Motoric Cognitive Risk Syndrome Research Articles

Association between pain interference and motoric cognitive risk syndrome in older adults: a population-based cohort study.

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. 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. 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). 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.

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

ObjectiveWe 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). MethodsWe 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. ResultsIn 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. ConclusionsFor 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.

Elevated blood homocysteine increases the risk of incident Motoric Cognitive Risk syndrome: A two cohort study.

Motoric Cognitive Risk (MCR) syndrome, a pre-dementia syndrome characterized by cognitive complaints and slow gait, may have an underlying vascular etiology. Elevated blood levels of homocysteine, a known vascular risk factor, have been linked to physical and cognitive decline in older adults, though the relationship with MCR is unknown. We aimed to identify the association between homocysteine and MCR risk. We examined the association between baseline homocysteine levels and incident MCR using Cox proportional hazard models in 1,826 community-dwelling older adults (55% female) from two cohorts (Einstein Aging Study [EAS] and Quebec Longitudinal Study on Nutrition and Successful Aging [NuAge]). We calculated hazard ratios (HR) with 95% confidence intervals (CI), for each cohort as well as stratified by sex and vascular disease/risk factors. Median follow-up time was 2.2 years in EAS and 3.0 years in NuAge. Individuals with elevated baseline homocysteine levels (> 14 µmol/L) had a significantly higher risk of incident MCR compared to those with normal levels in NuAge (HR 1.41, 95% CI = 1.01-1.97, p = .04), after adjusting for covariates. Our exploratory stratified analyses found that these associations were significant only in men with vascular disease/risk factors. Higher blood homocysteine levels are associated with increased risk of developing MCR in older adults, particularly in men with vascular disease or vascular risk factors.

Before Diagnosing Motoric Cognitive Risk Syndrome, Neurological and Psychiatric Diseases must be excluded

Before Diagnosing Motoric Cognitive Risk Syndrome, Neurological and Psychiatric Diseases must be excluded

The associations of daytime napping and motoric cognitive risk syndrome: Findings from the China Health and Retirement Longitudinal Study

IntroductionMotoric 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. MethodsBaseline 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. ResultsA 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. ConclusionA moderate nap of 30–89 min could lower the odds of MCR, especially for older adults with a night sleep duration of ≤8 h.

Motoric Cognitive Risk Syndrome and the Risk of Incident Dementia: A Systematic Review and Meta-Analysis of Cohort Studies

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.

Does the Cognitive Change Index Predict Future Cognitive and Clinical Decline? Longitudinal Analysis in a Demographically Diverse Cohort.

The Cognitive Change Index (CCI) is a widely-used measure of self-perceived cognitive ability and change. Unfortunately, it is unclear if the CCI predicts future cognitive and clinical decline. We evaluated baseline CCI to predict transition from normal cognition to cognitive impairment in nondemented older adults and in predementia groups including, subjective cognitive decline, motoric cognitive risk syndrome, and mild cognitive impairment. Different versions of the CCI were assessed to uncover any differential risk sensitivity. We also examined the effect of ethnicity/race on CCI. Einstein Aging Study participants (N = 322, Mage = 77.57±4.96, % female=67.1, Meducation = 15.06±3.54, % non-Hispanic white = 46.3) completed an expanded 40-item CCI version (CCI-40) and neuropsychological evaluation (including Clinical Dementia Rating Scale [CDR], Montreal Cognitive Assessment, and Craft Story) at baseline and annual follow-up (Mfollow-up=3.4 years). CCI-40 includes the original 20 items (CCI-20) and the first 12 memory items (CCI-12). Linear mixed effects models (LME) and generalized LME assessed the association of CCI total scores at baseline with rate of decline in neuropsychological tests and CDR. In the overall sample and across predementia groups, the CCI was associated with rate of change in log odds on CDR, with higher CCI at baseline predicting faster increase in the odds of being impaired on CDR. The predictive validity of the CCI broadly held across versions (CCI-12, 20, 40) and ethnic/racial groups (non-Hispanic black and white). Self-perception of cognitive change on the CCI is a useful marker of dementia risk in demographically/clinically diverse nondemented samples. All CCI versions successfully predicted decline.

