systematic Review

OBJECTIVES

Individuals with motoric cognitive risk (MCR) syndrome have a high dementia risk. However, a knowledge gap exists in the measurement procedure for slow gait speed, which is a crucial component of MCR diagnosis. The study aimed to systematically review slow gait speed measurement practices in MCR diagnosis to identify critical constructs in gait speed measurement procedure.

DESIGN

Systematic review.

SETTING AND PARTICIPANTS

Included studies were conducted in clinical and community settings, involving participants with MCR receiving gait speed measurement.

METHODS

A systematic search across PubMed, Medline, Embase, CINHAL (EBSCO), Web of Science, Cochrane Library, and ProQuest Dissertation from inception until January 2024 for articles with detailed MCR diagnosis. Study quality was evaluated with the Joanna Briggs Institute (JBI) Critical Appraisal Checklists and slow gait speed measurement methods were summarized through narrative synthesis.

RESULTS

From 27,600 unique entries, 50 relevant studies with 55 cohorts were identified and included in the review. Slow gait speed measurement methods in existing MCR studies showed heterogeneity in measurement tools, start/end protocols and buffer distance, walking test distance, number of tests, calculation methods, and cutoff values. Commonly, manual stopwatches and 4-meter walking test distance with a 2-meter buffer at each end at a usual pace were used, averaging 2 tests for gait speed analysis, with the need for cohort-specific slow gait cutoff values.

CONCLUSIONS AND IMPLICATIONS

The measurement practices of slow gait speed in MCR diagnosis were heterogeneous. A relatively comprehensive gait speed measurement procedure with 7 constructs was initially delineated in this study based on synthesis analysis, with the potential to improve diagnostic accuracy and consistency of MCR, although further validation is still needed.

Motoric cognitive risk syndrome as a predictor of mortality in older male adults with cancer: A prospective cohort study in Peru

We aimed to assess motoric cognitive risk syndrome (MCRS) as a mortality predictor in older male adults with cancer at Centro Médico Naval (CEMENA) in Peru from 2012 to 2015. We conducted a secondary analysis of a prospective cohort within CEMENA's Geriatrics Service. We considered all-cause mortality as the primary outcome. MCRS was defined as slow gait speed, cognitive impairment, preserved activities of daily living, and absence of dementia. We utilized Poisson family generalized linear models with a logarithmic link function and robust variance to calculate both crude and adjusted relative risks (RR) with 95 % confidence intervals (95 % CI). We included 832 older male adults, with an MCRS frequency of 18.27 % (n = 152) and a mortality incidence of 22.84 % (n = 190). MCRS was a predictor of mortality in older adults at the end of follow-up (aRR=2.55; 95 % CI: 2.13-2.66). Survival was lower in older adults with MCRS (log-rank test p < 0.001). MCRS was a mortality predictor in older male adults with cancer.

Predictors for the development of motoric cognitive risk syndrome in older adults

BACKGROUND

Motoric cognitive risk (MCR) syndrome refers to a condition where both slow gait and memory complaints coexist, which heightens their vulnerability to developing dementia. Considering that the risk factors of MCR are elucidated from cross-sectional studies and also likely vary based on socioeconomic status, we conducted a community-based longitudinal study to determine the predictors of MCR among older adults in Malaysia.

METHODS

Out of 1,249 older participants (aged 60 years and above) without MCR at baseline (Wave II of LRGS-TUA cohort study), 719 were successfully followed up after 3.5 years to identify predictors of subsequent MCR development. A comprehensive interview-based questionnaire was administered for sociodemographic information, cognitive function, psychosocial, functional status, and dietary intake. Anthropometric measurements, body composition, and physical performance were assessed. Univariate analyses were performed for each variable, followed by a hierarchical logistic regression analysis to identify the predictors of MCR that accounted for confounding effects between the studied factors.

RESULTS

The incidence rate of MCR was 4.0 per 100 person-years. Smoking (Adjusted Odd Ratio (Adj OR) = 1.782; 95% Confidence Interval (CI):1.050-3.024), hypertension (Adj OR = 1.725; 95% CI:1.094-2.721), decreased verbal memory as assessed by the lower Rey Auditory Verbal Learning Test (RAVLT) (Adj OR = 1.891; 95% CI:1.103-3.243), and decreased functional status measured using instrumental activity of daily living (IADL) (Adj OR = 4.710; 95% CI:1.319-16.823), were predictors for MCR incidence.

CONCLUSIONS

Our study results provide an initial reference for future studies to formulate effective preventive management and intervention strategies to reduce the growing burden of adverse health outcomes, particularly among Asian older adults.

Enhancing predictive validity of motoric cognitive risk syndrome for incident dementia and all-cause mortality with handgrip strength: insights from a prospective cohort study

Background

This study aimed to assess whether integrating handgrip strength (HGS) into the concept of motoric cognitive risk (MCR) would enhance its predictive validity for incident dementia and all-cause mortality.

Methods

A cohort of 5, 899 adults from the Health and Retirement Study underwent assessments of gait speed, subjective cognitive complaints, and HGS were involved. Over a 10-year follow-up, biennial cognitive tests and mortality data were collected. Cox proportional hazard analyses assessed the predictive power of MCR alone and MCR plus HGS for incident dementia and all-cause mortality.

Results

Patients with MCR and impaired HGS (MCR-HGS) showed the highest adjusted hazard ratios (AHR) for dementia (2.33; 95% CI, 1.49-3.65) and mortality (1.52; 95% CI, 1.07-2.17). Even patients with MCR and normal HGS (MCR-non-HGS) experienced a 1.77-fold increased risk of incident dementia; however, this association was not significant when adjusted for socioeconomic status, lifestyle factors, and medical conditions. Nevertheless, all MCR groups demonstrated increased risks of all-cause mortality. The inclusion of HGS in the MCR models significantly improved predictive discrimination for both incident dementia and all-cause mortality, as indicated by improvements in the C-statistic, integrated discrimination improvement (IDI) and net reclassification indices (NRI).

Conclusion

Our study underscores the incremental predictive value of adding HGS to the MCR concept for estimating risks of adverse health outcomes among older adults. A modified MCR, incorporating HGS, could serve as an effective screening tool during national health examinations for identifying individuals at risk of dementia and mortality.

The associations of daytime napping and motoric cognitive risk syndrome: Findings from the China Health and Retirement Longitudinal Study

INTRODUCTION

Motoric cognitive risk syndrome (MCR), characterized by subjective cognitive complaints and slow gait in older populations, is associated with sleep duration. However, the association between MCR and daytime nap duration has not been thoroughly explored.

METHODS

Baseline data from the China Health and Retirement Longitudinal Study (CHARLS) were used in this study. MCR was defined as the coexistence of subjective cognitive complaints and objective slow gait speed without a history of dementia or mobility disability. Daytime nap duration was categorized into four groups: no napping, short napping (<30 min), moderate napping (30-89 min) and extended napping (≥90 min). Multivariable logistic regression models were used to explore the association of daytime napping duration and MCR.

RESULTS

A total of 4230 individuals aged ≥60 were included in the current analysis, of which 463 were diagnosed with MCR. Moderate napping of 30-89 min per day was found to be significantly associated with lower odds of MCR compared with the reference group of no napping. In subgroup analysis, individuals with sleep durations of <7 h per night had lower odds of MCR in the model that adjusted for all potential confounders with ≥30 min daytime nap duration compared with no napping. Interestingly, for people with a night sleep duration of 7-8 h, only those with a moderate nap of 30-89 min had lower odds of MCR than non-nappers after adjustment for potential confounders.

CONCLUSION

A moderate nap of 30-89 min could lower the odds of MCR, especially for older adults with a night sleep duration of ≤8 h.

Association between pain interference and motoric cognitive risk syndrome in older adults: a population-based cohort study

OBJECTIVES

Motoric cognitive risk syndrome (MCR) is a pre-dementia condition characterized by subjective complaints in cognition and slow gait. Pain interference has previously been linked with cognitive deterioration; however, its specific relationship with MCR remains unclear. We aimed to examine how pain interference is associated with concurrent and incident MCR.

