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Blumen HM, Jayakody O, Ayers E, Barzilai N, Habeck C, Milman S, Stern Y, Weiss EF, Verghese J. Cognitive reserve proxies are associated with age-related cognitive decline - Not age-related gait speed decline. Neurobiol Aging 2024; 141:46-54. [PMID: 38820770 DOI: 10.1016/j.neurobiolaging.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 06/02/2024]
Abstract
Cognition and gait share brain substrates in aging and dementia. Cognitive reserve (CR) allows individuals to cope with brain pathology and delay cognitive impairment and dementia. Yet, evidence for that CR is associated with age-related cognitive decline is mixed, and evidence for that CR is associated with age-related gait decline is limited. In 1,079 older (M Age = 75.4 years; 56.0% women) LonGenity study participants without dementia at baseline and up to 12 years of annual follow-up (M follow-up = 3.9 years, SD = 2.5 years), high CR inferred from cognitive (education years), physical (number of blocks walked per day; weekly physical activity days), and social (volunteering/working; living with someone) proxies were associated with slower rates of age-related decline in global cognition - not gait speed decline. Thus, cognitive, physical, and social CR proxies are associated with cognitive decline in older adults without dementia. The multifactorial etiology and earlier decline in gait than cognition may render it less modifiable by CR proxies later in life.
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Affiliation(s)
- Helena M Blumen
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Oshadi Jayakody
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nir Barzilai
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Sofiya Milman
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yaakov Stern
- Department of Neurology, Columbia University, New York, NY, USA
| | - Erica F Weiss
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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Yuan Y, Chang J, Sun Q. Research Progress on Cognitive Frailty in Older Adults with Chronic Kidney Disease. Kidney Blood Press Res 2024; 49:302-309. [PMID: 38663363 DOI: 10.1159/000538689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/01/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND As the medical challenges posed by the ageing population become increasingly severe, the proportion of older people among patients with chronic kidney disease (CKD) is increasing every year. SUMMARY The prevalence of frailty in patients with CKD is significantly higher than that in the general population, and older patients are also a high-risk group for frailty and cognitive impairment. Cognitive frailty, as an important subtype of frailty, is a syndrome characterised by cognitive dysfunction caused by physiological factors, excluding Alzheimer's disease and other types of dementia. It is characterised by the coexistence of physical frailty and cognitive impairment. Previous studies have mainly focused on cognitive impairment, and there is limited research on cognitive frailty, particularly in older patients with CKD. KEY MESSAGES This article provides a comprehensive review of the concept, epidemiology, screening methods, prevention, and treatment measures and possible pathogenesis of cognitive frailty in patients with CKD.
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Affiliation(s)
- Yuqing Yuan
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jing Chang
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qianmei Sun
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Lee P, Chou K, Lee W, Peng L, Chen L, Lin C, Liang C, Chung C. Altered cerebellar and caudate gray-matter volumes and structural covariance networks preceding dual cognitive and mobility impairments in older people. Alzheimers Dement 2024; 20:2420-2433. [PMID: 38298159 PMCID: PMC11032519 DOI: 10.1002/alz.13714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/17/2023] [Accepted: 12/16/2023] [Indexed: 02/02/2024]
Abstract
INTRODUCTION The neuroanatomical changes driving both cognitive and mobility impairments, an emerging preclinical dementia syndrome, are not fully understood. We examined gray-matter volumes (GMVs) and structural covariance networks (SCNs) abnormalities in community-based older people preceding the conversion to physio-cognitive decline syndrome (PCDS). METHODS Voxel-wise brain GMV and established SCNs were compared between PCDS and non-PCDS converters. RESULTS The study included 343 individuals (60.2 ± 6.9 years, 49.6% men) with intact cognitive and mobility functions. Over an average 5.6-year follow-up, 116 transitioned to PCDS. Identified regions with abnormal GMVs in PCDS converters were over cerebellum and caudate, which served as seeds for SCNs establishment. Significant differences in cerebellum-based (to right frontal pole and left middle frontal gyrus) and caudate-based SCNs (to right caudate putamen, right planum temporale, left precentral gyrus, right postcentral gyrus, and left parietal operculum) between converters and nonconverters were observed. DISCUSSION This study reveals early neuroanatomic changes, emphasizing the cerebellum's role, in dual cognitive and mobility impairments. HIGHLIGHTS Neuroanatomic precursors of dual cognitive and mobility impairments are identified. Cerebellar GMV reductions and increased right caudate GMV precede the onset of PCDS. Altered cerebellum- and caudate-based SCNs drive PCDS transformation. This research establishes a foundation for understanding PCDS as a specific dementia syndrome.
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Affiliation(s)
- Pei‐Lin Lee
- Center for Healthy Longevity and Aging SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Institute of NeuroscienceNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Kun‐Hsien Chou
- Institute of NeuroscienceNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Brain Research CenterNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Wei‐Ju Lee
- Center for Healthy Longevity and Aging SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Department of Family MedicineTaipei Veterans General Hospital Yuanshan BranchYi‐LanTaiwan
| | - Li‐Ning Peng
- Center for Healthy Longevity and Aging SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Center for Geriatric and GerontologyTaipei Veterans General HospitalTaipeiTaiwan
| | - Liang‐Kung Chen
- Center for Healthy Longevity and Aging SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Center for Geriatric and GerontologyTaipei Veterans General HospitalTaipeiTaiwan
- Taipei Municipal Gan‐Dau Hospital (managed by Taipei Veterans General Hospital)TaipeiTaiwan
| | - Ching‐Po Lin
- Institute of NeuroscienceNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Brain Research CenterNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Department of Education and ResearchTaipei City HospitalTaipeiTaiwan
| | - Chih‐Kuang Liang
- Center for Healthy Longevity and Aging SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Center for Geriatrics and GerontologyKaohsiung Veterans General HospitalKaohsiungTaiwan
- Division of NeurologyDepartment of Internal MedicineKaohsiung Veterans General HospitalKaohsiungTaiwan
| | - Chih‐Ping Chung
- Center for Healthy Longevity and Aging SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Department of NeurologyNeurological InstituteTaipei Veterans General HospitalTaipeiTaiwan
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Xu W, Bai A, Liang Y, Lin Z. Motoric Cognitive Risk Syndrome and the Risk of Incident Dementia: A Systematic Review and Meta-Analysis of Cohort Studies. Gerontology 2024; 70:479-490. [PMID: 38461816 PMCID: PMC11098020 DOI: 10.1159/000535082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/03/2023] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Epidemiologic studies have indicated an association of motoric cognitive risk syndrome (MCR), a pre-dementia stage characterized by the presence of cognitive complaints and a slow gait, with increased risk of incident dementia. OBJECTIVES We aimed to clarify this association using meta-analysis. METHODS We systematically searched the PubMed, Embase, and Web of Science databases up to December 2022 for relevant studies that investigated the association between MCR and incident all-cause dementia and Alzheimer's disease (AD). The random-effects model was used to determine a pooled-effect estimate of the association. RESULTS We identified seven articles that corresponded with nine cohort studies investigating the association between MCR and the risk of dementia. Pooled analysis showed that MCR was associated with a significantly increased risk of incident all-cause dementia (HR = 2.28; 95% CI: 1.90-2.73) and AD (HR = 2.05; 95% CI: 1.61-2.61). Sensitivity analysis showed that there was no evidence that individual studies influenced the pooled-effect estimate, verifying the robustness of the results. CONCLUSIONS Our results confirm that MCR is an independent risk factor of incident all-cause dementia and AD. Future studies are needed to better understand the mechanisms underlying this association.
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Affiliation(s)
- Weihao Xu
- Department of Cardiology, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Geriatrics, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Anying Bai
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,
| | - Yuanfeng Liang
- Department of Geriatrics, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Zhanyi Lin
- Department of Cardiology, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Geriatrics, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
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Zhao HY, Zhang ZQ, Huang YH, Li H, Wei FY. Performance of the walking trail making test in older adults with white matter hyperintensities. World J Psychiatry 2024; 14:102-110. [PMID: 38327891 PMCID: PMC10845218 DOI: 10.5498/wjp.v14.i1.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/30/2023] [Accepted: 12/21/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Several studies have reported that the walking trail making test (WTMT) completion time is significantly higher in patients with developmental coordination disorders and mild cognitive impairments. We hypothesized that WTMT performance would be altered in older adults with white matter hyperintensities (WMH). AIM To explore the performance in the WTMT in older people with WMH. METHODS In this single-center, observational study, 25 elderly WMH patients admitted to our hospital from June 2019 to June 2020 served as the WMH group and 20 participants matched for age, gender, and educational level who were undergoing physical examination in our hospital during the same period served as the control group. The participants completed the WTMT-A and WTMT-B to obtain their gait parameters, including WTMT-A completion time, WTMT-B completion time, speed, step length, cadence, and stance phase percent. White matter lesions were scored according to the Fazekas scale. Multiple neuropsychological assessments were carried out to assess cognitive function. The relationships between WTMT performance and cognition and motion in elderly patients with WMH were analyzed by partial Pearson correlation analysis. RESULTS Patients with WMH performed significantly worse on the choice reaction test (CRT) (0.51 ± 0.09 s vs 0.44 ± 0.06 s, P = 0.007), verbal fluency test (VFT, 14.2 ± 2.75 vs 16.65 ± 3.54, P = 0.012), and digit symbol substitution test (16.00 ± 2.75 vs 18.40 ± 3.27, P = 0.010) than participants in the control group. The WMH group also required significantly more time to complete the WTMT-A (93.00 ± 10.76 s vs 70.55 ± 11.28 s, P < 0.001) and WTMT-B (109.72 ± 12.26 s vs 82.85 ± 7.90 s, P < 0.001). WTMT-A completion time was positively correlated with CRT time (r = 0.460, P = 0.001), while WTMT-B completion time was negatively correlated with VFT (r = -0.391, P = 0.008). On the WTMT-A, only speed was found to statistically differ between the WMH and control groups (0.803 ± 0.096 vs 0.975 ± 0.050 m/s, P < 0.001), whereas on the WTMT-B, the WMH group exhibited a significantly lower speed (0.778 ± 0.111 vs 0.970 ± 0.053 m/s, P < 0.001) and cadence (82.600 ± 4.140 vs 85.500 ± 5.020 steps/m, P = 0.039), as well as a higher stance phase percentage (65.061 ± 1.813% vs 63.513 ± 2.465%, P = 0.019) relative to controls. CONCLUSION Older adults with WMH showed obviously poorer WTMT performance. WTMT could be a potential indicator for cognitive and motor deficits in patients with WMH.
