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

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.

Association of motoric cognitive risk syndrome with depression in older adults: a meta-analysis and systematic review of cross-sectional and cohort studies

BACKGROUND

In an aging society, depression has become a public health challenge that can lead to many adverse health outcomes; evidence addressing the link between depression and motor cognitive risk syndrome (MCR, a novel syndrome that effectively predicts dementia) is still lacking.

METHODS

A PRISMA checklist was used to systematically review the relevant peer-reviewed literature for the primary data analysis. A computer search of CNKI, Wan Fang Data, CBM, VIP, PubMed, Web of Science, Embase, Cochrane Library, Scopus, and Ovid databases, all from creation to March 15, 2023. A meta-analysis was conducted using Stata 17.0, the Newcastle-Ottawa Scale instrument (NOS), and the Agency for Healthcare Research and Quality (AHRQ) for quality appraisal. We used Q and I2 statistics to assess heterogeneity and random effects models to pool estimates. Egger's regression tests and adjustments were made using the trim and fill test.

RESULT

Thirteen studies were included, including seven cross-sectional studies and six cohort studies, and data on the association between depression and MCR in the elderly were extracted. Moreover, the results of the meta-analysis showed that there was a significant correlation between depression and MCR in the cross-sectional study [OR = 2.43, 95% CI(1.31 ~ 3.54), P < 0.01]. In the cohort study, depression in the elderly was associated with the occurrence of MCR [HR = 1.19, 95% CI(1.08 ~ 1.30), P < 0.01]; Subgroup analysis by age, depression assessment tool, MCR assessment tool, and follow-up time (cohort study only) showed statistically significant differences (P < 0.01).

CONCLUSION

Meta-analysis of cross-sectional studies and cohort studies showed that depression in older adults was associated with the development of MCR, and depression increased the risk of MCR in older adults.

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.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

[Relationship between the subjective age, higher-life function, and new certification as needing long-term care in community-dwelling older adults: The KAGUYA project longitudinal survey of older adults]

AIM

To determine the relationship between the subjective age, higher-life function, and new certification for the need for long-term care among older adults in the community.

METHODS

A mail survey was conducted in 2016 among community-dwelling older adults, and the 2,323 participants who were available for follow-up in 2019 were included in the analysis. Subjective age was evaluated using the following three items in response to the question "Please answer how old you feel you are": "Same as actual age," "Feel younger," and "Feel older." Other assessments included an evaluation of the higher-life function, Geriatric Depression Scale scores, general self-efficacy, and exercise adherence. In addition, at follow-up, we investigated whether or not participants required new certification for the need for long-term care.

RESULTS

At baseline, participants who felt "older than their actual age" had a significantly lower life function and general self-efficacy and were less likely to exercise at least once a week than the other groups. Furthermore, those who felt "older than their actual age" was more likely than the other groups to be newly certified as needing long-term care, while those who felt "younger than their actual age" were less likely to receive new certification. A logistic regression analysis revealed that "feeling older" was a risk factor for being certified as needing long-term care, even after adjusting for other factors (odds ratio= 3.33, 95% confidence interval: 1.02-10.94, p=0.047).

CONCLUSIONS

Among community-dwelling older adults, those with a subjective age exceeding their chronological age were expected to show a decreased life function in the future and an increased risk of needing long-term care.

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.