Motoric Cognitive Risk Syndrome Using Three-Item Recall Test and Its Associations with Fall-Related Outcomes: The Korean Frailty and Aging Cohort Study

The clinical characteristics of cerebral small vessel disease patients with motoric cognitive risk syndrome during single- and dual-task walking

Objective

We aimed to (1) identify neuroimaging biomarkers of distinguishing motoric cognitive risk syndrome (MCRS) risk among older Chinese adults with cerebral small vessel disease (CSVD) and (2) detect differences in gait parameters and neuroimaging biomarkers between CSVD individual with and without MCRS, especially during dual-task walking (DTW).

Methods

We enrolled 126 inpatients with CSVD who were divided into two groups according to MCRS status. Data on basic parameters, variability, asymmetry, and coordination were collected during single-task walking (STW) and DTW. Neuroimaging features (white matter hyperintensities, lacunes, and microbleeds) and total disease burden were calculated. Analysis of variance and logistic regression analyses were applied to assess the role of STW, DTW, and neuroimaging biomarkers in MCRS.

Results

In total, 126 consecutive inpatients with CSVD were included (84 and 42 patients were classified as MCRS-negative and MCRS-positive, respectively). The MCRS-positive group showed poorer performance for nearly all gait parameters compared with the MCRS-negative group during cognitive DTW. Meanwhile, all gait parameters except asymmetry were assessed in participants with MCRS for significant deterioration during cognitive DTW compared with that during STW. However, only basic parameters differed between STW and cognitive DTW in participants without MCRS. A significant independent association between total CSVD scores and MCRS was also detected.

Conclusions

For CSVD patients, with higher total CSVD burden rather than any single neuroimaging marker, was linked to a greater risk of MCRS. In addition, CSVD individuals with MCRS had higher variability and phase coordination index (PCI), especially in cognitive DTW. Thus, they should concentrate more on their gait variability or coordination and reduce secondary task loads while walking in daily life, especially in cognitive secondary tasks.

Motoric Cognitive Risk Syndrome as a Predictor of Adverse Health Outcomes: A Systematic Review and Meta-Analysis

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.

Longitudinal association between falls and motoric cognitive risk syndrome among community-dwelling older adults

The motoric cognitive risk (MCR) syndrome is a predementia syndrome associated with dementia and mortality risk. This longitudinal study aimed to investigated the longitudinal association between MCR and falls in older adults, including 3,720 participants in the China Health and Retirement Longitudinal Study. A total of 482 participants (13.0%) met the MCR requirements at baseline. There were 226 incident cases of MCR (13.0%) throughout follow-up (duration: 4 years). Controlling for microsystem factors, a single fall (OR: 2.412, 95 % CI: 1.100-5.290; p < .05) was associated with incident MCR at baseline and to almost 2.0 times (HR: 2.021, 95 % CI: 1.031-3.961; p < .05) more inclined to develop MCR over time, compared to those without falls. These associations remained significant when meso/ exosystem factors and macrosystem factors were included in the analytic models. Falls may be useful in predicting MCR risk in the near future among Chinese older adults.

Prevalence of motoric cognitive risk syndrome among older adults: a systematic review and meta-analysis

OBJECTIVE

Motoric cognitive risk syndrome (MCR) is a newly proposed pre-dementia syndrome. Several studies on the prevalence of MCR have been published; however, the data vary across studies with different epidemiological characteristics. Thus, this study aimed to quantitatively analyse the overall prevalence and associated epidemiological characteristics of MCR among older adults aged ≥ 60 years.

METHODS

The Cochrane Library, PubMed, Web of Science, CINAHL, Embase, Scopus, PsycInfo, China National Knowledge Infrastructure, Weipu Database, China Biology Medicine disc and Wanfang Database were searched from their inception to January 2022. A modified Newcastle-Ottawa Scale evaluated the risk of bias. Statistical heterogeneity among the included studies was analysed using Cochran's Q and I² tests. A random effect model calculated pooled prevalence owing to study heterogeneity. Begg's and Egger's tests were used to assess the publication bias. Additionally, subgroup analysis and meta-regression were performed based on different epidemiological characteristics to determine heterogeneity sources.