METHODS

This study included older adults aged ≥ 65 years without dementia from the Health and Retirement Study. We combined participants with MCR information in 2006 and 2008 as baseline, and the participants were followed up 4 and 8 years later. The states of pain interference were divided into 3 categories: interfering pain, non-interfering pain, and no pain. Logistic regression analysis was done at baseline to examine the associations between pain interference and concurrent MCR. During the 8-year follow-up, Cox regression analysis was done to investigate the associations between pain interference and incident MCR.

RESULTS

The study included 7120 older adults (74.6 ± 6.7 years; 56.8% females) at baseline. The baseline prevalence of MCR was 5.7%. Individuals with interfering pain had a significantly increased risk of MCR (OR = 1.51, 95% CI = 1.17-1.95; p = 0.001). The longitudinal analysis included 4605 participants, and there were 284 (6.2%) MCR cases on follow-up. Participants with interfering pain at baseline had a higher risk for MCR at 8 years of follow-up (HR = 2.02, 95% CI = 1.52-2.69; p < 0.001).

CONCLUSIONS

Older adults with interfering pain had a higher risk for MCR versus those with non-interfering pain or without pain. Timely and adequate management of interfering pain may contribute to the prevention and treatment of MCR and its associated adverse outcomes.

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.

Intraindividual difference in estimated GFR by creatinine and cystatin C, cognitive trajectories and motoric cognitive risk syndrome

BACKGROUND

Intraindividual differences between estimated glomerular filtration rate (eGFR) based on cystatin C (eGFRcys) and creatinine (eGFRcr) can convey important clinical information regarding health status. However, the clinical implications of these differences (eGFRdiff) for risk of cognitive decline and motoric cognitive risk (MCR) syndrome remains unclear. We aimed to investigate the longitudinal associations of eGFRdiff with cognitive trajectories and incident MCR.

METHODS

Based on the China Health and Retirement Longitudinal Study, we identified two study subcohorts: one for cognitive trajectory follow-up (6423 participants, 2011-2018) and another for incident MCR follow-up (2477 participants, 2011-2015). The eGFRdiff was defined as eGFRcys - eGFRcr. Adjusted ordinal and binary logistic regression models were separately used to assess the associations of eGFRdiff with cognitive trajectories and incident MCR. We also performed discordance analyses for eGFRdiff versus eGFRcys, eGFRcr or eGFR based on both creatinine and cystatin C (eGFRcys-cr).

RESULTS

In the first subcohort, four distinct 7-year cognitive trajectories were identified. Each 1 standard deviation (SD) higher eGFRdiff (value for eGFRcys - eGFRcr) was associated with a lower risk of poorer cognitive trajectories {odds ratio 0.909 [95% confidence interval (CI) 0.877-0.942]}. In the second subcohort, 121 participants developed incident MCR after a 4-year follow-up. Each 1-SD higher eGFRdiff (value for eGFRcys - eGFRcr) was linked with a 25.3% (95% CI 16.6-33.2) decreased risk for MCR. The above associations persisted in individuals with normal kidney function. Additionally, the risk for cognitive decline and incident MCR was more strongly associated with eGFRcys than eGFRcr and eGFRcys-cr. For the discordance analyses, the 'discordantly high eGFRdiff/low eGFR' group but not the 'discordantly low eGFRdiff/high eGFR' exhibited a significantly lower risk of poorer cognitive trajectories and MCR compared with the concordant group.

CONCLUSIONS

A large negative difference between eGFRcys and eGFRcr (eGFRcys < eGFRcr) was associated with a higher risk of cognitive decline and incident MCR. The eGFRdiff could capture additional valuable risk information beyond eGFRcys, eGFRcr and eGFRcys-cr.

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.

Association between Perceived Stress and Motoric Cognitive Risk Syndrome in an Elderly Population: Rugao Longevity and Aging Study

INTRODUCTION

Previous studies have indicated a correlation between perceived stress and cognitive decline. However, it remains unknown whether high levels of perceived stress can result in motoric cognitive risk (MCR) syndrome. This study investigated the relationship between perceived stress and MCR in a community-based population.

METHODS

The study cohort comprised 852 elderly individuals from the Rugao Longitudinal Aging Cohort. Perceived stress was assessed using the 10-item Perceived Stress Scale (PSS-10), while MCR was defined as the coexistence of subjective memory complaints (SMCs) and slow gait speed.

RESULTS

The average age of the study participants is 79.84 ± 4.34 years. The mean score of PSS-10 among participants is 10.32 (range = 0-33; [SD] = 5.71), with a median score of 10.00 (6.00, 14.00). The prevalence of MCR is 9.3%. In the logistic regression analysis, for each 1-SD (5.71) increase in the global PSS-10 score, the risk of MCR increased by 40% (95% CI 1.09-1.80). Additionally, in the aspect of two components of MCR, with a 1-SD increase (5.71) in the global PSS-10 score, there was a 50% (95% CI 1.29-1.75) increase in the risk of SMCs and a 27% (95% CI 1.04-1.55) increase in the risk of slow gait speed. In terms of specific walking speed, there was a reverse correlation between the global PSS-10 score and walking speed (r = -0.14, p < 0.001).

CONCLUSIONS

This study provided preliminary evidence that high levels of perceived stress were associated with the risk of MCR in a community-dwelling population.

Associations of visual, hearing, and dual sensory impairment with motoric cognitive risk syndrome: Observational and Mendelian randomization analyses

BACKGROUND

Dementia is associated with individual vision impairment (VI) and hearing impairment (HI). However, little is known about their associations with motoric cognitive risk syndrome (MCR), a pre-dementia stage. We investigated the association of VI, HI, and dual sensory impairment (DSI) with MCR and to further evaluate causal relationships using Mendelian randomization (MR) approach.

METHODS

First, an observational study was conducted in the China Health and Retirement Longitudinal Study (CHARLS). Evaluate the cross-sectional and longitudinal associations of VI, HI, and DSI with MCR using the logistic regression models and Cox proportional hazard models, respectively. Second, evaluate the causal association between VI and HI with MCR using MR analysis. The GWAS data was used for genetic instruments, including 88,250 of European ancestry (43,877 cases and 44,373 controls) and 504,307 with "white British" ancestry (100,234 cases and 404,073 controls), respectively; MCR information was obtained from the GWAS with 22,593 individuals. Inverse variance weighted was the primary method and sensitivity analysis was used to evaluate the robustness of MR methods.

RESULTS

In the observational study, VI (HR: 1.767, 95%CI: 1.331-2.346; p < 0.001), HI (HR: 1.461, 95%CI: 1.196-1.783; p < 0.001), and DSI (HR: 1.507, 95%CI: 1.245-1.823; p < 0.001) were significantly associated with increased risk of MCR. For the MR, no causal relationship between VI (OR: 0.902, 95% CI: 0.593-1.372; p = 0.631) and HI (OR: 1.016, 95% CI: 0.989-1.043; p = 0.248) with MCR risk, which is consistent with the sensitivity analysis.

CONCLUSION

VI, HI, and DSI were significantly associated with MCR, but MR analysis failed to provide evidence of their causal relationship. Emphasized the importance of sensory impairment screening in identifying high-risk populations for dementia.

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.

Association of Handgrip Strength Weakness and Asymmetry With Incidence of Motoric Cognitive Risk Syndrome in the China Health and Retirement Longitudinal Study

BACKGROUND AND OBJECTIVES

Motoric cognitive risk (MCR) syndrome is a type of pre-dementia. It is defined as the co-occurrence of subjective cognitive complaints and a slow gait speed. A recent study found that handgrip strength (HGS) asymmetry is associated with an increased risk of neurodegenerative disorders. We aimed to investigate the associations of HGS weakness and asymmetry separately and together with MCR incidence among older Chinese adults.

