Apathy Is Associated with Slower Gait and Subjective Cognitive Complaints in a South Indian Community-Dwelling Cohort

Background/Objectives: Apathy is an independent risk factor for dementia and motoric-cognitive risk syndrome (MCR), a predementia syndrome characterized by slow gait and subjective cognitive complaints (SCCs). Our objective is to assess the cross-sectional association of apathy with gait velocity, SCC, and MCR in a community-based cohort of older adults. Methods: A cross-sectional survey of N = 746 community-dwelling older adults (≥60 years of age) enrolled in the Kerala Einstein Study. Apathy was measured using the Apathy Evaluation Scale (AES). Participants were stratified by AES tertile to evaluate bivariate associations, and multivariate linear and logistic regression models were used to assess the relationship of apathy with gait velocity, SCC, and MCR. Results: Compared with participants in the lowest apathy tertile, those in the highest tertile were significantly older, less physically active, and had slower gait. High-apathy participants also had lower Addenbrooke's Cognitive Examination scores (79.4 vs. 84.5, p < 0.001) and higher depression scores (9.3 vs. 5.4, p < 0.001). Apathy was associated with slower gait velocity (β = -3.465, p ≤ 0.002), but this relationship was no longer significant after adjusting for ACE score. Apathy and SCC were significantly associated in adjusted models (p < 0.001). Although participants with MCR had higher levels of apathy compared to those without MCR (34.6 vs. 31.4, p < 0.01), prevalent MCR and apathy were not significantly associated in regression models. Conclusions: Among community-dwelling older adults in Kerala, apathy is associated with slower gait and more severe subjective cognitive complaints but not cross-sectional MCR prevalence. These findings suggest that apathy may serve as an early risk factor in dementia pathogenesis across diverse patient populations, warranting further longitudinal investigation.