Motoric Cognitive Risk Research Articles

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

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.

Apathy as a Predictor of Motoric Cognitive Risk Syndrome

AbstractBackgroundApathy is a psychological syndrome, characterized by lack of motivation and interest, flattening of affect, and social withdrawal; that predicts cognitive decline including dementia. Current literature highlights apathy as a separate entity from depression, which is uniquely correlated to cognitive and functional decline in neurologic diseases like stroke and Parkinson’s Disease as well as in community dwelling‐older adults. Further, apathy may mediate the previously described association between depression and cognitive/functional decline. Our objectives were to 1) investigate the association between apathy at baseline and incident predementia syndromes including mild cognitive impairment (MCI) and motoric cognitive risk syndrome (MCR) and 2) explore the direct and indirect relationships of apathy and motoric cognitive outcomes.MethodWe prospectively studied the association between apathy (3‐item subscale of the Geriatric Depression Scale) and incident predementia syndromes 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 dysphoria. In a subset of 347 participants, we examined the mediating role of cytokines on the association between apathy and gait velocity in linear regression models at cross section. We also looked at the mediating role of apathy on the association between dysphoria and multimorbidity and gait velocity.ResultApathy was associated with incident MCR (HR 2.39, 95% CI: 1.10‐5.20), but not MCI. Linear regression models showed that Interleukin‐6 (Il‐6), but not C‐Reactive Protein was significantly associated with apathy adjusted for age, gender, and years of education (B = 0.037, 95% CI: 0.002–0.072, p = 0.04). Apathy was associated with a slower gait velocity (B = 14.45, 95% CI: 24.89–4.01, p = 0.01), cross sectionally. Mediation analyses demonstrated that IL‐6 modestly mediates the relationship between apathy and gait velocity. Additionally, apathy mediated the relationships between dysphoria and multimorbidity and gait velocity.ConclusionOverall, our findings indicate that apathy may be an early predictor of motoric cognitive decline, which precedes predementia syndromes. Inflammation plays a modest role, but the underlying biology of apathy warrants further investigation.

Associations of sarcopenia, sarcopenia parameters and motoric cognitive risk syndrome in Chinese older adults

Associations of sarcopenia, sarcopenia parameters and motoric cognitive risk syndrome in Chinese older adults

Prodromal Motoric Cognitive Risk Syndrome and Everyday Function.

Motoric cognitive risk syndrome (MCR), a pre-dementia syndrome characterized by subjective cognitive complaints and slow gait, is associated with disability in instrumental activities of daily living. It is unknown whether these functional limitations occur even before this pre-dementia syndrome is diagnosed. To assess profiles of complex and instrumental activities of daily living in the prodromal stages of MCR. We examined functional profiles in 46 older adults (mean age 79 years, 59% women) living in the community with normal cognition at baseline who developed MCR over follow-up ('pre-MCR') with 264 older adults (mean age 75 years, 57% women) who remained cognitively intact over the follow-up period. Pre-MCR individuals had more limitations on complex everyday function at baseline compared to normal controls in multivariable logistic regression models (odds ratio 1.21). Pre-MCR cases at baseline had limitations in handling finances (odds ratio 3.0) and performing hobbies (odds ratio 5.5) as compared to normal controls. Pre-MCR cases had a greater difference in the number of complex functional limitations from baseline to MCR compared to the difference from baseline to final visit for the controls (1.2±3.0 versus 0.5±2.2, p < 0.001). Limitations in complex everyday tasks arise in the prodromal stages of MCR and can assist in risk prognostication.

Intraindividual difference in estimated GFR by creatinine and cystatin C, cognitive trajectories and motoric cognitive risk syndrome.