METHODS

Data from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study were used. HGS values <28 kg for male participants and <18 kg for female participants were considered HGS weaknesses. HGS asymmetry was assessed by the ratio of nondominant to dominant HGS. We used 3 different cutoff values of HGS ratio to define asymmetry, including 10%, 20%, and 30%. Specifically, HGS ratios <0.90 or >1.10 (10%), <0.80 or >1.20 (20%), and <0.70 or >1.30 (30%) were classified as asymmetry. The participants were classified into 4 groups: neither weakness nor asymmetry (neither), asymmetry only, weakness only, and weakness and asymmetry (both). The association between baseline HGS status and 4-year incidence of MCR was examined using logistic regression analyses.

RESULTS

A total of 3,777 participants 60 years and older were included in the baseline analysis. The prevalence of MCR at the baseline was 12.8%. Participants with asymmetry only, weakness only, and both showed significantly increased risk of MCR. After excluding participants with MCR at baseline, 2,328 participants were included in the longitudinal analysis. There were 111 MCR cases (4.77%) over the 4-year follow-up period. Participants with HGS weakness and asymmetry together at baseline had increased odds of incident MCR (HGS ratio at 10%: odds ratio [OR] 4.48, p < 0.001; HGS ratio at 20%: OR 5.43, p < 0.001; HGS ratio at 30%: OR 6.02, p < 0.001).

DISCUSSION

These results show that the presence of both HGS asymmetry and weakness is associated with MCR incidence. The early recognition of HGS asymmetry and weakness may be helpful in the prevention and treatment of cognitive dysfunction.

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.

Handgrip strength is associated with risks of new-onset stroke and heart disease: results from 3 prospective cohorts

BACKGROUND

Stroke and heart disease are two major contributors to the global disease burden. We aimed to evaluate and compare the roles of different handgrip strength (HGS) expressions in predicting stroke and heart disease in three nationally representative cohorts.

METHODS

This longitudinal study used data from the Health and Retirement Study (HRS), the Survey of Health, Ageing, and Retirement in Europe (SHARE), and the China Health and Retirement Longitudinal Study (CHARLS). The Cox proportional hazard model was applied to analyze the relationship between HGS and stroke and heart disease, and Harrell's C index was used to assess the predictive abilities of different HGS expressions.

RESULTS

A total of 4,407 participants suffered from stroke and 9,509 from heart disease during follow-up. Compared with the highest quartile, participants in the lowest quartile of dominant HGS, absolute HGS and relative HGS possessed a significantly higher risk of new-onset stroke in Europe, America, and China (all P < 0.05). After adding HGS to office-based risk factors, there were minimal or no differences in the increases of Harrell's C indexes among three HGS expressions. In contrast, the modest association between HGS and heart disease was only seen in SHARE and HRS, but not in CHARLS.

CONCLUSION

Our findings support that HGS can be used as an independent predictor of stroke in middle-aged and older European, American and Chinese populations, and the predictive ability of HGS may not depend on how it is expressed. The relationship between HGS and heart disease calls for further validation.

Chronic pain increases the risk of motoric cognitive risk syndrome at 4 years of follow-up: evidence from the China Health and Retirement Longitudinal Study

BACKGROUND AND PURPOSE

Slower gait speed and subjective cognitive concerns are characteristics of the motoric cognitive risk (MCR) syndrome. This study aimed to examine if changes in pain may be hallmarks of early MCR, through investigating the magnitude of the association of chronic pain and the risk of MCR at 4 years follow-up.

METHODS

In total, 3711 participants without dementia or any mobility disability aged ≥60 years were studied, including 1413 with chronic pain, enrolled in the China Health and Retirement Longitudinal Study, a prospective cohort study. MCR assessed at wave 1 (2011) and wave 3 (2015) was used as the exposure. Cox regression analysis was used to examine the longitudinal association between chronic pain and MCR after adjusting for individual factors, behaviors/physiology factors and societal factors. Four years later, the incident MCR was evaluated.

RESULTS

After adjusting for individual factors, chronic pain was found to increase the risk of MCR development over time by about 1.5 times (hazard ratio 1.562, 95% confidence interval 1.228-1.986; p < 0.001) and to be linked with incident MCR at baseline (odds ratio 1.397, 95% confidence interval 1.149-1.698; p < 0.001). These associations remained substantial when behaviors/physiology factors and societal factors were taken into account in the analytical models.

CONCLUSIONS

The findings of our study imply that incident MCR may be exacerbated by chronic pain. Further exploration is required to find out whether chronic pain is a modifiable risk factor for MCR.

Association of polypharmacy and motoric cognitive risk syndrome in older adults: A 4-year longitudinal study in China

BACKGROUND

Polypharmacy is related to motoric cognitive risk (MCR) syndrome is not fully understood. Therefore, our aim was to fill this gap in knowledge.

METHODS

This population-based prospective longitudinal study used data from the China Health and Retirement Longitudinal Study. It included 3827 dementia-free older adults (age >60 years) who were followed from 2011 to 2015. Data on subjective cognitive complaints, walking speed, and polypharmacy were reported by the participants. The cross-sectional relationship between polypharmacy and the MCR at baseline was examined using multinomial logistic regression, and Cox regression will be used to analyze the impact of polypharmacy on MCR over a four-year period.

RESULTS

At baseline, 492 (12.9%) participants had been diagnosed with MCR. With 4 years of follow-up, 304 (12.5%) were classified as having incident MCR. Controlling for microsystem factors, polypharmacy (OR: 1.273, 95 % CI: 1.051-1.541; p < .05) was associated with MCR at baseline and every unit increase in polypharmacy was linked to a 53.8% (HR:1.538, 95 % CI: 1.227-1.927; p < .001) increase more likely to developing incident MCR. They adjusted for meso/ exosystem and macrosystem factors, and these associations remained significant, coping resources are believed to have a role in the relationships between polypharmacy and MCR in older persons.

CONCLUSION

Polypharmacy is significantly associated with MCR incidence during 4 years of follow-up in older adults. Future studies should independently confirm this observation for potentially bringing clinical benefits to older people with polypharmacy.

Deep Neural Network-Based Video Processing to Obtain Dual-Task Upper-Extremity Motor Performance Toward Assessment of Cognitive and Motor Function

Dementia is an increasing global health challenge. Motoric Cognitive Risk Syndrome (MCR) is a predementia stage that can be used to predict future occurrence of dementia. Traditionally, gait speed and subjective memory complaints are used to identify older adults with MCR. Our previous studies indicated that dual-task upper-extremity motor performance (DTUEMP) quantified by a single wrist-worn sensor was correlated with both motor and cognitive function. Therefore, the DTUEMP had a potential to be used in the diagnosis of MCR. Instead of using inertial sensors to capture kinematic data of upper-extremity movements, here we proposed a deep neural network-based video processing model to obtain DTUEMP metrics from a 20-second repetitive elbow flexion-extension test under dual-task condition. In details, we used a deep residual neural network to obtain joint coordinate set of the elbow and wrist in each frame, and then used optical flow method to correct the joint coordinates generated by the neural network. The coordinate sets of all frames in a video recording were used to generate an angle sequence which represents rotation angle of the line between the wrist and elbow. Then, the DTUEMP metrics (the mean and SD of flexion and extension phase) were derived from angle sequences. Multi-task learning (MTL) was used to assess cognitive and motor function represented by MMSE and TUG scores based on DTUEMP metrics, with single-task learning (STL) linear model as a benchmark. The results showed a good agreement (r $\ge0.80$ and ICC $\ge0.58$ ) between the derived DTUEMP metrics from our proposed model and the ones from clinically validated sensor processing model. We also found that there were correlations with statistical significance (p < 0.05) between some of video-derived DTUEMP metrics (i.e. the mean of flexion time and extension time) and clinical cognitive scale (Mini-Mental State Examination, MMSE). Additionally, some of video-derived DTUEMP metrics (i.e. the mean and standard deviation of flexion time and extension time) were also associated with the scores of timed-up and go (TUG) which is a gold standard to measure functional mobility. Mean absolute percentage error (MAPE) of MTL surpassed that of STL (For MMSE, MTL: 18.63%, STL: 23.18%. For TUG, MTL: 17.88%, STL: 22.53%). The experiments with different light conditions and shot angles verified the robustness of our proposed video processing model to extract DTUEMP metrics in potentially various home environments (r $\ge0.58$ and ICC $\ge0.71$ ). This study shows possibility of replacing sensor processing model with video processing model for analyzing the DTUEMP and a promising future to adjuvant diagnosis of MCR via a mobile platform.

