1
|
Lim NEK, Yeo BSY, Lee RS, Lim JX, Chan YH, Kandiah N, Ho R, Ho CSH, Woo J, Arai H, Merchant RA. Motoric cognitive risk syndrome as a predictive factor of cognitive impairment and dementia - A systematic review and meta-analysis. Ageing Res Rev 2024; 101:102470. [PMID: 39245075 DOI: 10.1016/j.arr.2024.102470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 08/24/2024] [Accepted: 08/24/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Motoric cognitive risk syndrome (MCR) is defined as the presence of slow gait-speed and subjective cognitive decline in older individuals without mobility disability or dementia. While some studies suggest that MCR is a pre-dementia syndrome and may help predict the risk of cognitive impairment and dementia, not all studies concur. The objective of this study is to comprehensively summarize and synthesize evidence to assess the association between MCR and cognitive impairment and dementia. METHODS Following a pre-specified protocol, two authors systematically searched PubMed, Embase, and The Cochrane Library from inception to 19 August 2024 for observational or randomized studies pertaining to the association between MCR and cognitive impairment and dementia. We favoured maximally adjusted hazards and odds ratios to determine the longitudinal and cross-sectional risk of cognitive impairment and dementia. We investigated for potential sources of heterogeneity and also conducted sensitivity and subgroup analyses by continent and the type of cognitive outcome. The quality of evidence was assessed using the Newcastle-Ottawa Scale (NOS) and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. RESULTS We included 20 studies comprising a combined cohort of 1206,782 participants, of which 17 studies were included in the quantitative analysis. The pooled analysis outlined that individuals with MCR exhibited 2.20-fold higher risk of cognitive impairment and dementia, compared to controls (RR=2.20; 95 %CI=1.91-2.53). These findings remained robust across all subgroup analyses, sensitivity analyses and assessments of publication bias. CONCLUSION MCR may be considered a predictive factor for long-term cognitive impairment and dementia. This should be taken into consideration when clinically evaluating the risk of cognitive impairment and dementia but further research is required to lend greater clarity to this association.
Collapse
Affiliation(s)
- Nicholas E-Kai Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Brian Sheng Yep Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Rachel Siying Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jun Xiang Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nagaendran Kandiah
- Division of Neurology, Department of Medicine, National University Hospital, Singapore; Dementia Research Centre Singapore, Lee Kong Chian School of Medicine, Singapore
| | - Roger Ho
- Department of Psychological Medicine, National University Hospital Singapore, Singapore
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, National University Hospital Singapore, Singapore
| | - Jean Woo
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hidenori Arai
- National Centre for Geriatrics and Gerontology, Obu, Japan
| | - Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| |
Collapse
|
2
|
Xu H, Gong X, Cui K, Li X, Chen L, Lu Y, Liao Y, Liu J. Association of peak expiratory flow with motoric cognitive risk syndrome among older adults. Front Aging Neurosci 2024; 16:1412542. [PMID: 39170900 PMCID: PMC11335682 DOI: 10.3389/fnagi.2024.1412542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/25/2024] [Indexed: 08/23/2024] Open
Abstract
Background The association between lung function and motoric cognitive risk syndrome (MCR) is unclear. We aimed to explore the association of peak expiratory flow (PEF) with MCR using cross-sectional and longitudinal analyses. Methods Within the CHARLS, 5095 participants were included in the cross-sectional analysis, and 4340 MCR-free participants were included in the longitudinal analysis. The PEF was assessed with a lung peak flow meter. MCR was characterized by cognitive complaints and a slow walking speed with normal mobility and without dementia. Logistic regression, Cox regression, and Laplace regression models were employed for data analysis. Results In this cross-sectional study, logistic regression analyses revealed that continuous PEF was associated with MCR (odds ratio [OR], 0.998; 95% confidence interval [CI], 0.998, 0.999), and the ORs (95% CIs) of MCR prevalence were 0.857 (0.693, 1.061) for the middle tertile and 0.665 (0.524, 0.845) for the highest tertile compared to the lowest tertile. In a longitudinal cohort study, continuous PEF was dose-dependently associated with the risk of MCR. Compared with those in the lowest tertile of PEF, the hazard ratios (95% CIs) of incident MCR were 0.827 (0.661, 1,036) for the middle tertile and 0.576 (0.432, 0.767) for the highest tertile. Furthermore, compared with the lowest tertile, the highest tertile was associated with a delayed onset time of MCR of 0.484 (95% CI: 0.151, 0.817) years. Conclusion A higher PEF was related to a lower prevalence of MCR and a lower risk for MCR, and a higher PEF also prolonged the onset time of MCR.
Collapse
Affiliation(s)
- Hui Xu
- Big Data Center, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - Xiangwen Gong
- Department of Respiratory and Critical Care Medicine, Ganzhou Key Laboratory of Respiratory Diseases, Ganzhou Institute of Respiratory Diseases, The Fifth People’s Hospital of Ganzhou, Ganzhou, Jiangxi, China
| | - Kaiwang Cui
- Department of Respiratory and Critical Care Medicine, Ganzhou Key Laboratory of Respiratory Diseases, Ganzhou Institute of Respiratory Diseases, The Fifth People’s Hospital of Ganzhou, Ganzhou, Jiangxi, China
| | - Xuerui Li
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin Geriatrics Institute, Tianjin, China
| | - Long Chen
- School of Rehabilitation Medicine, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Yiyi Lu
- Department of Respiratory and Critical Care Medicine, Ganzhou Key Laboratory of Respiratory Diseases, Ganzhou Institute of Respiratory Diseases, The Fifth People’s Hospital of Ganzhou, Ganzhou, Jiangxi, China
| | - Yangfang Liao
- Department of Respiratory and Critical Care Medicine, Ganzhou Key Laboratory of Respiratory Diseases, Ganzhou Institute of Respiratory Diseases, The Fifth People’s Hospital of Ganzhou, Ganzhou, Jiangxi, China
| | - Jianping Liu
- Department of Respiratory and Critical Care Medicine, Ganzhou Key Laboratory of Respiratory Diseases, Ganzhou Institute of Respiratory Diseases, The Fifth People’s Hospital of Ganzhou, Ganzhou, Jiangxi, China
| |
Collapse
|
3
|
Zhou L, Zhang Y, Ge M, Zhang G, Cheng R, Liu Y, Chen X, Liu X, Dong B. The associations of daytime napping and motoric cognitive risk syndrome: Findings from the China Health and Retirement Longitudinal Study. Exp Gerontol 2024; 191:112426. [PMID: 38604250 DOI: 10.1016/j.exger.2024.112426] [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: 01/02/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Motoric cognitive risk syndrome (MCR), characterized by subjective cognitive complaints and slow gait in older populations, is associated with sleep duration. However, the association between MCR and daytime nap duration has not been thoroughly explored. METHODS Baseline data from the China Health and Retirement Longitudinal Study (CHARLS) were used in this study. MCR was defined as the coexistence of subjective cognitive complaints and objective slow gait speed without a history of dementia or mobility disability. Daytime nap duration was categorized into four groups: no napping, short napping (<30 min), moderate napping (30-89 min) and extended napping (≥90 min). Multivariable logistic regression models were used to explore the association of daytime napping duration and MCR. RESULTS A total of 4230 individuals aged ≥60 were included in the current analysis, of which 463 were diagnosed with MCR. Moderate napping of 30-89 min per day was found to be significantly associated with lower odds of MCR compared with the reference group of no napping. In subgroup analysis, individuals with sleep durations of <7 h per night had lower odds of MCR in the model that adjusted for all potential confounders with ≥30 min daytime nap duration compared with no napping. Interestingly, for people with a night sleep duration of 7-8 h, only those with a moderate nap of 30-89 min had lower odds of MCR than non-nappers after adjustment for potential confounders. CONCLUSION A moderate nap of 30-89 min could lower the odds of MCR, especially for older adults with a night sleep duration of ≤8 h.
Collapse
Affiliation(s)
- Lixing Zhou
- National Clinical Research Center for Geriatrics and Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Zhang
- National Clinical Research Center for Geriatrics and Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Meiling Ge
- National Clinical Research Center for Geriatrics and Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Gongchang Zhang
- National Clinical Research Center for Geriatrics and Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Cheng
- National Clinical Research Center for Geriatrics and Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, China; Department of Geriatrics, West China Xiamen Hospital of Sichuan University, Xiamen, China
| | - Yixin Liu
- National Clinical Research Center for Geriatrics and Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoli Chen
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Xiaolei Liu
- National Clinical Research Center for Geriatrics and Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
| | - Birong Dong
- National Clinical Research Center for Geriatrics and Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
4
|
De Sanctis P, Mahoney JR, Wagner J, Blumen HM, Mowrey W, Ayers E, Schneider C, Orellana N, Molholm S, Verghese J. Linking Dementia Pathology and Alteration in Brain Activation to Complex Daily Functional Decline During the Preclinical Dementia Stages: Protocol for a Prospective Observational Cohort Study. JMIR Res Protoc 2024; 13:e56726. [PMID: 38842914 PMCID: PMC11190628 DOI: 10.2196/56726] [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: 01/30/2024] [Revised: 02/07/2024] [Accepted: 02/20/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Progressive difficulty in performing everyday functional activities is a key diagnostic feature of dementia syndromes. However, not much is known about the neural signature of functional decline, particularly during the very early stages of dementia. Early intervention before overt impairment is observed offers the best hope of reducing the burdens of Alzheimer disease (AD) and other dementias. However, to justify early intervention, those at risk need to be detected earlier and more accurately. The decline in complex daily function (CdF) such as managing medications has been reported to precede impairment in basic activities of daily living (eg, eating and dressing). OBJECTIVE Our goal is to establish the neural signature of decline in CdF during the preclinical dementia period. METHODS Gait is central to many CdF and community-based activities. Hence, to elucidate the neural signature of CdF, we validated a novel electroencephalographic approach to measuring gait-related brain activation while participants perform complex gait-based functional tasks. We hypothesize that dementia-related pathology during the preclinical period activates a unique gait-related electroencephalographic (grEEG) pattern that predicts a subsequent decline in CdF. RESULTS We provide preliminary findings showing that older adults reporting CdF limitations can be characterized by a unique gait-related neural signature: weaker sensorimotor and stronger motor control activation. This subsample also had smaller brain volume and white matter hyperintensities in regions affected early by dementia and engaged in less physical exercise. We propose a prospective observational cohort study in cognitively unimpaired older adults with and without subclinical AD (plasma amyloid-β) and vascular (white matter hyperintensities) pathologies. We aim to (1) establish the unique grEEG activation as the neural signature and predictor of decline in CdF during the preclinical dementia period; (2) determine associations between dementia-related pathologies and incidence of the neural signature of CdF; and (3) establish associations between a dementia risk factor, physical inactivity, and the neural signature of CdF. CONCLUSIONS By establishing the clinical relevance and biological basis of the neural signature of CdF decline, we aim to improve prediction during the preclinical stages of ADs and other dementias. Our approach has important research and translational implications because grEEG protocols are relatively inexpensive and portable, and predicting CdF decline may have real-world benefits. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56726.
