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

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.

Comparisons of four cognitive-frailty measures in predicting dementia and disability

BACKGROUND

Several cognitive-frailty (CF) measurements, such as traditional CF, the CF phenotype, physio-cognitive decline syndrome (PCDS), and motoric cognitive risk syndrome (MCRS) have been developed but their predictive abilities for incident dementia and incident disability are seldom compared. We conducted a 2-year prospective study to compare the associations of traditional CF, the CF phenotype, PCDS, and MCRS with incident dementia and incident disability.

METHODS

In total, 755 individuals aged 65 years or older, without preexisting dementia or disability, participated in the baseline assessment and were subsequently monitored over a 2-year period. Data on cognitive and frailty components of traditional CF, the CF phenotype, PCDS, and MCRS, were collected. The logistic regression model was used to investigate independent associations of each CF measure with incident dementia and incident disability.

RESULTS

In total, 505 participants completed the two annual follow-ups. After adjusting for other CF measures, age, and sex, incident dementia was significantly associated with PCDS (odds ratio [OR] = 2.54; 95% confidence interval [CI], 1.25 ~ 5.19) but was not significantly associated with traditional CF, the CF phenotype, or MCRS, and incident disability was significantly associated with the CF phenotype (OR = 2.90; 95% CI, 1.59 ~ 5.30) but was not significantly associated with traditional CF, PCDS, or MCRS. After adjusting for other CF measures, age, sex, educational level, and other variables, incident dementia was not independently associated with any CF measure, while the association of incident disability with the CF phenotype remained significant (OR = 2.72; 95% CI, 1.45 ~ 5.11).

CONCLUSIONS

The CF phenotype, MCRS, and PCDS can possibly identify a higher number of CF cases than can the traditional CF measure. While the CF phenotype was a significant predictor of incident disability, all four CF measures lacked an independent association with incident dementia over a 2-year period. Future studies with a longer study period are needed to validate our results.

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.

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.

Stumbles, Gait, and Cognition: Risk Factors Associated with Falls in Older Adults with Subjective Memory Complaints

Falls are a public health problem, impacting quality of life, independence, and health costs. Subjective memory complaints (SMCs) and mild cognitive impairment (MCI) increase with age and may coexist. The risk of falls coinciding with SMCs is less understood. This study explored the risk factors associated with falls in adults with SMCs or MCI. A case-control study in adults over 50 was conducted. All participants underwent a neuropsychological assessment and a Timed Up and Go (TUG) test for gait analysis. Logistic regression calculated OR and p values, adjusting for demographic, clinical, cognitive, and gait variables. There was a total of 64 patients (47.06%) and 72 controls (52.94%). Fallers were older (70.76 ± 7.31) and had hypertension (29.63%), a history of stumbling (13.97%), slow TUG test performance (19.12%), and an asymmetric arm swing (19.85%). Fallers had lower verbal fluency (p = 0.043) and impairment on the Rey-Osterrieth figure copy (p = 0.047). Highest risk factors included female sex (OR 3.55, p = 0.006), older age (OR= 1.08, p = 0.006), hypertension (OR 3.33, p = 0.005), and stumbles (OR 5.65, p = 0.002). This study reconsiders clinical fall risk assessments in older adults with SMCs. Visuo-constructional abilities and executive dysfunction should be followed over time. Female sex, hypertension, and stumbles are risk factors. Integrated cognitive and motor assessments are crucial for detecting and proposing interventions for fall prevention in this population.

Development and validation of a nomogram for predicting motoric cognitive risk syndrome among community-dwelling older adults in China: a cross-sectional study

Background

Motoric cognitive risk (MCR) syndrome is characterized by slow gait speed and subjective cognitive complaints (SCC) and increases the risk of dementia and mortality.

Objective

This study aimed to examine the clinical risk factors and prevalence of MCR in community-dwelling older adults, with the goal of developing and validating a nomogram model for developing prevention strategies against MCR.

Methods

We enrolled community-dwelling participants aged 60-85 years at Guangwai Community Health Service Center between November 2023 and January 2024. A total of 1,315 older adults who met the criteria were randomly divided into a training set (n = 920) and a validation set (n = 395). By using univariate and stepwise logistic regression analysis in the training set, the MCR nomogram prediction model was developed. The area under the receiver operator characteristic curve (AUC), calibration plots, and Hosmer-Lemeshow goodness of fit test were used to evaluate the nomogram model's predictive performance, while decision curve analysis (DCA) was used to evaluate the model's clinical utility.

Results

Education, physical exercise, hyperlipoidemia, osteoarthritis, depression, and Time Up and Go (TUG) test time were identified as independent risk factors and were included to develop a nomogram model. The model exhibited high accuracy with AUC values of 0.909 and 0.908 for the training and validation sets, respectively. Calibration curves confirmed the model's reliability, and DCA highlighted its clinical utility.

Conclusion

This study constructs a nomogram model for MCR with high predictive accuracy, which provides a reference for large-scale early identification and screening of high-risk groups for MCR.

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.