Longitudinal association between falls and motoric cognitive risk syndrome among community-dwelling older adults

The motoric cognitive risk (MCR) syndrome is a predementia syndrome associated with dementia and mortality risk. This longitudinal study aimed to investigated the longitudinal association between MCR and falls in older adults, including 3,720 participants in the China Health and Retirement Longitudinal Study. A total of 482 participants (13.0%) met the MCR requirements at baseline. There were 226 incident cases of MCR (13.0%) throughout follow-up (duration: 4 years). Controlling for microsystem factors, a single fall (OR: 2.412, 95 % CI: 1.100-5.290; p < .05) was associated with incident MCR at baseline and to almost 2.0 times (HR: 2.021, 95 % CI: 1.031-3.961; p < .05) more inclined to develop MCR over time, compared to those without falls. These associations remained significant when meso/ exosystem factors and macrosystem factors were included in the analytic models. Falls may be useful in predicting MCR risk in the near future among Chinese older adults.

Prevalence of motoric cognitive risk syndrome among older adults: a systematic review and meta-analysis

OBJECTIVE

Motoric cognitive risk syndrome (MCR) is a newly proposed pre-dementia syndrome. Several studies on the prevalence of MCR have been published; however, the data vary across studies with different epidemiological characteristics. Thus, this study aimed to quantitatively analyse the overall prevalence and associated epidemiological characteristics of MCR among older adults aged ≥ 60 years.

METHODS

The Cochrane Library, PubMed, Web of Science, CINAHL, Embase, Scopus, PsycInfo, China National Knowledge Infrastructure, Weipu Database, China Biology Medicine disc and Wanfang Database were searched from their inception to January 2022. A modified Newcastle-Ottawa Scale evaluated the risk of bias. Statistical heterogeneity among the included studies was analysed using Cochran's Q and I² tests. A random effect model calculated pooled prevalence owing to study heterogeneity. Begg's and Egger's tests were used to assess the publication bias. Additionally, subgroup analysis and meta-regression were performed based on different epidemiological characteristics to determine heterogeneity sources.

RESULTS

Sixty-two studies comprising 187,558 samples were obtained. The pooled MCR prevalence was 9.0% (95% confidence interval: 8.3-9.8). A higher MCR prevalence was observed in females, older adults with a low educational level, depression and cardiovascular risk factors, South American populations, and studies with small sample sizes and cross-section designs. Furthermore, subjective cognitive complaint using scale score and gait speed using instrument gait showed higher MCR prevalence.

CONCLUSION

MCR is common in older adults, and various epidemiological characteristics influence its prevalence. Thus, preventive measures are required for older adults with higher MCR prevalence.

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

We aimed to refine the hypothesis that motoric cognitive risk (MCR), a syndrome combining measured slow gait speed and self-reported cognitive complaints, is prognostic of incident dementia and other major causes of morbidity in older age. We propose mechanisms on the relationship between motor and cognitive function and describe a roadmap to validate these hypotheses. We systematically searched major electronic databases from inception to August 2021 for original longitudinal cohort studies of adults aged ≥60 years that compared an MCR group to a non-MCR group with any health outcome. Fifteen cohorts were combined by meta-analysis. Participants with MCR were at an increased risk of cognitive impairment (adjusted hazard ratio [aHR] 1.76, 95% CI 1.49-2.08; I²  = 24.9%), dementia (aHR 2.12, 1.85-2.42; 33.1%), falls (adjusted Relative Risk 1.38, 1.15-1.66; 62.1%), and mortality (aHR 1.49, 1.16-1.91; 79.2%). The prognostic value of MCR is considerable and mechanisms underlying the syndrome are proposed.

Motoric cognitive risk syndrome as a predictor of incident disability: A 7 year follow-up study

Background

Though motoric cognitive risk syndrome (MCR) share risk factors with disability, whether it predict disability remains understudied.

Objectives

This study aims to examine the association between MCR and incident disability.

Design

Longitudinal study.

Methods

MCR was defined as subjective cognitive complaints and objective slow gait speed. Two subtypes of MCR were defined by whether memory impairment (MI) was also present, MCR-MI and MCR-non-MI. Incident activities of daily living (ADL) disability and instrumental activities of daily living (IADL) disability were outcome measures. Multiple logistic regression analysis was used to assess the independent effect of MCR at baseline on the odds of ADL/IADL disability at a 7 year follow-up.

Results

Among the subjects who were not disabled at baseline and followed for 7 years, 34.66% reported incident ADL disability, and 31.64% reported incident IADL disability. Compared with participants without MCR at baseline, those with MCR had 58% increased odds of incident ADL disability (OR=1.58, 95% CI: 1.19–2.09) and 46% increased odds of incident IADL disability (OR=1.46, 95% CI: 1.13–1.88) after 7 years. MCR-non-MI was associated with a 56.63% increased risk of ADL disability and a 34.73% increased risk of IADL disability. MCR-MI was associated with an even higher risk of IADL disability (OR = 2.14, 95% CI: 1.18–3.88).

Conclusions

MCR is an independent risk factor for both incident ADL and IADL disability. MCR-MI predicts a higher risk for disability than MCR-non-MI. Early identification of MCR among older adult is recommended and may decrease future risk of disability.

Plasma metabolomics and lipidomics signatures of motoric cognitive risk syndrome in community-dwelling older adults

Introduction

Motoric cognitive risk syndrome (MCR) is characterized by subjective cognitive complaints (SCCs) and slow gait (SG). Metabolomics and lipidomics may potentiate disclosure of the underlying mechanisms of MCR.

Methods

This was a cross-sectional study from the West China Health and Aging Trend cohort study (WCHAT). The operational definition of MCR is the presence of SCCs and SG without dementia or mobility disability. The test and analysis were based on untargeted metabolomics and lipidomics, consensus clustering, lasso regression and 10-fold cross-validation.

Results

This study enrolled 6,031 individuals for clinical analysis and 577 plasma samples for omics analysis. The overall prevalence of MCR was 9.7%, and the prevalence of MCR-only, assessed cognitive impairment-only (CI-only) and MCR-CI were 7.5, 13.3, and 2.1%, respectively. By consensus clustering analysis, MCR-only was clustered into three metabolic subtypes, MCR-I, MCR-II and MCR-III. Clinically, body fat mass (OR = 0.89, CI = 0.82–0.96) was negatively correlated with MCR-I, and comorbidity (OR = 2.19, CI = 1.10–4.38) was positively correlated with MCR-III. Diabetes mellitus had the highest ORs above 1 in MCR-II and MCR-III (OR = 3.18, CI = 1.02–9.91; OR = 2.83, CI = 1.33–6.04, respectively). The risk metabolites of MCR-III showed relatively high similarity with those of cognitive impairment. Notably, L-proline, L-cystine, ADMA, and N1-acetylspermidine were significantly changed in MCR-only, and PC(40:3), SM(32:1), TG(51:3), eicosanoic acid(20:1), methyl-D-galactoside and TG(50:3) contributed most to the prediction model for MCR-III.

Interpretation

Pre-dementia syndrome of MCR has distinct metabolic subtypes, and SCCs and SG may cause different metabolic changes to develop MCR.

The association of white matter hyperintensities with motoric cognitive risk syndrome

BACKGROUND

The motoric cognitive risk syndrome (MCR) was characterized by slow gait and subjective cognitive complaints. MCR was associated with brain structural changes. However, the association between white matter hyperintensities (WMH) and MCR was unclear and the aim of this study was to examine this association.

