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Wu W, Zhou Q, Gao Q, Li H, Zhang J, Wu J, Shen J, Li J, Shi H. Construction of an instrument to enable the assessment of the risk of falls in older outpatients: A quantitative methodological study. J Adv Nurs 2024; 80:3825-3834. [PMID: 38402452 DOI: 10.1111/jan.16059] [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: 03/31/2023] [Revised: 12/04/2023] [Accepted: 01/07/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES To develop an instrument to facilitate the risk assessment of falls in older outpatients. DESIGN A quantitative methodological study using the cross-sectional data. METHODS This study enrolled 1988 older participants who underwent comprehensive geriatric assessment (CGA) in an outpatient clinic from May 2020 to November 2022. The history of any falls (≥1 falls in a year) and recurrent falls (≥2 falls in a year) were investigated. Potential risk factors of falls were selected by stepwise logistic regression, and a screening tool was constructed based on nomogram. The tool performance was compared with two reference tools (Fried Frailty Phenotype; CGA with 10 items, CGA-10) by using receiver operating curves, sensitivity (Sen), specificity (Spe), and area under the curve (AUC). RESULTS Age, unintentional weight loss, depression measured by the Patient Health Questionnaire-2, muscle strength measured by the five times sit-to-stand test, and stand balance measured by semi- and full-tandem standing were the most important risk factors for falls. A fall risk screening tool was constructed with the six measurements (FRST-6). FRST-6 showed the best AUC (Sen, Spe) of 0.75 (Sen = 0.72, Spe = 0.69) for recurrent falls and 0.65 (Sen = 0.74, Spe = 0.48) for any falls. FRST-6 was comparable to CGA-10 and outperformed FFP in performance. CONCLUSIONS Age, depression, weight loss, gait, and balance were important risk factors of falls. The FRST-6 tool based on these factors showed acceptable performance in risk stratification. IMPACT Performing a multifactorial assessment in primary care clinics is urgent for falls prevention. The FRST-6 provides a simple and practical way for falls risk screening. With this tool, healthcare professionals can efficiently identify patients at risk of falling and make appropriate recommendations in resource-limited settings. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was received, due to our study design.
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Affiliation(s)
- Wenbin Wu
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Zhou
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, China
| | - Qiang Gao
- Department of Scientific Research, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Hong Li
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jie Zhang
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Juan Wu
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ji Shen
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Li
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Hong Shi
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Li Y, Huang Y, Wei F, Li T, Wang Y. Development and validation of a risk prediction model for motoric cognitive risk syndrome in older adults. Aging Clin Exp Res 2024; 36:143. [PMID: 39002102 PMCID: PMC11246282 DOI: 10.1007/s40520-024-02797-5] [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: 04/20/2024] [Accepted: 06/22/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVE The objective of this study was to develop a risk prediction model for motoric cognitive risk syndrome (MCR) in older adults. METHODS Participants were selected from the 2015 China Health and Retirement Longitudinal Study database and randomly assigned to the training group and the validation group, with proportions of 70% and 30%, respectively. LASSO regression analysis was used to screen the predictors. Then, identified predictors were included in multivariate logistic regression analysis and used to construct model nomogram. The performance of the model was evaluated by area under the receiver operating characteristic (ROC) curve (AUC), calibration curves and decision curve analysis (DCA). RESULTS 528 out of 3962 participants (13.3%) developed MCR. Multivariate logistic regression analysis showed that weakness, chronic pain, limb dysfunction score, visual acuity score and Five-Times-Sit-To-Stand test were predictors of MCR in older adults. Using these factors, a nomogram model was constructed. The AUC values for the training and validation sets of the predictive model were 0.735 (95% CI = 0.708-0.763) and 0.745 (95% CI = 0.705-0.785), respectively. CONCLUSION The nomogram constructed in this study is a useful tool for assessing the risk of MCR in older adults, which can help clinicians identify individuals at high risk.
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Affiliation(s)
- Yaqin Li
- School of Nursing, Jinan University, Guangzhou, Guangdong Province, China
| | - Yuting Huang
- School of Nursing, Jinan University, Guangzhou, Guangdong Province, China
| | - Fangxin Wei
- School of Nursing, Jinan University, Guangzhou, Guangdong Province, China
| | - Tanjian Li
- School of Nursing, Jinan University, Guangzhou, Guangdong Province, China
| | - Yu Wang
- The Community Service Center of Jinan University, The First Affiliated Hospital of Jinan University, Tianhe District, Guangzhou, Guangzhou Province, China.