Association between Perceived Stress and Motoric Cognitive Risk Syndrome in an Elderly Population: Rugao Longevity and Aging Study

Plain Language SummaryPrevious studies have indicated a correlation between perceived stress and cognitive decline. However, it remains unknown whether high levels of perceived stress can result in motoric cognitive risk (MCR) syndrome. Perceived stress has been defined as the result of a series of environmental events and demands (stressors) perceived by an individual as exceeding their subjective capacity to cope. MCR syndrome is a novel pre-dementia syndrome consisting of subjective memory complaints (SMCs) and slow gait speed. MCR syndrome is a public health problem with a prevalence of 6.3–9.6% in community-dwelling elderly populations in different countries. It is important to identify and treat risk factors for MCR. This will help prevent MCR in order to prevent dementia at an early stage. This study investigated the relationship between perceived stress and MCR in a community-based population. The study cohort comprised 852 elderly individuals from the Rugao Longitudinal Aging Cohort. Perceived stress was assessed using the 10-item Perceived Stress Scale (PSS-10), while MCR was defined as the coexistence of SMCs and slow gait speed. In conclusion, we discovered a significant association between high levels of perceived stress and an increased risk of MCR among individuals aged 70 and older in the community.

Associations of social connections and motoric cognitive risk syndrome: A 4-year prospective cohort study.

Associations of social connections and motoric cognitive risk syndrome: A 4-year prospective cohort study.

Social frailty and the incidence of motoric cognitive risk syndrome in older adults.

Various associations between social factors and motoric cognitive risk syndrome (MCR) have been reported. However, whether social frailty (integrated from multiple social factors) is associated with MCR is still unclear. We included 4657 individuals without MCR at Round 1 of the NHATS as the discovery sample, and 3075 newly recruited individuals from Round 5 of the NHATS as the independent validation sample. Social frailty was assessed by five social items. MCR was defined as the presence of both subjective cognitive complaints and slow gait speed in individuals without dementia or mobility disability. Compared with normal individuals, those with social frailty had higher risk of incident MCR (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.34-1.84). Each additional unfavorable social item was associated with an increased risk of MCR (HR: 1.32, 95% CI: 1.22-1.43). Social frailty was associated with an increased risk of incident MCR in older adults. Various associations between social factors and motoric cognitive risk syndrome (MCR) have been reported. Social frailty that integrated from multiple social factors was associated with an increased risk of incident MCR. Social frailty should be included in the early screening of individuals to identify those at higher risk of MCR.

Incidence of Motoric Cognitive Risk Syndrome and Associated Factors in Older Adults in Türkiye.

Motoric cognitive risk syndrome (MCRS) is characterized by slow gait and subjective cognitive decline. It is a predementia syndrome associated with an increased risk of dementia and mortality. To investigate the incidence of MCRS and its associated factors in older adults in Türkiye. A retrospective study. This study enrolled community-dwelling older adults admitted to the geriatric outpatient clinic. Participants were assessed for MCRS according to previously described criteria. Logistic regression analysis was conducted to evaluate the association among MCRS and demographic features, clinical status, and geriatric syndromes. Of the 1,352 older adults examined, 577 met the inclusion criteria, and the mean age was 75.2 years. The overall incidence of MCRS was 7.8%. The MCRS group was predominantly older, female, and unmarried, with polypharmacy and higher Deyo-Charlson comorbidity index and Yesavage geriatric depression scale scores than the non-MCRS group. In the multivariate model, significant associations were found between MCRS and age and polypharmacy [odds ratios (OR), 2.22; 95% confidence interval (CI), 1.04-4.71, p = 0.039; OR, 2.02; 95% CI, 1.02-3.99, p = 0.043, respectively]. The overall incidence of MCRS was found in 7.8% of older adults. Advanced age and polypharmacy are risk factors associated with MCRS.