RESULTS

Sixty-two studies comprising 187,558 samples were obtained. The pooled MCR prevalence was 9.0% (95% confidence interval: 8.3-9.8). A higher MCR prevalence was observed in females, older adults with a low educational level, depression and cardiovascular risk factors, South American populations, and studies with small sample sizes and cross-section designs. Furthermore, subjective cognitive complaint using scale score and gait speed using instrument gait showed higher MCR prevalence.

CONCLUSION

MCR is common in older adults, and various epidemiological characteristics influence its prevalence. Thus, preventive measures are required for older adults with higher MCR prevalence.

Validation of a "subjective motoric cognitive risk syndrome" screening tool for motoric cognitive risk syndrome-A prospective cohort study

BACKGROUND AND PURPOSE

Motoric cognitive risk syndrome (MCR) is a gait-based pre-dementia syndrome associated with risk of dementia. Ascertaining subjective cognitive and motoric complaints may facilitate early and remote identification of individuals with MCR as they are reported to precede and predict objective cognitive and motoric impairments in aging.

METHODS

The validity of five subjective motoric complaint (SMC) questions and 10 subjective cognitive complaint (SCC) questions was examined for discriminating MCR in 538 non-demented community-dwelling adults. Backward logistic regression was used to identify questions to develop a weighted score to define subjective MCR (MCR-S). Receiver operating characteristic analysis was applied to determine the discriminative ability of MCR-S for the objective MCR (MCR-O) definition based on SCCs and objectively measured gait. Cox proportional hazard models adjusted for potential confounders were used to examine the predictive validity of MCR-S for incident dementia.

RESULTS

Five subjective complaint questions (three SCC and two SMC) were associated with MCR-O. They were combined to define an MCR-S score (range 0-7) which yielded an area under the curve of 0.89 for discriminating MCR-O from receiver operating characteristic analysis. An optimal cut-score of 2 on the MCR-S score was determined to have good sensitivity (84%) and specificity (82%) for MCR-O. Over a median follow-up of 2.5 years, 29 participants developed dementia. Both MCR-S (adjusted hazard ratio 2.39) and MCR-O at baseline (adjusted hazard ratio 3.16) predicted risk of incident dementia.

CONCLUSIONS

Subjective MCR had high concordance with MCR-O and can provide a remote screening assessment for MCR-O, which can identify those at high risk for dementia.

Physical and cognitive profiles in motoric cognitive risk syndrome in an older population from Southern Italy

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.

Síndrome de risco cognitivo motor em pessoas idosas de um serviço de saúde do Distrito Federal: estudo transversal

Resumo Objetivo Verificar a prevalência da síndrome de risco cognitivo motor (SRCM) em pessoas idosas do Distrito Federal (DF), Brasil, que frequentaram os serviços de saúde de uma unidade de referência em Geriatria e Gerontologia, comparar os grupos de idosos com e sem a síndrome e investigar os possíveis fatores associados ao desenvolvimento dessa síndrome. Método Trata-se de estudo observacional transversal analítico, desenvolvido com idosos (idade ≥60 anos) com marcha independente e sem alterações cognitivas graves, que possuíam registro de dados sociodemográficos, avaliação cognitiva, capacidade funcional e velocidade de marcha em prontuários datados de 2017 a 2019. A análise dos dados foi expressa em média e desvio-padrão, frequência e percentual, e em odds ratios (OR) com intervalos de confiança de 95%. As comparações entre os grupos com e sem a SRCM foram feitas por meio dos testes: qui-quadrado, U de Mann-Whitney e t de Student. Resultados Não houve diferenças significativas na comparação das variáveis entre os grupos. A prevalência da SRCM na população estudada foi de 24%. Nenhum dos fatores analisados demonstrou associação com a presença da síndrome. Conclusão A prevalência da SRCM na amostra foi de 24% e mostrou-se mais alta na população do DF quando comparada as populações estudadas em outros países. Não houve diferenças entre os grupos de idosos com e sem a síndrome, e os fatores associados não foram encontrados. O rastreio da síndrome é de extrema relevância, pois a partir desses achados pode-se desenvolver mecanismos para a prevenção de demência em idosos.

Slow Gait, Subjective Cognitive Decline and Motoric Cognitive RISK Syndrome: Prevalence and Associated Factors in Community Dwelling Older Adults

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.

Association of C-Reactive Protein and Motoric Cognitive Risk Syndrome in Community-Dwelling Older Adults: The China Health and Retirement Longitudinal Study

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.