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Bai W, Ma R, Yang Y, Xu J, Qin L. Enhancing predictive validity of motoric cognitive risk syndrome for incident dementia and all-cause mortality with handgrip strength: insights from a prospective cohort study. Front Aging Neurosci 2024; 16:1421656. [PMID: 38974906 PMCID: PMC11224449 DOI: 10.3389/fnagi.2024.1421656] [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: 04/22/2024] [Accepted: 06/03/2024] [Indexed: 07/09/2024] Open
Abstract
Background This study aimed to assess whether integrating handgrip strength (HGS) into the concept of motoric cognitive risk (MCR) would enhance its predictive validity for incident dementia and all-cause mortality. Methods A cohort of 5, 899 adults from the Health and Retirement Study underwent assessments of gait speed, subjective cognitive complaints, and HGS were involved. Over a 10-year follow-up, biennial cognitive tests and mortality data were collected. Cox proportional hazard analyses assessed the predictive power of MCR alone and MCR plus HGS for incident dementia and all-cause mortality. Results Patients with MCR and impaired HGS (MCR-HGS) showed the highest adjusted hazard ratios (AHR) for dementia (2.33; 95% CI, 1.49-3.65) and mortality (1.52; 95% CI, 1.07-2.17). Even patients with MCR and normal HGS (MCR-non-HGS) experienced a 1.77-fold increased risk of incident dementia; however, this association was not significant when adjusted for socioeconomic status, lifestyle factors, and medical conditions. Nevertheless, all MCR groups demonstrated increased risks of all-cause mortality. The inclusion of HGS in the MCR models significantly improved predictive discrimination for both incident dementia and all-cause mortality, as indicated by improvements in the C-statistic, integrated discrimination improvement (IDI) and net reclassification indices (NRI). Conclusion Our study underscores the incremental predictive value of adding HGS to the MCR concept for estimating risks of adverse health outcomes among older adults. A modified MCR, incorporating HGS, could serve as an effective screening tool during national health examinations for identifying individuals at risk of dementia and mortality.
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Affiliation(s)
- Weimin Bai
- Department of Emergency, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, China
| | - Ruizhu Ma
- Department of Endocrinology, The People’s Hospital of Danyang, Danyang Hospital of Nantong University, Danyang, Jiangsu, China
| | - Yanhui Yang
- Department of Cardiology, The Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Juan Xu
- Department of General Surgery, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Lijie Qin
- Department of Emergency, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, China
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Chung J, Byun S. Motoric Cognitive Risk and Incident Dementia in Older Adults. JAMA Netw Open 2023; 6:e2338534. [PMID: 37856120 PMCID: PMC10587785 DOI: 10.1001/jamanetworkopen.2023.38534] [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: 05/24/2023] [Accepted: 09/06/2023] [Indexed: 10/20/2023] Open
Abstract
Importance Motoric cognitive risk (MCR) is a novel predementia syndrome; however, whether it can estimate dementia in a nationwide population or has additive estimation validity over cognitive or motoric components alone remains unknown. Objective To examine whether modified MCR, which incorporates the timed-up-and-go and one-leg-standing tests, improves estimation validity for incident dementia over using cognitive or motoric components alone. Design, Setting, and Participants This nationwide cohort study evaluated data from individuals aged 66 years who participated in the National Screening Program for Transitional Ages in Korea from January 1, 2009, to December 31, 2013, and examined the association between MCR and incident dementia using Cox proportional hazards regression analysis. Data were collected from the index date (the date on which the participant had the screening) until dementia onset, death, or the end of the follow-up period, whichever came first. The 2 subtypes were defined as subjective cognitive declines with timed-up-and-go impairment or one-leg-standing impairment. The data set was generated with permission from the Korean National Health Insurance Service, and data analysis was conducted from August 2, 2021, to January 31, 2022. Individuals diagnosed with dementia or psychotic disorders or those who had a documented history of dementia medication use before the index date were excluded. Main Outcomes and Measures The main outcome was incidence of dementia, defined as an individual receiving their first dementia medication with the relevant International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, codes after the index date. Results Among the 1 137 530 participants (53.7% women), 15 380 (1.4%) met the MCR criteria for the timed-up-and-go subtype, and 32 910 (2.9%) met the criteria for the one-leg-standing subtype. The mean (SD) follow-up period was 7.02 (1.38) years. Participants with MCR demonstrated an approximately 2-fold higher risk of incident dementia than those without MCR (timed-up-and-go subtype, adjusted hazard ratio, 2.03; 95% CI, 1.94-2.13; one-leg-standing subtype, adjusted hazard ratio, 2.05; 95% CI, 1.98-2.12). Conclusions and Relevance In this cohort study of participants aged 66 years of the National Screening Program for Transitional Ages, modified motoric cognitive risk had higher adjusted hazard ratios of incident dementia than individual cognitive or motoric components. Motoric cognitive risk may be a practical screening tool for estimating dementia among individuals in their mid-60s ; however, further investigation of the clinical and neurobiological aspects is necessary.