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Affiliation(s)
- Hong-Yi Zhao
- Department of Neurology, No. 984 Hospital of PLA, Beijing 100094, China
- Department of Neurology, The Seventh Medical Center of PLA General Hospital, Beijing 100700, China
| | - Zhi-Qiang Zhang
- Mental Health Institute of Inner Mongolia Autonomous Region, The Third Hospital of Inner Mongolia Autonomous Region, Hohhot 010010, Inner Mongolia Autonomous Region, China
| | - Yong-Hua Huang
- Department of Neurology, The Seventh Medical Center of PLA General Hospital, Beijing 100700, China
| | - Hong Li
- Department of Neurosurgery, No. 984 Hospital of PLA, Beijing 100094, China
| | - Fang-Yuan Wei
- Department of Hand and Foot Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing 100029, China
- Engineering Research Center of Chinese Orthopaedic and Sports Rehabilitation Artificial Intelligent, Ministry of Education, Beijing 100029, China
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Sathyan S, Ayers E, Blumen H, Weiss EF, Adhikari D, Stimmel M, Abdulsalam K, Noone M, George RK, Ceide M, Ambrose AF, Wang C, Narayanan P, Sureshbabu S, Shaji KS, Sigamani A, Mathuranath PS, Pradeep VG, Verghese J. Epidemiology of Motoric Cognitive Risk Syndrome in the Kerala Einstein Study: Protocol for a Prospective Cohort Study. JMIR Res Protoc 2023; 12:e49933. [PMID: 37590054 PMCID: PMC10472178 DOI: 10.2196/49933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND The southern India state of Kerala has among the highest proportion of older adults in its population in the country. An increase in chronic age-related diseases such as dementia is expected in the older Kerala population. Identifying older individuals early in the course of cognitive decline offers the best hope of introducing preventive measures early and planning management. However, the epidemiology and pathogenesis of predementia syndromes at the early stages of cognitive decline in older adults are not well established in India. OBJECTIVE The Kerala Einstein Study (KES) is a community-based cohort study that was established in 2008 and is based in the Kozhikode district in Kerala state. KES aims to establish risk factors and brain substrates of motoric cognitive risk syndrome (MCR), a predementia syndrome characterized by the presence of slow gait and subjective cognitive concerns in individuals without dementia or disability. This protocol describes the study design and procedures for this KES project. METHODS KES is proposing to enroll a sample of 1000 adults ≥60 years old from urban and rural areas in the Kozhikode district of Kerala state: 200 recruited in the previous phase of KES and 800 new participants to be recruited in this project. MCR is the cognitive phenotype of primary interest. The associations between previously established risk factors for dementia as well as novel risk factors (apathy and traumatic brain injury) and MCR will be examined in KES. Risk factor profiles for MCR will be compared between urban and rural residents as well as with individuals who meet the criteria for mild cognitive impairment (MCI). Cognitive and physical function, medical history and medications, sociodemographic characteristics, lifestyle patterns, and activities of daily living will be evaluated. Participants will also undergo magnetic resonance imaging and electrocardiogram investigations. Longitudinal follow-up is planned in a subset of participants as a prelude to future longitudinal studies. RESULTS KES (2R01AG039330-07) was funded by the US National Institutes of Health in September 2019 and received approval from the Indian Medical Council of Research to start the study in June 2021. We had recruited 433 new participants from urban and rural sites in Kozhikode as of May 2023: 41.1% (178/433) women, 67.7% (293/433) rural residents, and 13.4% (58/433) MCR cases. Enrollment is actively ongoing at all the KES recruitment sites. CONCLUSIONS KES will provide new insights into risk factors and brain substrates associated with MCR in India and will help guide future development of regionally specific preventive interventions for dementia. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/49933.
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Affiliation(s)
- Sanish Sathyan
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Helena Blumen
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Erica F Weiss
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Dristi Adhikari
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Marnina Stimmel
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | | | - Mohan Noone
- Institute of Neurosciences, Baby Memorial Hospital, Kozhikode, India
| | - Roy K George
- Institute of Neurosciences, Baby Memorial Hospital, Kozhikode, India
| | - Mirnova Ceide
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Anne Felicia Ambrose
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Cuiling Wang
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | | | | | | | | | - Pavagada S Mathuranath
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Joe Verghese
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
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Zhào H, Wei W, Xie H, Huang Y. Motoric Cognitive Risk Syndrome Among Chinese Older Adults with White Matter Lesions: A Cross-Sectional Observational Study. J Alzheimers Dis 2023; 91:925-931. [PMID: 36565113 DOI: 10.3233/jad-220712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Brain aging is characterized by the declines in motor and cognitive features. The present study is to detect motor cognitive risk syndrome (MCRS) in older adults with white matter lesions (WML). 134 WML aged patients were recruited and diagnosed with the criteria for MCRS. Numerous cognitive function tests and walking tests were performed. The frequency of MCRS is 28.35%. Verbal fluency test, Mini-Mental State Examination, and dual-task walking speed were independent risk factor of MCRS. These findings indicated that MCRS was common in WML seniors. MCRS was associated with the pathologies of WML in older adults.
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Affiliation(s)
- Hóngyi Zhào
- Department of Neurology, Seventh Medical Centre of PLA General Hospital, Beijing, China.,Department of Neurology, Number 984 Hospital of the PLA, Beijing, China
| | - Wei Wei
- Department of Neurology, Seventh Medical Centre of PLA General Hospital, Beijing, China
| | - Hongyang Xie
- Department of Neurology, Seventh Medical Centre of PLA General Hospital, Beijing, China
| | - Yonghua Huang
- Department of Neurology, Seventh Medical Centre of PLA General Hospital, Beijing, China
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Blumen HM, Jayakody O, Verghese J. Gait in cerebral small vessel disease, pre-dementia, and dementia: A systematic review. Int J Stroke 2023; 18:53-61. [PMID: 35797006 PMCID: PMC9841467 DOI: 10.1177/17474930221114562] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The interrelationships between gait, cerebral small vessel disease (CSVD), and cognitive impairments in aging are not well-understood-despite their common co-occurrence. OBJECTIVE To systematically review studies of gait impairment in CSVD, pre-dementia, and dementia, and to identify key gaps for future research and novel pathways toward intervention. METHODS A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided search strategy was implemented in PubMed to identify relevant studies. Potential articles (n = 263) published prior to 1 December 2021 were screened by two reviewers. Studies with sample sizes >20 and including some adults over > 65 years (n = 202) were included. RESULTS The key findings were that (1) adverse gait and cognitive outcomes were associated with several (rather than select) CSVD pathologies distributed across the brain, and (2) poor gait and CSVD pathologies were more strongly associated with dementia with a vascular, rather than an Alzheimer's disease-related, cause. DISCUSSION A better understanding of the interrelationships between gait performance in CSVD, pre-dementia, and dementia requires studies examining (1) comprehensive patterns in the clinical manifestations of CSVD, (2) racially/ethnically diverse samples, (3) samples followed for extended periods of time or across the adult life span, (4) non-traditional CSVD neuroimaging markers (e.g. resting-state functional magnetic resonance imaging (fMRI)), and (5) continuous (e.g. wearable sensors) and complex (e.g. dual-task) walking performance.
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Affiliation(s)
- Helena M Blumen
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA,Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Oshadi Jayakody
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA,Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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Wen ZF, Peng SH, Wang JL, Wang HY, Yang LP, Liu Q, Zhang XG. Prevalence of motoric cognitive risk syndrome among older adults: a systematic review and meta-analysis. Aging Ment Health 2022:1-13. [PMID: 36533320 DOI: 10.1080/13607863.2022.2158305] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
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.
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Affiliation(s)
- Zhi-Fei Wen
- School of Nursing, Chengdu university of Traditional Chinese Medicine, Sichuan, China
| | - Si-Han Peng
- School Clinical, Chengdu university of Traditional Chinese Medicine, Sichuan, China
| | - Jia-Lin Wang
- School of Nursing, Chengdu university of Traditional Chinese Medicine, Sichuan, China
| | - Hong-Yan Wang
- Dean Office, Sichuan Nursing Vocational College, Sichuan, China
| | - Li-Ping Yang
- School of Nursing, Chengdu university of Traditional Chinese Medicine, Sichuan, China
| | - Qin Liu
- School of Nursing, Chengdu university of Traditional Chinese Medicine, Sichuan, China
| | - Xian-Geng Zhang
- Dean Office, Sichuan Nursing Vocational College, Sichuan, China
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Association Between Motoric Cognitive Risk Syndrome and Risk of Mortality in Older Adults: Results of a 5-year Retrospective Cohort. AGEING INTERNATIONAL 2022. [DOI: 10.1007/s12126-022-09508-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Mullin DS, Stirland LE, Welstead M, Russ TC, Luciano M, Muniz‐Terrera G. Prevalence and predictors of Motoric Cognitive Risk syndrome in a community-dwelling older Scottish population: A longitudinal observational study. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5824. [PMID: 36200618 PMCID: PMC9828770 DOI: 10.1002/gps.5824] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/29/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Motoric Cognitive Risk (MCR) is a gait-based predementia syndrome that is easy to measure and prognostic of dementia and falls. We aimed to examine the prevalence and risk factors for MCR, and assess its overlap with Mild Cognitive Impairment, Prefrailty, and Frailty, in a cohort of older Scottish adults without dementia. METHODS In this longitudinal prospective study, we classified 690 participants (mean [SD] age 76.3 [0.8] years; wave 3) of the Lothian Birth Cohort 1936 (LBC1936) into non-MCR or MCR groups. We examined their baseline (age 69.5 [0.8] years; wave 1) risk factors for MCR at waves 3, 4, and 5 (6, 9, and 12 years later respectively). RESULTS MCR prevalence rate ranged from 5.3% to 5.7% across the three waves. The presence of MCR was associated with older baseline age (6 and 9 years later), lower occupational socioeconomic status (6 years later), and worse scores in a range of tests of executive function (6, 9 and 12 years later). Approximately 46% of the MCR group also had Mild Cognitive Impairment, and almost everyone in the MCR group had either Prefrailty or Frailty. CONCLUSIONS The prevalence of MCR in this Scottish cohort is lower than the pooled global average, possibly reflecting the general good health of the LBC cohort. However, it is higher than the prevalence in two neighbouring countries' cohorts, which may reflect the younger average ages of those cohorts. Future LBC1936 research should assess the risk factors associated with MCR to validate previous findings and analyse novel predictive factors, particularly socioeconomic status.