Intraindividual differences between estimated glomerular filtration rate (eGFR) based on cystatin C (eGFRcys) and creatinine (eGFRcr) can convey important clinical information regarding health status. However, the clinical implications of these differences (eGFRdiff) for risk of cognitive decline and motoric cognitive risk (MCR) syndrome remains unclear. We aimed to investigate the longitudinal associations of eGFRdiff with cognitive trajectories and incident MCR. Based on the China Health and Retirement Longitudinal Study, we identified two study subcohorts: one for cognitive trajectory follow-up (6423 participants, 2011-2018) and another for incident MCR follow-up (2477 participants, 2011-2015). The eGFRdiff was defined as eGFRcys-eGFRcr. Adjusted ordinal and binary logistic regression models were separately used to assess the associations of eGFRdiff with cognitive trajectories and incident MCR. We also performed discordance analyses for eGFRdiff versus eGFRcys, eGFRcr or eGFR based on both creatinine and cystatin C (eGFRcys-cr). In the first subcohort, four distinct 7-year cognitive trajectories were identified. Each 1 standard deviation (SD) higher eGFRdiff (value for eGFRcys-eGFRcr) was associated with a lower risk of poorer cognitive trajectories {odds ratio 0.909 [95% confidence interval (CI) 0.877-0.942]}. In the second subcohort, 121 participants developed incident MCR after a 4-year follow-up. Each 1-SD higher eGFRdiff (value for eGFRcys-eGFRcr) was linked with a 25.3% (95% CI 16.6-33.2) decreased risk for MCR. The above associations persisted in individuals with normal kidney function. Additionally, the risk for cognitive decline and incident MCR was more strongly associated with eGFRcys than eGFRcr and eGFRcys-cr. For the discordance analyses, the 'discordantly high eGFRdiff/low eGFR' group but not the 'discordantly low eGFRdiff/high eGFR' exhibited a significantly lower risk of poorer cognitive trajectories and MCR compared with the concordant group. A large negative difference between eGFRcys and eGFRcr (eGFRcys < eGFRcr) was associated with a higher risk of cognitive decline and incident MCR. The eGFRdiff could capture additional valuable risk information beyond eGFRcys, eGFRcr and eGFRcys-cr.

Association of multimorbidity patterns with motoric cognitive risk syndrome among older adults: Evidence from a China longitudinal study.

Motoric cognitive risk syndrome (MCR), a pre-dementia syndrome, is characterized by slow gait and subjective cognitive complaints among older adults. This study assessed the relationship between multimorbidity, its patterns, and MCR. Data for this study were obtained from three waves (2011, 2013, and 2015) of the China Health and Retirement Longitudinal Study. Participants who were aged 60years and older and had complete data at baseline as well as complete data about MCR at follow-up were selected. Patients without MCR at baseline were selected for further analyses. Longitudinal associations between multimorbidity, its patterns, and MCR were examined using a Cox proportional hazards model. Multimorbidity patterns were classified using latent class analysis. A total of 4923 respondents were included at baseline, 43.47% of whom had multimorbidity. Additionally, the prevalence of MCR at baseline was 12.61%. After adjusting for covariates, multimorbidity was positively associated with MCR (hazard ratio [HR]=1.33, 95% confidence interval [CI]=1.06-1.68). A higher number of multimorbidity was also significantly associated with an increased risk of developing MCR (HR=1.10, 95% CI=1.02-1.19). Three multimorbidity patterns were selected: relatively healthy pattern, respiratory pattern, and cardiovascular pattern. Older adults with the cardiovascular pattern were 1.57 times more likely to develop MCR than those with the relatively healthy pattern (HR=1.57, 95% CI=1.16-2.13). There was no significant difference between the relatively healthy pattern and the respiratory pattern (HR=1.31, 95% CI=0.91-1.92). MCR is highly prevalent among older Chinese adults. MCR may be exacerbated by multimorbidity. For older adults with multimorbidity (especially cardiovascular multimorbidity), attention should be paid to MCR to achieve early detection, diagnosis, and treatment.