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Affiliation(s)
- Jeehae Chung
- Industry-Academic Cooperation Foundation, The Catholic University of Korea, Seoul, Korea
| | - Seonjeong Byun
- Department of Neuropsychiatry, Uijeongbu St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Wen ZF, Peng SH, Wang JL, Wang HY, Yang LP, Liu Q, Zhang XG. Prevalence of motoric cognitive risk syndrome among older adults: a systematic review and meta-analysis. Aging Ment Health 2022:1-13. [PMID: 36533320 DOI: 10.1080/13607863.2022.2158305] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Motoric cognitive risk syndrome (MCR) is a newly proposed pre-dementia syndrome. Several studies on the prevalence of MCR have been published; however, the data vary across studies with different epidemiological characteristics. Thus, this study aimed to quantitatively analyse the overall prevalence and associated epidemiological characteristics of MCR among older adults aged ≥ 60 years. METHODS The Cochrane Library, PubMed, Web of Science, CINAHL, Embase, Scopus, PsycInfo, China National Knowledge Infrastructure, Weipu Database, China Biology Medicine disc and Wanfang Database were searched from their inception to January 2022. A modified Newcastle-Ottawa Scale evaluated the risk of bias. Statistical heterogeneity among the included studies was analysed using Cochran's Q and I2 tests. A random effect model calculated pooled prevalence owing to study heterogeneity. Begg's and Egger's tests were used to assess the publication bias. Additionally, subgroup analysis and meta-regression were performed based on different epidemiological characteristics to determine heterogeneity sources. RESULTS Sixty-two studies comprising 187,558 samples were obtained. The pooled MCR prevalence was 9.0% (95% confidence interval: 8.3-9.8). A higher MCR prevalence was observed in females, older adults with a low educational level, depression and cardiovascular risk factors, South American populations, and studies with small sample sizes and cross-section designs. Furthermore, subjective cognitive complaint using scale score and gait speed using instrument gait showed higher MCR prevalence. CONCLUSION MCR is common in older adults, and various epidemiological characteristics influence its prevalence. Thus, preventive measures are required for older adults with higher MCR prevalence.