SOCIAL DISCONNECTION, EPIGENETIC AGING, AND MOTORIC COGNITIVE RISK SYNDROME: A CAUSAL MEDIATION ANALYSIS

Abstract Social isolation and loneliness are two different aspects of social disconnection. Motoric cognitive risk syndrome (MCR), a preclinical phase of dementia, is characterized by memory complaints and slow gait. It is unclear how social disconnection relates to MCR and its underlying mechanisms. Using data from Health and Retirement Study 2012-2020, we aimed to 1) examine the association between social isolation and loneliness and MCR and 2) investigate whether accelerated epigenetic aging mediates this association. We measured social isolation and loneliness at baseline (2012-2014) and epigenetic aging in 2016 using three DNA methylation-based measures (GrimAge, PhenoAge, and DunedinPoAm38), and recorded the incidence of MCR in 2016-2020. We used Cox proportional hazard models to investigate the association between social disconnection and MCR, and counterfactual mediation analysis to examine the role of epigenetic aging. Our sample consisted of 3,287 participants without MCR, with 678 developed MCR during follow-up. Our results showed that social isolation was significantly associated with an older GrimAge, a faster aging pace (DunedinPoAm38), and higher risks of MCR (HR, 1.36; 95% CI, 1.10-1.68), while loneliness was associated with faster DunedinPoAm38 aging pace but not MCR (HR, 0.95; 95% CI, 0.79-1.14). Further, GrimAge mediated 16% of the effect of social isolation (Indirect Effect HR, 1.09; 95% CI, 1.03-1.15), and DunedinPoAm38 mediated 11% (Indirect Effect HR, 1.06; 95% CI, 1.02-1.10). Findings suggest that epigenetic aging is a biological mechanism that underlies the association between social isolation and MCR. Further research is necessary to identify strategies to reduce social isolation for dementia prevention.

FEASIBILITY OF A COMMUNITY-LEVEL PHYSICAL ACTIVITY STRATEGY FOR OLDER ADULTS WITH MOTORIC COGNITIVE RISK SYNDROME

Abstract The motoric cognitive risk syndrome (MCR) is a pre-dementia syndrome characterized by slow walking speeds and subjective memory complaints. To date, the feasibility of a community-based physical activity (PA) program for improving outcomes in MCR has not been examined. To address this knowledge gap, we conducted a translational randomized controlled trial (RCT) of 24-weeks of PA or a healthy aging education (HE) control intervention delivered within the existing infrastructure of an urban senior center in Greater Boston. A senior center employee was trained to administer the multimodal group-based PA program that included moderate-intensity aerobic walking, strength, flexibility and balance training. A total of 79 older adults attended the senior center for a screening visit of whom 25 met the MCR criteria and were randomized to PA or HE (mean age: 74.4 ± 7 yrs; BMI: 32.4 ± 7 kg/m2; 85% female; 3MSE score: 92.4 ± 7; gait speed: 0.52 ± 0.1 m/sec; SPPB score 4.8 ± 1.9). Due to COVID-19 the study was terminated early, however participants successfully completed baseline and follow-up study assessments that included objective tests of physical function and an iPad-based cognitive testing battery. Participants could appropriately adhere to the study interventions (overall attendance rate: PA: 69.3% vs. HE:70.1% at study termination). No study-related adverse events occurred. Trends for improved executive cognitive performance were exhibited in PA compared to HE. Our study provides important preliminary information to aid the design of larger-scale RCTs to preserve the independence of vulnerable older adults with MCR in community-based settings.