Collapse
Affiliation(s)
- Pierfilippo De Sanctis
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Pediatrics, Cognitive Neurophysiology Laboratory, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Jeannette R Mahoney
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Johanna Wagner
- Swartz Center for Computational Neuroscience, Institute for Neural Computation, University of California, San Diego, La Jolla, CA, United States
| | - Helena M Blumen
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Medicine (Geriatrics), Albert Einstein College of Medicine, Bronx, NY, United States
| | - Wenzhu Mowrey
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Emmeline Ayers
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Claudia Schneider
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Natasha Orellana
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Sophie Molholm
- Department of Pediatrics, Cognitive Neurophysiology Laboratory, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Joe Verghese
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Medicine (Geriatrics), Albert Einstein College of Medicine, Bronx, NY, United States
| |
Collapse
|
5
|
Li G, He Z, Hu J, Xiao C, Fan W, Zhang Z, Yao Q, Zou J, Huang G, Zeng Q. Association between pain interference and motoric cognitive risk syndrome in older adults: a population-based cohort study. BMC Geriatr 2024; 24:437. [PMID: 38760712 PMCID: PMC11102256 DOI: 10.1186/s12877-024-04974-7] [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: 12/29/2023] [Accepted: 04/12/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVES Motoric cognitive risk syndrome (MCR) is a pre-dementia condition characterized by subjective complaints in cognition and slow gait. Pain interference has previously been linked with cognitive deterioration; however, its specific relationship with MCR remains unclear. We aimed to examine how pain interference is associated with concurrent and incident MCR. METHODS This study included older adults aged ≥ 65 years without dementia from the Health and Retirement Study. We combined participants with MCR information in 2006 and 2008 as baseline, and the participants were followed up 4 and 8 years later. The states of pain interference were divided into 3 categories: interfering pain, non-interfering pain, and no pain. Logistic regression analysis was done at baseline to examine the associations between pain interference and concurrent MCR. During the 8-year follow-up, Cox regression analysis was done to investigate the associations between pain interference and incident MCR. RESULTS The study included 7120 older adults (74.6 ± 6.7 years; 56.8% females) at baseline. The baseline prevalence of MCR was 5.7%. Individuals with interfering pain had a significantly increased risk of MCR (OR = 1.51, 95% CI = 1.17-1.95; p = 0.001). The longitudinal analysis included 4605 participants, and there were 284 (6.2%) MCR cases on follow-up. Participants with interfering pain at baseline had a higher risk for MCR at 8 years of follow-up (HR = 2.02, 95% CI = 1.52-2.69; p < 0.001). CONCLUSIONS Older adults with interfering pain had a higher risk for MCR versus those with non-interfering pain or without pain. Timely and adequate management of interfering pain may contribute to the prevention and treatment of MCR and its associated adverse outcomes.
Collapse
Affiliation(s)
- Gege Li
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Zijun He
- Department of Rehabilitation Medicine, The Tenth Affiliated Hospital of Southern Medical University (Dongguan people's hospital), Dongguan, China
| | - Jinjing Hu
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Chongwu Xiao
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Weichao Fan
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Zhuodong Zhang
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Qiuru Yao
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Jihua Zou
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
- School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China.
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong (SAR), China.
| | - Guozhi Huang
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
- School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China.
| | - Qing Zeng
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
- School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China.
| |
Collapse
|
6
|
Huang C, Wu B, Zhang C, Wei Z, Su L, Zhang J, Wang L. Motoric Cognitive Risk Syndrome as a Predictor of Adverse Health Outcomes: A Systematic Review and Meta-Analysis. Gerontology 2024; 70:669-688. [PMID: 38697041 DOI: 10.1159/000538314] [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: 04/11/2023] [Accepted: 03/02/2024] [Indexed: 05/04/2024] Open
Abstract
INTRODUCTION Motoric cognitive risk syndrome (MCR) is a newly proposed pre-dementia syndrome characterized by subjective cognitive complaints (SCCs) and slow gait (SG). Increasing evidence links MCR to several adverse health outcomes, but the specific relationship between MCR and the risk of frailty, Alzheimer's disease (AD), and vascular dementia (VaD) remains unclear. Additionally, literature lacks analysis of MCR's components and associated health outcomes, complicating risk identification. This systematic review and meta-analysis aimed to provide a comprehensive overview of MCR's predictive value for adverse health outcomes. METHODS Relevant cross-sectional, cohort, and longitudinal studies examining the association between MCR and adverse health outcomes were extracted from ten electronic databases. The Newcastle-Ottawa Scale (NOS) and modified NOS were used to assess the risk of bias in studies included in the analysis. Relative ratios (RRs) and 95% confidence intervals (CIs) were pooled for outcomes associated with MCR. RESULTS Twenty-eight longitudinal or cohort studies and four cross-sectional studies with 1,224,569 participants were included in the final analysis. The risk of bias in all included studies was rated as low or moderate. Pooled analysis of RR indicated that MCR had a greater probability of increased the risk of dementia (adjusted RR = 2.02; 95% CI = 1.94-2.11), cognitive impairment (adjusted RR = 1.72; 95% CI = 1.49-1.99), falls (adjusted RR = 1.32; 95% CI = 1.17-1.50), mortality (adjusted RR = 1.66; 95% CI = 1.32-2.10), and hospitalization (adjusted RR = 1.46; 95% CI = 1.16-1.84); MCR had more prominent predictive efficacy for AD (adjusted RR = 2.23; 95% CI = 1.81-2.76) compared to VaD (adjusted RR = 3.78; 95% CI = 0.49-28.95), while excluding analyses from the study that utilized the timed-up-and-go test and one-leg-standing to evaluate gait speed. One study examined the association between MCR and disability (hazard ratios [HR] = 1.69; 95% CI = 1.08-2.02) and frailty (OR = 5.53; 95% CI = 1.46-20.89). SG was a stronger predictor of the risk for dementia and falls than SCC (adjusted RR = 1.22; 95% CI = 1.11-1.34 vs. adjusted RR = 1.19; 95% CI = 1.03-1.38). CONCLUSION MCR increases the risk of developing any discussed adverse health outcomes, and the predictive value for AD is superior to VaD. Additionally, SG is a stronger predictor of dementia and falls than SCC. Therefore, MCR should be routinely assessed among adults to prevent poor prognosis and provide evidence to support future targeted interventions.
Collapse
Affiliation(s)
- Cheng Huang
- School of Medicine, Huzhou University, Huzhou, China,
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Chen Zhang
- Department of General Medicine, Community Health Service Center of Renhuangshan, Huzhou, China
| | - Zhuqin Wei
- School of Medicine, Huzhou University, Huzhou, China
| | - Liming Su
- School of Medicine, Huzhou University, Huzhou, China
| | - Junwei Zhang
- School of Medicine, Huzhou University, Huzhou, China
| | - Lina Wang
- School of Medicine, Huzhou University, Huzhou, China
| |
Collapse
|
7
|
Chang H, Zhao Y. Longitudinal trajectories of handgrip strength and their association with motoric cognitive risk syndrome in older adults. Arch Gerontol Geriatr 2024; 120:105334. [PMID: 38382231 DOI: 10.1016/j.archger.2024.105334] [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: 10/26/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND To identify heterogeneous developmental trajectories of handgrip strength (HGS) in Chinese older adults and to explore the relationship between different developmental trajectories and motoric cognitive risk syndrome (MCR). METHODS We used three waves of longitudinal data from the China Health and Retirement Longitudinal Study from 2011 to 2015, which involved 3773 older adults. Growth mixture modeling (GMM) was used to estimate trajectory classes for HGS, followed by binary logistic regression to explore the association between trajectory classes and MCR. RESULTS GMM analyses extracted four distinct trajectories of HGS: low level-declining group (16.0 %), upper middle level group (30.9 %), high level-steady group (9.5 %), and lower middle level group (43.6 %). In addition, we found that even after adjusting for important covariates, the odds of MCR prevalence were lower in the medium level-high group, high level-steady group, and medium level-low group compared with the low level-declining group. CONCLUSION Appreciable heterogeneity in HGS among older people in China was revealed. Only 9.5 % of older people with HGS in the high level-steady group. And poorer grip strength levels mean a higher risk of MCR. Therefore, interventions should be taken to maintain muscle mass and thus prevent MCR in older adults.
Collapse
Affiliation(s)
- Hui Chang
- School of nursing, Guizhou medical university, Guiyang, China.
| | - Yu Zhao
- Hanzhong Central Hospital, Hanzhong, China
| |
Collapse
|
8
|
Wang J, Liu Y, Jin R, Zhao X, Wu Z, Han Z, Xu Z, Guo X, Tao L. Intraindividual difference in estimated GFR by creatinine and cystatin C, cognitive trajectories and motoric cognitive risk syndrome. Nephrol Dial Transplant 2024; 39:860-872. [PMID: 37930847 DOI: 10.1093/ndt/gfad234] [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: 05/08/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Intraindividual differences between estimated glomerular filtration rate (eGFR) based on cystatin C (eGFRcys) and creatinine (eGFRcr) can convey important clinical information regarding health status. However, the clinical implications of these differences (eGFRdiff) for risk of cognitive decline and motoric cognitive risk (MCR) syndrome remains unclear. We aimed to investigate the longitudinal associations of eGFRdiff with cognitive trajectories and incident MCR. METHODS Based on the China Health and Retirement Longitudinal Study, we identified two study subcohorts: one for cognitive trajectory follow-up (6423 participants, 2011-2018) and another for incident MCR follow-up (2477 participants, 2011-2015). The eGFRdiff was defined as eGFRcys - eGFRcr. Adjusted ordinal and binary logistic regression models were separately used to assess the associations of eGFRdiff with cognitive trajectories and incident MCR. We also performed discordance analyses for eGFRdiff versus eGFRcys, eGFRcr or eGFR based on both creatinine and cystatin C (eGFRcys-cr). RESULTS In the first subcohort, four distinct 7-year cognitive trajectories were identified. Each 1 standard deviation (SD) higher eGFRdiff (value for eGFRcys - eGFRcr) was associated with a lower risk of poorer cognitive trajectories {odds ratio 0.909 [95% confidence interval (CI) 0.877-0.942]}. In the second subcohort, 121 participants developed incident MCR after a 4-year follow-up. Each 1-SD higher eGFRdiff (value for eGFRcys - eGFRcr) was linked with a 25.3% (95% CI 16.6-33.2) decreased risk for MCR. The above associations persisted in individuals with normal kidney function. Additionally, the risk for cognitive decline and incident MCR was more strongly associated with eGFRcys than eGFRcr and eGFRcys-cr. For the discordance analyses, the 'discordantly high eGFRdiff/low eGFR' group but not the 'discordantly low eGFRdiff/high eGFR' exhibited a significantly lower risk of poorer cognitive trajectories and MCR compared with the concordant group. CONCLUSIONS A large negative difference between eGFRcys and eGFRcr (eGFRcys < eGFRcr) was associated with a higher risk of cognitive decline and incident MCR. The eGFRdiff could capture additional valuable risk information beyond eGFRcys, eGFRcr and eGFRcys-cr.