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Affiliation(s)
- Zhi-Fei Wen
- School of Nursing, Chengdu university of Traditional Chinese Medicine, Sichuan, China
| | - Si-Han Peng
- School Clinical, Chengdu university of Traditional Chinese Medicine, Sichuan, China
| | - Jia-Lin Wang
- School of Nursing, Chengdu university of Traditional Chinese Medicine, Sichuan, China
| | - Hong-Yan Wang
- Dean Office, Sichuan Nursing Vocational College, Sichuan, China
| | - Li-Ping Yang
- School of Nursing, Chengdu university of Traditional Chinese Medicine, Sichuan, China
| | - Qin Liu
- School of Nursing, Chengdu university of Traditional Chinese Medicine, Sichuan, China
| | - Xian-Geng Zhang
- Dean Office, Sichuan Nursing Vocational College, Sichuan, China
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Su L, Sun X, Huang C, Wei Z, Shen X, Wang L. Methodology of Measuring Motoric Cognitive Risk Syndrome-Focusing on Slow Gait Speed: Protocol for a Systematic Review. Front Psychiatry 2022; 13:858950. [PMID: 35418886 PMCID: PMC8995464 DOI: 10.3389/fpsyt.2022.858950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/21/2022] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Older adults with motoric cognitive risk (MCR) syndrome are at high risk of developing dementia. Although the definition of MCR is well recognized and consensus, previous studies did not reach an agreement on diagnostic criteria and measurement methods/tools for slow gait speed, which is one of four components of MCR diagnosis. The substantial heterogeneity in the methodology of slow gait speed diagnosis for MCR limits comparability and meta-analysis of studies. OBJECTIVE The study aims to conduct systematic and standardized integration for diagnostic criteria and methods of slow gait speed diagnosis for MCR based on previous evidence that may improve comparability between future studies. METHODS A systematic literature review will be undertaken by searching the following electronic databases (until February 1, 2022): PUBMED, EMBASE, The Cochrane Library, Web of Science. Additional studies will be identified by checking the reference lists of included studies or relevant reviews, manually searching the internet search engine Google Scholar, and searching the authors' personal files, if necessary. Two researchers will perform data extraction independently, and discrepancies will be resolved by discussion, which will include a third researcher if requires. The paper selection will perform in duplicate. Finally, a narrative account will synthesize the findings to answer the objectives of this review. DISCUSSION This is the first study on systematic and standardized integration for diagnostic criteria and measurement methods/tools for slow gait speed in diagnosing MCR. The findings of this study will be convenient for medical staff to examine the intended use and applicability of each instrument/tool for evaluating the gait speed, and provide insight into developing uniform guidelines for MCR. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42021232671.
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Affiliation(s)
- Liming Su
- School of Medicine, Huzhou University, Huzhou, China
| | - Xue Sun
- School of Medicine, Huzhou University, Huzhou, China
| | - Cheng Huang
- School of Medicine, Huzhou University, Huzhou, China
| | - Zhuqin Wei
- School of Medicine, Huzhou University, Huzhou, China
| | - Xinhua Shen
- Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, Huzhou, China
| | - Lina Wang
- School of Medicine, Huzhou University, Huzhou, China
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Lu WH, Giudici KV, Rolland Y, Guyonnet S, Mangin JF, Vellas B, de Souto Barreto P. Associations Between Nutritional Deficits and Physical Performance in Community-Dwelling Older Adults. Front Nutr 2021; 8:771470. [PMID: 34859035 PMCID: PMC8632557 DOI: 10.3389/fnut.2021.771470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Whether multiple nutritional deficiencies have a synergic effect on mobility loss remains unknown. This study aims to evaluate associations between multi-nutritional deficits and physical performance evolution among community-dwelling older adults. Methods: We included 386 participants from the Multidomain Alzheimer Preventive Trial (MAPT) (75.6 ± 4.5 years) not receiving omega-3 polyunsaturated fatty acid (PUFA) supplementation and who had available data on nutritional deficits. Baseline nutritional deficits were defined as plasma 25 hydroxyvitamin D <20 ng/ml, plasma homocysteine >14 μmol/L, or erythrocyte omega-3 PUFA index ≤ 4.87% (lower quartile). The Short Physical Performance Battery (SPPB), gait speed, and chair rise time were used to assess physical performance at baseline and after 6, 12, 24, 36, 48, and 60 months. We explored if nutrition-physical performance associations varied according to the presence of low-grade inflammation (LGI) and brain imaging indicators. Results: Within-group comparisons showed that physical function (decreased SPPB and gait speed, increased chair rise time) worsened over time, particularly in participants with ≥2 nutritional deficits; however, no between-group differences were observed when individuals without deficit and those with either 1 or ≥2 deficits were compared. Our exploratory analysis on nutritional deficit-LGI interactions showed that, among people with ≥2 deficits, chair rise time was increased over time in participants with LGI (adjusted mean difference: 3.47; 95% CI: 1.03, 5.91; p = 0.017), compared with individuals with no LGI. Conclusions: Accumulated deficits on vitamin D, homocysteine, and omega-3 PUFA were not associated with physical performance evolution in older adults, but they determined declined chair rise performance in subjects with low-grade inflammation. Clinical Trial Registration: [https://clinicaltrials.gov/ct2/show/NCT00672685], identifier [NCT00672685].