Motoric Cognitive Risk and Incident Dementia in Older Adults

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. 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. 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. 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. 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). 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.

Association of cardiometabolic multimorbidity with motoric cognitive risk syndrome in older adults.

Motoric cognitive risk syndrome (MCR) is a predementia syndrome that is characterized by cognitive complaints and slow gait. Cardiometabolic multimorbidity (CMM) is associated with an increased risk of dementia. However, the relationship between CMM and MCR is still unclear. We included 4744 participants (aged 65+ years) without MCR at baseline from the National Health and Aging Trends Study (NHATS), who were followed-up from 2011 to 2018. CMM was defined as the presence of two or more cardiometabolic diseases (including diabetes mellitus, heart disease, and stroke). CMM was significantly associated with an increased risk of MCR (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.13-1.75) in fully adjusted models. Consistent results were observed from stratified analyses of different subgroups. Increasing numbers of cardiometabolic diseases were dose-dependently associated with increased MCR risk (HR 1.33, 95% CI 1.20-1.48). CMM is associated with an increased risk of MCR in older adults. Motoric cognitive risk syndrome (MCR) is a predementia syndrome characterized by slow gait speed and cognitive complaints.Cardiometabolic multimorbidity was associated with an increased MCR risk.An increased number of cardiometabolic diseases were dose-dependently associated with increased MCR risk.

Motoric cognitive risk syndrome and its association with falls: a secondary analysis of the Mexican Health and Aging Study

To reveal whether motoric cognitive risk syndrome (MCR) is associated with falls, recurrent falls, and complicated falls in older Mexican adults. This is a secondary analysis of the Mexican Health and Aging Study. MCR was assessed in 2012 and included fall-related outcomes (recurrent [≥2], complicated [need for medical treatment] and number) in the 2018 follow-up. Competing risks analysis was performed, and subhazard ratios (sHRs) were estimated, adjusting for different variables. Negative binomial regression was used to estimate the incidence rate ratio (IRR) of the number of falls. A total of 1 929 participants were included, with a median age of 62 years and 58.3% female. The prevalence of MCR was 17.4% and was associated with falls sHR 1.11 (95%CI: 1.11, 1.12), recurrent falls sHR 1.16 (95%CI: 1.15, 1.16) and complicated falls sHR 1.25 (95%CI: 1.24, 1.25). The number of falls was also independently associated with baseline MCR (IRR 1.19; 95% CI 1.01, 1.40; p=0.039). MCR is independently associated with falls. Increasing the evidence on how MCR anticipates burdensome problems in older adults could lead to actions to halt them; therefore, including it in screening assessments could be clinically useful.

Motoric Cognitive Risk Syndrome and Traffic Incidents in Older Drivers in Japan

To prevent motor vehicle collisions by older drivers, the increased risk of collisions should be considered early. Cognitive decline increases the risk of car collisions. Motoric cognitive risk syndrome (MCR), characterized by the presence of cognitive concerns and slow gait, can be assessed conveniently and is useful to assess the risk of dementia. To examine the association between MCR assessment findings and car collisions among older drivers in Japan. This cross-sectional study used data from a community-based cohort study, the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes, conducted in Japan from 2015 to 2018. Participants were community-dwelling older adults aged at least 65 years. Data were analyzed from February to March 2023. MCR was defined as having subjective memory concerns (SMC) and slow gait. Participants were classified into 4 groups: no SMC or slow gait, only SMC, only slow gait, and MCR. Participants were asked about the experience of car collisions during the last 2 years and near-miss traffic incidents during the previous year through face-to-face interviews. Odds of experiencing a collision or near-miss traffic incident were assessed using logistic regression. Among a total of 12 475 participants, the mean (SD) age was 72.6 (5.2) years, and 7093 (56.9%) were male. The group with only SMC and the group with MCR showed a higher proportion of both car collisions and near-miss traffic incidents than the other groups (adjusted standardized residuals > 1.96; P < .001). Logistic regression analysis showed the only SMC and MCR groups had increased odds of car collisions (only SMC group: odds ratio [OR], 1.48; 95% CI, 1.27-1.72; MCR group: OR, 1.73; 95% CI, 1.39-2.16) and near-miss traffic incidents (only SMC group: OR, 2.07; 95% CI, 1.91-2.25; MCR group: OR, 2.13; 95% CI, 1.85-2.45) after adjusting for confounding factors. After stratifying MCR assessments by objective cognitive impairment, significant associations were still observed. In the only slow gait group, objective cognitive impairment was associated with increased odds of car collisions (OR, 1.96; 95% CI, 1.17-3.28). In this cross-sectional study of community-dwelling older drivers in Japan, SMC and MCR were associated with car collisions and near-miss traffic incidents independent from objective cognitive impairment. Future studies should examine the mechanism of these associations in more detail.