Collapse
Affiliation(s)
- Jinqi Wang
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Yueruijing Liu
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Rui Jin
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Xiaoyu Zhao
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Zhiyuan Wu
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Department of Public Health, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Ze Han
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Zongkai Xu
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Xiuhua Guo
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Lixin Tao
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| |
Collapse
|
9
|
Jiang S, Guan R, Guo C, Wei C. Prevalence of Motoric Cognitive Risk Syndrome Among Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis. J Gerontol Nurs 2024; 50:16-24. [PMID: 38569106 DOI: 10.3928/00989134-20240312-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
PURPOSE To systematically review the prevalence of motoric cognitive risk syndrome (MCR) among community-dwelling older adults and provide evidence-based support for policymakers planning health and social care policies. METHOD Web of Science, PubMed, and Cochrane Library databases were searched for cross-sectional, prospective cohort, or population-based longitudinal studies of community-dwelling older adults aged ≥60 years with MCR from inception of the database through December 18, 2021. RESULTS Seventeen studies were included. Pooled prevalence of MCR was found to be 10% (95% confidence interval [8%, 12%], I2 = 98.4%). Results of a subgroup analysis revealed a combined prevalence of MCR of 8.2% in males and 9.2% in females. Pooled prevalence of MCR was 9.7% in Asia and 10.2% in other regions. CONCLUSION Prevalence of MCR in community-dwelling older adults is high. Our research may improve the epidemiological understanding of MCR, draw attention to older adults with MCR, and thus promote research of MCR and the formulation of relevant public health policies. With early identification and intervention of MCR, cognitive function can be improved, and the onset of dementia can be delayed or prevented. [Journal of Gerontological Nursing, 50(4), 16-24.].
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Kerminen H, Marzetti E, D’Angelo E. Biological and Physical Performance Markers for Early Detection of Cognitive Impairment in Older Adults. J Clin Med 2024; 13:806. [PMID: 38337499 PMCID: PMC10856537 DOI: 10.3390/jcm13030806] [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: 12/28/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Dementia is a major cause of poor quality of life, disability, and mortality in old age. According to the geroscience paradigm, the mechanisms that drive the aging process are also involved in the pathogenesis of chronic degenerative diseases, including dementia. The dissection of such mechanisms is therefore instrumental in providing biological targets for interventions and new sources for biomarkers. Within the geroscience paradigm, several biomarkers have been discovered that can be measured in blood and that allow early identification of individuals at risk of cognitive impairment. Examples of such markers include inflammatory biomolecules, markers of neuroaxonal damage, extracellular vesicles, and DNA methylation. Furthermore, gait speed, measured at a usual and fast pace and as part of a dual task, has been shown to detect individuals at risk of future dementia. Here, we provide an overview of available biomarkers that may be used to gauge the risk of cognitive impairment in apparently healthy older adults. Further research should establish which combination of biomarkers possesses the highest predictive accuracy toward incident dementia. The implementation of currently available markers may allow the identification of a large share of at-risk individuals in whom preventive interventions should be implemented to maintain or increase cognitive reserves, thereby reducing the risk of progression to dementia.
Collapse
Affiliation(s)
- Hanna Kerminen
- Faculty of Medicine and Health Technology, Gerontology Research Center (GEREC), Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland;
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Emanuele Marzetti
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy;
| | - Emanuela D’Angelo
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy;
| |
Collapse
|
12
|
Zhang Q, Zhao S, Feng J, Wang S, Song L, Han Q, Cong L, Wang Y, Du Y, Qiu C. High-Frequency Hearing Loss, Hippocampal Volume, and Motoric Cognitive Risk Syndrome in Older Adults in China: A Population-Based Study. J Alzheimers Dis 2024; 101:487-498. [PMID: 39177601 DOI: 10.3233/jad-240522] [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] [Indexed: 08/24/2024]
Abstract
Background Little is known about the associations of hearing loss, hippocampal volume, and motoric cognitive risk syndrome (MCR) in older adults. Objective We aimed to investigate the associations of hearing loss with MCR and hippocampal volume; and the interaction of hearing loss with hippocampal volume on MCR. Methods This population-based cross-sectional study included 2,540 dementia-free participants (age≥60 years; 56.5% women) in the baseline examination of the Multimodal Interventions to Delay Dementia and Disability in rural China. Data were collected through face-to-face interviews, clinical examination, and laboratory tests. Hearing function was assessed using pure tone audiometry test. In the subsample (n = 661), hippocampal volume was assessed on structural magnetic resonance images. Data were analyzed with logistic regression models. Results In the total sample, MCR was diagnosed in 246 persons (9.7%). High-frequency hearing loss was significantly associated with an increased likelihood of MCR and slow gait. In the subsample, the restricted cubic spline plots indicated an inverted U-shaped nonlinear relationship between high-frequency hearing performance and hippocampal volume. Moreover, greater hippocampal volume was significantly associated with a deduced likelihood of MCR and subjective cognitive decline (SCD). In addition, there were statistical interactions of high-frequency hearing loss with hippocampal volume on MCR and slow gait (p for interaction < 0.05), such that the associations were statistically significant only among participants free of high-frequency hearing loss. Conclusions High-frequency hearing loss was associated with an increased likelihood of MCR in older adults. The hippocampus might play a part in the relationship of high-frequency hearing loss and MCR.
Collapse
Affiliation(s)
- Qinghua Zhang
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P. R. China
- Shandong Provincial Clinical Research Center for Geriatric Neurological Diseases, Jinan, Shandong, P. R. China
| | - Shicheng Zhao
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P. R. China
| | - Jianli Feng
- Department of Neurology, Shandong Second Provincial General Hospital, Shandong Provincial ENT Hospital, Jinan, Shandong, The People's Republic of China
| | - Shanshan Wang
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P. R. China
- Shandong Provincial Clinical Research Center for Geriatric Neurological Diseases, Jinan, Shandong, P. R. China
| | - Lin Song
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P. R. China
- Shandong Provincial Clinical Research Center for Geriatric Neurological Diseases, Jinan, Shandong, P. R. China
| | - Qi Han
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, The People's Republic of China
| | - Lin Cong
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P. R. China
- Shandong Provincial Clinical Research Center for Geriatric Neurological Diseases, Jinan, Shandong, P. R. China
| | - Yongxiang Wang
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P. R. China
- Shandong Provincial Clinical Research Center for Geriatric Neurological Diseases, Jinan, Shandong, P. R. China
| | - Yifeng Du
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, P. R. China
- Shandong Provincial Clinical Research Center for Geriatric Neurological Diseases, Jinan, Shandong, P. R. China
| | - Chengxuan Qiu
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Aging Research Center and Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
| |
Collapse
|
13
|
Katayama O, Lee S, Bae S, Makino K, Chiba I, Harada K, Shinkai Y, Shimada H. Differential effects of lifestyle activities on disability incidence based on neighborhood amenities. BMC Geriatr 2023; 23:483. [PMID: 37563564 PMCID: PMC10416387 DOI: 10.1186/s12877-023-04170-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 07/13/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND This study examined the effect of neighborhood amenities on disability risk among community-dwelling older adults in Japan, based on lifestyle activities. METHOD This was an observational prospective cohort study. Participants comprised 13,258 older adults from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. We calculated participants' Walk Score using their home addresses and divided them into three groups: "car-dependent," "somewhat walkable," and "very walkable." We then calculated the average value of lifestyle activities. We divided the neighborhood amenity groups into two groups, "fewer lifestyle activities" and "more lifestyle activities," for a total of six groups. After identifying interactions between neighborhood amenities and lifestyle activities, Cox proportional hazard models to calculate hazard ratios for incident disability risk, based on neighborhood amenities and lifestyle activities. RESULTS An interaction occurred between neighborhood amenities and lifestyle activities (p < 0.05). Survival probabilities for incident disability based on lifestyle activities were estimated for each neighborhood amenity group: car-dependent, 1.62 (95% CI 1.07 to 2.46); somewhat walkable, 1.08 (95% CI 0.84 to 1.40); and very walkable, 1.05 (95% CI 0.87 to 1.27). Those with fewer lifestyle activities in the car-dependent group exhibited the highest risk of incident disability in the unadjusted and adjusted models. CONCLUSION Given that the aging population is increasing steadily, considering older adults' neighborhood amenities and lifestyle activities in their day-to-day lives can help clinicians to deliver more older adult-centered care. Incorporating the lifestyle activities and neighborhood amenities of older adults into care planning will lead to the design and development of integrated clinical and community screening programs.
Collapse
Affiliation(s)
- Osamu Katayama
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, 474-8511, Aichi, Japan.
- Japan Society for the Promotion of Science, Tokyo, Japan.
- Columbia University Irving Medical Center, New York, USA.
| | - Sangyoon Lee
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, 474-8511, Aichi, Japan
| | - Seongryu Bae
- Department of Health Care and Science, Dong-A University, Busan, Korea
| | - Keitaro Makino
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, 474-8511, Aichi, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Ippei Chiba
- Tohoku Medical Megabank Organization (ToMMo), Tohoku University, Sendai, Japan
| | - Kenji Harada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, 474-8511, Aichi, Japan
| | - Yohei Shinkai
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, 474-8511, Aichi, Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, 474-8511, Aichi, Japan
| |
Collapse
|
14
|
Kurita S, Doi T, Harada K, Katayama O, Morikawa M, Nishijima C, Fujii K, Misu Y, Yamaguchi R, Von Fingerhut G, Kakita D, Shimada H. Motoric Cognitive Risk Syndrome and Traffic Incidents in Older Drivers in Japan. JAMA Netw Open 2023; 6:e2330475. [PMID: 37624598 PMCID: PMC10457720 DOI: 10.1001/jamanetworkopen.2023.30475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/13/2023] [Indexed: 08/26/2023] Open
Abstract
Importance To prevent motor vehicle collisions by older drivers, the increased risk of collisions should be considered early. Cognitive decline increases the risk of car collisions. Motoric cognitive risk syndrome (MCR), characterized by the presence of cognitive concerns and slow gait, can be assessed conveniently and is useful to assess the risk of dementia. Objective To examine the association between MCR assessment findings and car collisions among older drivers in Japan. Design, Setting, and Participants This cross-sectional study used data from a community-based cohort study, the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes, conducted in Japan from 2015 to 2018. Participants were community-dwelling older adults aged at least 65 years. Data were analyzed from February to March 2023. Exposure MCR was defined as having subjective memory concerns (SMC) and slow gait. Participants were classified into 4 groups: no SMC or slow gait, only SMC, only slow gait, and MCR. Main Outcomes and Measures Participants were asked about the experience of car collisions during the last 2 years and near-miss traffic incidents during the previous year through face-to-face interviews. Odds of experiencing a collision or near-miss traffic incident were assessed using logistic regression. Results Among a total of 12 475 participants, the mean (SD) age was 72.6 (5.2) years, and 7093 (56.9%) were male. The group with only SMC and the group with MCR showed a higher proportion of both car collisions and near-miss traffic incidents than the other groups (adjusted standardized residuals > 1.96; P < .001). Logistic regression analysis showed the only SMC and MCR groups had increased odds of car collisions (only SMC group: odds ratio [OR], 1.48; 95% CI, 1.27-1.72; MCR group: OR, 1.73; 95% CI, 1.39-2.16) and near-miss traffic incidents (only SMC group: OR, 2.07; 95% CI, 1.91-2.25; MCR group: OR, 2.13; 95% CI, 1.85-2.45) after adjusting for confounding factors. After stratifying MCR assessments by objective cognitive impairment, significant associations were still observed. In the only slow gait group, objective cognitive impairment was associated with increased odds of car collisions (OR, 1.96; 95% CI, 1.17-3.28). Conclusions and Relevance In this cross-sectional study of community-dwelling older drivers in Japan, SMC and MCR were associated with car collisions and near-miss traffic incidents independent from objective cognitive impairment. Future studies should examine the mechanism of these associations in more detail.