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Affiliation(s)
- Wan-Hsuan Lu
- Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France
- Maintain Aging Research Team, CERPOP, INSERM, Université Paul Sabatier, Toulouse, France
| | - Kelly Virecoulon Giudici
- Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France
| | - Yves Rolland
- Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France
- Maintain Aging Research Team, CERPOP, INSERM, Université Paul Sabatier, Toulouse, France
| | - Sophie Guyonnet
- Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France
- Maintain Aging Research Team, CERPOP, INSERM, Université Paul Sabatier, Toulouse, France
| | - Jean-François Mangin
- CATI Multicenter Neuroimaging Platform, Neurospin, CEA, Gif-sur-Yvette, France
- Université Paris-Saclay, CEA, CNRS, Neurospin, Baobab, Gif-sur-Yvette, France
| | - Bruno Vellas
- Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France
- Maintain Aging Research Team, CERPOP, INSERM, Université Paul Sabatier, Toulouse, France
| | - Philipe de Souto Barreto
- Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France
- Maintain Aging Research Team, CERPOP, INSERM, Université Paul Sabatier, Toulouse, France
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Saho K, Sugano K, Uemura K, Matsumoto M. Screening of apathetic elderly adults using kinematic information in gait and sit-to-stand/stand-to-sit movements measured with Doppler radar. Health Informatics J 2021; 27:1460458221990051. [PMID: 33509024 DOI: 10.1177/1460458221990051] [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] [Indexed: 11/15/2022]
Abstract
This paper presents a Doppler radar apathy-screening technique applied to elderly people based on their basic daily activities of walking and movements of sit-to-stand and stand-to-sit (STS). Our Doppler radar system remotely measured the kinematic parameters of the movements of 78 community-dwelling elderly adults (27 apathetic participants and 51 non-apathetic ones). Subsequently, logistic regression models using the measured kinematic parameters of gait and sit-to-stand/stand-to-sit movements were constructed for screening. The experimental results verified that, although the model using gait parameters could screen an apathetic group with a sensitivity of 85.2% and a specificity of 58.8%, the model using the STS parameters achieved better screening accuracies with a sensitivity of 88.9% and a specificity of 76.5%. These results reveal that the kinematic information of STS movements is significantly more effective at detecting apathy than is the gait information, which is otherwise regarded to be effective in conventional epidemiological studies.
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Ceïde ME, Warhit A, Ayers EI, Kennedy G, Verghese J. Apathy and the Risk of Predementia Syndromes in Community-Dwelling Older Adults. J Gerontol B Psychol Sci Soc Sci 2021; 75:1443-1450. [PMID: 32374839 PMCID: PMC7424283 DOI: 10.1093/geronb/gbaa063] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Indexed: 12/21/2022] Open
Abstract
Objectives Apathy is a potential predictor of dementia in older adults, but this investigation has been limited to older adults with a preexisting neurological illness like mild cognitive impairment (MCI), stroke or Parkinson’s disease. The objective of this study was to investigate the association between apathy at baseline and incident predementia syndromes, including MCI and motoric cognitive risk syndrome (MCR), subjective cognitive complaints and slow gait, in community-dwelling older adults. Method We prospectively studied the association between apathy (using the 3-item subscale of the Geriatric Depression Scale [GDS3A]) and incident cognitive disorders in 542 community-dwelling older adults enrolled in the Central Control of Mobility in Aging study using Cox proportional hazard models. Associations were reported as hazard ratio (HR) with 95% confidence intervals (CIs), adjusting for age, education, baseline cognitive performance, and depressive symptoms. Results Apathy was associated with incident MCR (HR 2.39, 95% CI: 1.10–5.20), but not predementia syndromes overall nor MCI. In sensitivity analyses of MCI subtypes, apathy was associated with nonamnestic MCI (HR 2.44, 95% CI: 1.14–5.22), but not amnestic MCI. Our study was limited by a short follow-up time (median 13.6 months; interquartile range 29.8) and a brief subscale measurement of apathy, GDS3A. Discussion In our study, apathy predicted MCR but not MCI in community-dwelling older adults. These results and the current literature suggest that apathy is an early risk factor for dementia. Additionally, apathy may be a novel treatment target that could forestall the disability of dementia.