Epidemiology of Motoric Cognitive Risk Syndrome in the Kerala Einstein Study: Protocol for a Prospective Cohort Study.

The southern India state of Kerala has among the highest proportion of older adults in its population in the country. An increase in chronic age-related diseases such as dementia is expected in the older Kerala population. Identifying older individuals early in the course of cognitive decline offers the best hope of introducing preventive measures early and planning management. However, the epidemiology and pathogenesis of predementia syndromes at the early stages of cognitive decline in older adults are not well established in India. The Kerala Einstein Study (KES) is a community-based cohort study that was established in 2008 and is based in the Kozhikode district in Kerala state. KES aims to establish risk factors and brain substrates of motoric cognitive risk syndrome (MCR), a predementia syndrome characterized by the presence of slow gait and subjective cognitive concerns in individuals without dementia or disability. This protocol describes the study design and procedures for this KES project. KES is proposing to enroll a sample of 1000 adults ≥60 years old from urban and rural areas in the Kozhikode district of Kerala state: 200 recruited in the previous phase of KES and 800 new participants to be recruited in this project. MCR is the cognitive phenotype of primary interest. The associations between previously established risk factors for dementia as well as novel risk factors (apathy and traumatic brain injury) and MCR will be examined in KES. Risk factor profiles for MCR will be compared between urban and rural residents as well as with individuals who meet the criteria for mild cognitive impairment (MCI). Cognitive and physical function, medical history and medications, sociodemographic characteristics, lifestyle patterns, and activities of daily living will be evaluated. Participants will also undergo magnetic resonance imaging and electrocardiogram investigations. Longitudinal follow-up is planned in a subset of participants as a prelude to future longitudinal studies. KES (2R01AG039330-07) was funded by the US National Institutes of Health in September 2019 and received approval from the Indian Medical Council of Research to start the study in June 2021. We had recruited 433 new participants from urban and rural sites in Kozhikode as of May 2023: 41.1% (178/433) women, 67.7% (293/433) rural residents, and 13.4% (58/433) MCR cases. Enrollment is actively ongoing at all the KES recruitment sites. KES will provide new insights into risk factors and brain substrates associated with MCR in India and will help guide future development of regionally specific preventive interventions for dementia. DERR1-10.2196/49933.

Can Social Participation Mediate the Motoric Cognitive Risk Syndrome, Depression &amp; Loneliness in Older Adults?

Abstract Date Presented 04/22/2023 In this study, we found the mediating role of social participation in the association of motoric cognitive risk (MCR) with depression of older adults. A social participation program to intervene with depression is recommended for older adults with MCR. Primary Author and Speaker: Jihyeun Park Additional Authors and Speakers: Suyeong Bae, Ji-Hyuk Park Contributing Authors: Ickpyo Hong, Sangmi Park, Jaehyu Jung, Sohyeon Yun, Anastassiya Khan

The Mediating Role of Social Participation in Motoric Cognitive Risk and its Relation to Depression and Loneliness in Older Adults.