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Affiliation(s)
- Donncha S. Mullin
- Alzheimer Scotland Dementia Research CentreUniversity of EdinburghEdinburghUK
- Edinburgh Dementia Prevention GroupUniversity of EdinburghEdinburghUK
- Division of PsychiatryCentre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- NHS LothianRoyal Edinburgh HospitalEdinburghUK
| | - Lucy E. Stirland
- Alzheimer Scotland Dementia Research CentreUniversity of EdinburghEdinburghUK
- Edinburgh Dementia Prevention GroupUniversity of EdinburghEdinburghUK
- Division of PsychiatryCentre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- NHS LothianRoyal Edinburgh HospitalEdinburghUK
| | - Miles Welstead
- Lothian Birth CohortsDepartment of PsychologyUniversity of EdinburghEdinburghUK
| | - Tom C. Russ
- Alzheimer Scotland Dementia Research CentreUniversity of EdinburghEdinburghUK
- Edinburgh Dementia Prevention GroupUniversity of EdinburghEdinburghUK
- Division of PsychiatryCentre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- NHS LothianRoyal Edinburgh HospitalEdinburghUK
- Lothian Birth CohortsDepartment of PsychologyUniversity of EdinburghEdinburghUK
| | - Michelle Luciano
- Lothian Birth CohortsDepartment of PsychologyUniversity of EdinburghEdinburghUK
| | - Graciela Muniz‐Terrera
- Edinburgh Dementia Prevention GroupUniversity of EdinburghEdinburghUK
- Department of Social MedicineOhio UniversityAthensOhioUSA
- BrainLatUniversidad Adolfo IbanezPenalolenChile
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12
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Li W, Sun X, Liu Y, Ge M, Lu Y, Liu X, Zhou L, Liu X, Dong B, Yue J, Xue Q, Dai L, Dong B. Plasma metabolomics and lipidomics signatures of motoric cognitive risk syndrome in community-dwelling older adults. Front Aging Neurosci 2022; 14:977191. [PMID: 36158552 PMCID: PMC9490321 DOI: 10.3389/fnagi.2022.977191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionMotoric 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.MethodsThis 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.ResultsThis 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.InterpretationPre-dementia syndrome of MCR has distinct metabolic subtypes, and SCCs and SG may cause different metabolic changes to develop MCR.
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Affiliation(s)
- Wanmeng Li
- National Clinical Research Center for Geriatrics and Department of General Practice, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Xuelian Sun
- National Clinical Research Center for Geriatrics and Department of General Practice, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institute, Solna, Sweden
| | - Yu Liu
- National Clinical Research Center for Geriatrics and Department of General Practice, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Meiling Ge
- National Clinical Research Center for Geriatrics and Department of General Practice, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Ying Lu
- National Clinical Research Center for Geriatrics and Department of General Practice, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Xiaolei Liu
- National Clinical Research Center for Geriatrics and Department of General Practice, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Lixing Zhou
- National Clinical Research Center for Geriatrics and Department of General Practice, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Xiaohui Liu
- School of Life Sciences, Tsinghua University, Beijing, China
| | - Biao Dong
- National Clinical Research Center for Geriatrics and Department of General Practice, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Jirong Yue
- National Clinical Research Center for Geriatrics and Department of General Practice, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Qianli Xue
- Department of Medicine, Biostatistics, and Epidemiology, Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Lunzhi Dai
- National Clinical Research Center for Geriatrics and Department of General Practice, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
- *Correspondence: Lunzhi Dai,
| | - Birong Dong
- National Clinical Research Center for Geriatrics and Department of General Practice, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
- Birong Dong,
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13
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Grande G, Vetrano DL, Kalpouzos G, Welmer AK, Laukka EJ, Marseglia A, Fratiglioni L, Rizzuto D. Brain Changes and Fast Cognitive and Motor Decline in Older Adults. J Gerontol A Biol Sci Med Sci 2022; 78:326-332. [PMID: 36037020 PMCID: PMC9951062 DOI: 10.1093/gerona/glac177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To identify brain magnetic resonance imaging (MRI) signatures characterizing people with different patterns of decline in cognition and motor function. METHODS In the Swedish National Study on Aging and Care in Kungsholmen, Stockholm, 385 participants had available repeated brain MRI examinations, where markers of brain volumes and white matter integrity were assessed. The speed of cognitive and motor decline was estimated as the rate of a Mini-Mental State Examination and gait speed decline over 12 years (linear mixed models), and further dichotomized into the upper (25% fastest rate of decline) versus the lower quartiles. Participants were grouped in slow/no decliners (reference), isolated motor decliners, isolated cognitive decliners, and cognitive and motor decliners. We estimated the associations between changes in brain markers (linear mixed models) and baseline diffusion tensor imaging measures (linear regression model) and the 4 decline patterns. RESULTS Individuals with concurrent cognitive and motor decline (n = 51) experienced the greatest loss in the total brain (β: -12.3; 95% confidence interval [CI]: -18.2; -6.38) and hippocampal (β: -0.25; 95% CI: -0.34; -0.16) volumes, the steepest accumulation of white matter hyperintensities (β: 1.61; 95% CI: 0.54; 2.68), and the greatest ventricular enlargement (β: 2.07; 95% CI: 0.67; 3.47). Compared to the reference, those only experiencing cognitive decline presented with steeper hippocampal volume loss, whereas those exhibiting only motor decline displayed a greater white matter hyperintensities burden. Lower microstructural white matter integrity was associated with concurrent cognitive and motor decline. CONCLUSION Concurrent cognitive and motor decline is accompanied by rapidly evolving and complex brain pathology involving both gray and white matter. Isolated cognitive and motor declines seem to exhibit brain damage with different qualitative features.
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Affiliation(s)
- Giulia Grande
- Address correspondence to: Giulia Grande, MD, PhD, Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Tomtebodavägen 18A, 171 65 Solna, Stockholm, Sweden. E-mail:
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Grégoria Kalpouzos
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Erika J Laukka
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Anna Marseglia
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden,Stockholm Gerontology Research Center, Stockholm, Sweden
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14
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Dreyer-Alster S, Menascu S, Aloni R, Givon U, Dolev M, Achiron A, Kalron A. Motoric cognitive risk syndrome in people with multiple sclerosis: prevalence and correlations with disease-related factors. Ther Adv Neurol Disord 2022; 15:17562864221109744. [PMID: 35813608 PMCID: PMC9260572 DOI: 10.1177/17562864221109744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/09/2022] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
| | - Shay Menascu
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Roy Aloni
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Uri Givon
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Mark Dolev
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Alon Kalron
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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15
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Felix N, Ayers E, Verghese J, Blumen HM. Increased Social Support Reduces the Incidence of Motoric Cognitive Risk Syndrome. Innov Aging 2022; 6:igac048. [PMID: 36081405 PMCID: PMC9447853 DOI: 10.1093/geroni/igac048] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Objectives
The motoric cognitive risk syndrome (MCR) is a predementia syndrome characterized by slow gait and cognitive complaint. The relationship between MCR and social support—a potentially modifiable risk factor of dementia—is currently unknown. The current study aimed to determine whether MCR incidence varies as a function of social support in aging.
Research Design and Methods
We examined MCR incidence in 506 community-dwelling older adults (M Age 76.59; 57.3% female) without MCR or dementia at baseline. We quantified perceived levels of social support with the Medical Outcomes Study Social Support Survey, incorporating four different categories of support: (a) emotional/informational support, (b) tangible support, (c) affectionate support, and (d) positive social interactions. We used Cox regression analyses, adjusted for age, sex, race/ethnicity, education, marital status, comorbidities, and global cognition, to estimate hazard ratios (aHR) with 95% confidence intervals (CIs).
Results
Over a median follow-up time of 2.5 years (range = 1–7 years), 38 participants (9.8%) developed MCR. Increased tangible support decreased the risk of MCR by 30% (aHR: 0.70, 95% CI: 0.53–0.92, p = .011). Increased overall social support decreased the risk of MCR by 33% (aHR: 0.67, 95% CI: 0.46–0.98, p = .038). Other subcategories of social support were not associated with a decreased risk of MCR (p > .05).
Discussion and Implications
Higher levels of tangible social support, as well as overall social support, were associated with reduced risk for MCR in older adults. Increasing social support may be a promising avenue of intervention for reducing the risk of MCR, dementia, and other forms of cognitive decline.
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Affiliation(s)
- Nicole Felix
- Department of Medicine, Albert Einstein College of Medicine , Bronx, New York , USA
| | - Emmeline Ayers
- Departments of Neurology, Albert Einstein College of Medicine , Bronx, New York , USA
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine , Bronx, New York , USA
- Departments of Neurology, Albert Einstein College of Medicine , Bronx, New York , USA
| | - Helena M Blumen
- Department of Medicine, Albert Einstein College of Medicine , Bronx, New York , USA
- Departments of Neurology, Albert Einstein College of Medicine , Bronx, New York , USA
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16
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Jayakody O, Breslin M, Ayers E, Verghese J, Barzilai N, Milman S, Weiss E, Blumen HM. Relative Trajectories of Gait and Cognitive Decline in Aging. J Gerontol A Biol Sci Med Sci 2022; 77:1230-1238. [PMID: 34791239 PMCID: PMC9159658 DOI: 10.1093/gerona/glab346] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Gait and cognition decline with advancing age, and presage the onset of dementia. Yet, the relative trajectories of gait and cognitive decline in aging are poorly understood-particularly among those with the motoric cognitive risk (MCR) syndrome. This study compared changes in simple and complex gait performance and cognition, as a function of age and MCR. METHODS We examined gait and cognitive functions of 1 095 LonGenity study participants (mean age = 75.4 ± 6.7 years) with up to 12 years of annual follow-up. Participants were of Ashkenazi Jewish descent, free of dementia, ambulatory, and had a 12.2% MCR prevalence at baseline. Gait speed was measured at usual pace walking (single-task walking, STW-speed) and walking while talking (WWT-speed). Eleven neuropsychological test scores were examined separately, and as a global cognition composite. Linear mixed-effects models adjusted for baseline sex, education, parental longevity, cognitive impairment, and global health were used to estimate changes in gait and cognition, as a function of age and MCR. RESULTS STW-speed, WWT-speed, and cognitive tests performance declined in a nonlinear (accelerating) fashion with age. STW-speed declined faster than WWT-speed and cognitive test scores. People with MCR showed faster rates of decline on figure copy and phonemic fluency. CONCLUSIONS Gait declines at a faster rate than cognition in aging. People with MCR are susceptible to faster decline in visuospatial, executive, and language functions. This study adds important knowledge of trajectories of gait and cognitive decline in aging, and identifies MCR as a risk factor for accelerated cognitive decline.
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Affiliation(s)
- Oshadi Jayakody
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nir Barzilai
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Genetics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sofiya Milman
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Genetics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Erica Weiss
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Helena M Blumen
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
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17
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Xu W, Bai A, Liang Y, Lin Z. Association between depression and motoric cognitive risk syndrome among community-dwelling older adults in China: A 4-year prospective cohort study. Eur J Neurol 2022; 29:1377-1384. [PMID: 35098617 DOI: 10.1111/ene.15262] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Depression can lead to a wide range of adverse health outcomes, including dementia. However, evidence supporting the relationship between depression and motoric cognitive risk syndrome (MCR), a pre-dementia syndrome, remains lacking. This study aimed to examine the association between depression and MCR among community-dwelling Chinese older adults. METHODS Data were taken from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study (CHARLS). Depression was defined by a Center for Epidemiological Studies Depression Scale (CES-D) score ≥10. MCR was defined as subjective cognitive complaints and objective slow gait speed. Multivariate logistic regression analyses were conducted to examine the cross-sectional and longitudinal associations between depression and MCR at baseline and a 4-year follow-up period for the sample population and gender groups. RESULTS The prevalence of MCR was higher in participants with depression than in those without depression at baseline (12.2% vs. 8.9%; p = 0.001). Participants with depression at baseline had a higher 4-year incidence of MCR than those without depression (14.8% vs. 8.7%; p < 0.001). Both cross-sectional analysis (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.13-1.75) and prospective analysis (OR 1.95, 95% CI 1.56-2.44) demonstrated that depression was significantly associated with MCR. These associations were consistent across different gender groups and stronger among female individuals. CONCLUSIONS Depression is an independent risk factor for MCR among community-dwelling Chinese older adults. Special attention should be paid to the care of older people with depression to reduce the occurrence of MCR and even dementia.