Collapse
Affiliation(s)
- Satoshi Kurita
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takehiko Doi
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kenji Harada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Osamu Katayama
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Masanori Morikawa
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Chiharu Nishijima
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kazuya Fujii
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yuka Misu
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Ryo Yamaguchi
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Medical Sciences, Medical Science Division, Graduate School of Medicine, Science and Technology, Shinshu University, Matsumoto, Japan
| | - Georg Von Fingerhut
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Daisuke Kakita
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Medical Sciences, Medical Science Division, Graduate School of Medicine, Science and Technology, Shinshu University, Matsumoto, Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| |
Collapse
|
15
|
Mullin DS, Gadd D, Russ TC, Luciano M, Muniz-Terrera G. Motoric cognitive risk syndrome trajectories and incident dementia over 10 years. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 5:100178. [PMID: 38162293 PMCID: PMC10757175 DOI: 10.1016/j.cccb.2023.100178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/25/2023] [Accepted: 07/29/2023] [Indexed: 01/03/2024]
Abstract
Background Motoric Cognitive Risk (MCR) syndrome is a high-risk state for adverse health outcomes in older adults characterised by measured slow gait speed and self-reported cognitive complaints. The recent addition to the Lothian Birth Cohort 1936 of robust dementia outcomes enabled us to assess the prognostic value of MCR for dementia and explore the various trajectories of participants diagnosed with MCR. Methods We classified 680 community-dwelling participants free from dementia into non-MCR or MCR groups at mean [SD] age 76.3 [0.8] years. We used Cox and competing risk regression methods, adjusted for potential confounders, to evaluate the risk of developing all-cause incident dementia over 10 years of follow-up. Secondarily, we followed the trajectories for individuals with and without MCR at baseline and categorised them into subgroups based on whether MCR was still present at the next research wave, three years later. Results The presence of MCR increased the risk of incident dementia (adjusted HR 2.34, 95%CI 1.14-4.78, p = 0.020), as did fewer years of education and higher depression symptoms. However, MCR has a heterogenous progression trajectory. The MCR progression subgroups each have different prognostic values for incident dementia. Conclusion MCR showed similar prognostic ability for dementia in a Scottish cohort as for other populations. MCR could identify a target group for early interventions of modifiable risk factors to prevent incident dementia. This study illustrates the heterogeneous nature of MCR progression. Exploring the underlying reasons will be important work in future work.
Collapse
Affiliation(s)
- Donncha S. Mullin
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, United Kingdom
- Edinburgh Dementia Prevention Group, University of Edinburgh, United Kingdom
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, United Kingdom
| | - Danni Gadd
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, United Kingdom
- Optima Partners, Edinburgh EH2 4HQ, United Kingdom
| | - Tom C. Russ
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, United Kingdom
- Edinburgh Dementia Prevention Group, University of Edinburgh, United Kingdom
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom
- NHS Lothian, Royal Edinburgh Hospital, Edinburgh, United Kingdom
- Department of Psychology, Lothian Birth Cohorts, University of Edinburgh, United Kingdom
| | - Michelle Luciano
- Department of Psychology, Lothian Birth Cohorts, University of Edinburgh, United Kingdom
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention Group, University of Edinburgh, United Kingdom
- Ohio University Osteopathic College of Medicine, Ohio University, USA
| |
Collapse
|
16
|
Merchant RA, Chan YH, Anbarasan D, Aprahamian I. Association of Motoric Cognitive Risk Syndrome with Sarcopenia and Systemic Inflammation in Pre-Frail Older Adults. Brain Sci 2023; 13:936. [PMID: 37371414 DOI: 10.3390/brainsci13060936] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Motoric cognitive risk syndrome (MCR) is defined by the presence of slow gait and subjective cognitive decline. It is well recognized as a prodrome for dementia, but the biological mechanism and trajectory for MCR are still lacking. The objective of this study was to explore the association of MCR with body composition, including sarcopenia and systemic inflammation, in pre-frail older adults in a cross-sectional study of 397 pre-frail community-dwelling older adults. Data on demographics, physical function, frailty, cognition (Montreal Cognitive Assessment (MoCA)), perceived health and depression were collected. Body composition was measured using a bioelectrical impedance analyzer. Systemic inflammatory biomarkers, such as progranulin, growth differentiation factor-15 (GDF-15), interleukin-10 (IL-10), interleukin-6 and tumor necrosis factor-α (TNF-α), were collected. Univariate and multivariate logistic regression were used to analyze the association between MCR, body composition, sarcopenia and systemic inflammatory biomarkers. The prevalence of MCR was 14.9%. They were significantly older and there were more females, depression, functional impairment, lower education, physical activity and MoCA scores. Body fat percentage (BF%), fat mass index, fat to fat free mass ratio (FM/FFM) and sarcopenia prevalence were significantly higher in MCR. Serum GDF-15 and TNF-α levels were highest with progranulin/TNF-α and IL-10/TNF-α ratio lowest in MCR. Compared to healthy patients, MCR was significantly associated with sarcopenia (aOR 2.62; 95% CI 1.46-3.17), BF% (aOR 1.06; 95% CI 1.01-1.12), FMI (aOR 1.16; 95% CI 1.02-1.30) and FM/FFM (aOR 6.38; 95% CI 1.20-33.98). The association of IL-10 to TNF-α ratio (aOR 0.98, 95% CI 0.97-0.99) and IL-10 (aOR 2.22, 95% CI 0.05-0.98) with MCR were independent of sarcopenia and BF%. Longitudinal population studies are needed to understand the role of body fat indices and IL-10 in pre-frail older adults with MCR and trajectory to dementia.
Collapse
Affiliation(s)
- Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 119228, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Denishkrshna Anbarasan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Ivan Aprahamian
- Geriatrics Division, Department of Internal Medicine, Jundiai Medical School, Jundiai 13202-550, SP, Brazil
| |
Collapse
|
17
|
Jia S, Zhao W, Ge M, Zhou L, Sun X, Zhao Y, Dong B. Association of Handgrip Strength Weakness and Asymmetry With Incidence of Motoric Cognitive Risk Syndrome in the China Health and Retirement Longitudinal Study. Neurology 2023; 100:e2342-e2349. [PMID: 37076310 PMCID: PMC10256126 DOI: 10.1212/wnl.0000000000207308] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/03/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Motoric cognitive risk (MCR) syndrome is a type of pre-dementia. It is defined as the co-occurrence of subjective cognitive complaints and a slow gait speed. A recent study found that handgrip strength (HGS) asymmetry is associated with an increased risk of neurodegenerative disorders. We aimed to investigate the associations of HGS weakness and asymmetry separately and together with MCR incidence among older Chinese adults. METHODS Data from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study were used. HGS values <28 kg for male participants and <18 kg for female participants were considered HGS weaknesses. HGS asymmetry was assessed by the ratio of nondominant to dominant HGS. We used 3 different cutoff values of HGS ratio to define asymmetry, including 10%, 20%, and 30%. Specifically, HGS ratios <0.90 or >1.10 (10%), <0.80 or >1.20 (20%), and <0.70 or >1.30 (30%) were classified as asymmetry. The participants were classified into 4 groups: neither weakness nor asymmetry (neither), asymmetry only, weakness only, and weakness and asymmetry (both). The association between baseline HGS status and 4-year incidence of MCR was examined using logistic regression analyses. RESULTS A total of 3,777 participants 60 years and older were included in the baseline analysis. The prevalence of MCR at the baseline was 12.8%. Participants with asymmetry only, weakness only, and both showed significantly increased risk of MCR. After excluding participants with MCR at baseline, 2,328 participants were included in the longitudinal analysis. There were 111 MCR cases (4.77%) over the 4-year follow-up period. Participants with HGS weakness and asymmetry together at baseline had increased odds of incident MCR (HGS ratio at 10%: odds ratio [OR] 4.48, p < 0.001; HGS ratio at 20%: OR 5.43, p < 0.001; HGS ratio at 30%: OR 6.02, p < 0.001). DISCUSSION These results show that the presence of both HGS asymmetry and weakness is associated with MCR incidence. The early recognition of HGS asymmetry and weakness may be helpful in the prevention and treatment of cognitive dysfunction.
Collapse
Affiliation(s)
- Shuli Jia
- From the Center of Gerontology and Geriatrics and National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu
| | - Wanyu Zhao
- From the Center of Gerontology and Geriatrics and National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu
| | - Meiling Ge
- From the Center of Gerontology and Geriatrics and National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu
| | - Lixing Zhou
- From the Center of Gerontology and Geriatrics and National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu
| | - Xuelian Sun
- From the Center of Gerontology and Geriatrics and National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu
| | - Yunli Zhao
- From the Center of Gerontology and Geriatrics and National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu
| | - Birong Dong
- From the Center of Gerontology and Geriatrics and National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu.
| |
Collapse
|
18
|
Park JH, Park S, Jung JH, Bae S, Yun S, Khan A, Hong I, Park JH. The Mediating Role of Social Participation in Motoric Cognitive Risk and its Relation to Depression and Loneliness in Older Adults. Ann Geriatr Med Res 2023; 27:134-140. [PMID: 37403316 DOI: 10.4235/agmr.23.0007] [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: 01/19/2023] [Accepted: 06/12/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Motoric cognitive risk syndrome (MCR) reduces the quality of life, independence, and social interaction in older adults. Social participation is a potentially modifiable factor that benefits cognitive and mental health. This study explored the mediating roles of social participation between MCR and depression and between MCR and loneliness. METHODS We performed a secondary analysis of data from the 2015-2016 National Social Life, Health, and Aging Project. Slow gait speed and cognitive decline were used to assess MCR. Mediation analysis was applied to two models, both of which used MCR as an exposure and social participation as a mediator. The outcomes were depression and loneliness for each model, respectively. RESULTS Among 1,697 older adults, 196 (11.6%) had MCR. The mediating role of social participation was statistically significant in both models. The indirect effect (β=0.267, p=0.001) of MCR on depression through social participation comprised 11.97% of the total effect (β=2.231, p<0.001). The indirect effect (β=0.098, p=0.001) of MCR on loneliness through social participation was 19.48% of the total effect (β=0.503, p<0.001). CONCLUSION Interventions to increase social participation may reduce depression and loneliness of older adults with MCR.