Motoric cognitive risk syndrome (MCR) reduces the quality of life, independence, and social interaction in older adults. Social participation is a potentially modifiable factor that benefits cognitive and mental health. This study explored the mediating roles of social participation between MCR and depression and between MCR and loneliness. We performed a secondary analysis of data from the 2015-2016 National Social Life, Health, and Aging Project. Slow gait speed and cognitive decline were used to assess MCR. Mediation analysis was applied to two models, both of which used MCR as an exposure and social participation as a mediator. The outcomes were depression and loneliness for each model, respectively. Among 1,697 older adults, 196 (11.6%) had MCR. The mediating role of social participation was statistically significant in both models. The indirect effect (β=0.267, p=0.001) of MCR on depression through social participation comprised 11.97% of the total effect (β=2.231, p&lt;0.001). The indirect effect (β=0.098, p=0.001) of MCR on loneliness through social participation was 19.48% of the total effect (β=0.503, p&lt;0.001). Interventions to increase social participation may reduce depression and loneliness of older adults with MCR.

Association of Motoric Cognitive Risk Syndrome with Sarcopenia and Systemic Inflammation in Pre-Frail Older Adults.

Motoric cognitive risk syndrome (MCR) is defined by the presence of slow gait and subjective cognitive decline. It is well recognized as a prodrome for dementia, but the biological mechanism and trajectory for MCR are still lacking. The objective of this study was to explore the association of MCR with body composition, including sarcopenia and systemic inflammation, in pre-frail older adults in a cross-sectional study of 397 pre-frail community-dwelling older adults. Data on demographics, physical function, frailty, cognition (Montreal Cognitive Assessment (MoCA)), perceived health and depression were collected. Body composition was measured using a bioelectrical impedance analyzer. Systemic inflammatory biomarkers, such as progranulin, growth differentiation factor-15 (GDF-15), interleukin-10 (IL-10), interleukin-6 and tumor necrosis factor-α (TNF-α), were collected. Univariate and multivariate logistic regression were used to analyze the association between MCR, body composition, sarcopenia and systemic inflammatory biomarkers. The prevalence of MCR was 14.9%. They were significantly older and there were more females, depression, functional impairment, lower education, physical activity and MoCA scores. Body fat percentage (BF%), fat mass index, fat to fat free mass ratio (FM/FFM) and sarcopenia prevalence were significantly higher in MCR. Serum GDF-15 and TNF-α levels were highest with progranulin/TNF-α and IL-10/TNF-α ratio lowest in MCR. Compared to healthy patients, MCR was significantly associated with sarcopenia (aOR 2.62; 95% CI 1.46-3.17), BF% (aOR 1.06; 95% CI 1.01-1.12), FMI (aOR 1.16; 95% CI 1.02-1.30) and FM/FFM (aOR 6.38; 95% CI 1.20-33.98). The association of IL-10 to TNF-α ratio (aOR 0.98, 95% CI 0.97-0.99) and IL-10 (aOR 2.22, 95% CI 0.05-0.98) with MCR were independent of sarcopenia and BF%. Longitudinal population studies are needed to understand the role of body fat indices and IL-10 in pre-frail older adults with MCR and trajectory to dementia.

Association between motoric cognitive risk syndrome and future falls among Chinese community-dwelling elderly: A nationwide cohort study.