MATERIAL AND METHODS

The study participants were 1227 older adults (mean age: 72.0 ± 6.0 yrs, women: 52.6%). We collected magnetic resonance imaging (MRI) data to assess WMH. To assess MCR, data on gait speed and subjective cognitive complaints were collected. Demographical and medical data was collected as covariates.

RESULTS

Among participants, the proportion of MCR was 5.0% (n = 61) and severe WMH was 16.8% (n = 206). From logistic regression analysis, severe WMH associated with MCR even when adjusted for covariates (odds ratio 2.18 [95% confidential interval 1.15-4.16], p = 0.017). This association was observed in subgroups stratified by the participants' characteristics: higher age, not having fall history, not obesity, not being physical inactivity and not having depressive symptom.

CONCLUSIONS

Our findings revealed that vascular pathophysiological changes in the brain were associated with MCR. The association was pronounced by several factors. Further evaluation was required to clarify pathophysiology of MCR.

Motoric cognitive risk syndrome and incident hospitalization in Quebec's older population: Results of the NuAge cohort study

Background

Screening older adults at risk of hospitalization is essential to prevention of this adverse event. Motoric cognitive risk syndrome (MCR) has been associated with incident dementia and falls, which are both risk factors of hospitalization. There is no information on the association of MCR with incident hospitalization in older adults.

Objective

The study aims to examine the association of MCR with incident hospitalization in community-dwelling older adults.

Design

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

Setting

Community dwellings.

Subjects

A subset of 999 participants recruited in the NuAge study.

Methods

Participants with MCR (i.e., with slow gait and cognitive complaint without dementia or motor disability) were identified at baseline assessment. Incident hospitalization (i.e., ≥1) and its recurrence (i.e., ≥2) were collected annually over a 3 year follow-up period.

Results

The prevalence of MCR was 5.0% at baseline. The overall incidence of hospitalization was 29.0% and its recurrence 4.8%. MCR was associated with incident recurrent hospitalization [adjusted Hazard Ratio (aHR) = 2.58 with 95% Confidence Interval (CI) = (1.09–6.09) and P = 0.031], but not with incident hospitalization [aHR = 1.48, with 95%CI = (0.95–2.28) and P = 0.081].

Conclusion

MCR is associated with incident recurrent hospitalization in NuAge participants, suggesting that MCR may be of clinical interest for screening individuals at risk for hospitalization in Quebec's older population.

Motoric cognitive risk syndrome in people with multiple sclerosis: prevalence and correlations with disease-related factors

Background:

The motoric cognitive risk (MCR) syndrome, defined as the coexistence of slow gait and subjective cognitive complaints, has as yet not been researched in people with multiple sclerosis (pwMS).

Objective:

To examine the prevalence of the MCR syndrome in pwMS and its association with disability, disease duration, perceived fatigue, and fear of falling.

Methods:

The study comprised 618 pwMS [43.7 (SD = 12.6) years, 61.7% females]. Gait speed was measured by the GAITRite™ electronic walkway (CIR Systems, Inc. Haverton, PA, USA). Cognitive status was defined according to the global cognitive score computed by the NeuroTrax™ cognitive battery (NeuroTrax Corporation, Medina, NY, USA). The sample was divided into four main groups: ‘normal’, ‘cognitively impaired’, ‘gait impaired’ or ‘MCR’. Perceived fatigue was assessed by the Modified Fatigue Impact Scale; fear of falling by the Falls Efficacy Scale International.

Results:

Sixty-three (10.2%) patients were diagnosed with MCR. The percentage of subjects categorized as MCR was 26.0% in severely disabled pwMS compared with 10.9%, 6.0%, and 4.6% in moderately, mildly and very mildly disabled pwMS, respectively. Subjects in the MCR group presented with elevated fatigue compared with patients classified as normal [49.7 (SD = 23.3) vs 26.5 (SD = 19.2), p < 0.001]. Fear of falling was significantly higher in the MCR and gait impairment groups compared with the cognitively impaired and normal groups.

Conclusions:

The current study corroborates the presence of MCR in pwMS. Nevertheless, future longitudinal research is warranted to better understand its application.

Facets of conscientiousness and motoric cognitive risk syndrome

Conscientiousness is related to a lower risk of motoric cognitive risk syndrome (MCR), a pre-dementia syndrome characterized by slow gait speed and cognitive complaints. The present study examines which facets of conscientiousness are related to concurrent and incident MCR. Participants were dementia-free older adults aged 65-99 years (N = 6001) from the Health and Retirement Study (HRS). Baseline data on conscientiousness facets and MCR (cognitive complaints and gait speed) were collected in 2008/2010, along with the covariates: demographic factors, cognition, physical activity, disease burden, depressive symptoms, and body mass index (BMI). MCR was assessed again in 2012/2014 and 2016/2018. Controlling for demographic factors, higher industriousness was related to a nearly 30% lower likelihood of concurrent MCR (Odds Ratio [OR] = 0.75, 95%CI: 0.67-0.85, p < .001) and to about 60% reduced risk of incident MCR (Hazard ratio [HR] = 0.63, 95%CI: 0.56-0.71, p < .001). Self-control, order, and responsibility were also associated with a lower likelihood of concurrent (OR range: 0.82-0.88) and incident (HR range: 0.72-0.82) MCR. Traditionalism (HR = 0.84, 95%CI: 0.75-0.93, p < .01) and virtue (HR = 0.84, 95%CI: 0.75-0.93, p < .01) were related to a lower risk of incident MCR. Cognition, physical activity, disease burden, depressive symptoms, and BMI partially accounted for these associations. Industriousness is the facet of conscientiousness with the strongest association with risk of MCR. This facet could be targeted in interventions to reduce MCR and, ultimately, dementia.

Prevalence and Correlates of Motoric Cognitive Risk Syndrome in Chinese Community-Dwelling Older Adults

Background: Motoric cognitive risk (MCR) syndrome is considered to be a pre-dementia syndrome. Although an increasing number of studies have begun to focus on this syndrome, few investigations have been launched in China. This study was performed to examine the prevalence and correlates of MCR in China.

Methods: We included 5,725 adults aged over 60 years from China Health and Retirement Longitudinal Study (CHARLS). MCR was defined as the presence of subjective cognitive complaints and a gait speed ≤20th percentile of the weighted population distribution adjusted for sex and height. The associations among selected modifiable associated factors and clinical measures with MCR were examined using multivariate logistic regression analysis.

Results: Of the participants, 414 met the criteria for MCR with an overall prevalence 7.29% (95% CI: 6.62–7.96%). MCR was found to be more prevalent among women than men (9.73 vs 4.85%), and more prevalent among participants ≥75 years than those &lt;75 years (7.85 vs 5.23%). After multivariable adjustment, lower or upper extremity functional limitations, activities of daily living (ADL) disabilities, weak grip strength, exhaustion, and history of hypertension were found to be significantly associated with MCR. The multivariate analysis also showed higher levels of cystatin C and C-reactive protein were associated with increased odds for MCR.

Conclusions: The present study showed that MCR syndrome is highly prevalent among Chinese community-dwelling older adults, and revealed several factors that were correlated with MCR. Longitudinal studies are warranted to further explore the modifiable risk factors of MCR.