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Affiliation(s)
- Weihao Xu
- Department of Cardiology, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Geriatrics, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Anying Bai
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuanfeng Liang
- Department of Geriatrics, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhanyi Lin
- Department of Cardiology, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Geriatrics, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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18
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Bommarito G, Garibotto V, Frisoni GB, Ribaldi F, Stampacchia S, Assal F, Armand S, Allali G, Griffa A. The Biological Substrate of the Motoric Cognitive Risk Syndrome: A Pilot Study Using Amyloid-/Tau-PET and MR Imaging. J Alzheimers Dis 2022; 87:1483-1490. [PMID: 35491777 PMCID: PMC9277684 DOI: 10.3233/jad-215461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We conducted a cross-sectional pilot study to explore the biological substrate of the Motoric Cognitive Risk (MCR) syndrome in a Memory Clinic cohort, using a multimodal imaging approach. Twenty participants were recruited and classified as MCR+/−. Amyloid- and tau-PET uptakes, temporal atrophy, white matter hyperintensities, lateral ventricular volume (LVV), and diffusion tensor parameters were compared between groups. No significant differences were found in imaging features related to Alzheimer’s disease or gross vascular damage. MCR+ patients had increased LVV and altered diffusion parameters in the superior corona radiata. Ventricular enlargement and microstructural damage of the surrounding white matter tracts could contribute to MCR pathophysiology.
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Affiliation(s)
- Giulia Bommarito
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals and NIMTlab, Geneva University, Geneva, Switzerland
| | - Giovanni B. Frisoni
- Memory Clinic and LANVIE-Laboratory of Neuroimaging of Aging, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Federica Ribaldi
- Memory Clinic and LANVIE-Laboratory of Neuroimaging of Aging, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Sara Stampacchia
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals and NIMTlab, Geneva University, Geneva, Switzerland
| | - Frédéric Assal
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphane Armand
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Switzerland
| | - Gilles Allali
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
- Leenaards Memory Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alessandra Griffa
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute of Bioengineering, Center of Neuroprosthetics, Ecole Polytechnique Fédérale De Lausanne (EPFL), Geneva, Switzerland
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Borda MG, Ferreira D, Selnes P, Tovar-Rios DA, Jaramillo-Jiménez A, Kirsebom BE, Garcia-Cifuentes E, Dalaker TO, Oppedal K, Sønnesyn H, Fladby T, Aarsland D. Timed Up and Go in People with Subjective Cognitive Decline Is Associated with Faster Cognitive Deterioration and Cortical Thickness. Dement Geriatr Cogn Disord 2022; 51:63-72. [PMID: 35339996 DOI: 10.1159/000522094] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/14/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Early markers of neurodegeneration provide an opportunity to detect, monitor, and initiate interventions in individuals who have an increased risk of developing dementia. Here, we investigated whether the Timed Up and Go (TUG) test is associated with early brain neurodegeneration and whether the TUG test could be a marker of cognitive decline in people with subjective cognitive decline (SCD). METHODS This is a longitudinal analysis of the Dementia Disease Initiation Study, a prospective, community-based, cohort study from Norway, designed to investigate early markers of cognitive impairment and dementia. Participants were classified as SCD and healthy controls (HC). The main studied variables were the TUG test and cognition as measured by the Mini-Mental State Examination and the Consortium to Establish a Registry for Alzheimer's Disease memory composite score. Additionally, we investigated the cross-sectional association of brain morphology with the TUG using 1.5T-MRI. RESULTS The sample included 45 participants (SCD = 21, HC = 24) followed during a mean time of 1.50 ± 0.70 years. At baseline, the cognitive performance did not differ between the groups, but TUG was longer in SCD. Slower baseline TUG was associated with a faster cognitive decline in both groups and it was also associated with reduced cortical thickness especially in motor, executive, associative, and somatosensory cortical regions in people with SCD. DISCUSSION/CONCLUSION TUG predicted cognitive change in individuals with SCD, and there was a negative association between TUG and cortical thickness. TUG is a promising cheap and noninvasive marker of early cognitive decline and may help initiate interventions in individuals who have an increased risk of dementia.
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Affiliation(s)
- Miguel Germán Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School Pontificia Universidad Javeriana, Bogotá, Colombia.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Per Selnes
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
| | - Diego Alejandro Tovar-Rios
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,Universidad Del Valle, Santiago De Cali, Colombia
| | - Alberto Jaramillo-Jiménez
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,Grupo de Neurociencias de Antioquia, School of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Bjørn-Eivind Kirsebom
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway.,Department of Psychology, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Elkin Garcia-Cifuentes
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School Pontificia Universidad Javeriana, Bogotá, Colombia.,Unidad de Neurologia, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Turi O Dalaker
- Stavanger Medical Imaging Laboratory, Department of Radiology, Stavanger University Hospital, Stavanger, Norway
| | - Ketil Oppedal
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
| | - Hogne Sønnesyn
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
| | - Tormod Fladby
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,Universidad Del Valle, Santiago De Cali, Colombia
| | - Dag Aarsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Old Age Psychiatry, King's College, London, United Kingdom
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Marquez I, Garcia-Cifuentes E, Velandia FR, Iragorri A, Saavedra AM, Borda MG, Osuna M, Ailshire J, Cano-Gutierrez CA. Motoric Cognitive Risk Syndrome: Prevalence and Cognitive Performance. A cross-sectional study. LANCET REGIONAL HEALTH. AMERICAS 2022; 8:100162. [PMID: 36778728 PMCID: PMC9904094 DOI: 10.1016/j.lana.2021.100162] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
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.
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Affiliation(s)
- Isabel Marquez
- Semillero de Neurociencias y Envejecimiento, Instituto de Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Elkin Garcia-Cifuentes
- Semillero de Neurociencias y Envejecimiento, Instituto de Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
- Unidad de Neurología, Hospital Universitario San Ignacio, Bogotá, Colombia
- Corresponding author: Elkin García-Cifuentes, Unidad de Neurología, Hospital Universitario San Ignacio, Carrera 7 No. 40–62 Bogotá 110231 (Colombia)
| | - Felipe Ramirez Velandia
- Semillero de Neurociencias y Envejecimiento, Instituto de Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Angela Iragorri
- Unidad de Neurología, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Ana Maria Saavedra
- Semillero de Neurociencias y Envejecimiento, Instituto de Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Miguel Germán Borda
- Semillero de Neurociencias y Envejecimiento, Instituto de Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Margarita Osuna
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, USA
| | - Jennifer Ailshire
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, USA
| | - Carlos Alberto Cano-Gutierrez
- Semillero de Neurociencias y Envejecimiento, Instituto de Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
- Unidad de Geriatría, Hospital Universitario San Ignacio, Bogotá, Colombia
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Reward System Dysfunction and the Motoric-Cognitive Risk Syndrome in Older Persons. Biomedicines 2022; 10:biomedicines10040808. [PMID: 35453558 PMCID: PMC9029623 DOI: 10.3390/biomedicines10040808] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 02/04/2023] Open
Abstract
During aging, many physiological systems spontaneously change independent of the presence of chronic diseases. The reward system is not an exception and its dysfunction generally includes a reduction in dopamine and glutamate activities and the loss of neurons of the ventral tegmental area (VTA). These impairments are even more pronounced in older persons who have neurodegenerative diseases and/or are affected by cognitive and motoric frailty. All these changes may result in the occurrence of cognitive and motoric frailty and accelerated progression of neurodegenerative diseases, such as Alzheimer’s and Parkinson’s diseases. In particular, the loss of neurons in VTA may determine an acceleration of depressive symptoms and cognitive and motor frailty trajectory, producing an increased risk of disability and mortality. Thus, we hypothesize the existence of a loop between reward system dysfunction, depression, and neurodegenerative diseases in older persons. Longitudinal studies are needed to evaluate the determinant role of the reward system in the onset of motoric-cognitive risk syndrome.
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Gomez GT, Gottesman RF, Gabriel KP, Palta P, Gross AL, Soldan A, Albert MS, Sullivan KJ, Jack CR, Knopman DS, Windham BG, Walker KA. The association of motoric cognitive risk with incident dementia and neuroimaging characteristics: The Atherosclerosis Risk in Communities Study. Alzheimers Dement 2022; 18:434-444. [PMID: 34786837 PMCID: PMC10064850 DOI: 10.1002/alz.12412] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/05/2021] [Accepted: 06/01/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Motoric cognitive risk (MCR), a clinical syndrome characterized by slow gait speed and subjective cognitive complaints, has been associated with dementia risk. The neuropathological features underlying MCR remain poorly understood. METHODS The Atherosclerosis Risk in Communities (ARIC) community-based cohort study classified participants using standardized criteria as MCR+/- and mild cognitive impairment (MCI)+/- at study baseline (2011-2013). We examined the 5-year dementia risk and baseline brain structural/molecular abnormalities associated with MCR+ and MCI+ status. RESULTS Of 5023 nondemented participants included, 204 were MCR+ and 1030 were MCI+. Both MCR+ and MCI+ participants demonstrated increased dementia risk. The pattern of structural brain abnormalities associated with MCR+ differed from that of MCI+. Whereas MCI+ was associated with comparatively smaller volumes in brain regions vulnerable to Alzheimer's disease pathology, MCR+ status was associated with smaller volumes in frontoparietal regions and greater white matter abnormalities. DISCUSSION MCR may represent a predementia syndrome characterized by prominent white matter abnormalities and frontoparietal atrophy.
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Affiliation(s)
- Gabriela T. Gomez
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca F. Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Priya Palta
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Alden L. Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Anja Soldan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marilyn S. Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kevin J. Sullivan
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, MS
| | | | | | - B. Gwen Windham
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, MS
| | - Keenan A. Walker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, Baltimore, MD
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Xiang K, Liu Y, Sun L. Motoric Cognitive Risk Syndrome: Symptoms, Pathology, Diagnosis, and Recovery. Front Aging Neurosci 2022; 13:728799. [PMID: 35185512 PMCID: PMC8847709 DOI: 10.3389/fnagi.2021.728799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/14/2021] [Indexed: 12/20/2022] Open
Abstract
The motoric cognitive risk (MCR) syndrome is a pre-dementia condition, marked by the enhanced risk for Alzheimer's disease (AD) and vascular dementia, together with falls, disability, and abnormal movements. The research studies revealed the distinct neurological and non-neurological clinical gait irregularities during dementia and accelerated functional decline, such as postural and balance impairments, memory loss, cognitive failure, and metabolic dysfunctions. The disabling characteristics of MCR comprise altered afferent sensory and efferent motor responses, together with disrupted visual, vestibular, and proprioceptive components. The pathological basis of MCR relates with the frontal lacunar infarcts, white matter hyperintensity (WMH), gray matter atrophy in the pre-motor and pre-frontal cortex, abnormal cholinergic functioning, inflammatory responses, and genetic factors. Further, cerebrovascular lesions and cardiovascular disorders exacerbate the disease pathology. The diagnosis of MCR is carried out through neuropsychological tests, biomarker assays, imaging studies, questionnaire-based evaluation, and motor function tests, including walking speed, dual-task gait tests, and ambulation ability. Recovery from MCR may include cognitive, physical, and social activities, exercise, diet, nutritional supplements, symptomatic drug treatment, and lifestyle habits that restrict the disease progression. Psychotherapeutic counseling, anti-depressants, and vitamins may support motor and cognitive improvement, primarily through the restorative pathways. However, an in-depth understanding of the association of immobility, dementia, and cognitive stress with MCR requires additional clinical and pre-clinical studies. They may have a significant contribution in reducing MCR syndrome and the risk for dementia. Overall, the current review informs the vital connection between gait performance and cognition in MCR and highlights the usefulness of future research in the discernment and treatment of dementiating illness.