Motoric Cognitive Risk syndrome (MCR), known as the predementia stage, is characterized by both subjective cognitive complaint (SCC) and slow gait. This study aimed to investigate the causal relationship between MCR, its components, and falls. Participants aged ≥ 60 years were selected from China Health and Retirement Longitudinal Study. SCC was determined by participants' responses to the question "How would you rate your memory at present?" with "poor" being the indicative answer. Slow gait was defined as one standard deviation or more below age- and gender-appropriate mean values of gait speed. MCR was identified when both SCC and slow gait were presented. Future falls were investigated by the question "have you fallen down during follow-up until wave 4 in 2018?" Logistic regression analysis was performed to test the longitudinal association of MCR, its components and future falls during the following 3 years. Of 3748 samples in this study, the prevalence of MCR, SCC, and slow gait was 5.92%, 33.06%, and 15.21%, respectively. MCR increased the risk of falls during the following 3 years by 66.7% compared to non-MCR after controlling for covariates. In the fully adjusted models, with the healthy group as reference, MCR (OR=1.519, 95%CI=1.086-2.126) and SCC (OR=1.241, 95%CI=1.018-1.513), but not slow gait, increased the risk of future falls. MCR independently predicts future falls risk in the following 3 years. Measuring MCR can be a pragmatic tool for early identification of falls risk.

Motoric cognitive risk syndrome-Setting the course for dementia prevention?

The predicted increase in adults with dementia will pose amajor challenge for the German healthcare system. To mitigate this challenge, the early detection of adults with an increased risk of dementia is crucial. In this context, the concept of motoric cognitive risk (MCR) syndrome has been introduced into the English literature but is currently relatively unknown in German-speaking countries. What are the characteristics and diagnostic criteria of MCR? What is the impact of MCR on health-related parameters? What is the current state of evidence regarding the risk factors and prevention of the MCR? We reviewed the English language literature concerning MCR, the associated risk factors, and protective factors, similarities or differences with the concept of mild cognitive impairment (MCI), and its influence on the central nervous system. The MCR syndrome is characterized by subjective cognitive impairment and aslower gait speed. Compared to healthy adults, adults with the MCR have ahigher risk of dementia, falls, and mortality. Modifiable risk factors provide astarting point for specific multimodal lifestyle-related preventive interventions. As MCR can be easily diagnosed in practical settings, it could become an important concept for the early detection of adults with an increased risk of dementia in German-speaking countries, although further research is necessary to empirically confirm this assumption.

Association of Handgrip Strength Weakness and Asymmetry With Incidence of Motoric Cognitive Risk Syndrome in the China Health and Retirement Longitudinal Study.

Motoric cognitive risk (MCR) syndrome is a type of pre-dementia. It is defined as the co-occurrence of subjective cognitive complaints and a slow gait speed. A recent study found that handgrip strength (HGS) asymmetry is associated with an increased risk of neurodegenerative disorders. We aimed to investigate the associations of HGS weakness and asymmetry separately and together with MCR incidence among older Chinese adults. Data from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study were used. HGS values <28 kg for male participants and <18 kg for female participants were considered HGS weaknesses. HGS asymmetry was assessed by the ratio of nondominant to dominant HGS. We used 3 different cutoff values of HGS ratio to define asymmetry, including 10%, 20%, and 30%. Specifically, HGS ratios <0.90 or >1.10 (10%), <0.80 or >1.20 (20%), and <0.70 or >1.30 (30%) were classified as asymmetry. The participants were classified into 4 groups: neither weakness nor asymmetry (neither), asymmetry only, weakness only, and weakness and asymmetry (both). The association between baseline HGS status and 4-year incidence of MCR was examined using logistic regression analyses. A total of 3,777 participants 60 years and older were included in the baseline analysis. The prevalence of MCR at the baseline was 12.8%. Participants with asymmetry only, weakness only, and both showed significantly increased risk of MCR. After excluding participants with MCR at baseline, 2,328 participants were included in the longitudinal analysis. There were 111 MCR cases (4.77%) over the 4-year follow-up period. Participants with HGS weakness and asymmetry together at baseline had increased odds of incident MCR (HGS ratio at 10%: odds ratio [OR] 4.48, p < 0.001; HGS ratio at 20%: OR 5.43, p < 0.001; HGS ratio at 30%: OR 6.02, p < 0.001). These results show that the presence of both HGS asymmetry and weakness is associated with MCR incidence. The early recognition of HGS asymmetry and weakness may be helpful in the prevention and treatment of cognitive dysfunction.