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Affiliation(s)
- Mirnova E Ceïde
- Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, New York.,Department of Psychiatry and Behavioral Sciences and Medicine, Montefiore Medical Center, Bronx, New York
| | - Alana Warhit
- Department of Psychiatry, Weill Cornell Medicine, New York City, New York
| | - Emmeline I Ayers
- Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, New York
| | - Gary Kennedy
- Department of Psychiatry and Behavioral Sciences and Medicine, Montefiore Medical Center, Bronx, New York
| | - Joe Verghese
- Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, New York
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Calderón-Garcidueñas L, Torres-Solorio AK, Kulesza RJ, Torres-Jardón R, González-González LO, García-Arreola B, Chávez-Franco DA, Luévano-Castro SC, Hernández-Castillo A, Carlos-Hernández E, Solorio-López E, Crespo-Cortés CN, García-Rojas E, Mukherjee PS. Gait and balance disturbances are common in young urbanites and associated with cognitive impairment. Air pollution and the historical development of Alzheimer's disease in the young. ENVIRONMENTAL RESEARCH 2020; 191:110087. [PMID: 32890478 PMCID: PMC7467072 DOI: 10.1016/j.envres.2020.110087] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 05/03/2023]
Abstract
To determine whether gait and balance dysfunction are present in young urbanites exposed to fine particular matter PM2.5 ≥ annual USEPA standard, we tested gait and balance with Tinetti and Berg tests in 575 clinically healthy subjects, age 21.0 ± 5.7 y who were residents in Metropolitan Mexico City, Villahermosa and Reynosa. The Montreal Cognitive Assessment was also applied to an independent cohort n:76, age 23.3 ± 9.1 y. In the 575 cohort, 75.4% and 34.4% had abnormal total Tinetti and Berg scores and high risk of falls in 17.2% and 5.7% respectively. BMI impacted negatively Tinetti and Berg performance. Gait dysfunction worsen with age and males performed worse than females. Gait and balance dysfunction were associated with mild cognitive impairment MCI (19.73%) and dementia (55.26%) in 57/76 and 19 cognitively intact subjects had gait and balance dysfunction. Seventy-five percent of urbanites exposed to PM2.5 had gait and balance dysfunction. For MMC residents-with historical documented Alzheimer disease (AD) and CSF abnormalities, these findings suggest Alzheimer Continuum is in progress. Early development of a Motoric Cognitive Risk Syndrome ought to be considered in city dwellers with normal cognition and gait dysfunction. The AD research frame in PM2.5 exposed young urbanites should include gait and balance measurements. Multicity teens and young adult cohorts are warranted for quantitative gait and balance measurements and neuropsychological and brain imaging studies in high vs low PM2.5 exposures. Early identification of gait and balance impairment in young air pollution-exposed urbanites would facilitate multidisciplinary prevention efforts for modifying the course of AD.
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Affiliation(s)
| | | | - Randy J Kulesza
- Auditory Research Center, Lake Erie College of Osteopathic Medicine, Erie, PA, 16509, USA
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Zhang L, Feng BL, Wang CY, Zhang Y, Lin P, Zhang YL, He NN, Wang DJ, Jiang LF, Ye HH. Prevalence and factors associated with motoric cognitive risk syndrome in community-dwelling older Chinese: a cross-sectional study. Eur J Neurol 2020; 27:1137-1145. [PMID: 32301557 DOI: 10.1111/ene.14266] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/13/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE A recently proposed pre-dementia syndrome, motoric cognitive risk (MCR) syndrome, is characterized by cognitive complaints and slow gait, and increases the risk of dementia and mortality. The aim of the present study was to explore the prevalence of and factors associated with MCR syndrome in elderly community-dwelling Chinese subjects. METHODS The Ningbo Community Study on Aging recruited 953 Chinese community-dwelling participants aged ≥ 65 years from November 2016 to March 2017. Handgrip, Five-Times-Sit-to-Stand (FTSS) test time and body composition, as well as comprehensive geriatric evaluation, were measured as potentially independent factors associated with MCR syndrome. RESULTS The prevalence of MCR syndrome was 12.8% in men and 12.6% in women, and high prevalence of MCR syndrome was not associated with age or sex. Multiple logistic regression analysis by sex showed that a 1-SD increase in FTSS test time in males and females was associated with 45% (95% confidence intervals, 19-76; P < 0.01) and 20% (95% confidence intervals, 9-33; P < 0.01) higher risk of having MCR syndrome, respectively, whereas handgrip strength was inversely correlated with MCR syndrome in males [odds ratio (OR), 0.91; P = 0.02] but not females (P = 0.06). Moreover, the relationship of arm fat mass and MCR syndrome was statistically significant in both sexes (OR, 1.69-1.77), but leg fat mass was only associated with MCR syndrome (OR, 1.56; P = 0.02) in men. CONCLUSIONS Handgrip, FTSS test time and body composition were associated in a sex-specific manner with MCR syndrome in elderly community-dwelling Chinese subjects. Our results on MCR syndrome are novel and should be considered as important information in future studies.