IDENTIFYING MARKERS OF NEURODEGENERATION FOR MOTORIC COGNITIVE RISK SYNDROME

Abstract Cognitive disorders, particularly dementia, are a major cause of disability in the elderly population. Gait disturbances, decreased grip strength and memory complaints are early signs of dementia that can occur well before the disease manifests. To better understand the close interactions between the physical and cognitive domains, the concept of Motoric Cognitive Risk Syndrome (MCRS) has been proposed. We had 25 older adults (10 cognitively unimpaired and 15 with MCRS) generate multiple force pulses at 15% of their maximum voluntary contraction with a fixed duration of 2 seconds for each pulse in which participants must rely on visual spatial abilities to gauge the amount force required in real-time to reach the criterion target. We also assessed neurofilament light chain levels also a blood-based marker of neuronal loss. Our results indicate the MCRS group demonstrated blood oxygenation level dependent (BOLD) hyperactivity in visual cortical/hippocampal regions, parahippocampal regions, and dorsolateral prefrontal cortex. The MCRS group also demonstrated BOLD hypoactivity in primarily involved with movement, such as cerebellar lobules, supplementary motor areas, middle frontal gyrus, and prefrontal cortex areas.be useful in tracking disease progression. We also found a significant strong positive correlation (0.83) between serum NFL levels and Right BOLD coefficients only for the CI group. This finding suggests that these motor task fMRI measures may be specific in tracking neurodegeneration in MCRS group. Overall, the current preliminary findings provide novel insights into the neurobiological mechanisms underlying early changes in Alzheimer’s disease and related dementias.

COGNITIVE IMPAIRMENT, FALLS, AND DEMENTIA: NOVEL APPROACHES FOR EARLIER DETECTION AND MORE EFFECTIVE INTERVENTION

Abstract This symposium will discuss novel digital approaches for the remote assessment of cognitive status and detection of fall risk in older adults. We will then describe several emerging digital exercise, ballroom dancing, and other non-invasive intervention strategies targeted for vulnerable older populations at increased risk for falling, or developing cognitive impairment and dementia. Collectively, we posit that these innovative detection and intervention strategies hold significant potential as more effective and scalable approaches for identifying cognitive impairment, preventing falls, and mitigating cognitive decline in high-risk older adults. In presentation 1, Roque et al. examines the utility of ecological momentary cognitive assessment and its potential as a digital biomarker of cognitive impairment in community-dwelling older adults. In presentation 2, Mahoney et al. discusses the development and clinical potential of a novel digital health app, CatchU®, that remotely captures visual-somatosensory integration performance to detect fall propensity in older adults. In presentation 3, Bajdek et al. describes the feasibility of a 12-week digitally delivered home-based fall prevention exercise program for older adults with elevated fall risk. In presentation 4, Blumen et al. report preliminary efficacy and mechanistic findings from a randomized trial of social ballroom dancing in older adults at increased risk for dementia. In presentation 5, Reid et al. describes the feasibility of a real-world community-level physical activity intervention for older adults with motoric cognitive risk syndrome. The discussant, Dr. Verghese, will integrate the key findings from these studies, discuss their theoretical and methodological contributions, and consider future research directions.

A CROSS-NATIONAL COMPARISON OF RISK FACTORS ASSOCIATED WITH THE MOTORIC COGNITIVE RISK (MCR) SYNDROME

Abstract The Motoric Cognitive Risk (MCR) syndrome predicts risk of Alzheimer’s disease and vascular dementia. Cross-national comparisons of risk factors for MCR are important for identifying region-specific factors to design regionally tailored preventive interventions. We examined risk factors associated with MCR in 20,468 adults aged ≥65 years from the U.S Health and Retirement Study (HRS), English Longitudinal Study of Ageing (ELSA), Mexican Health and Aging Study (MHAS), China Health and Retirement Study (CHARLES), Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD), Survey of Health, Ageing and Retirement in Europe (SHARE) and Brazilian Longitudinal Study of Aging (ELSI-Brazil). MCR was defined as the presence of cognitive complaints and slow gait with no mobility disability and dementia. Associations between demographic [sex, education], medical [hypertension, diabetes, Parkinson’s, heart disease, stroke, obesity, depression, multiple falls], sensorimotor [grip strength, hearing] and behavioral factors [smoking, sedentariness, sleep quality], and prevalent MCR were examined using logistic models. Despite some overlap, cohort-specific risk factors for MCR were identified with relative risk ratios ranging as: 0.4-2.8 for education and multiple falls in HRS, 2.3-7.4 for poor hearing and sedentariness in ELSA, 2.3-2.6 for poor grip 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, 0.3-2.4 for education and depression in SHARE and 2.4-4.0 for multiple falls and stroke in ELSI-Brazil. In this cross-sectional, cross-national comparison of 21 countries, MCR associated risk factors were region-specific, laying the foundation for tailored interventions to prevent MCR and subsequently dementia.