Association between positive control in self-perceptions of aging and motoric cognitive risk syndrome among Chinese community-dwelling older adults: a cross-sectional study

BackgroundSelf-perceptions of aging (SPA) are important psychosocial factors that lead to a wide range of outcomes including dementia. However, the relationships between positive SPA and motoric cognitive risk syndrome (MCR) which is a predementia syndrome are still unknown. This study aimed to reveal the associations of positive control and aging awareness of SPA with the risk of MCR and its components.MethodsA cross-sectional design was conducted among 1137 Chinese community-dwelling older adults. Positive control and aging awareness were defined by two dimensions of SPA (Positive control and Timeline chronic). MCR was determined according to definition. Multivariable logistic regression was used to examine the associations.ResultsThe overall prevalence of MCR was 11.5% (mean age = 71.62 ± 5.22). After adjusting for depression, anxiety, and cognitive function, positive control was associated with reduced risk of MCR (OR = 0.624, 95% CI 0.402–0.969, P = 0.036), subjective cognitive complaints (SCC) (OR = 0.687, 95% CI 0.492–0.959, P = 0.027), and gait speed (GS) (OR = 0.377, 95% CI 0.197–0.720, P = 0.003), respectively. Aging awareness was merely related to increased risk of MCR (OR = 1.386, 95% CI 1.062–1.810, P = 0.016).ConclusionsThis study highlights the crucial associations of positive control and aging awareness with MCR and its components. Our results emphasize that positive belief in control and adaptive aging awareness might be promising targets for preventing MCR.

38 Plasma proteomic signature of motoric cognitive risk syndrome

OBJECTIVES/GOALS: Motoric cognitive risk (MCR) is a pre-dementia syndrome characterized by slow gait and subjective cognitive complaints. In the Atherosclerosis Risk in Communities (ARIC) study, we aim to (1) identify plasma proteins and protein modules associated with MCR and (2) compare the proteomic signature of MCR to that of mild cognitive impairment (MCI). METHODS/STUDY POPULATION: Nondemented ARIC participants were classified by MCR status (yes/no) according to a memory questionnaire and 4-meter walk. MCI status (yes/no) was classified by expert diagnosis using standardized criteria. We measured 4,877 proteins in plasma collected at ARIC Visit 5 (late-life) and Visit 2 (midlife) utilizing the SomaScan4 proteomic assay. Multivariable logistic regression”adjusted for demographic variables, kidney function, cardiovascular risk factors, and APOE4 status”related each protein to MCR at late-life. An FDR corrected P RESULTS/ANTICIPATED RESULTS: Proteome-wide association study among 4076 ARIC participants (mean age=75; 58% women, 17% Black, 4% MCR+, 21% MCI+; MCR+ and MCI+ groups overlapped) at late-life identified 26 MCR-associated proteins involved in metabolism, vascular/visceral smooth muscle, and extracellular matrix organization. At an uncorrected P DISCUSSION/SIGNIFICANCE: This proteomic characterization of MCR identifies novel plasma proteins and networks, both distinct from and overlapping with those of MCI, thus highlighting the partially divergent mechanisms underlying these pre-dementia syndromes. These findings may be leveraged toward dementia prognostication and targeted therapeutic approaches.

Motoric Cognitive Risk Syndrome and Cognitive Frailty

Motoric cognitive risk (MCR) syndrome and cognitive frailty (CF) are relatively new predementia syndromes that represent changes from baseline cognition that may be reversible or nonprogressive. Rehabilitation therapists may be the first clinicians to identify the symptoms of MCR syndrome and CF, of subjective cognitive complaints with the associated gait or strength impairments. Adopting screening tools in clinical practice and health screening events may help to identify these syndromes early and provide the opportunity for medical and lifestyle interventions to potentially minimize progression.