Collapse
Affiliation(s)
- Ji Hyeun Park
- Department of Occupational Therapy, Graduate School, Yonsei University, Wonju, Korea
| | - Sangmi Park
- Department of Occupational Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Korea
| | - Jae Hyu Jung
- Department of Rehabilitation, Gyeonggi Provincial Medical Center, Anseong, Korea
| | - Suyeong Bae
- Department of Occupational Therapy, Graduate School, Yonsei University, Wonju, Korea
| | - Sohyeon Yun
- Department of Occupational Therapy, Graduate School, Yonsei University, Wonju, Korea
| | - Anastassiya Khan
- Department of Occupational Therapy, Graduate School, Yonsei University, Wonju, Korea
| | - Ickpyo Hong
- Department of Occupational Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Korea
| | - Ji-Hyuk Park
- Department of Occupational Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Korea
| |
Collapse
|
19
|
Udina C, Avtzi S, Mota-Foix M, Rosso AL, Ars J, Kobayashi Frisk L, Gregori-Pla C, Durduran T, Inzitari M. Dual-task related frontal cerebral blood flow changes in older adults with mild cognitive impairment: A functional diffuse correlation spectroscopy study. Front Aging Neurosci 2022; 14:958656. [PMID: 36605362 PMCID: PMC9807627 DOI: 10.3389/fnagi.2022.958656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction In a worldwide aging population with a high prevalence of motor and cognitive impairment, it is paramount to improve knowledge about underlying mechanisms of motor and cognitive function and their interplay in the aging processes. Methods We measured prefrontal cerebral blood flow (CBF) using functional diffuse correlation spectroscopy during motor and dual-task. We aimed to compare CBF changes among 49 older adults with and without mild cognitive impairment (MCI) during a dual-task paradigm (normal walk, 2- forward count walk, 3-backward count walk, obstacle negotiation, and heel tapping). Participants with MCI walked slower during the normal walk and obstacle negotiation compared to participants with normal cognition (NC), while gait speed during counting conditions was not different between the groups, therefore the dual-task cost was higher for participants with NC. We built a linear mixed effects model with CBF measures from the right and left prefrontal cortex. Results MCI (n = 34) showed a higher increase in CBF from the normal walk to the 2-forward count walk (estimate = 0.34, 95% CI [0.02, 0.66], p = 0.03) compared to participants with NC, related to a right- sided activation. Both groups showed a higher CBF during the 3-backward count walk compared to the normal walk, while only among MCI, CFB was higher during the 2-forward count walk. Discussion Our findings suggest a differential prefrontal hemodynamic pattern in older adults with MCI compared to their NC counterparts during the dual-task performance, possibly as a response to increasing attentional demand.
Collapse
Affiliation(s)
- Cristina Udina
- REFiT Barcelona Research Group, Parc Sanitari Pere Virgili and Vall d’Hebron Research Institute (VHIR), Barcelona, Spain,Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain,*Correspondence: Cristina Udina,
| | - Stella Avtzi
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Miriam Mota-Foix
- Statistics and Bioinformatics Unit, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Andrea L. Rosso
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Joan Ars
- REFiT Barcelona Research Group, Parc Sanitari Pere Virgili and Vall d’Hebron Research Institute (VHIR), Barcelona, Spain,Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lisa Kobayashi Frisk
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Clara Gregori-Pla
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Turgut Durduran
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Marco Inzitari
- REFiT Barcelona Research Group, Parc Sanitari Pere Virgili and Vall d’Hebron Research Institute (VHIR), Barcelona, Spain,Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Mullin DS, Cockburn A, Welstead M, Luciano M, Russ TC, Muniz-Terrera G. Mechanisms of motoric cognitive risk-Hypotheses based on a systematic review and meta-analysis of longitudinal cohort studies of older adults. Alzheimers Dement 2022; 18:2413-2427. [PMID: 35142038 PMCID: PMC10078717 DOI: 10.1002/alz.12547] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 01/31/2023]
Abstract
We aimed to refine the hypothesis that motoric cognitive risk (MCR), a syndrome combining measured slow gait speed and self-reported cognitive complaints, is prognostic of incident dementia and other major causes of morbidity in older age. We propose mechanisms on the relationship between motor and cognitive function and describe a roadmap to validate these hypotheses. We systematically searched major electronic databases from inception to August 2021 for original longitudinal cohort studies of adults aged ≥60 years that compared an MCR group to a non-MCR group with any health outcome. Fifteen cohorts were combined by meta-analysis. Participants with MCR were at an increased risk of cognitive impairment (adjusted hazard ratio [aHR] 1.76, 95% CI 1.49-2.08; I2 = 24.9%), dementia (aHR 2.12, 1.85-2.42; 33.1%), falls (adjusted Relative Risk 1.38, 1.15-1.66; 62.1%), and mortality (aHR 1.49, 1.16-1.91; 79.2%). The prognostic value of MCR is considerable and mechanisms underlying the syndrome are proposed.
Collapse
Affiliation(s)
- Donncha S Mullin
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.,Edinburgh Dementia Prevention Group, University of Edinburgh, Edinburgh, UK.,Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK
| | | | - Miles Welstead
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Michelle Luciano
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Tom C Russ
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.,Edinburgh Dementia Prevention Group, University of Edinburgh, Edinburgh, UK.,Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,NHS Lothian, Royal Edinburgh Hospital, Edinburgh, UK.,Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention Group, University of Edinburgh, Edinburgh, UK.,Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
22
|
Bai A, Bai W, Ju H, Xu W, Lin Z. Motoric cognitive risk syndrome as a predictor of incident disability: A 7 year follow-up study. Front Aging Neurosci 2022; 14:972843. [PMID: 36158535 PMCID: PMC9493455 DOI: 10.3389/fnagi.2022.972843] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 08/18/2022] [Indexed: 11/15/2022] Open
Abstract
Background Though motoric cognitive risk syndrome (MCR) share risk factors with disability, whether it predict disability remains understudied. Objectives This study aims to examine the association between MCR and incident disability. Design Longitudinal study. Methods MCR was defined as subjective cognitive complaints and objective slow gait speed. Two subtypes of MCR were defined by whether memory impairment (MI) was also present, MCR-MI and MCR-non-MI. Incident activities of daily living (ADL) disability and instrumental activities of daily living (IADL) disability were outcome measures. Multiple logistic regression analysis was used to assess the independent effect of MCR at baseline on the odds of ADL/IADL disability at a 7 year follow-up. Results Among the subjects who were not disabled at baseline and followed for 7 years, 34.66% reported incident ADL disability, and 31.64% reported incident IADL disability. Compared with participants without MCR at baseline, those with MCR had 58% increased odds of incident ADL disability (OR=1.58, 95% CI: 1.19–2.09) and 46% increased odds of incident IADL disability (OR=1.46, 95% CI: 1.13–1.88) after 7 years. MCR-non-MI was associated with a 56.63% increased risk of ADL disability and a 34.73% increased risk of IADL disability. MCR-MI was associated with an even higher risk of IADL disability (OR = 2.14, 95% CI: 1.18–3.88). Conclusions MCR is an independent risk factor for both incident ADL and IADL disability. MCR-MI predicts a higher risk for disability than MCR-non-MI. Early identification of MCR among older adult is recommended and may decrease future risk of disability.
Collapse
Affiliation(s)
- Anying Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weimin Bai
- Department of Emergency, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Hepeng Ju
- Center for Disease Control and Prevention of Southern Theatre Command, Guangzhou, China
| | - Weihao Xu
- Department of Geriatrics, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Weihao Xu
| | - Zhanyi Lin
- Department of Geriatrics, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Zhanyi Lin
| |
Collapse
|
23
|
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.
Collapse
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,
| |
Collapse
|
24
|
Doi T, Nakakubo S, Tsutsumimoto K, Kurita S, Kiuchi Y, Nishimoto K, Shimada H. The association of white matter hyperintensities with motoric cognitive risk syndrome. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2022; 3:100150. [PMID: 36324398 PMCID: PMC9616382 DOI: 10.1016/j.cccb.2022.100150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/06/2022] [Accepted: 07/12/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The motoric cognitive risk syndrome (MCR) was characterized by slow gait and subjective cognitive complaints. MCR was associated with brain structural changes. However, the association between white matter hyperintensities (WMH) and MCR was unclear and the aim of this study was to examine this association. MATERIAL AND METHODS The study participants were 1227 older adults (mean age: 72.0 ± 6.0 yrs, women: 52.6%). We collected magnetic resonance imaging (MRI) data to assess WMH. To assess MCR, data on gait speed and subjective cognitive complaints were collected. Demographical and medical data was collected as covariates. RESULTS Among participants, the proportion of MCR was 5.0% (n = 61) and severe WMH was 16.8% (n = 206). From logistic regression analysis, severe WMH associated with MCR even when adjusted for covariates (odds ratio 2.18 [95% confidential interval 1.15-4.16], p = 0.017). This association was observed in subgroups stratified by the participants' characteristics: higher age, not having fall history, not obesity, not being physical inactivity and not having depressive symptom. CONCLUSIONS Our findings revealed that vascular pathophysiological changes in the brain were associated with MCR. The association was pronounced by several factors. Further evaluation was required to clarify pathophysiology of MCR.
Collapse
Affiliation(s)
- Takehiko Doi
- Corresponding author at: Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi 474-8511, Japan.
| | | | | | | | | | | | | |
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
Stephan Y, Sutin AR, Luchetti M, Aschwanden D, Terracciano A. Facets of conscientiousness and motoric cognitive risk syndrome. J Psychiatr Res 2022; 151:73-77. [PMID: 35468428 PMCID: PMC9843494 DOI: 10.1016/j.jpsychires.2022.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 01/19/2023]
Abstract
Conscientiousness is related to a lower risk of motoric cognitive risk syndrome (MCR), a pre-dementia syndrome characterized by slow gait speed and cognitive complaints. The present study examines which facets of conscientiousness are related to concurrent and incident MCR. Participants were dementia-free older adults aged 65-99 years (N = 6001) from the Health and Retirement Study (HRS). Baseline data on conscientiousness facets and MCR (cognitive complaints and gait speed) were collected in 2008/2010, along with the covariates: demographic factors, cognition, physical activity, disease burden, depressive symptoms, and body mass index (BMI). MCR was assessed again in 2012/2014 and 2016/2018. Controlling for demographic factors, higher industriousness was related to a nearly 30% lower likelihood of concurrent MCR (Odds Ratio [OR] = 0.75, 95%CI: 0.67-0.85, p < .001) and to about 60% reduced risk of incident MCR (Hazard ratio [HR] = 0.63, 95%CI: 0.56-0.71, p < .001). Self-control, order, and responsibility were also associated with a lower likelihood of concurrent (OR range: 0.82-0.88) and incident (HR range: 0.72-0.82) MCR. Traditionalism (HR = 0.84, 95%CI: 0.75-0.93, p < .01) and virtue (HR = 0.84, 95%CI: 0.75-0.93, p < .01) were related to a lower risk of incident MCR. Cognition, physical activity, disease burden, depressive symptoms, and BMI partially accounted for these associations. Industriousness is the facet of conscientiousness with the strongest association with risk of MCR. This facet could be targeted in interventions to reduce MCR and, ultimately, dementia.