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Sun X, Harris KE, Hou L, Xia X, Liu X, Ge M, Jia S, Zhou L, Zhao W, Zhang Y, Zhao Y, Mei Y, Zhang G, Xin L, Hao Q, Shen Y, Xiao C, Yue J, Ge N, Li Y, Dong B, Xue Q. The prevalence and associated factors of motoric cognitive risk syndrome in multiple ethnic middle‐aged to older adults in west China: A cross‐sectional study. Eur J Neurol 2022; 29:1354-1365. [PMID: 35118760 DOI: 10.1111/ene.15255] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/15/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Xuelian Sun
- National Clinical Research Center of Geriatrics and Department of Geriatrics West China Hospital Sichuan University Chengdu Sichuan China
| | | | - Lisha Hou
- National Clinical Research Center of Geriatrics and Department of Geriatrics West China Hospital Sichuan University Chengdu Sichuan China
| | - Xin Xia
- National Clinical Research Center of Geriatrics and Department of Geriatrics West China Hospital Sichuan University Chengdu Sichuan China
| | - Xiaolei Liu
- National Clinical Research Center of Geriatrics and Department of Geriatrics West China Hospital Sichuan University Chengdu Sichuan China
| | - Meiling Ge
- National Clinical Research Center of Geriatrics and Department of Geriatrics West China Hospital Sichuan University Chengdu Sichuan China
| | - Shuli Jia
- National Clinical Research Center of Geriatrics and Department of Geriatrics West China Hospital Sichuan University Chengdu Sichuan China
| | - Lixing Zhou
- National Clinical Research Center of Geriatrics and Department of Geriatrics West China Hospital Sichuan University Chengdu Sichuan China
| | - Wanyu Zhao
- National Clinical Research Center of Geriatrics and Department of Geriatrics West China Hospital Sichuan University Chengdu Sichuan China
| | - Yan Zhang
- National Clinical Research Center of Geriatrics and Department of Geriatrics West China Hospital Sichuan University Chengdu Sichuan China
| | - Yunli Zhao
- National Clinical Research Center of Geriatrics and Department of Geriatrics West China Hospital Sichuan University Chengdu Sichuan China
| | - Yang Mei
- National Clinical Research Center of Geriatrics and Department of Geriatrics West China Hospital Sichuan University Chengdu Sichuan China
| | - Gongchang Zhang
- National Clinical Research Center of Geriatrics and Department of Geriatrics West China Hospital Sichuan University Chengdu Sichuan China
| | - Liuyi Xin
- National Clinical Research Center of Geriatrics and Department of Geriatrics West China Hospital Sichuan University Chengdu Sichuan China
| | - Qiukui Hao
- National Clinical Research Center of Geriatrics and Department of Geriatrics West China Hospital Sichuan University Chengdu Sichuan China
| | - Yanjiao Shen
- Department of Guideline and Rapid Recommendation Cochrane China Centre MAGIC China Centre Chinese Evidence‐Based Medicine Centre West China Hospital Sichuan University Chengdu Sichuan China
| | - Chun Xiao
- National Clinical Research Center of Geriatrics and Department of Geriatrics West China Hospital Sichuan University Chengdu Sichuan China
| | - Jirong Yue
- National Clinical Research Center of Geriatrics and Department of Geriatrics West China Hospital Sichuan University Chengdu Sichuan China
| | - Ning Ge
- National Clinical Research Center of Geriatrics and Department of Geriatrics West China Hospital Sichuan University Chengdu Sichuan China
| | - Ying Li
- National Clinical Research Center of Geriatrics and Department of Geriatrics West China Hospital Sichuan University Chengdu Sichuan China
| | - Birong Dong
- National Clinical Research Center of Geriatrics and Department of Geriatrics West China Hospital Sichuan University Chengdu Sichuan China
| | - Qianli Xue
- Departments of Medicine, Biostatistics, and Epidemiology Johns Hopkins University Baltimore USA
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Su L, Sun X, Huang C, Wei Z, Shen X, Wang L. Methodology of Measuring Motoric Cognitive Risk Syndrome-Focusing on Slow Gait Speed: Protocol for a Systematic Review. Front Psychiatry 2022; 13:858950. [PMID: 35418886 PMCID: PMC8995464 DOI: 10.3389/fpsyt.2022.858950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/21/2022] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Liming Su
- School of Medicine, Huzhou University, Huzhou, China
| | - Xue Sun
- School of Medicine, Huzhou University, Huzhou, China
| | - Cheng Huang
- School of Medicine, Huzhou University, Huzhou, China
| | - Zhuqin Wei
- School of Medicine, Huzhou University, Huzhou, China
| | - Xinhua Shen
- Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, Huzhou, China
| | - Lina Wang
- School of Medicine, Huzhou University, Huzhou, China
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Iqbal K, Hasanain M, Ahmed J, Iqbal A, Rathore SS, Monis A, Baig MD, Ul Haq ZG. Association of Motoric Cognitive Risk Syndrome with Cardiovascular and Noncardiovascular Factors: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2021; 23:810-822. [PMID: 34973959 DOI: 10.1016/j.jamda.2021.11.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/09/2021] [Accepted: 11/27/2021] [Indexed: 12/20/2022]
Abstract
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.
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Affiliation(s)
- Kinza Iqbal
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Muhammad Hasanain
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Jawad Ahmed
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Ayman Iqbal
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | | | - Mirza Daniyal Baig
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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Udina C, Ayers E, Inzitari M, Verghese J. Walking While Talking and Prefrontal Oxygenation in Motoric Cognitive Risk Syndrome: Clinical and Pathophysiological Aspects. J Alzheimers Dis 2021; 84:1585-1596. [PMID: 34744077 DOI: 10.3233/jad-210239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Cristina Udina
- REFiT Barcelona Research Group, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.,Medicine Department, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Marco Inzitari
- REFiT Barcelona Research Group, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.,Medicine Department, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Joe Verghese
- Albert Einstein College of Medicine, Bronx, NY, USA
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Blumen HM, Schwartz E, Allali G, Beauchet O, Callisaya M, Doi T, Shimada H, Srikanth V, Verghese J. Cortical Thickness, Volume, and Surface Area in the Motoric Cognitive Risk Syndrome. J Alzheimers Dis 2021; 81:651-665. [PMID: 33867359 DOI: 10.3233/jad-201576] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The motoric cognitive risk (MCR) syndrome is a pre-clinical stage of dementia characterized by slow gait and cognitive complaint. Yet, the brain substrates of MCR are not well established. OBJECTIVE To examine cortical thickness, volume, and surface area associated with MCR in the MCR-Neuroimaging Consortium, which harmonizes image processing/analysis of multiple cohorts. METHODS Two-hundred MRIs (M age 72.62 years; 47.74%female; 33.17%MCR) from four different cohorts (50 each) were first processed with FreeSurfer 6.0, and then analyzed using multivariate and univariate general linear models with 1,000 bootstrapped samples (n-1; with resampling). All models adjusted for age, sex, education, white matter lesions, total intracranial volume, and study site. RESULTS Overall, cortical thickness was lower in individuals with MCR than in those without MCR. There was a trend in the same direction for cortical volume (p = 0.051). Regional cortical thickness was also lower among individuals with MCR than individuals without MCR in prefrontal, insular, temporal, and parietal regions. CONCLUSION Cortical atrophy in MCR is pervasive, and include regions previously associated with human locomotion, but also social, cognitive, affective, and motor functions. Cortical atrophy in MCR is easier to detect in cortical thickness than volume and surface area because thickness is more affected by healthy and pathological aging.
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Affiliation(s)
- Helena M Blumen
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Emily Schwartz
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Gilles Allali
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Clinical Neurosciences, Geneva University Hospitals and University of Geneva, Switzerland
| | - Olivier Beauchet
- Division of Geriatric Medicine, Sir Mortimer B. Davis Jewish General Hospital & Dr. Joseph Kaufmann Chair in Geriatric Medicine, Faculty of Medicine McGill University, Montreal, Quebec, Canada
| | - Michele Callisaya
- Peninsula Clinical School, Central Clinical School, Monash University, Victoria, Australia.,Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Takehiko Doi
- Section for Health Promotion, Department of Preventive Gerontology
| | - Hiroyuki Shimada
- National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Velandai Srikanth
- Peninsula Clinical School, Central Clinical School, Monash University, Victoria, Australia.,Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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Ambrose AF, Gulley E, Verghese T, Verghese J. Home-based exercise program for older adults with Motoric Cognitive Risk syndrome: feasibility study. Neurodegener Dis Manag 2021; 11:221-228. [PMID: 34011161 DOI: 10.2217/nmt-2020-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We developed a home-based goal-directed exercise program with telephonic coaching to overcome barriers to exercise participation in cognitively impaired older adults. Methods: Six patients with Motoric Cognitive Risk syndrome at high risk for dementia were enrolled, three assigned to goal-directed exercises and three to stretching exercises. All participants underwent an in-person training session followed by a session at home with a telephonic coach. Sessions were supervised by a physiatrist, and exercise programs were personalized. Results: In-person training and remote telephonic coaching support promoted adherence. There were no adverse effects and interventions were rated highly. Participant and logistical barriers were identified that can inform design of home-based clinical trials. Conclusion: Home-based exercises are safe and feasible in older adults with Motoric Cognitive Risk.
