A cross‐national comparison of the risk factors associated with the Motoric Cognitive Risk syndrome in high and middle‐income countries

Abstract

AbstractBackgroundThe Motoric Cognitive Risk (MCR) syndrome is associated with increased risk of Alzheimer’s disease and vascular dementia. MCR does not require cognitive or lab tests to diagnose, increasing its utility in resource‐poor settings. The specific risk factors associated with MCR in different high‐ and middle‐income countries are not established.MethodsWe examined the epidemiology of MCR in harmonized cross‐sectional data from 17,050 adults aged ≥ 65 years enrolled in the U.S. Health and Retirement Study (HRS; n = 3,748), English Longitudinal Study of Ageing (ELSA; n = 4,110), Mexican Health and Aging Study (MHAS; n = 738), the China Health and Retirement Study (CHARLES; n = 3,275), the Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI‐DAD; n = 1,276) and the Survey of Health, Ageing and Retirement in Europe (SHARE; n = 3,973). MCR was defined as the presence of cognitive complaints and slow gait in the absence of mobility disability and dementia. Risk factors included demographics [age, sex, education], medical [hypertension, diabetes, Parkinson’s, heart disease, stroke, obesity], sensorimotor [grip strength, hearing], psychological [depression], behavioral factors [smoking, sedentariness, sleep quality] and falls (see Table 1 for definitions). Logistic regression was used to examine factors associated with prevalent MCR.ResultsParticipants’ mean age in different cohorts ranged between 71.3 and 80.2 years. Proportion of females ranged between 45.3% and 60.9%. MCR prevalence was 3.6%, 2.1%, 8.9% 6.1%, 5.8% and 6.8% in HRS, ELSA, MHAS, CHARLES, LASI‐DAD and SHARE, respectively. Tables 2 and 3 show risk factors associated with each cohort in univariate and multivariable models. Despite some overlaps, specific risk factors were associated with each cohort with relative risk ratios ranging as follows: 0.4‐2.8 for education and multiple falls in HRS, 2.3‐7.1 for poor hearing and sedentariness in ELSA, 2.3‐2.6 for weak grip strength and diabetes in MHAS, 1.9‐2.2 for depression and sedentariness in CHARLES, 0.5‐5.3 for education and stroke in LASI‐DAD and 0.3‐2.4 for education and depression in SHARE.ConclusionIn community‐dwelling older adults from twenty countries (high‐ and middle‐income), specific risk factors were associated with MCR in each cohort – laying the foundation for preventing MCR and subsequently dementia in ethnically, culturally, and socioeconomically diverse populations.