Collapse
Affiliation(s)
| | - Angelina R Sutin
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, USA
| | - Martina Luchetti
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, USA
| | - Damaris Aschwanden
- Department of Geriatrics, College of Medicine, Florida State University, USA
| | - Antonio Terracciano
- Department of Geriatrics, College of Medicine, Florida State University, USA
| |
Collapse
|
27
|
Bai A, Xu W, Lin Z. Prevalence and Correlates of Motoric Cognitive Risk Syndrome in Chinese Community-Dwelling Older Adults. FRONTIERS IN AGING 2022; 3:895138. [PMID: 35821814 PMCID: PMC9261413 DOI: 10.3389/fragi.2022.895138] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022]
Abstract
Background: Motoric cognitive risk (MCR) syndrome is considered to be a pre-dementia syndrome. Although an increasing number of studies have begun to focus on this syndrome, few investigations have been launched in China. This study was performed to examine the prevalence and correlates of MCR in China.Methods: We included 5,725 adults aged over 60 years from China Health and Retirement Longitudinal Study (CHARLS). MCR was defined as the presence of subjective cognitive complaints and a gait speed ≤20th percentile of the weighted population distribution adjusted for sex and height. The associations among selected modifiable associated factors and clinical measures with MCR were examined using multivariate logistic regression analysis. Results: Of the participants, 414 met the criteria for MCR with an overall prevalence 7.29% (95% CI: 6.62–7.96%). MCR was found to be more prevalent among women than men (9.73 vs 4.85%), and more prevalent among participants ≥75 years than those <75 years (7.85 vs 5.23%). After multivariable adjustment, lower or upper extremity functional limitations, activities of daily living (ADL) disabilities, weak grip strength, exhaustion, and history of hypertension were found to be significantly associated with MCR. The multivariate analysis also showed higher levels of cystatin C and C-reactive protein were associated with increased odds for MCR. Conclusions: The present study showed that MCR syndrome is highly prevalent among Chinese community-dwelling older adults, and revealed several factors that were correlated with MCR. Longitudinal studies are warranted to further explore the modifiable risk factors of MCR.
Collapse
Affiliation(s)
- 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
| | - 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
| | - 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
- *Correspondence: Zhanyi Lin,
| |
Collapse
|
28
|
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: 22] [Impact Index Per Article: 11.0] [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.
Collapse
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
| |
Collapse
|
29
|
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.
Collapse
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
| |
Collapse
|
30
|
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.
Collapse
|
31
|
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.
Collapse
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
| |
Collapse
|
32
|
Sun X, Tang S, Miyawaki CE, Li Y, Hou T, Liu M. Longitudinal association between personality traits and homebound status in older adults: results from the National Health and Aging Trends Study. BMC Geriatr 2022; 22:93. [PMID: 35109812 PMCID: PMC8812013 DOI: 10.1186/s12877-022-02771-8] [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: 08/31/2021] [Accepted: 01/17/2022] [Indexed: 12/02/2022] Open
Abstract
Background Personality is associated with predictors of homebound status like frailty, incident falls, mobility, and depression. However, the relationship between personality traits and homebound status is unclear. This study aims to examine the longitudinal association between personality traits and homebound status among older adults. Methods Using data of non-homebound community-dwelling adults aged 65 years and older in the 2013 and 2014 waves (baseline) of the National Health and Aging Trends Study (N = 1538), this study examined the association between personality traits and homebound status. Homebound status (non-homebound, semi-homebound, and homebound) was determined by the frequency of going outside, difficulty in going outside, and whether there was help when going outside. Personality traits, including conscientiousness, extraversion, neuroticism, openness, and agreeableness were assessed using the 10-item Midlife Development Inventory on a rating scale from 1 (not at all) to 4 (a lot). Ordered logistic regression models were used to examine whether personality traits predicted homebound status in later 3 years with and without adjusting covariates. Results The sample was on average 77.0 ± 6.70 years old, and 55% were female. The majority were non-Hispanic whites (76%), and received some college or vocational school education or higher (55%). Homebound participants tended to be less educated older females. Three years later, 42 of 1538 baseline-non-homebound participants (3%) became homebound, and 195 participants (13%) became semi-homebound. Among these five personality traits, high conscientiousness (adjusted odds ratio [OR] = 0.73, p < 0.01) was associated with a low likelihood of becoming homebound after adjusting demographic and health-related covariates. Conclusions These findings provided a basis for personality assessment to identify and prevent individuals from becoming homebound. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02771-8.
Collapse
Affiliation(s)
- Xiaocao Sun
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road of Yuelu District, Changsha, 410013, Hunan, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road of Yuelu District, Changsha, 410013, Hunan, China
| | | | - Yuxiao Li
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road of Yuelu District, Changsha, 410013, Hunan, China
| | - Tianxue Hou
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road of Yuelu District, Changsha, 410013, Hunan, China
| | - Minhui Liu
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road of Yuelu District, Changsha, 410013, Hunan, China.
| |
Collapse
|
33
|
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.
Collapse
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
| |
Collapse
|
34
|
Zhou H, Park C, Shahbazi M, York MK, Kunik ME, Naik AD, Najafi B. Digital Biomarkers of Cognitive Frailty: The Value of Detailed Gait Assessment Beyond Gait Speed. Gerontology 2022; 68:224-233. [PMID: 33971647 PMCID: PMC8578566 DOI: 10.1159/000515939] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/16/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Cognitive frailty (CF), defined as the simultaneous presence of cognitive impairment and physical frailty, is a clinical symptom in early-stage dementia with promise in assessing the risk of dementia. The purpose of this study was to use wearables to determine the most sensitive digital gait biomarkers to identify CF. METHODS Of 121 older adults (age = 78.9 ± 8.2 years, body mass index = 26.6 ± 5.5 kg/m2) who were evaluated with a comprehensive neurological exam and the Fried frailty criteria, 41 participants (34%) were identified with CF and 80 participants (66%) were identified without CF. Gait performance of participants was assessed under single task (walking without cognitive distraction) and dual task (walking while counting backward from a random number) using a validated wearable platform. Participants walked at habitual speed over a distance of 10 m. A validated algorithm was used to determine steady-state walking. Gait parameters of interest include steady-state gait speed, stride length, gait cycle time, double support, and gait unsteadiness. In addition, speed and stride length were normalized by height. RESULTS Our results suggest that compared to the group without CF, the CF group had deteriorated gait performances in both single-task and dual-task walking (Cohen's effect size d = 0.42-0.97, p < 0.050). The largest effect size was observed in normalized dual-task gait speed (d = 0.97, p < 0.001). The use of dual-task gait speed improved the area under the curve (AUC) to distinguish CF cases to 0.76 from 0.73 observed for the single-task gait speed. Adding both single-task and dual-task gait speeds did not noticeably change AUC. However, when additional gait parameters such as gait unsteadiness, stride length, and double support were included in the model, AUC was improved to 0.87. CONCLUSIONS This study suggests that gait performances measured by wearable sensors are potential digital biomarkers of CF among older adults. Dual-task gait and other detailed gait metrics provide value for identifying CF above gait speed alone. Future studies need to examine the potential benefits of gait performances for early diagnosis of CF and/or tracking its severity over time.
Collapse
Affiliation(s)
- He Zhou
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA,BioSensics LLC, Newton, MA, USA
| | - Catherine Park
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Mohammad Shahbazi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Michele K. York
- Neurology and Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Mark E. Kunik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA,VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA,Geriatrics and Palliative Medicine Section, Baylor College of Medicine, Houston, TX, USA
| | - Aanand D. Naik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA,VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA,Geriatrics and Palliative Medicine Section, Baylor College of Medicine, Houston, TX, USA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA,Geriatrics and Palliative Medicine Section, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
35
|
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.
Collapse
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
| | | |
Collapse
|
36
|
Xu W, Bai A, Huang X, Gao Y, Liu L. Association Between Sleep and Motoric Cognitive Risk Syndrome Among Community-Dwelling Older Adults: Results From the China Health and Retirement Longitudinal Study. Front Aging Neurosci 2021; 13:774167. [PMID: 34867301 PMCID: PMC8641045 DOI: 10.3389/fnagi.2021.774167] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/11/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Sleep is increasingly recognized as an important lifestyle contributor to health; however, its relationship with Motoric cognitive risk syndrome (MCR) is still unclear. The present study aimed to examine the associations between sleep duration, sleep quality, and MCR among community-dwelling Chinese older adults. Methods: We recruited 5,387 participants aged ≥60 years from the China Health and Retirement Longitudinal Study (CHARLS). Sleep-related variables including night sleep duration and sleep quality were assessed via self-reported questionnaires. MCR syndrome was defined as cognitive complaints and slow gait speed without dementia or impaired mobility. Multivariate logistic regression analysis was performed to explore the associations between sleep-related variables and MCR after controlling for all potential confounders including demographic characteristics, lifestyle factors, and comorbidities. Results: We found that sleep duration was significantly associated with MCR, and the multivariate-adjusted odds ratios (OR) were highest for those with the shortest (<6 h OR = 1.55, 95% CI = 1.18–2.04) and longest (≥10 h OR = 1.73, 95% CI = 1.03–2.91) sleep durations. Moreover, an increasing frequency of self-perceived poor sleep quality was significantly associated with MCR in the adjusted model (3–4 days OR = 1.58, 95% CI = 1.16–2.17; 5–7 days OR = 1.81, 95% CI = 1.37–2.40). Conclusions: Our study indicated an inverted U-shaped association between night sleep duration and MCR. Poor sleep quality was also associated with higher odds of MCR in community-dwelling Chinese elders. Longitudinal studies with a larger population size are needed to establish causality in the future and further explore potential action mechanisms.
Collapse
Affiliation(s)
- Weihao Xu
- Haikou Cadre's sanitarium of Hainan Military Region, Haikou, 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
| | - Xin Huang
- Department of Geriatric Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yinghui Gao
- PKU-UPenn Sleep Center, Peking University International Hospital, Beijing, China
| | - Lin Liu
- Department of Pulmonary and Critical Care Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
37
|
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.
Collapse
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
| |
Collapse
|
38
|
Katayama O, Lee S, Bae S, Makino K, Chiba I, Harada K, Shinkai Y, Shimada H. Life Satisfaction and the Relationship between Mild Cognitive Impairment and Disability Incidence: An Observational Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126595. [PMID: 34205253 PMCID: PMC8296376 DOI: 10.3390/ijerph18126595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 11/25/2022]
Abstract
The relationship between the incidence of disability and cognitive function has been clarified, but whether life satisfaction is related to this relationship is unclear. Therefore, the purpose of this study was to clarify whether life satisfaction is related to the relationship between the incidence of disability and mild cognitive impairment. We included 2563 older adults from the National Center for Geriatrics and Gerontology–Study of Geriatric Syndromes. Baseline measurements included cognitive, life satisfaction, and demographic characteristics. Life satisfaction was measured using the Life Satisfaction Scale, which was stratified into three levels based on the score: lower, moderate, and higher. Associations between disability incidence and mild cognitive impairment were examined for each group according to life satisfaction, and monthly assessment for disability was monitored through long-term care insurance certification for at least 2 years from the baseline. At a 35.5-month mean follow-up, 150 participants had developed a disability. The potential confounding factors adjusted hazard for incidence of disability in the group with lower life satisfaction was 1.88 (CI: 1.05–3.35; p = 0.034) for mild cognitive impairment. Mild cognitive impairment was associated with disability incidence, and the effect was more pronounced among older adults with lower life satisfaction.