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Affiliation(s)
- Anne Felicia Ambrose
- Departments of Rehabilitation Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Emma Gulley
- Departments of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Tanya Verghese
- Albert Einstein College of Medicine Medical School, Bronx, NY 10461, USA
| | - Joe Verghese
- Departments of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Koren MJ, Blumen HM, Ayers EI, Verghese J, Abramowitz MK. Cognitive Dysfunction and Gait Abnormalities in CKD. Clin J Am Soc Nephrol 2021; 16:694-704. [PMID: 33824156 PMCID: PMC8259490 DOI: 10.2215/cjn.16091020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/11/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Cognitive impairment is a major cause of morbidity in CKD. We hypothesized that gait abnormalities share a common pathogenesis with cognitive dysfunction in CKD, and therefore would be associated with impaired cognitive function in older adults with CKD, and focused on a recently defined gait phenotype linked with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Gait assessments and neuropsychological testing were performed in 312 nondisabled, community-dwelling older adults (aged ≥65 years). A subset (n=115) underwent magnetic resonance imaging. The primary cognitive outcome was the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) total scale score. Associations with cognitive function were tested using multivariable linear regression and nearest-neighbor matching. The risk of developing mild cognitive impairment syndrome was assessed using Cox proportional hazards models. RESULTS Lower eGFR was associated with lower RBANS score only among participants with the gait phenotype (P for interaction =0.04). Compared with participants with neither CKD nor the gait phenotype, adjusted RBANS scores were 5.4 points (95% confidence interval, 1.8 to 9.1) lower among participants with both, who demonstrated poorer immediate memory, visuospatial ability, delayed memory, and executive function. In a matched analysis limited to participants with CKD, the gait phenotype was similarly associated with lower RBANS scores (-6.9; 95% confidence interval, -12.2 to -1.5). Neuroimaging identified a pattern of gray matter atrophy common to both CKD and the gait phenotype involving brain regions linked with cognition. The gait phenotype was associated with higher risk of mild cognitive impairment (hazard ratio, 3.91; 95% confidence interval, 1.46 to 10.44) independent of eGFR. CONCLUSIONS The gait phenotype was associated with poorer function in a number of cognitive domains among older adults with CKD, and was associated with incident mild cognitive impairment independent of eGFR. CKD and the gait phenotype were associated with a shared pattern of gray matter atrophy.
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Affiliation(s)
- Melanie J. Koren
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Helena M. Blumen
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York,Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Emmeline I. Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York,Department of Neurology, Albert Einstein College of Medicine, Bronx, New York,Institute for Aging Research, Albert Einstein College of Medicine, Bronx, New York
| | - Matthew K. Abramowitz
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York,Institute for Aging Research, Albert Einstein College of Medicine, Bronx, New York,Diabetes Research Center, Albert Einstein College of Medicine, Bronx, New York,Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, Bronx, New York
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Meiner Z, Ayers E, Bennett DA, Wang C, Verghese J. Risk factors for the progression of motoric cognitive risk syndrome to dementia: Retrospective cohort analysis of two populations. Eur J Neurol 2021; 28:1859-1867. [PMID: 33780585 DOI: 10.1111/ene.14841] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Motoric cognitive risk syndrome (MCR) is a predementia syndrome characterized by cognitive complaints and slow gait. MCR is associated with increased risk of cognitive decline and incident dementia. Predictors of transition to dementia in MCR patients are still obscure. METHODS We examined clinical, biological and lifestyle parameters related to conversion to dementia using Cox models in 439 older adults with prevalent MCR (mean age 79.87 ± 8.13 years, 70% women) from two cohorts, 268 from the Chicago-based Rush Memory and Aging project (MAP) and 171 from the Religious Orders Study (ROS), which enrolled religious clergy across the United States. RESULTS In the pooled sample, 439 (13.2%) had prevalent MCR (268 MAP and 171 ROS). There were 140 (31.9%) incident dementia cases over a median follow up of 4.0 years. Age predicted conversion from MCR to dementia in both cohorts. Male gender was a risk factor only in ROS. In the pooled data, only higher depressive symptoms were associated with higher risk of conversion to dementia (adjusted hazard ratio [aHR] 1.13, 95% CI 1.03-1.24). Lower cognitive activity participation (aHR 0.59, 95% CI 0.44-0.79) and apolipoprotein E ε4 allele (aHR 2.57, 95% CI 1.48-4.45) predicted conversion to dementia in MAP. CONCLUSIONS Depressive symptoms and other cohort-specific risk factors were identified as predictors of transition to dementia in individuals with MCR. These findings suggest common pathological mechanisms underlying mood, gait and cognitive declines in aging, which could help develop preventive strategies.
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Affiliation(s)
- Zeev Meiner
- Department of Physical Medicine and Rehabilitation, Hadassah Mount Scopus, Jerusalem, Israel
| | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David A Bennett
- Department of Neurology, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Cuiling Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joe Verghese
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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Beauchet O, Cooper-Brown LA, Allali G. Motoric cognitive risk syndrome: what's new? Aging (Albany NY) 2021; 13:7711-7712. [PMID: 33779575 PMCID: PMC8034922 DOI: 10.18632/aging.202899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Olivier Beauchet
- Departments of Medicine, University of Montreal, Montreal, Quebec, Canada.,Research Center of the Geriatric University Institute of Montreal, Montreal, Quebec, Canada.,Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada.,Lee Kong Chian School of Medicine, Nanyang Technological University, Nanyang, Singapore
| | - Liam A Cooper-Brown
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Gilles Allali
- Department of Neurology, Geneva University Hospital and University of Geneva, Geneva, Switzerland
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Merchant RA, Goh J, Chan YH, Lim JY, Vellas B. Slow Gait, Subjective Cognitive Decline and Motoric Cognitive RISK Syndrome: Prevalence and Associated Factors in Community Dwelling Older Adults. J Nutr Health Aging 2021; 25:48-56. [PMID: 33367462 DOI: 10.1007/s12603-020-1525-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Motoric Cognitive Risk Syndrome (MCR), slow gait speed (SG) and subjective cognitive decline (SCD) are known to be harbingers of dementia. MCR is known to be associated with a 3-fold increased risk of future dementia, while SG can precede cognitive impairment. OBJECTIVE We aim to determine the prevalence and demographics of MCR, slow gait alone (SG-A) and subjective cognitive decline alone (SCD-A) in community-dwelling older adults and association with physical, functional, cognition and psychosocial factors. METHODS A total of 509 participants were classified into four groups according to presence of SG and/or SCD. Multinomial logistic regression was used to identify the factors associated with SG-A, SCD-A and MCR. RESULTS The prevalence of MCR was 13.6%, SG-A 13.0% and SCD-A 35.0%. Prevalence of MCR doubled every decade in females with 27.7% of female ≥ 80 years old had MCR. Almost 4 in 10 had no SG or SCD (SG+SCD negative). MCR and SG-A groups were significantly older, had higher body mass index (BMI), lower education, lower global cognition scores especially in non-memory domains, higher prevalence of low grip strength and lower short physical performance battery scores than those with SCD-A and SG+SCD negative. In addition, the SG-A group had significantly higher prevalence of multi-morbidity and diabetes. The prevalence of pain, depression, frailty, social isolation and activity of daily living impairment were significantly higher in MCR. The global cognitive and functional scores for those with SCD-A were comparable to the SG+SCD negative group. The Malay ethnic group had the lowest prevalence of SCD but highest prevalence of SG. After adjusting for confounding factors, age, BMI, frailty status, instrumental activity of daily living, depression and pain remained significantly associated with MCR. For SG-A, age, BMI, education and number of chronic diseases remained significant. CONCLUSION Both MCR and SG-A are associated with global cognitive decline especially in the non-memory domains and lower functional scores. Gait speed is a good predictor of negative outcomes and should be considered as the 'sixth' vital sign. Long term prospective studies are needed to evaluate: i) the conversion to dementia in different ethnic groups and ii) effect of targeted physical and / or dual task exercise on delaying the conversion to dementia and / or improvement in physical measures and reduction of disability.
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Affiliation(s)
- Reshma A Merchant
- Associate Professor Reshma Merchant, Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore 119228, , Telephone number: +65 6779 5555, ORCID iD: 0000-0002-9032-0184
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Chung CP, Lee WJ, Peng LN, Shimada H, Tsai TF, Lin CP, Arai H, Chen LK. Physio-Cognitive Decline Syndrome as the Phenotype and Treatment Target of Unhealthy Aging. J Nutr Health Aging 2021; 25:1179-1189. [PMID: 34866145 DOI: 10.1007/s12603-021-1693-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In this era of unprecedented longevity, healthy aging is an important public health priority. Avoiding or shortening the period of disability or dementia before death is critical to achieving the defining objectives of healthy aging, namely to develop and maintain functional capabilities that enable wellbeing in older age. The first step is to identify people who are at risk and then to implement effective primary interventions. Geriatricians have identified a distinct clinical phenotype of concurrent physical frailty and cognitive impairment, which predicts high risk of incident dementia and disability and is potentially reversible. Differing operational definitions for this phenotype include "cognitive frailty", "motoric cognitive risk syndrome" and the recently proposed "physio-cognitive decline syndrome (PCDS)". PCDS is defined as concurrent mobility impairment no disability (MIND: slow gait or/and weak handgrip) and cognitive impairment no dementia (CIND: ≥1.5 SD below the mean for age-, sex-, and education-matched norms in any cognitive domain but without dementia). By these criteria, PCDS has a prevalence of 10-15% among community-dwelling older persons without dementia or disability, who are at increased risk for incident disability (HR 3.9, 95% CI 3.0-5.1), incident dementia (HR 3.4, 95% CI 2.4-5.0) and all-cause mortality (HR 6.7, 95% CI 1.8-26.1). Moreover, PCDS is associated with characteristic neuroanatomic changes in the cerebellum and hippocampus, and their neurocircuitry, which are distinct from neuroimaging features in normal aging and common dementia syndromes. Basic research and longitudinal clinical studies also implicate a hypothetical muscle-brain axis in the pathoetiology of PCDS. Most important, community-dwelling elders with PCDS who participated in a multidomain intervention had significant improvements in global cognitive function, and especially in the subdomains of naming and concentration. Our proposed operational definition of PCDS successfully identifies an appreciable population of at-risk older people, establishes a distinct phenotype with an apparently unique pathoetiology, and is potentially reversible. We now need further studies to elucidate the pathophysiology of PCDS, to validate neuroimaging features and muscle-secreted microRNA biomarkers, and to evaluate the effectiveness of sustained multidomain interventions.