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Affiliation(s)
- L Zhang
- Department of Cardiology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo Cardiovascular Center, Ningbo, China
| | - B L Feng
- Department of Cardiology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo Cardiovascular Center, Ningbo, China
| | - C Y Wang
- Department of Cardiology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo Cardiovascular Center, Ningbo, China
| | - Y Zhang
- Department of Cardiology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo Cardiovascular Center, Ningbo, China
| | - P Lin
- Ximen Community Health Service Centre, Ningbo, China
| | - Y L Zhang
- Department of Cardiology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo Cardiovascular Center, Ningbo, China
| | - N N He
- Department of Experimental Medical Science, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - D J Wang
- Department of Cardiology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo Cardiovascular Center, Ningbo, China
| | - L F Jiang
- Department of Cardiology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo Cardiovascular Center, Ningbo, China
| | - H H Ye
- Department of Cardiology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo Cardiovascular Center, Ningbo, China
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Meiner Z, Ayers E, Verghese J. Motoric Cognitive Risk Syndrome: A Risk Factor for Cognitive Impairment and Dementia in Different Populations. Ann Geriatr Med Res 2020; 24:3-14. [PMID: 32743316 PMCID: PMC7370775 DOI: 10.4235/agmr.20.0001] [Citation(s) in RCA: 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.
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Affiliation(s)
- Zeev Meiner
- Department of Physical Medicine and Rehabilitation, Hadassah Mount Scopus, Jerusalem, Israel
| | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joe Verghese
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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13
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Beauchet O, Sekhon H, Launay CP, Rolland Y, Schott AM, Allali G. Motoric cognitive risk syndrome and incident dementia: results from a population-based prospective and observational cohort study. Eur J Neurol 2019; 27:468-474. [PMID: 31571342 DOI: 10.1111/ene.14093] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/27/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Motoric cognitive risk syndrome (MCR), which is the juncture of subjective cognitive complaint and slow gait speed, is a pre-dementia stage. The aims of the study are (i) to compare characteristics between individuals who have MCR defined using slow walking speed and/or increased five-times-sit-to-stand (FTSS) time as its motor component(s); and (ii) to characterize the association of MCR and its various motor components with incident dementia including Alzheimer disease and non-Alzheimer dementia in the participants of the Epidémiologie de l'Ostéoporose (EPIDOS) study. METHODS This prospective and observational cohort study selected 651 participants recruited from the EPIDOS study in Toulouse (France). MCR was defined as the association of subjective cognitive complaint and slow gait speed and/or increased FTSS time in participants without either dementia and mobility disabilities at baseline. Individuals with dementia were prospectively diagnosed during the physical and neuropsychological assessments included in the 7-year follow-up. RESULTS The prevalence of MCR was around 7% when using an exclusive motor criterion, either slow gait speed or increased FTSS time, and was 20.9% when MCR subgroups were pooled. MCR was positively associated with incident dementia regardless of its type, and with Alzheimer disease in the slow gait speed MCR subgroup [odds ratio (OR) > 2.18 with P ≤ 0.037] but not with non-Alzheimer dementia. No significant association between incident dementia and MCR defined using increased FTSS time was shown. CONCLUSIONS Our findings confirm that MCR is associated with incident dementia and that slow gait speed is the appropriate motor criterion for detecting dementia risk.
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Affiliation(s)
- O Beauchet
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada.,Dr Joseph Kaufmann Chair in Geriatric Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Centre of Excellence on Longevity, McGill Integrated University Health Network, Montreal, QC, Canada.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
| | - H Sekhon
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada.,Centre of Excellence on Longevity, McGill Integrated University Health Network, Montreal, QC, Canada.,Department of Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - C P Launay
- Geriatric Medicine and Geriatric Rehabilitation Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Y Rolland
- Department of Geriatric, Toulouse University Hospital, Toulouse, France
| | - A-M Schott
- Pôle de Santé Publique, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - G Allali
- Department of Neurology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
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