Motoric Cognitive Risk Syndrome, Subtypes and 8-Year All-Cause Mortality in Aging Phenotypes: The Salus in Apulia Study

Background: This study aims to establish the key clinical features of different motoric cognitive risk (MCR) subtypes based on individual quantitative measures of cognitive impairment and to compare their predictive power on survival over an 8-year observation time. Methods: We analyzed data from a population-based study of 1138 subjects aged 65 years and older in south Italy. These individuals were targeted and allocated to subtypes of the MCR phenotype according to the slowness criterion plus one other different cognitive domain for each characterized phenotype (Subjective Cognitive Complaint [SCC]; Global Function [Mini Mental State Examination (MMSE) < 24]; or a combination of both). Clinical evaluation and laboratory assays, along with a comprehensive battery of neuropsychological and physical tests, completed the sample investigation. Results: MCR prevalence was found to be 9.8% (n = 112), 3.6% (n = 41), 3.4% (n = 39) and 1.8% (n = 21) for the MCR, MCR-GlobalFunction, MCR-StructuredSCC and MCR-SCC and GlobalFunction, respectively. Univariate Cox survival analysis showed an association only of the MCR-GlobalFunction subtype with an almost three-fold increased risk of overall death as compared to the other counterparts (HR 2.53, 95%CI 1.28 to 4.99) over an 8-year observation period. Using Generalized Estimating Equations (GEE) for clustered survival data, we found that MCR males had an increased and significant mortality risk with respect to MCR female subjects. Conclusions: MCR phenotypes assigned to the MMSE cognitive domain are more likely to have an increased risk of overall mortality, and gender showed a huge effect on the risk of death for MCR subjects over the 8-year observation.

Motoric Cognitive Risk Syndrome: Prevalence and Cognitive Performance. A cross-sectional study

Background

Motoric Cognitive Risk Syndrome (MCR) is a predementia stage where slow gait speed and subjective memory complaints are present. The purpose of this study was to estimate the prevalence of MCR and assess its relationship with sociodemographic factors and chronic conditions.

Methods

This is a secondary analysis of the SABE Colombia study conducted in 2015. The analytic sample consisted of 17·577 participants. After determining MCR prevalence, logistic regression was performed to examine the correlates of MCR.

Findings

The prevalence of MCR was 10·71 %. The median age was 71 years and women composed 74·63 % of the MCR group. After adjusting for confounding variables MCR was associated with increasing age (OR 1·69, CI 1·43 - 1·92), no or low education (OR 1·99, CI 1·67- 2·37), MMSE (OR 0·93, CI 0·91 - 0·95) and chronic conditions such as mental disorders (OR 1·36, CI 1·11-1·67), history of myocardial infarction (OR 1·24, CI 1·04 - 1·47), hypertension (OR 1·23, CI 1·08 - 1·40) and diabetes (OR 1.18, CI 1.01 - 1.37).

Interpretation

This study found a prevalence of 10·71 % of MCR in Colombian older adults. Additionally, MCR was associated with chronic conditions and sociodemographic factors identified in prior studies. These results increase the awareness of a novel predementia stage whose identification can be performed by clinicians in the outpatient clinic, minimizing the cost of a full neuropsychologic evaluation performed in a memory clinic.

Funding

Funded by the Administrative Department of Science, Technology and Innovation (Colciencias) and the Ministry of Health and Social Protection of Colombia.

Mixed Neuropathologies, Neural Motor Resilience and Target Discovery for Therapies of Late-Life Motor Impairment

By age 85, most adults manifest some degree of motor impairment. However, in most individuals a specific etiology for motor decline and treatment to modify its inexorable progression cannot be identified. Recent clinical-pathologic studies provide evidence that mixed-brain pathologies are commonly associated with late-life motor impairment. Yet, while nearly all older adults show some degree of accumulation of Alzheimer's disease and related dementias (ADRD) pathologies, the extent to which these pathologies contribute to motor decline varies widely from person to person. Slower or faster than expected motor decline in the presence of brain injury and/or pathology has been conceptualized as more or less "resilience" relative to the average person This suggests that other factors, such as lifestyles or other neurobiologic indices may offset or exacerbate the negative effects of pathologies via other molecular pathways. The mechanisms underlying neural motor resilience are just beginning to be illuminated. Unlike its cousin, cognitive resilience which is restricted to neural mechanisms above the neck, the motor system extends the total length of the CNS and beyond the CNS to reach muscle and musculoskeletal structures, all of which are crucial for motor function. Building on prior work, we propose that by isolating motor decline unrelated to neuropathologies and degeneration, investigators can identify genes and proteins that may provide neural motor resilience. Elucidating these molecular mechanisms will advance our understanding of the heterogeneity of late-life motor impairment. This approach will also provide high value therapeutic targets for drug discovery of therapies that may offset the negative motor consequences of CNS pathologies that are currently untreatable.

Sarcopenia and motoric cognitive risk syndrome: a moderated mediation model

Background

Sarcopenia has been identified as a risk factor for cognitive impairment, and motoric cognitive risk syndrome (MCR) is a recently defined pre-dementia syndrome. It is not known whether they are related. We aimed to investigate the association and potential pathways between sarcopenia and MCR in the community elderly by establishing a moderated mediation model.

Methods

846 community residents aged ≥ 60 years were recruited from May 2021 to September 2021 and had a comprehensive geriatric evaluation. The diagnosis of sarcopenia followed the criteria issued by the Asian Working Group for Sarcopenia in 2019. MCR was defined as subjective cognitive decline and slow gait. Apathy symptoms and physical activity were assessed by the Apathy Evaluation Scale (AES) and the International Physical Activity Questionnaire (IPAQ). Logistic regression and moderated mediation analyses were conducted to explore the association between the four.

Results

60 (7.1%) had MCR among 846 participants. After full adjustment, sarcopenia (odds ratio [OR] = 3.81, 95% confidence interval [CI] = 1.69–8.60, P = 0.001), AES score (OR = 1.09, 95% CI = 1.04–1.14, P < 0.001), and IPAQ level (OR = 0.43, 95% CI = 0.28–0.66, P < 0.001) were associated with MCR. Apathy partially mediated the relationship between sarcopenia and MCR. Physical activity played a moderation role in the indirect pathway of the mediation model. The increase in physical activity can alleviate the indirect effect of sarcopenia on MCR.

Conclusion

We established a moderated mediation model to uncover the underlying association mechanism of sarcopenia and MCR preliminarily. These findings suggest that attention should be paid to the management of apathy and physical activity in the context of sarcopenia to prevent early dementia actively. Further validation is needed in future longitudinal studies.

Risk factors, neuroimaging correlates and prognosis of the motoric cognitive risk syndrome: a population-based comparison with mild cognitive impairment

Background and purpose

This study was undertaken to compare risk factors, neuroimaging characteristics and prognosis between two clinical prodromes of dementia, namely, the motoric cognitive risk syndrome (MCRS) and mild cognitive impairment (MCI).

Methods

Between 2009 and 2015, dementia‐free participants of the population‐based Rotterdam Study were classified with a dementia prodrome if they had subjective cognitive complaints and scored >1 SD below the population mean of gait speed (MCRS) or >1.5 SD below the population mean of cognitive test scores (MCI). Using multinomial logistic regression models, we determined cross‐sectional associations of risk factors and structural neuroimaging markers with MCRS and MCI, followed by subdistribution hazard models, to determine risk of incident dementia until 2016.

Results

Of 3025 included participants (mean age = 70.4 years, 54.7% women), 231 had MCRS (7.6%), 132 had MCI (4.4%), and 62 (2.0%) fulfilled criteria for both. Although many risk factors were shared, a higher body mass index predisposed to MCRS, whereas male sex and hypercholesterolemia were associated with MCI only. Gray matter volumes, hippocampal volumes, white matter hyperintensities, and structural white matter integrity were worse in both MCRS and MCI. During a mean follow‐up of 3.9 years, 71 individuals developed dementia and 200 died. Five‐year cumulative risk of dementia was 7.0% (2.5%–11.5%) for individuals with MCRS, versus 13.3% (5.8%–20.8%) with MCI and only 2.3% (1.5%–3.1%) in unaffected individuals.

Conclusions

MCRS is associated with imaging markers of neurodegeneration and risk of dementia, even in the absence of MCI, highlighting the potential of motor function assessment in early risk stratification for dementia.

Methodology of Measuring Motoric Cognitive Risk Syndrome-Focusing on Slow Gait Speed: Protocol for a Systematic Review

INTRODUCTION

Older adults with motoric cognitive risk (MCR) syndrome are at high risk of developing dementia. Although the definition of MCR is well recognized and consensus, previous studies did not reach an agreement on diagnostic criteria and measurement methods/tools for slow gait speed, which is one of four components of MCR diagnosis. The substantial heterogeneity in the methodology of slow gait speed diagnosis for MCR limits comparability and meta-analysis of studies.