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Affiliation(s)
- C-P Chung
- Prof. Liang-Kung Chen, Aging and Health Research Center, National Yang Ming Chiao Tung University Yangming Campus, No. 155, Section 2, Linong St, Beitou District, Taipei City, 112, Taiwan. Tel: +886-2-28757830, E-mail:
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Calderón-Garcidueñas L, Torres-Solorio AK, Kulesza RJ, Torres-Jardón R, González-González LO, García-Arreola B, Chávez-Franco DA, Luévano-Castro SC, Hernández-Castillo A, Carlos-Hernández E, Solorio-López E, Crespo-Cortés CN, García-Rojas E, Mukherjee PS. Gait and balance disturbances are common in young urbanites and associated with cognitive impairment. Air pollution and the historical development of Alzheimer's disease in the young. ENVIRONMENTAL RESEARCH 2020; 191:110087. [PMID: 32890478 PMCID: PMC7467072 DOI: 10.1016/j.envres.2020.110087] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 05/03/2023]
Abstract
To determine whether gait and balance dysfunction are present in young urbanites exposed to fine particular matter PM2.5 ≥ annual USEPA standard, we tested gait and balance with Tinetti and Berg tests in 575 clinically healthy subjects, age 21.0 ± 5.7 y who were residents in Metropolitan Mexico City, Villahermosa and Reynosa. The Montreal Cognitive Assessment was also applied to an independent cohort n:76, age 23.3 ± 9.1 y. In the 575 cohort, 75.4% and 34.4% had abnormal total Tinetti and Berg scores and high risk of falls in 17.2% and 5.7% respectively. BMI impacted negatively Tinetti and Berg performance. Gait dysfunction worsen with age and males performed worse than females. Gait and balance dysfunction were associated with mild cognitive impairment MCI (19.73%) and dementia (55.26%) in 57/76 and 19 cognitively intact subjects had gait and balance dysfunction. Seventy-five percent of urbanites exposed to PM2.5 had gait and balance dysfunction. For MMC residents-with historical documented Alzheimer disease (AD) and CSF abnormalities, these findings suggest Alzheimer Continuum is in progress. Early development of a Motoric Cognitive Risk Syndrome ought to be considered in city dwellers with normal cognition and gait dysfunction. The AD research frame in PM2.5 exposed young urbanites should include gait and balance measurements. Multicity teens and young adult cohorts are warranted for quantitative gait and balance measurements and neuropsychological and brain imaging studies in high vs low PM2.5 exposures. Early identification of gait and balance impairment in young air pollution-exposed urbanites would facilitate multidisciplinary prevention efforts for modifying the course of AD.
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Affiliation(s)
| | | | - Randy J Kulesza
- Auditory Research Center, Lake Erie College of Osteopathic Medicine, Erie, PA, 16509, USA
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Cerebellar-limbic neurocircuit is the novel biosignature of physio-cognitive decline syndrome. Aging (Albany NY) 2020; 12:25319-25336. [PMID: 33234736 PMCID: PMC7803525 DOI: 10.18632/aging.104135] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/20/2020] [Indexed: 12/14/2022]
Abstract
Both physical and cognitive deficits occur in the aging process. We operationally defined the phenomenon as physio-cognitive decline syndrome (PCDS) and aimed to decipher its corresponding neuroanatomy patterns and neurocircuit. High resolution 3T brain magnetic resonance imaging (MRI) images from a community-dwelling longitudinal aging cohort were analysed. PCDS was defined as weakness (handgrip strength) and/or slowness (gait speed) concomitant with impairment in any cognitive domain (defined by 1.5 standard deviation below age, sex-matched norms), but without dementia or disability. Among 1196 eligible ≥ 50-year-old (62±9 years, 47.6%men) subjects, 15.9% had PCDS. Compared to the other participants, individuals with PCDS had significantly lower gray-matter volume (GMV) in the bilateral amygdala and thalamus, right hippocampus, right temporo-occipital cortex, and left cerebellum VI and V regions. The regions of reduced GMV in people with PCDS were similar between the middle-aged and older adults; whereas larger clusters with more extensive GMV-depleted regions were observed in ≥65-year-olds with PCDS. Diffusion-weighted tractography showed disrupted hippocampus-amygdala-cerebellum connections in subjects with PCDS. The neuroanatomic characteristics revealed by this study provide evidence for pathophysiological processes associated with concomitant physio-cognitive decline in the elderly. This neurocircuit might constitute a target for future preventive interventions.
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Abstract
BACKGROUND Motoric cognitive risk (MCR) syndrome is a cognitive-motor syndrome associated with increased risk of transition to dementia. The clinical phenotype of MCR is not yet established. OBJECTIVE To systematically assess clinical gait abnormalities in older adults with MCR. METHODS Of the 522 community-dwelling non-demented adults aged 65 and older enrolled in the Central Control of Mobility in Aging study, 43 were diagnosed with MCR (47% women) based on presence of cognitive complaints and slow gait velocity (MCRv). Four additional subtypes of MCR were defined by substituting slow gait with short stride length (MCRsl, n = 41), slow swing time (MCRsw, n = 21), high stride length variability (MCRslv, n = 24), and high swing time variability (MCRswv, n = 25). The prevalence of clinical gait abnormalities (neurological or non-neurological) in MCR overall (n = 81) and subtypes was studied. We also examined if gait abnormalities predicted further cognitive and functional decline in MCR cases. RESULTS Most clinical gait abnormalities were mild (walked without assistance) in the five MCR subtypes (44 to 61%). Neurological (range 24 to 46%) and non-neurological gait abnormalities (33 to 61%) were common in all MCR subtypes. Neurological gaits were most frequent in MCRsl (46%) and non-neurological gaits in MCRv (61%). Over a median 3.02 years of follow-up, presence of gait abnormality in MCR cases at baseline predicted worsening disability scores (estimate 0.17, p-value = 0.033) but not decline on cognitive scores (p-value = 0.056). CONCLUSION Clinical gait abnormalities are common in MCR syndrome and its subtypes, and are associated with accelerated functional decline.
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Affiliation(s)
- Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joe Verghese
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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Tian Q, Studenski SA, Montero-Odasso M, Davatzikos C, Resnick SM, Ferrucci L. Cognitive and neuroimaging profiles of older adults with dual decline in memory and gait speed. Neurobiol Aging 2020; 97:49-55. [PMID: 33152563 DOI: 10.1016/j.neurobiolaging.2020.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/16/2020] [Accepted: 10/03/2020] [Indexed: 12/11/2022]
Abstract
We previously showed that dual decline in memory and gait speed was associated with an increased risk of dementia compared to memory or gait decline only or no decline. We now characterized cognitive and neuroimaging profiles of dual decliners by comparing longitudinal rates of change in various cognitive domains (n = 664) and brain volumes (n = 391; selected frontal, temporal, parietal, subcortical, and cerebellar areas) in Baltimore Longitudinal Study of Aging participants who experienced age-related dual decline to others. Compared to others, dual decliners had steeper declines in verbal fluency, attention, and sensorimotor function by Pegboard nondominant hand performance. Dual decliners had greater brain volume loss in superior frontal gyrus, superior parietal gyrus, precuneus, thalamus, and cerebellum (all p ≤ 0.01). Participants with age-related dual decline experienced steeper declines in multiple cognitive domains and greater brain volume loss in cognitive, sensorimotor, and locomotion areas. Impaired sensorimotor integration and locomotion are underlying features of dual decline. Whether these features contribute to the increased risk of dementia should be investigated.
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Affiliation(s)
- Qu Tian
- Translational Gerontology Branch Longitudinal Studies Section, National Institute on Aging, Baltimore, MD, USA.
| | - Stephanie A Studenski
- Translational Gerontology Branch Longitudinal Studies Section, National Institute on Aging, Baltimore, MD, USA; Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Manuel Montero-Odasso
- Division of Geriatric Medicine, Department of Medicine, Parkwood Hospital, The University of Western Ontario, London, Ontario, Canada; Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada
| | - Christos Davatzikos
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Susan M Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA
| | - Luigi Ferrucci
- Translational Gerontology Branch Longitudinal Studies Section, National Institute on Aging, Baltimore, MD, USA
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Wei Y, Wang C, Liu J, Miao P, Wu L, Wang Y, Wang K, Cheng J. Progressive Gray Matter Atrophy and Abnormal Structural Covariance Network in Ischemic Pontine Stroke. Neuroscience 2020; 448:255-265. [PMID: 32890665 DOI: 10.1016/j.neuroscience.2020.08.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/10/2020] [Accepted: 08/26/2020] [Indexed: 01/02/2023]
Abstract
Our aim was to identify the longitudinal changes in gray matter volume (GMV) and secondary alterations of structural covariance after pontine stroke (PS). Structural MRI and behavioral scores were obtained at 1 week, 1 month, 3 months, 6 months in 11 patients with PS. Twenty healthy subjects underwent the same examination only once. We used voxel-based morphometry and seed-based structural covariance to investigate the altered GMV and structural covariance patterns. Furthermore, the associations between the GMV changes and behavioral scores were assessed. With the progression of the disease, GMV decreased significantly in the bilateral cerebellar posterior lobe (ipsilateral Crus II (CBE Crus II_IL) and contralateral Crus I (CBE Crus I_CL)), which were initially detected at the first month and then continued to decrease during the following 6 months. Based on the CBE Crus II_IL and CBE Crus I_CL as seed regions, structural covariance analysis revealed that there were more positively and negatively correlated brain regions in PS group, mainly distributed in the bilateral prefrontal lobe, parietal lobe, temporal lobe, paralimbic system and cerebellum. In addition, PS group showed more additional correlations between these covariant brain regions, and the changes of GMV in these regions were correlated with behavioral scores related to motor and cognitive functions. These findings indicate that PS could lead to significant GMV atrophy in the bilateral cerebellar posterior lobe at the early stage, accompanied by anomalous structural covariance patterns with more covariant brain regions and additional structural connectivity, which may provide useful information for understanding the neurobiological mechanisms of behavioral recovery after PS.
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Affiliation(s)
- Ying Wei
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Caihong Wang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingchun Liu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Peifang Miao
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Luobing Wu
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingying Wang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kaiyu Wang
- GE Healthcare MR Research, Beijing, China
| | - Jingliang Cheng
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Lin CS, Lin HH, Wang SJ, Fuh JL. Association between regional brain volume and masticatory performance differed in cognitively impaired and non-impaired older people. Exp Gerontol 2020; 137:110942. [DOI: 10.1016/j.exger.2020.110942] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/09/2020] [Accepted: 03/28/2020] [Indexed: 12/11/2022]
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Nester C, Ayers E, Rabin L, Verghese J. Non-memory subjective cognitive concerns predict incident motoric cognitive risk syndrome. Eur J Neurol 2020; 27:1146-1154. [PMID: 32319724 DOI: 10.1111/ene.14271] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Motoric cognitive risk syndrome (MCR) is a predementia condition that combines slow gait and subjective cognitive concerns. As the earliest markers of MCR are relatively unknown, the role of subjective cognitive concerns was investigated to predict incident MCR in a well-characterized prospective cohort of non-demented older adults. METHODS Non-demented MCR-free older adults (n = 476) from the Central Control of Mobility in Aging cohort completed gait, subjective cognition and neuropsychological assessment at baseline and follow-up. Subjective concerns were analyzed via responses to 12 items from three validated measures, the Late-Life Function and Disability Instrument - Disability Component, the Activities of Daily Living Prevention Instrument and the Geriatric Depression Scale, and were independent of items utilized to diagnose MCR. Cox proportional hazard models examined the association between cognitive concerns and incident MCR. RESULTS After 2.36 ± 1.4 years, 28 participants developed MCR. Executive functioning (adjusted hazard ratio 2.458, 95% confidence interval 1.094-5.524, P = 0.029) and mental clarity concerns (adjusted hazard ratio 3.917, 95% confidence interval 1.690-9.077, P = 0.001) were associated with incident MCR, controlling for age, sex, education and gait speed. CONCLUSIONS Subjective cognitive concerns in non-memory cognitive domains predict incident MCR. Although most MCR studies assess cognitive concerns about memory, our findings suggest the need to broaden the scope of subjective cognitive assessment to enhance the accuracy of diagnosis and prediction of future cognitive decline.