Healthy aging meta-analyses and scoping review of risk factors across Latin America reveal large heterogeneity and weak predictive models

Models of healthy aging are typically based on the United States and Europe and may not apply to diverse and heterogeneous populations. In this study, our objectives were to conduct a meta-analysis to assess risk factors of cognition and functional ability across aging populations in Latin America and a scoping review focusing on methodological procedures. Our study design included randomized controlled trials and cohort, case-control and cross-sectional studies using multiple databases, including MEDLINE, the Virtual Health Library and Web of Science. From an initial pool of 455 studies, our meta-analysis included 38 final studies (28 assessing cognition and 10 assessing functional ability, n = 146,000 participants). Our results revealed significant but heterogeneous effects for cognition (odds ratio (OR) = 1.20, P = 0.03, confidence interval (CI) = (1.0127, 1.42); heterogeneity: I2 = 92.1%, CI = (89.8%, 94%)) and functional ability (OR = 1.20, P = 0.01, CI = (1.04, 1.39); I2 = 93.1%, CI = (89.3%, 95.5%)). Specific risk factors had limited effects, especially on functional ability, with moderate impacts for demographics and mental health and marginal effects for health status and social determinants of health. Methodological issues, such as outliers, inter-country differences and publication bias, influenced the results. Overall, we highlight the specific profile of risk factors associated with healthy aging in Latin America. The heterogeneity in results and methodological approaches in studying healthy aging call for greater harmonization and further regional research to understand healthy aging in Latin America.

Incidence of Motoric Cognitive Risk Syndrome and Associated Factors in Older Adults in Türkiye

Background

Motoric cognitive risk syndrome (MCRS) is characterized by slow gait and subjective cognitive decline. It is a predementia syndrome associated with an increased risk of dementia and mortality.

Aims

To investigate the incidence of MCRS and its associated factors in older adults in Türkiye.

Study Design

A retrospective study.

Methods

This study enrolled community-dwelling older adults admitted to the geriatric outpatient clinic. Participants were assessed for MCRS according to previously described criteria. Logistic regression analysis was conducted to evaluate the association among MCRS and demographic features, clinical status, and geriatric syndromes.

Results

Of the 1,352 older adults examined, 577 met the inclusion criteria, and the mean age was 75.2 years. The overall incidence of MCRS was 7.8%. The MCRS group was predominantly older, female, and unmarried, with polypharmacy and higher Deyo-Charlson comorbidity index and Yesavage geriatric depression scale scores than the non-MCRS group. In the multivariate model, significant associations were found between MCRS and age and polypharmacy [odds ratios (OR), 2.22; 95% confidence interval (CI), 1.04-4.71, p = 0.039; OR, 2.02; 95% CI, 1.02-3.99, p = 0.043, respectively].

Conclusion

The overall incidence of MCRS was found in 7.8% of older adults. Advanced age and polypharmacy are risk factors associated with MCRS.

[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.

The impacts of social determinants of health and cardiometabolic factors on cognitive and functional aging in Colombian underserved populations

Global initiatives call for further understanding of the impact of inequity on aging across underserved populations. Previous research in low- and middle-income countries (LMICs) presents limitations in assessing combined sources of inequity and outcomes (i.e., cognition and functionality). In this study, we assessed how social determinants of health (SDH), cardiometabolic factors (CMFs), and other medical/social factors predict cognition and functionality in an aging Colombian population. We ran a cross-sectional study that combined theory- (structural equation models) and data-driven (machine learning) approaches in a population-based study (N = 23,694; M = 69.8 years) to assess the best predictors of cognition and functionality. We found that a combination of SDH and CMF accurately predicted cognition and functionality, although SDH was the stronger predictor. Cognition was predicted with the highest accuracy by SDH, followed by demographics, CMF, and other factors. A combination of SDH, age, CMF, and additional physical/psychological factors were the best predictors of functional status. Results highlight the role of inequity in predicting brain health and advancing solutions to reduce the cognitive and functional decline in LMICs.

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.

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.

The relationship between spatiotemporal gait parameters and cognitive function in healthy adults: protocol for a cross-sectional study

BACKGROUND

Motor dysfunctions, such as slower walking speed, precede the occurrence of dementia and mild cognitive impairment, suggesting that walking parameters are effective biomarkers for detecting early sub-clinical cognitive risk. It is often also concurrent with self-complained cognitive dysfunction, called motoric cognitive risk (MCR) syndrome. Our preliminary study found several walking parameters, obtained by a three-dimensional motion capture system, to be correlated with computer-based assessments of various cognitive function modalities, although the sample size was small. The Cognitive-Gait (CoGait) Database Project, described in the current protocol, aims to establish a database of multi-dimensional walking and cognitive performance data, collected from a large sample of healthy participants, crucial for detecting early sub-clinical cognitive risk.

METHODS

We will recruit healthy volunteers, 20 years or older, without any neurological musculoskeletal or psychiatric disorders. The estimated sample size is 450 participants, including a 10% attrition rate. Using computer-based cognitive assessments, participants will perform six tasks: (i) the simple reaction time task, (ii) Go/No-Go task, (iii) Stroop Color-Word Test, (iv) N-back test, (v) Trail Making Test, and (vi) digit span test. We will also conduct paper-based cognitive assessments such as the Mini-Mental State Examination, Montreal Cognitive Assessment, and the Geriatric Depression Scale-15 for assessing MCR. Gait will be measured through joint kinematics and global positioning in participants' lower legs while walking at a comfortable and faster pace, using pants with an inertial measurement unit-based three-dimensional motion capture system. Finally, we will establish a prediction model for various cognitive performance modalities based on walking performance.

DISCUSSION

This will be the first study to reveal the relationship between walking and cognitive performance using multi-dimensional data collected from a large sample of healthy adults, from the general population. Despite certain methodological limitations such as the accuracy of measurements, the CoGait database is expected to be the standard value for both walking and cognitive functions, supporting the evaluation of psychomotor function in early sub-clinical cognitive risk identification, including motoric-cognitive risk syndrome.