Collapse
Affiliation(s)
- Osamu Katayama
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu 474-8511, Japan; (S.L.); (S.B.); (K.M.); (I.C.); (K.H.); (Y.S.); (H.S.)
- Japan Society for the Promotion of Science, Tokyo 102-0083, Japan
- Correspondence: ; Tel.: +81-562-45-5639
| | - Sangyoon Lee
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu 474-8511, Japan; (S.L.); (S.B.); (K.M.); (I.C.); (K.H.); (Y.S.); (H.S.)
| | - Seongryu Bae
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu 474-8511, Japan; (S.L.); (S.B.); (K.M.); (I.C.); (K.H.); (Y.S.); (H.S.)
| | - Keitaro Makino
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu 474-8511, Japan; (S.L.); (S.B.); (K.M.); (I.C.); (K.H.); (Y.S.); (H.S.)
- Japan Society for the Promotion of Science, Tokyo 102-0083, Japan
| | - Ippei Chiba
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu 474-8511, Japan; (S.L.); (S.B.); (K.M.); (I.C.); (K.H.); (Y.S.); (H.S.)
| | - Kenji Harada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu 474-8511, Japan; (S.L.); (S.B.); (K.M.); (I.C.); (K.H.); (Y.S.); (H.S.)
| | - Yohei Shinkai
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu 474-8511, Japan; (S.L.); (S.B.); (K.M.); (I.C.); (K.H.); (Y.S.); (H.S.)
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu 474-8511, Japan; (S.L.); (S.B.); (K.M.); (I.C.); (K.H.); (Y.S.); (H.S.)
| |
Collapse
|
39
|
Bortone I, Griseta C, Battista P, Castellana F, Lampignano L, Zupo R, Sborgia G, Lozupone M, Moretti B, Giannelli G, Sardone R, Panza F. Physical and cognitive profiles in motoric cognitive risk syndrome in an older population from Southern Italy. Eur J Neurol 2021; 28:2565-2573. [PMID: 33899997 DOI: 10.1111/ene.14882] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE In older age, physical and cognitive declines have been shown to occur simultaneously or consequent to one another, and several operational definitions have been proposed to consider the co-presence of the two declines; for example, "Motoric cognitive risk syndrome" (MCR) has been proposed as a definition for the coexistence of slow gait plus subjective cognitive complaints. Given the increasing interest in MCR and its potential role as both biomarker and therapeutic target, we aimed to estimate its prevalence in a large cohort of non-demented older subjects, and to examine the associations between physical status, global cognitive dysfunction, and impairment in various cognitive domains in MCR. METHODS A population-based sample of 1041 older people in Southern Italy (mean age 75.15 years) was enrolled. We defined MCR using slowness and a single question for subjective cognitive complaints. We also administered a comprehensive neuropsychological test battery, together with tests assessing physical function. RESULTS The prevalence of MCR was 9.9% (95% confidence interval 8.2-11.9). MCR was associated with decreased processing speed and executive function after adjusting for all relevant confounders. However, we found no significant association of MCR with decreased global cognition and immediate/delayed free recall of verbal memory. MCR was also associated with increased exhaustion, low muscle strength, and low physical activity, and increased levels of C-reactive protein and interleukin-6. CONCLUSIONS The present findings on MCR prevalence and associated cognitive and physical domains and inflammatory biomarkers may help to uncover altered pathways and therapeutic targets for intervention during the long preclinical phase of neurodegenerative dementia.
Collapse
Affiliation(s)
- Ilaria Bortone
- Unit of Research Methodology and Data Sciences for Population Health, "Salus in Apulia Study,", National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Italy
| | - Chiara Griseta
- Unit of Research Methodology and Data Sciences for Population Health, "Salus in Apulia Study,", National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Italy
| | - Petronilla Battista
- Global Brain Health Institute, University of California, San Francisco, CA, USA
| | - Fabio Castellana
- Unit of Research Methodology and Data Sciences for Population Health, "Salus in Apulia Study,", National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Italy
| | - Luisa Lampignano
- Unit of Research Methodology and Data Sciences for Population Health, "Salus in Apulia Study,", National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Italy
| | - Roberta Zupo
- Unit of Research Methodology and Data Sciences for Population Health, "Salus in Apulia Study,", National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Italy
| | - Giancarlo Sborgia
- Eye Clinic, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Bari, Italy
| | - Madia Lozupone
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro,", Bari, Italy
| | - Biagio Moretti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro,", Bari, Italy
| | - Gianluigi Giannelli
- National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Italy
| | - Rodolfo Sardone
- Unit of Research Methodology and Data Sciences for Population Health, "Salus in Apulia Study,", National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Italy
| | - Francesco Panza
- Unit of Research Methodology and Data Sciences for Population Health, "Salus in Apulia Study,", National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Italy
| |
Collapse
|
40
|
Participation in Social Activities and Relationship between Walking Habits and Disability Incidence. J Clin Med 2021; 10:jcm10091895. [PMID: 33925562 PMCID: PMC8123784 DOI: 10.3390/jcm10091895] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/17/2021] [Accepted: 04/26/2021] [Indexed: 12/21/2022] Open
Abstract
Identifying the relationship between physical and social activity and disability among community-dwelling older adults may provide important information for implementing tailored interventions to prevent disability progression. The aim of this study was to determine the effect of the number of social activities on the relationship between walking habits and disability incidence in older adults. We included 2873 older adults (mean age, 73.1 years; SD, ±5.9 years) from the National Center for Geriatrics and Gerontology—Study of Geriatric Syndromes. Baseline measurements, including frequencies of physical and social activities, health conditions, physical function, cognitive function, metabolic parameters, and other potential disability risk factors (for example, the number of years of education); monthly assessment for disability was monitored through long-term care insurance certification for at least 2 years from baseline. During a mean follow-up of 35.1 months (SD, 6.4 months), 133 participants developed disability. The disability incidence was 19.0 and 27.9 per 1000 person-years for participants who walked more (≥3 times per week) and less (≤3 times per week) frequently, respectively. The potential confounding factor-adjusted disability hazard ratio was 0.67 (95% confidence interval, 0.46 to 0.96; p = 0.030). The relationship between habitual walking and the number of social activities was statistically significant (p = 0.004). The reduction of disability risk by walking was greater among participants with fewer social activities. Habitual walking was associated with disability incidence, with a more pronounced effect among older adults who were less likely to engage in social activities.
Collapse
|
41
|
Ebihara T, Yamasaki M, Kozaki K, Ebihara S. Medical aromatherapy in geriatric syndrome. Geriatr Gerontol Int 2021; 21:377-385. [PMID: 33789361 DOI: 10.1111/ggi.14157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 03/03/2021] [Accepted: 03/15/2021] [Indexed: 12/15/2022]
Abstract
Geriatric syndromes are symptoms and signs, such as falls, incontinence, delirium, pressure ulcers, dysphagia and so on, that often threaten the independence of older adults, rather than the disease itself. Although the syndromes are very common in older people, it is difficult to treat those by modern medicine due to their complexity. To mitigate the intractable geriatric symptoms, we review the efficacy of aromatherapy, especially for dysphagia, dyspnea, cognitive dysfunction and falls in geriatric syndrome. Olfactory stimulation using a volatile black pepper oil on institutional residents improved the swallowing reflex, which is a crucial risk factor of aspiration pneumonia. Brain imaging study showed that olfactory stimulation using volatile black pepper oil activated cerebral regions of the anterior cingulate and the insular cortex, which play a role in controlling appetite and swallowing. Also, aromatherapy with volatile l-menthol decreased the sense of dyspnea and improved the efficacy of exercise therapy. The fragrance of the combination of rosemary and lemon oils in the morning, and the combination of lavender and orange oils in the night-time were reported to improve cognition and behavioural and psychological symptoms of dementia, respectively. Also, the combination of lavender and lemon balm oils was reported to be effective for irritability-related agitation in older adults. Furthermore, aromatherapy with lavender fragrance could improve both static and dynamic balance, resulting in a reduction in the number of fallers and the incidence rate in older people. Thus, aromatherapy is a promising remedy for geriatric syndrome. Geriatr Gerontol Int 2021; 21: 377-385.
Collapse
Affiliation(s)
- Takae Ebihara
- Department of Geriatric Medicine, Graduate School of Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Miyako Yamasaki
- National Health Insurance Kuzumaki Hospital, Kuzumaki, Iwate, Japan
| | - Koichi Kozaki
- Department of Geriatric Medicine, Graduate School of Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Satoru Ebihara
- Department of Rehabilitation Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| |
Collapse
|
42
|
Cheng FY, Chang Y, Cheng SJ, Shaw JS, Lee CY, Chen PH. Do cognitive performance and physical function differ between individuals with motoric cognitive risk syndrome and those with mild cognitive impairment? BMC Geriatr 2021; 21:36. [PMID: 33421996 PMCID: PMC7797100 DOI: 10.1186/s12877-020-01992-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Motoric cognitive risk syndrome (MCR) is defined by slow gait speed combined with subjective cognitive complaint. MCR is a predementia syndrome, similar to mild cognitive impairment (MCI). However, there is currently no study comparing the differences in cognitive performance and physical function between these two types of cognitive impairment. Thus, the aim of this study is to compare cognitive performance and physical function in individuals with MCR versus MCI. METHODS A total of 77 participants, free of dementia, were recruited from the neurological outpatient clinic of a medical center in Taiwan. Participants were separated into 2 groups, MCR (n = 33) and MCI (n = 44) groups, based on definition criteria from previous studies. The priority was to assign a diagnosis of MCR first, followed by MCI. Hence, "pure" MCI had no overlap with MCR syndrome. Cognitive performance, including executive function, attention, working memory, episode memory, visuospatial function, and language, were measured. Physical functions such as activities in daily living, the Tinetti Assessment Scale, and the Timed Up and Go test were also measured. RESULTS Executive function, attention, working memory, episodic memory and language were all significantly lower in the MCR group than the MCI group. Abilities related to physical function, including those measured by the Tinetti Assessment Scale and the Timed Up and Go test, were significantly lower in the MCR group than the MCI group. CONCLUSIONS We noted that cognitive performance and physical function were lower in MCR individuals than MCI but without MCR syndrome. However, the conclusions were based on the enrollment procedure of participants prioritizes the MCR syndrome. Because of the overlap of MCR and MCI, future studies should use different enrollment strategies to further clarify the status of these two populations.