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Affiliation(s)
- C Nester
- Department of Psychology, Queens College, City University of New York (CUNY), Queens, NY, USA.,Department of Psychology, Graduate Center, City University of New York (CUNY), New York, NY, USA
| | - E Ayers
- Departments of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - L Rabin
- Department of Psychology, Graduate Center, City University of New York (CUNY), New York, NY, USA.,Department of Psychology, Brooklyn College, City University of New York (CUNY), Brooklyn, NY, USA
| | - J Verghese
- Departments of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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Meiner Z, Ayers E, Verghese J. Motoric Cognitive Risk Syndrome: A Risk Factor for Cognitive Impairment and Dementia in Different Populations. Ann Geriatr Med Res 2020; 24:3-14. [PMID: 32743316 PMCID: PMC7370775 DOI: 10.4235/agmr.20.0001] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 12/13/2022] Open
Abstract
Changes in gait, especially decreased gait velocity, may be a harbinger of cognitive decline in aging. Motoric cognitive risk syndrome (MCR), a pre-dementia syndrome combining slow gait and cognitive complaints, is a powerful clinical tool used to identify older adults at a high risk of developing dementia. The mean prevalence of MCR worldwide, including in a Korean cohort, was around 10%. The reported risk factors for incident MCR include older age, low education, cardiovascular disease, obesity, physical inactivity, and depression. In addition to dementia, MCR is also a risk factor for other age-related adverse conditions such as falls, disability, frailty, and mortality. The use of MCR has advantages over other pre-dementia syndromes in being much simpler to implement and requires fewer resources. Identification of mechanisms responsible for MCR may help in developing interventions to reduce the growing burden of dementia and disability worldwide.
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Affiliation(s)
- Zeev Meiner
- Department of Physical Medicine and Rehabilitation, Hadassah Mount Scopus, Jerusalem, Israel
| | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joe Verghese
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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Semba RD, Tian Q, Carlson MC, Xue QL, Ferrucci L. Motoric cognitive risk syndrome: Integration of two early harbingers of dementia in older adults. Ageing Res Rev 2020; 58:101022. [PMID: 31996326 PMCID: PMC7697173 DOI: 10.1016/j.arr.2020.101022] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/10/2020] [Accepted: 01/21/2020] [Indexed: 12/17/2022]
Abstract
Dementia is characterized by a long preclinical phase that may last years to decades before the onset of mild cognitive impairment. Slow gait speed and subjective memory complaint commonly co-occur during this preclinical phase, and each is a strong independent predictor of cognitive decline and dementia. Motoric cognitive risk (MCR) syndrome is a pre-dementia syndrome that combines these two early harbingers of dementia. The risk of cognitive decline or dementia is stronger for MCR than for either slow gait speed or subjective memory complaint alone. Slow gait speed and subjective memory complaint have several common risk factors: cardiovascular disease, diabetes mellitus, abnormal cortisol profiles, low vitamin D levels, brain atrophy with decreased hippocampal volume, and increased deposition of beta-amyloid in the brain. The underlying pathogenesis of MCR remains poorly understood. Metabolomics and proteomics have great potential to provide new insights into biological pathways involved in MCR during the long preclinical phase preceding dementia.
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Affiliation(s)
- Richard D Semba
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Qu Tian
- National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Michelle C Carlson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Qian-Li Xue
- Departments of Medicine, Biostatistics, and Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
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Xu Z, Wang J, Lyu H, Wang R, Hu Y, Guo Z, Xu J, Hu Q. Alterations of White Matter Microstructure in Subcortical Vascular Mild Cognitive Impairment with and without Depressive Symptoms. J Alzheimers Dis 2020; 73:1565-1573. [PMID: 31958086 DOI: 10.3233/jad-190890] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ziyun Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Jianjun Wang
- Department of Neurology and Psychiatry, Shenzhen Traditional Chinese Medicine Hospital / the Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, P. R. China
| | - Hanqing Lyu
- Department of Radiology, Shenzhen Traditional Chinese Medicine Hospital / the Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, P. R. China
| | - Runshi Wang
- School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuanming Hu
- Department of Radiology, Shenzhen Traditional Chinese Medicine Hospital / the Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, P. R. China
| | - Zhouke Guo
- Department of Neurology and Psychiatry, Shenzhen Traditional Chinese Medicine Hospital / the Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, P. R. China
| | - Jinping Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Qingmao Hu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- University of Chinese Academy of Sciences, Beijing, China
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
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Motoric cognitive risk syndrome and predictors of transition to dementia: A multicenter study. Alzheimers Dement 2019; 15:870-877. [PMID: 31164315 DOI: 10.1016/j.jalz.2019.03.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/12/2019] [Accepted: 03/25/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION To report clinical predictors of transition to dementia in motoric cognitive risk syndrome (MCR), a predementia syndrome characterized by cognitive complaints and slow gait. METHODS We examined if cognitive or motoric impairments predicted transition to dementia in 610 older adults with MCR from three cohorts. Association of cognitive (logical memory, clinical dementia rating, cognitive complaint severity, and Mini-Mental State Examination) and motoric factors (gait velocity) with dementia risk was computed using Cox models. RESULTS There were 156 incident dementias (134 Alzheimer's disease). In the pooled sample, logical memory (adjusted hazard ratio [aHR] 0.91), cognitive complaint severity (aHR 1.53), and Mini-Mental State Examination (aHR 0.75) predicted transition of MCR to dementia. Clinical dementia rating score ≥0.5 predicted dementia (aHR 3.18) in one cohort. Gait velocity did not predict dementia. DISCUSSION While MCR is a motoric-based predementia syndrome, severity of cognitive but not motoric impairments predicts conversion to dementia.
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Sekhon H, Allali G, Launay CP, Barden J, Szturm T, Liu-Ambrose T, Chester VL, Wong CH, Beauchet O. Motoric cognitive risk syndrome, incident cognitive impairment and morphological brain abnormalities: Systematic review and meta-analysis. Maturitas 2019; 123:45-54. [DOI: 10.1016/j.maturitas.2019.02.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/11/2019] [Accepted: 02/13/2019] [Indexed: 12/15/2022]
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Allali G, Blumen HM, Devanne H, Pirondini E, Delval A, Van De Ville D. Brain imaging of locomotion in neurological conditions. Neurophysiol Clin 2018; 48:337-359. [PMID: 30487063 PMCID: PMC6563601 DOI: 10.1016/j.neucli.2018.10.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 01/20/2023] Open
Abstract
Impaired locomotion is a frequent and major source of disability in patients with neurological conditions. Different neuroimaging methods have been used to understand the brain substrates of locomotion in various neurological diseases (mainly in Parkinson's disease) during actual walking, and while resting (using mental imagery of gait, or brain-behavior correlation analyses). These studies, using structural (i.e., MRI) or functional (i.e., functional MRI or functional near infra-red spectroscopy) brain imaging, electrophysiology (i.e., EEG), non-invasive brain stimulation (i.e., transcranial magnetic stimulation, or transcranial direct current stimulation) or molecular imaging methods (i.e., PET, or SPECT) reveal extended brain networks involving both grey and white matters in key cortical (i.e., prefrontal cortex) and subcortical (basal ganglia and cerebellum) regions associated with locomotion. However, the specific roles of the various pathophysiological mechanisms encountered in each neurological condition on the phenotype of gait disorders still remains unclear. After reviewing the results of individual brain imaging techniques across the common neurological conditions, such as Parkinson's disease, dementia, stroke, or multiple sclerosis, we will discuss how the development of new imaging techniques and computational analyses that integrate multivariate correlations in "large enough datasets" might help to understand how individual pathophysiological mechanisms express clinically as an abnormal gait. Finally, we will explore how these new analytic methods could drive our rehabilitative strategies.
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Affiliation(s)
- Gilles Allali
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.
| | - Helena M Blumen
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA; Department of Medicine, Division of Geriatrics, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Hervé Devanne
- Department of Clinical Neurophysiology, Lille University Medical Center, Lille, France; EA 7369, URePSSS, Unité de Recherche Pluridisciplinaire Sport Santé Société, Université du Littoral Côte d'Opale, Calais, France
| | - Elvira Pirondini
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland; Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Arnaud Delval
- Department of Clinical Neurophysiology, Lille University Medical Center, Lille, France; Unité Inserm 1171, Faculté de Médecine, Université de Lille, Lille, France
| | - Dimitri Van De Ville
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland; Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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Schättin A, Gennaro F, Egloff M, Vogt S, de Bruin ED. Physical Activity, Nutrition, Cognition, Neurophysiology, and Short-Time Synaptic Plasticity in Healthy Older Adults: A Cross-Sectional Study. Front Aging Neurosci 2018; 10:242. [PMID: 30214406 PMCID: PMC6125692 DOI: 10.3389/fnagi.2018.00242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/24/2018] [Indexed: 12/15/2022] Open
Abstract
The aging brain undergoes remodeling processes because of biological and environmental factors. To counteract brain aging, neuronal plasticity should be preserved. The aim of this study was to test if the capacity of generating short-time synaptic plasticity in older adults may be related to either physical activity, nutritional status, cognition, or neurophysiological activity. Thirty-six participants (mean age 73.3 ± 5.9 years) received transcranial magnetic stimulation in combination with peripheral nerve stimulation to experimentally induce short-time synaptic plasticity by paired associative stimulation (PAS). Adaptations in neuronal excitability were assessed by motor-evoked potential (MEP) in the right m. tibialis anterior before and after PAS. The Physical Activity Questionnaire 50+ and the StepWatchTM captured physical activity levels. Nutritional status was assessed by the Mini Nutritional Assessment. Cognition was assessed by reaction time for a divided attention test and with the Montreal Cognitive Assessment. Neurophysiological activity was assessed by electroencephalography during the divided attention test. MEPs of the highest stimulation intensity resulted significantly different comparing before, 5 min, or 30 min after PAS (p < 0.05). Data-driven automatic hierarchical classification of the individual recruitment curve slopes over the three-time points indicated four different response types, however, response groups did not significantly differ based on physical activity, nutritional status, cognition, or neurophysiological activity. In a second-level analysis, participants having an increased slope showed a significant higher energy expenditure (z = -2.165, p = 0.030, r = 0.36) and revealed a significant higher power activity in the alpha frequency band (z = -2.008, p = 0.046, r = 0.37) at the prefrontal-located EEG electrodes, compared to the participants having a decreased slope. This study hints toward older adults differing in their neuronal excitability which is strongly associated to their short-time synaptic plasticity levels. Furthermore, a physically active lifestyle and higher EEG power in the alpha frequency band seem to be connected to the capacity of generating long-term potentiation-like synaptic plasticity in older adults. Future studies should consider more sensitive assessments and bigger sample sizes to get a broad scope of the older adults' population.
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Affiliation(s)
- Alexandra Schättin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zürich, Zürich, Switzerland
| | - Federico Gennaro
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zürich, Zürich, Switzerland
| | - Martin Egloff
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zürich, Zürich, Switzerland
| | - Simon Vogt
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zürich, Zürich, Switzerland
| | - Eling D. de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zürich, Zürich, Switzerland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
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