FC45: Clinical profiles for motoric cognitive risk syndrome in rural-dwelling older adults: the MIND-China study

Objective:Motoric cognitive risk syndrome (MCR), which is defined as a pre-dementia syndrome characterized by subjective cognitive complaints and slow gait in older individuals free of dementia and mobility disability, has been associated with increased risks of dementia, functional dependence, and mortality. The aims of this study were to describe the prevalence and distribution of MCR and to explore the clinical profiles associated with MCR in rural-dwelling older adults.Methods:The population-based cross-sectional study included 5,021 dementia- and disability-free participants (age ≥60 years; 56.48% women) in the baseline assessments (March-September 2018) of the Multimodal Interventions to delay Dementia and disability in rural China (MIND-China). The MCR syndrome was diagnosed when the participants had subjective memory complaints and gait speed ≥1 standard deviation (SD) below the age- (&lt;75 and ≥75 years) and sex-specific means. We estimated the age- and sex-specific prevalence of MCR. We used logistic regression models to examine lifestyle and clinical factors associated with MCR while controlling for age, sex, and education.Results:The overall prevalence of MCR syndrome was 13.58%, with the prevalence being 11.53% in males and 15.16% in females (P&lt;0.001). The prevalence of MCR was increased with age, from 10.43% in people aged 60-69 years and 15.97% in those aged 70-79 years to 21.71% among those aged ≥80 years. The demographic-adjusted odds ratio (95% confidence interval) of MCR was 1.30 (1.08-1.57) for being overweight (body mass index 24-27.9 vs. &lt;24 kg/m2), 1.65 (1.32-2.05) for having obesity (≥28 kg/m2), 1.74 (1.41-2.15) for diabetes, 1.44 (1.20-1.73) for dyslipidemia, 1.59 (1.32-1.91) for having coronary heart disease, 2.17 (1.78-2.65) for having stroke history, 1.52 (1.24-1.86) for having osteoarthritis, and 3.40 (2.70-4.28) for having depressive symptoms. Ever (vs. never) smoking and alcohol consumption were related to odds ratio of 0.65 (0.48-0.86) and 0.71 (0.55-0.91), respectively, for MCR syndrome.Conclusion:The MCR syndrome affects nearly 1 in 7 Chinese rural older adults, and the MCR prevalence appears to be higher in women than in men. Cardiometabolic risk factors (e.g., overweight/obesity, diabetes, and dyslipidemia), osteoarthritis, coronary heart disease, stroke, and depressive symptoms were associated with increased likelihoods of the MCR syndrome.

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

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.

P177: Motoric cognitive risk syndrome is associated with MRI-derived brain age: the Arakawa Geriatric Cohort Study