Collapse
Affiliation(s)
- Fang-Yu Cheng
- Institute of Long-Term Care, Mackay Medical College, New Taipei City, Taiwan
| | - Yuanmay Chang
- Institute of Long-Term Care, Mackay Medical College, New Taipei City, Taiwan
| | - Shih-Jung Cheng
- Department of Neurology, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd, Taipei, 10449 Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Jin-Siang Shaw
- Graduate Institute of Mechanical and Electrical Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Chuo-Yu Lee
- Department of Neurology, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd, Taipei, 10449 Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Graduate Institute of Chemistry, Tamkang University, New Taipei City, Taiwan
| | - Pei-Hao Chen
- Department of Neurology, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd, Taipei, 10449 Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Graduate Institute of Mechanical and Electrical Engineering, National Taipei University of Technology, Taipei, Taiwan
| |
Collapse
|
43
|
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.
Collapse
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
| | | | | | | | | |
Collapse
|
44
|
Bai A, Shi H, Huang X, Xu W, Deng Y. Association of C-Reactive Protein and Motoric Cognitive Risk Syndrome in Community-Dwelling Older Adults: The China Health and Retirement Longitudinal Study. J Nutr Health Aging 2021; 25:1090-1095. [PMID: 34725666 DOI: 10.1007/s12603-021-1678-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Motoric cognitive risk syndrome (MCR) is a newly described pre-dementia syndrome characterized by cognitive complaints and slow gait and is associated with numerous adverse outcomes. Previous studies have indicated an association between C-reactive protein (CRP) and cognitive decline, but no clear relationship between CRP and MCR has been reported. The purpose of the study is to examine the associations between CRP with MCR and MCR subtypes. METHODS Participants were 5,642 adults aged ≥60 years from the China Health and Retirement Longitudinal Study (CHARLS). MCR was defined as cognitive complaints and slow gait speed without dementia or impaired mobility. Two subtypes of MCR were defined by whether memory impairment (MI) was also present, such as MCR-MI and MCR-non-MI. MI was evaluated through the immediate recall and delayed recall in a word recall test during the CHARLS and was defined as 1.0 standard deviation or more below the mean values of the test scores in this cohort. RESULTS Of the participants, 421 (7.46%) met the criteria for MCR. After multivariate adjustment, participants with higher CRP levels had an increased likelihood of MCR (fourth quartile: adjusted odds ratio [OR]=1.44; 95% confidence interval [CI]: 1.06-1.95) compared with those in the first quartile group. The OR for MCR-MI was 2.04 (95% CI: 1.35-3.09) for the highest quartile of CRP compared to the lowest quartile. No significant associations between CRP levels and odds of MCR-non-MI were observed. CONCLUSIONS Higher CRP levels were associated with increased odds of prevalent MCR-MI but not MCR-non-MI among community-dwelling older adults.
Collapse
Affiliation(s)
- A Bai
- Yujiao Deng, Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China, E-mail: ; Weihao Xu, Haikou Cadre's sanitarium of Hainan Military Region, Haikou, China, E-mail:
| | | | | | | | | |
Collapse
|
45
|
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.
Collapse
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
| |
Collapse
|
46
|
Makino K, Lee S, Bae S, Shinkai Y, Chiba I, Shimada H. Combined Effects of Pain Interference and Depressive Symptoms on Dementia Incidence: A 36-Month Follow-Up Study. J Alzheimers Dis 2020; 76:703-712. [PMID: 32538832 DOI: 10.3233/jad-191139] [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: 11/15/2022]
Abstract
BACKGROUND Both pain interference and depressive symptoms have certain effects on dementia, and these are reciprocally related. However, comorbid effects of pain interference and depressive symptoms on dementia have not been examined in detail. OBJECTIVE This longitudinal study aimed to examine the combined effects of pain interference and depressive symptoms on the incidence of dementia in community-dwelling elderly individuals. METHODS This prospective cohort study with a 36-month follow-up period included 4,326 community-dwelling elderly individuals without dementia at baseline. Pain interference and depressive symptoms were assessed for every participant at baseline. We collected medical records in the Japanese public health insurance system to identify the incidence of dementia for 36 months. RESULTS The incidence rates of dementia during the follow-up period in the control, pain-interference, depressive-symptoms, and comorbid group were 3.2%, 6.2%, 7.9%, and 11.3%, respectively. A Cox regression analysis showed that the hazard ratios for the incidence of dementia were 1.85 (95% CI: 1.13-3.03) in the pain interference group, 1.87 (95% CI: 1.27-2.76) in the depressive symptoms group, and 2.20 (95% CI: 1.26-3.84) in the comorbid group, after adjusting for covariates. CONCLUSION The coexistence of pain interference and depressive symptoms had a greater effect on the incidence of dementia than either condition alone in community-dwelling elderly individuals. Pain interference and depressive symptoms are known as common comorbid conditions and often form a negative cycle that accelerates the worsening of the individual symptoms of both. Thus, the comorbidity of these conditions may require monitoring for the prevention of dementia.
Collapse
Affiliation(s)
- Keitaro Makino
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu City, Aichi, Japan.,Japan Society for the Promotion of Science, Chiyoda-ku, Tokyo, Japan
| | - Sangyoon Lee
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu City, Aichi, Japan
| | - Seongryu Bae
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu City, Aichi, Japan
| | - Yohei Shinkai
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu City, Aichi, Japan
| | - Ippei Chiba
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu City, Aichi, Japan
| | - Hiroyuki Shimada
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu City, Aichi, Japan
| |
Collapse
|
47
|
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: 10] [Impact Index Per Article: 2.5] [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.
Collapse
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
| |
Collapse
|
48
|
Stephan Y, Sutin AR, Canada B, Terracciano A. Personality and Motoric Cognitive Risk Syndrome. J Am Geriatr Soc 2020; 68:803-808. [PMID: 31880326 PMCID: PMC7156302 DOI: 10.1111/jgs.16282] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To examine whether five major personality traits are related to the motoric cognitive risk (MCR) syndrome, a pre-dementia syndrome characterized by cognitive complaints and slow gait speed. DESIGN Cross-sectional. SETTING Health and Retirement Study (HRS) and the National Health and Aging Trends Survey (NHATS). PARTICIPANTS Dementia-free older adults aged 65 to 107 years (N > 8000). MEASUREMENTS In both samples, participants provided data on personality, cognitive complaints, and measures of gait speed, as well as on demographic factors, physical activity, depressive symptoms, and body mass index (BMI). RESULTS Across the two samples and a meta-analysis, higher neuroticism was related to higher risk of MCR (combined odds ratio [OR] = 1.32; 95% confidence interval [CI] = 1.21-1.45; P < .001), whereas higher extraversion (combined OR = .71; 95% CI = .65-.79; P < .001) and conscientiousness (combined OR = .70; 95% CI = .62-.78; P < .001) were associated with a lower likelihood of MCR. Higher openness was also related to a lower risk of MCR in the HRS and the meta-analysis (combined OR = .77; 95% CI = .70-.85; P < .001), whereas agreeableness was protective only in the HRS (OR = .83; 95% CI = .74-.92; P < .001). Additional analyses indicated that physical activity, depressive symptoms, and BMI partially accounted for these associations. CONCLUSION This study adds to existing research on the factors related to the risk of MCR by showing an association with personality traits. Personality assessment may help to identify individuals who may be targeted by interventions focused on reducing the risk of MCR and ultimately of dementia. J Am Geriatr Soc 68:803-808, 2020.
Collapse
Affiliation(s)
| | - Angelina R. Sutin
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, USA
| | | | - Antonio Terracciano
- Department of Geriatrics, College of Medicine, Florida State University, USA
| |
Collapse
|
49
|
Shen S, Zeng X, Xu L, Chen L, Liu Z, Chu J, Yang Y, Wu X, Chen X. Association between motoric cognitive risk syndrome and frailty among older Chinese adults. BMC Geriatr 2020; 20:110. [PMID: 32192446 PMCID: PMC7081673 DOI: 10.1186/s12877-020-01511-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 03/10/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Motoric cognitive risk syndrome (MCR) is a newly proposed predementia syndrome incorporating subjective cognitive complaints and slow gait. Previous studies have reported that subjective cognitive complaints and slow gait are associated with frailty in cognitively unimpaired older adults, but little is known about the link between MCR and frailty in older adults. Therefore, the aim of the study was to explore the associations of MCR and its components with frailty in older Chinese adults. METHODS In an observational cross-sectional study, a total of 429 older adults aged 60 years and older were admitted to the geriatric department. According to MCR criteria, all participants were classified into 4 groups: 1) the MCR group; 2) the subjective cognitive complaints only group; 3) the slow gait only group; and 4) the healthy control group. Physical frailty was assessed by the Clinical Frailty Scale (CFS). Multivariate logistic regression analysis was used to examine the association between MCR and frailty in older adults. RESULTS The prevalence rates of subjective cognitive complaints, slow gait and MCR were 15.9, 10.0 and 4.0%, respectively. After adjusting for confounding variables, the logistic regression analysis showed that slow gait (odds ratio [OR]: 3.40, 95% confidence interval [CI]: 1.40-8.23, P = 0.007) and MCR (OR: 5.53, 95% CI: 1.46-20.89, P = 0.012) were independently associated with frailty, but subjective cognitive complaints were not. CONCLUSIONS MCR and slow gait were significantly associated with frailty in older Chinese adults. Further studies should prospectively determine the causal relationship between MCR and frailty.
Collapse
Affiliation(s)
- Shanshan Shen
- Department of Geriatric, Zhejiang Hospital, No. 12 Lingyin Road, Hangzhou, 310013, Zhejiang Province, China
| | - Xingkun Zeng
- Department of Geriatric, Zhejiang Hospital, No. 12 Lingyin Road, Hangzhou, 310013, Zhejiang Province, China
| | - Liyu Xu
- Department of Geriatric, Zhejiang Hospital, No. 12 Lingyin Road, Hangzhou, 310013, Zhejiang Province, China
| | - Lingyan Chen
- Department of Geriatric, Zhejiang Hospital, No. 12 Lingyin Road, Hangzhou, 310013, Zhejiang Province, China
| | - Zixia Liu
- Department of Geriatric, Zhejiang Hospital, No. 12 Lingyin Road, Hangzhou, 310013, Zhejiang Province, China
| | - Jiaojiao Chu
- Department of Geriatric, Zhejiang Hospital, No. 12 Lingyin Road, Hangzhou, 310013, Zhejiang Province, China
| | - Yinghong Yang
- Department of Geriatric, Zhejiang Hospital, No. 12 Lingyin Road, Hangzhou, 310013, Zhejiang Province, China
| | - Xiushao Wu
- Department of Geriatric, Zhejiang Hospital, No. 12 Lingyin Road, Hangzhou, 310013, Zhejiang Province, China
| | - Xujiao Chen
- Department of Geriatric, Zhejiang Hospital, No. 12 Lingyin Road, Hangzhou, 310013, Zhejiang Province, China.
| |
Collapse
|
50
|
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: 61] [Impact Index Per Article: 15.3] [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.
Collapse
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
| |
Collapse
|