OBJECTIVE

The study aims to conduct systematic and standardized integration for diagnostic criteria and methods of slow gait speed diagnosis for MCR based on previous evidence that may improve comparability between future studies.

METHODS

A systematic literature review will be undertaken by searching the following electronic databases (until February 1, 2022): PUBMED, EMBASE, The Cochrane Library, Web of Science. Additional studies will be identified by checking the reference lists of included studies or relevant reviews, manually searching the internet search engine Google Scholar, and searching the authors' personal files, if necessary. Two researchers will perform data extraction independently, and discrepancies will be resolved by discussion, which will include a third researcher if requires. The paper selection will perform in duplicate. Finally, a narrative account will synthesize the findings to answer the objectives of this review.

DISCUSSION

This is the first study on systematic and standardized integration for diagnostic criteria and measurement methods/tools for slow gait speed in diagnosing MCR. The findings of this study will be convenient for medical staff to examine the intended use and applicability of each instrument/tool for evaluating the gait speed, and provide insight into developing uniform guidelines for MCR.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number: CRD42021232671.

Association of Motoric Cognitive Risk Syndrome with Cardiovascular and Noncardiovascular Factors: A Systematic Review and Meta-Analysis

OBJECTIVES

Motoric cognitive risk syndrome (MCR) is a recently proposed predementia syndrome characterized by subjective cognitive impairment and slow gait. We aim to assess the cardiovascular and noncardiovascular factors associated with MCR.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Studies comparing patients with MCR to those without MCR, and identifying the factors associated with MCR.

METHODS

We used databases, including PubMed, Cochrane CENTRAL, and Embase, to identify studies evaluating the factors associated with MCR. Mean differences, odds ratios (ORs), risk ratios (RRs), and hazard ratios (HRs) with 95% CIs were calculated using Review Manager.

RESULTS

Meta-analysis revealed that all cardiovascular factors, including diabetes (21 studies; OR 1.50, 95% CI 1.37, 1.64), hypertension (21 studies; OR 1.20, 95% CI 1.08, 1.33), stroke (16 studies; OR 2.03, 95% CI 1.70, 2.42), heart disease (7 studies; OR 1.45, 95% CI 1.13, 1.86), coronary artery disease (5 studies; OR 1.49, 95% CI 1.16, 1.91), smoking (13 studies; OR 1.28, 95% CI 1.04, 1.58), and obesity (12 studies; OR 1.34, 95% CI 1.13, 1.59) were significantly higher in the MCR than the non-MCR group. Noncardiovascular factors, including age (22 studies; MD = 1.08, 95% CI 0.55, 1.61), education (8 studies; OR 2.04, 95% CI 1.28, 3.25), depression (17 studies; OR 2.19, 95% CI 1.65, 2.91), prior falls (9 studies; OR 1.45, 95% CI 1.17, 1.80), arthritis (6 studies; OR 1.35, 95% CI 1.07, 1.70), polypharmacy (5 studies; OR 1.65, 95% CI 1.07, 2.54), and sedentary lifestyle (11 studies; OR 2.00, 95% CI 1.59, 2.52), were significantly higher in the MCR than in the non-MCR group. Alcohol consumption (6 studies; OR 0.84, 95% CI 0.72, 0.98), however, favored the MCR over the non-MCR group. Additionally, there was no significant association of MCR with gender (22 studies; OR 1.04, 95% CI 0.94, 1.15) and cancer (3 studies; OR 2.39, 95% CI 0.69, 8.28). MCR was also significantly associated with an increased likelihood of incident dementia (5 studies; HR 2.84, 95% CI 1.77, 4.56; P < .001), incident cognitive impairment [2 studies; adjusted hazard ratio (aHR) 1.76, 95% CI 1.44, 2.15], incident falls (4 studies; RR 1.37, 95% CI 1.17, 1.60), and mortality (2 studies; aHR 1.58, 95% CI 1.35, 1.85).

CONCLUSIONS AND IMPLICATIONS

MCR syndrome was significantly associated with diabetes, hypertension, stroke, obesity, smoking, low education, sedentary lifestyle, and depression. Moreover, MCR significantly increased the risk of incident dementia, cognitive impairment, falls, and mortality.

Walking While Talking and Prefrontal Oxygenation in Motoric Cognitive Risk Syndrome: Clinical and Pathophysiological Aspects

BACKGROUND

Motoric cognitive risk syndrome (MCR) combines slow gait and cognitive complaints and has been proposed as a predementia syndrome. The nature of dual-task performance in MCR has not been established.

OBJECTIVE

To assess differences in dual-task performance between participants with and without MCR and to study the prefrontal cortex (PFC)-based brain activity during dual-task using functional near-infrared spectroscopy.

METHODS

Cohort study of community-dwelling non-demented older adults included in the "Central Control of Mobility in Aging" study. Comprehensive assessment included global cognition and executive function tests along with clinical variables. Dual-task paradigm consisted in walking while reciting alternate letters of the alphabet (WWT) on an electronic walkway. We compared dual-task performance between MCR (n = 60) and No MCR (n = 478) participants and assessed the relationship of dual-task performance with cognitive function. In a subsample, we compared PFC oxygenation during WWT between MCR (n = 32) and No MCR (n = 293).

RESULTS

In our sample of 538 high-functioning older adults (76.6±6.5 years), with 11.2% prevalence of MCR, dual-task cost was not significantly different, compared to No MCR participants. Among MCR participants, no significant relationship was found between WWT velocity and cognitive function, whereas No MCR participants with better cognitive function showed faster WWT velocities. PFC oxygenation during WWT was higher in MCR compared to No MCR (1.02±1.25 versus 0.66±0.83, p = 0.03).

CONCLUSION

MCR participants showed no significant differences in the dual-task cost while exhibiting higher PFC oxygenation during dual-task walking. The dual-task performance (WWT velocity) in MCR participants was not related to cognition.

Role of handgrip strength in predicting new-onset diabetes: findings from the survey of health, ageing and retirement in Europe

BACKGROUND

Diabetes is a major concern for the global health burden. This study aimed to investigate the relationship between handgrip strength (HGS) and the risk of new-onset diabetes and to compare the predictive abilities between relative HGS and dominant HGS.

METHODS

This longitudinal study used data from the Survey of Health, Ageing and Retirement in Europe (SHARE), including 66,100 European participants aged 50 years or older free of diabetes at baseline. The Cox proportional hazard model was used to analyze the relationship between HGS and diabetes, and the Harrell's C index, net reclassification index (NRI), and integrated discrimination improvement (IDI) were calculated to evaluate the predictive abilities of different HGS expressions.

RESULTS

There were 5,661 diabetes events occurred during follow-up. Compared with individuals with lowest quartiles, the hazard ratios (95 % confidence intervals) of the 2nd-4th quartiles were 0.88 (0.81-0.94), 0.82 (0.76-0.89) and 0.85 (0.78-0.93) for dominant HGS, and 0.95 (0.88-1.02), 0.82 (0.76-0.89) and 0.60 (0.54-0.67) for relative HGS. After adding dominant HGS to an office-based risk score (including age, gender, body mass index, smoking, and hypertension), the incremental values of the Harrell's C index, NRI, IDI of relative HGS were all slightly higher than those of dominant HGS in both training and validation sets.

CONCLUSIONS

Our findings supported that HGS was an independent predictor of new-onset diabetes in the middle-aged and older European population. Moreover, relative HGS exhibited a slightly higher predictive ability than dominant HGS.

Prevalence/potential risk factors for motoric cognitive risk and its relationship to falls in elderly Chinese people: a cross-sectional study

BACKGROUND AND PURPOSE

Motoric cognitive risk syndrome (MCR) is characterized by slow walking speed and subjective memory complaints (SMCs). This study investigated the prevalence and potential risk factors of MCR and its association with falls in Chinese community-dwelling older adults.