Objective:Motoric cognitive risk (MCR) syndrome is characterized by slow gait speed and subjective cognitive decline, which could predict future dementia. Previous research reported the associations between MCR and gray matter volume reduction in total and specific cortical regions and increased white matter hyperintensities in the brain. However, knowledge is scarce on the relationship between MCR and neuroimaging-derived brain age. The present study explored the association between MCR and brain-predicted age differences.Methods:The present study is a cross-sectional study that involved 1,099 community- dwelling older adults in the Arakawa Ward, Tokyo, Japan, who were between 65 to 84 years old in 2016. In defining MCR, subjective cognitive decline was deemed positive for those who answered “Yes” to the question, “Do you feel that you have more problems with memory than most?” in the Geriatric Depression Scale. Slower gait speed was defined as walking slower than the -1 standard deviation of the age- and sex- stratified gait speed. Brain age was predicted on the 1,021 participants with brain magnetic resonance imaging without severe artifacts or lesions. We used the support vector regression algorithm using MATLAB's “fitrsvm” function, applying ten-fold cross-validation to the results of primary component analysis of the spatially normalized gray-matter images. We calculated the brain-predicted age difference (Brain-PAD) by subtracting the chronological age from the predicted brain age. After excluding the participants with dementia (N=23), the difference in the mean Brain-PAD between MCR+ and MCR- was compared with the Student's t-test. The association between MCR and Brain PAD was examined with multiple regression analyses, adjusting for clinical-demographical data.Results:The median ages were 72 for both MCR+ (N=96) and MCR- (N=902). The mean Brain-PAD was 3.29 for MCR+ and -0.19 for MCR- (p &lt; .001, Hedges' g = -0.504). Multiple regression analysis showed a significant association between Brain- PAD and MCR (standardized β = 0.159, p &lt; .001) after adjusting for covariates.Conclusion:The present findings suggest that MCR reflects accelerated brain aging, which may increase the risk of neurodegeneration. Future studies should examine the longitudinal trajectories of brain age and incident dementia in participants with MCR.

Optimizing Subjective Cognitive Concern Assessment to Predict Cognitive Decline in Motoric Cognitive Risk Syndrome: Results from the Einstein Aging Study

AbstractBackgroundMotoric Cognitive Risk Syndrome (MCR) is a predementia condition that combines slow gait speed and subjective cognitive concerns (SCC), and predicts incident dementia in diverse global populations. MCR status is simple and inexpensive to ascertain, facilitating assessment in low resource settings. Though the slow gait component of MCR diagnosis is well operationalized, there is no standardized approach to SCC assessment. We hypothesized that in older adults with slow gait, the SCC questions that best predicted cognitive decline would most successfully operationalize SCC.MethodEinstein Aging Study participants (n = 324; Mage = 70.4; Meducation= 15; 67%women; 46.3%White) completed the Cognitive Change Index Supplement (CCI‐40) as part of a comprehensive neuropsychological assessment (which included the Clinical Dementia Rating Scale [CDR]) at baseline and over up‐to‐5 annual follow‐ups (Mwave= 1.48). The CCI‐40 queries SCC across cognitive domains, including memory (21 items), language (4), executive functioning (5), attention/concentration (4), visuospatial functioning (2), calculation (1), mental clarity (2), and orientation (1). Slow gait was diagnosed based on established MCR criteria (1 SD below age/sex adjusted means). We used linear mixed effects models (LME) for continuous, and generalized LME for binary longitudinal cognitive outcomes, to examine how various definitions of SCC at baseline predict cognitive changes in older adults with slow gait, adjusting for covariates including age, sex, education, race/ethnicity, and depression. We report the interaction terms between SCC and time. The final sample included 43 participants (13%) who met slow gait criteria at baseline.ResultAmong participants with slow gait, the CCI‐40 total score was associated with decline on neuropsychological measures of attention/processing speed (β = ‐0.09, p = 0.05), verbal fluency (β = 0.03, p = 0.01), and a global dementia rating scale (β = 0.04, p = 0.02). Item‐by‐item analysis revealed a subset of items that were significantly associated with decline in key neuropsychological domains, including executive functioning, language, and memory.ConclusionOur findings suggest that attention to SCC assessment in older adults with slow gait may provide key insight into individuals at greatest risk for cognitive decline. SCC in MCR may be best operationalized through comprehensive assessment across broad cognitive domains. Future work will develop a brief SCC screen optimized to predict cognitive decline in this population.