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Published on: January 11, 2020
Motoric Cognitive Risk and Incident Dementia in Older Adults
Jeehae Chung1, Seonjeong Byun2
1Industry-Academic Cooperation Foundation, The Catholic University of Korea, Seoul, Korea.
Importance:
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.
Objective:
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.
Design, Setting, And Participants:
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.
Main Outcomes And Measures:
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.
Results:
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).
Conclusions And Relevance:
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.
Insights
Motoric cognitive risk (MCR), a predementia syndrome, effectively estimates dementia risk in older adults. Modified MCR using simple tests shows a 2-fold higher risk for incident dementia, suggesting its utility as a screening tool.
Area of Science:
- Gerontology
- Neurology
- Public Health
Background:
- Motoric cognitive risk (MCR) is a novel syndrome indicating increased risk for dementia.
- The predictive validity of MCR, especially modified versions, for nationwide dementia incidence remains under-explored.
Purpose of the Study:
- To assess if a modified Motoric Cognitive Risk (MCR) syndrome, incorporating timed up-and-go and one-leg-standing tests, improves dementia risk prediction compared to individual components.
- To evaluate the association between MCR and incident dementia in a large, nationwide cohort.
Main Methods:
- A nationwide cohort study of 1,137,530 individuals aged 66 years from Korea's National Screening Program for Transitional Ages (2009-2013).
- Modified MCR subtypes (timed up-and-go or one-leg-standing impairment with subjective cognitive decline) were defined.
- Cox proportional hazards regression analysis was used to examine the association between MCR and incident dementia over a mean follow-up of 7.02 years.
Main Results:
- 1.4% and 2.9% of participants met criteria for the timed up-and-go and one-leg-standing MCR subtypes, respectively.
- Participants with MCR exhibited approximately a 2-fold higher risk of incident dementia (aHRs ranging from 2.03 to 2.05).
- Modified MCR demonstrated higher adjusted hazard ratios for incident dementia compared to cognitive or motoric components alone.
Conclusions:
- Modified Motoric Cognitive Risk syndrome is a practical screening tool for estimating dementia risk in individuals in their mid-60s.
- The findings suggest MCR has additive validity over individual cognitive or motoric assessments for dementia risk prediction.
- Further research into the clinical and neurobiological underpinnings of MCR is warranted.
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