METHODS

The analysis was based on data from the Rugao Longevity and Aging Study (RuLAS). MCR was defined as the presence of both SMCs and slow walking speed in participants free of major neurocognitive disorders. SMCs were determined according to a positive answer to the question 'Do you feel you have more problems with memory than most?' in the 15-item Geriatric Depression Scale. Slow walking speed was defined as one standard deviation or more below the mean value for patients' age and sex. Data on falls were derived from a standardized questionnaire.

RESULTS

The prevalence of SMCs, slow walking speed and MCR in the RuLAS cohort (N = 1592) was 51.9%, 15.6% and 8.3%, respectively. After adjusting for other covariates, an occupation of farming (odds ratio [OR] 2.358, 95% confidence interval [CI] 1.007-5.521, p = 0.048), history of cerebrovascular disease (OR 2.215, 95% CI 1.032-4.752, p = 0.041) and hospitalization (OR 2.008, 95% CI 1.120-3.602, p = 0.019) were risk factors for MCR. Binary logistic regression analysis indicated that the risk of falls was increased by MCR (OR 1.547, 95% CI 1.009-2.371), SMC (OR 1.308, 95% CI 1.003-1.707) and slow walking speed (OR 1.442, 95% CI 1.030-2.017).

CONCLUSIONS

Early identification of potential risk factors of MCR can prevent the occurrence of adverse health events such as falls in the elderly.

Medical aromatherapy in geriatric syndrome

Geriatric syndromes are symptoms and signs, such as falls, incontinence, delirium, pressure ulcers, dysphagia and so on, that often threaten the independence of older adults, rather than the disease itself. Although the syndromes are very common in older people, it is difficult to treat those by modern medicine due to their complexity. To mitigate the intractable geriatric symptoms, we review the efficacy of aromatherapy, especially for dysphagia, dyspnea, cognitive dysfunction and falls in geriatric syndrome. Olfactory stimulation using a volatile black pepper oil on institutional residents improved the swallowing reflex, which is a crucial risk factor of aspiration pneumonia. Brain imaging study showed that olfactory stimulation using volatile black pepper oil activated cerebral regions of the anterior cingulate and the insular cortex, which play a role in controlling appetite and swallowing. Also, aromatherapy with volatile l-menthol decreased the sense of dyspnea and improved the efficacy of exercise therapy. The fragrance of the combination of rosemary and lemon oils in the morning, and the combination of lavender and orange oils in the night-time were reported to improve cognition and behavioural and psychological symptoms of dementia, respectively. Also, the combination of lavender and lemon balm oils was reported to be effective for irritability-related agitation in older adults. Furthermore, aromatherapy with lavender fragrance could improve both static and dynamic balance, resulting in a reduction in the number of fallers and the incidence rate in older people. Thus, aromatherapy is a promising remedy for geriatric syndrome. Geriatr Gerontol Int 2021; 21: 377-385.

The Association between Subjective Age and Motoric Cognitive Risk Syndrome: Results from a Population-Based Cohort Study

OBJECTIVES

The motoric cognitive risk (MCR) syndrome, characterized by cognitive complaints and slower gait speed, is a pre-dementia syndrome associated with dementia and mortality risk. The present study examined whether subjective age, that is how old or young individuals feel relative to their chronological age, is related to concurrent and incident MCR syndrome. A relation between subjective age and MCR will inform knowledge on psychological factors related to dementia risk, identify who is at greater risk, and suggest a potential target of intervention.

METHOD

The study sample was composed of 6,341 individuals aged 65 to 107 years without dementia from the Health and Retirement Study (HRS), a longitudinal study of adults aged 50 years and older. Participants completed measures of subjective age, cognitive complaints, and gait speed and provided information on demographic factors, cognition, physical activity, depressive symptoms, and body mass index (BMI) at baseline in 2008/2010. Incident MCR was assessed four and eight years later.

RESULTS

Controlling for demographic factors, an older subjective age was related to more than 60% higher likelihood of MCR at baseline and to around 50% higher risk of incident MCR over time. These associations remained significant when cognition, physical inactivity, depressive symptoms, and BMI were included in the analytic models.

CONCLUSION

This study provides evidence that how old individuals feel is related to concurrent and incident MCR beyond the effect of chronological age, other demographic factors, physical inactivity, depressive symptoms, BMI, and cognitive functioning.

Purpose in Life and Motoric Cognitive Risk Syndrome: Replicable Evidence from Two National Samples

BACKGROUND/OBJECTIVES

Motoric cognitive risk (MCR) syndrome is characterized by cognitive complaints and slow gait speed in the absence of dementia. Consistent evidence indicates that it predicts dementia and premature mortality. Less is known about its antecedents, particularly the role of psychological function. Purpose in life is an aspect of well-being that reflects a goal-oriented and -driven life that has been implicated in cognitive aging. We aimed to examine the cross-sectional association between purpose in life and MCR and to test the hypothesis that purpose is associated with a lower risk of new cases of MCR over an up to 12-year follow-up.

DESIGN

Cross-sectional and longitudinal multi-cohort design.

SETTING

Health and Retirement Study (HRS) and the National Health and Aging Trends Study (NHATS).

PARTICIPANTS

A total of 6,785 individuals from the HRS and 5,665 from the NHATS.

MEASUREMENTS

Participants reported on their purpose in life and cognitive complaints and completed a walking speed assessment. Cognitive complaints and walking speed were assessed again up to 12 years later in HRS and up to 7 years later in NHATS.

RESULTS

Higher purpose in life was associated with a 33% lower risk of MCR concurrently (meta-analytic odds ratio = .75; 95% confidence interval [CI] = .62-.90; P = .002) and an about 26% lower risk of incident MCR longitudinally (meta-analytic hazard ratio = .77; 95% CI = .70-.84; P < .001). These associations were significant in each sample, were independent of sociodemographic covariates, and persisted after controlling for personality and health-related factors (depressive symptoms, physical activity, disease burden).

CONCLUSION

Purpose in life is associated with a lower risk of incident MCR, an association that was replicated in two independent samples. Purpose is a malleable aspect of psychological function that is a promising target of intervention for healthier cognitive aging.

Association between sleep disturbance with motoric cognitive risk syndrome in Chinese older adults

BACKGROUND AND PURPOSE

Sleep disturbance and cognitive impairment are common and related in the elderly population worldwide. The aim of the present study was to explore the association between sleep disturbance and motoric cognitive risk (MCR) syndrome, which is characterized by subjective cognitive complaints and objective slow gait in older individuals without dementia or any mobility disability in the community-dwelling elderly Chinese population.

METHODS

We recruited 940 participants aged ≥65 years from November 2016 to March 2017 in the Ningbo Community Study on Aging (NCSA). Self-reported sleep duration and sleep-quality variables, comprehensive geriatric evaluation, as well as indicators for diagnosing MCR syndrome were evaluated in this cross-sectional study.

RESULTS

Multiple logistic regression analysis showed that a 1-SD increase in night (1.1 h) and 24-h sleep duration (1.3 h) was associated, respectively, with a 21% (95% confidence interval [CI], 1%-47%; p = 0.04) and 30% (95% CI, 3%-64%; p = 0.03) higher odds of having MCR syndrome. Considering sleep duration as a categorical variable, longer night-sleep duration (>8.5 h) was associated with MCR syndrome (OR, 2.03; p = 0.02) compared to shorter night-sleep duration (<8 h). For sleep-quality factors, increasing frequency of trouble falling asleep, waking early or easily, nightmares, and taking sleep drugs were significantly associated with MCR syndrome after adjusting for potential covariables (all p for trend < 0.05), but not for self-perceived sleep quality (p for trend = 0.10).

CONCLUSIONS

Long sleep duration, poor sleep quality, and taking sleep drugs were associated with higher odds of having MCR syndrome in the community-dwelling elderly Chinese population. Further research is needed to explore the underlying mechanisms.