Triage through motoric cognitive risk syndrome: Is it possible to assess the risk of developing dementia in fast‐paced acute care settings?

Abstract

AbstractBackgroundMotoric cognitive risk syndrome (MCR) is a practical tool for identifying independent community‐dwelling older people at risk of developing dementia.1 Whether this tool could be efficient in fast‐paced acute care settings, where clinicians have limited resources, remains to be discovered.2 We investigated the performance of MCR to identify acutely ill older outpatients at risk of developing dementia. We also estimated associations of MCR with incident disability, an age‐related condition highly associated with cognitive impairment.MethodCohort comprising older people in need of intensive management (intravenous therapy, laboratory test, radiology) to avoid hospitalization in Brazil. We excluded those with dementia diagnosis or experiencing disability. MCR was defined as presence of memory complaints and slow gait (one standard deviation below age‐ and sex‐specific gait speed means). Over a 3‐year follow‐up, investigators blinded to baseline data assessed the outcomes: (1) dementia diagnosis through detailed reviews of medical records and (2) incident disability (need for help) to execute basic activities of daily living (ADL) and take medications through structured telephone interviews. To investigate associations of MCR with outcomes, we used Fine‐Gray models (considering death as competing risk) adjusted for routine measures (sociodemographic factors, comorbidities, depressive symptoms, and weight loss). We also computed differences between Harrell’s C‐indexes to estimate whether MCR improves outcome discrimination when added to the routine measures.ResultAmong 610 patients (mean age = 77±8 years, women = 63%, non‐white = 40%), the MCR prevalence was 8% (Table 1). Patients with MCR presented a 3‐fold increased risk of developing dementia compared to those without the syndrome (27% vs. 8%; adjusted sub‐HR = 3.2; 95%CI = 1.6‐6.7) (Table 2). MCR was also associated with higher risks of incident disability in ADL and taking medications–an activity highly related to cognitive functioning. When added to routine measures, MCR remarkably improved the discrimination of models predicting dementia (Harrell’s C‐index = 0.76 vs. 0.69, p = 0.03) (Table 3).ConclusionMCR showed excellent performance in predicting the risks of developing dementia and disability among acutely ill older outpatients. The increase in dementia prevalence worldwide demands tools like MCR to expand the identification of high‐risk older people, even in fast‐paced acute healthcare settings where clinicians have limited time and resources.