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. 2023 Jul 30:5:100178.
doi: 10.1016/j.cccb.2023.100178. eCollection 2023.

Motoric cognitive risk syndrome trajectories and incident dementia over 10 years

Donncha S Mullin  1   2   3   4 , Danni Gadd  5   6 , Tom C Russ  1   2   3   4   7 , Michelle Luciano  7 , Graciela Muniz-Terrera  2   8
Affiliations

Motoric cognitive risk syndrome trajectories and incident dementia over 10 years

Donncha S Mullin et al. Cereb Circ Cogn Behav. .

Abstract

Background: Motoric Cognitive Risk (MCR) syndrome is a high-risk state for adverse health outcomes in older adults characterised by measured slow gait speed and self-reported cognitive complaints. The recent addition to the Lothian Birth Cohort 1936 of robust dementia outcomes enabled us to assess the prognostic value of MCR for dementia and explore the various trajectories of participants diagnosed with MCR.

Methods: We classified 680 community-dwelling participants free from dementia into non-MCR or MCR groups at mean [SD] age 76.3 [0.8] years. We used Cox and competing risk regression methods, adjusted for potential confounders, to evaluate the risk of developing all-cause incident dementia over 10 years of follow-up. Secondarily, we followed the trajectories for individuals with and without MCR at baseline and categorised them into subgroups based on whether MCR was still present at the next research wave, three years later.

Results: The presence of MCR increased the risk of incident dementia (adjusted HR 2.34, 95%CI 1.14-4.78, p = 0.020), as did fewer years of education and higher depression symptoms. However, MCR has a heterogenous progression trajectory. The MCR progression subgroups each have different prognostic values for incident dementia.

Conclusion: MCR showed similar prognostic ability for dementia in a Scottish cohort as for other populations. MCR could identify a target group for early interventions of modifiable risk factors to prevent incident dementia. This study illustrates the heterogeneous nature of MCR progression. Exploring the underlying reasons will be important work in future work.

Keywords: Cognitive impairment; Dementia; Dementia prediction; Motoric cognitive risk; Slow gait; Slow walking; Subjective cognitive complaint; Trajectories.

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Conflict of interest statement

The authors have stated explicitly that there are no conflicts of interest in connection with this article. DAG is a part-time employee of Optima partners, a health data science consultancy company. Optima had no role or influence in this study.

Figures

Fig 1
Fig. 1
Flow chart of participants. Note: MCR, Motoric Cognitive Risk; LBC1936, the Lothian Birth Cohort 1936. Dementia was ascertained in LBC1936 from wave 2 until August 2022, using medical data linkage. Therefore, all participants included in our baseline (wave 3) have been assessed for dementia. Green shading illustrates our study period. Waves 5 and 6 have now been completed but we did not require data from them (as we used medical data linkage), so have been excluded from the figure for clarity.
Fig 2
Fig. 2
Kaplan-Meier survival curve for MCR and incident dementia over time, with accompanying risk table. Note: MCR; Motoric Cognitive Risk. The p-value is from a log-rank test that compared the cumulative survival rates between those with and without MCR.
Fig 3
Fig. 3
Transitions between MCR states over three years and dementia over ten years. Ovals specify possible states. Arrows specify possible transitions between states. Arrow thickness represents the proportion of each starting state transitioning to a different state. Transition arrows between No MCR and MCR (and vice-versa) states represent occurrences between baseline (wave 3) and three-year follow-up (wave 4). Follow-up for the dementia outcome was over a mean of 10 years.
Fig 4
Fig. 4
Kaplan-Meier survival curve for MCR subgroups and incident dementia over time, with accompanying risk table. Note: MCR, Motoric Cognitive Risk. Tr, Transient. The p-value is from a log-rank test of the trend of the cumulative survival rates. Subgroups were defined by following the trajectories of participants between baseline (wave 3) and three-year follow-up (wave 4).
None
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