Emmeline Ayers

Motoric cognitive risk syndrome Multicenter incidence study

Objective: To report incidence and risk factors for motoric cognitive risk syndrome (MCR), a newly described predementia syndrome characterized by slow gait and cognitive complaints. Methods: We examined incidence rates of MCR in 3,128 adults aged 60 years and older, MCR- and dementia-free at baseline, participating in 4 US-based cohort studies. Hazard ratios (HRs) with 95% confidence intervals (CIs) for the association of modifiable risk factors with risk of MCR were computed using Cox models. Results: Over a median follow-up time of 3.2 years, 823 of the 3,128 participants met MCR criteria. The overall age- and sex-adjusted incidence of MCR was 65.2/1,000 person-years (95% CI: 53.3–77.1), and ranged from 50.8/1,000 person-years to 79.6/1,000 person-years in the individual cohorts. MCR incidence was higher with older age but there were no sex differences. In the pooled sample adjusted for age, sex, education, and cohort source, strokes (HR 1.42, 95% CI: 1.14–1.77), Parkinson disease (HR 2.52, 95% CI: 1.68–3.76), depressive symptoms (HR 1.65, 95% CI: 1.28–2.13), sedentariness (HR 1.76, 95% CI: 1.44–2.17), and obesity (HR 1.39, 95% CI: 1.17–1.65) predicted risk of incident MCR. Conclusions: The incidence of MCR is high in older adults. Identification of modifiable risk factors for MCR will improve identification of high-risk individuals and help develop interventions to prevent cognitive decline in aging.

Motoric Cognitive Risk Syndrome Subtypes and Cognitive Profiles

BACKGROUND The motoric cognitive risk (MCR) syndrome, characterized by slow gait and cognitive complaints, is a simple and easily accessible clinical approach to identify older adults at high risk for transitioning to dementia. This study aims to define subtypes of MCR based on individual quantitative gait variables and to compare their neuropsychological profiles and risk factors as well risk for incident cognitive impairment. METHODS MCR was diagnosed in 314 community-residing, nondemented, older adults aged 65 and older (56% women) based on the presence of cognitive complaints and slow gait velocity (MCRv). Four new subtypes of MCR were defined by substituting slow gait with short stride length (MCRsl), slow swing time (MCRsw), high stride length variability (MCRslv), and high swing time variability (MCRswv). MCR subtypes were not mutually exclusive. RESULTS A total of 25 participants (8%) met criteria for MCRv, 20 for MCRsl (6.4%), 15 for MCRsw (4.8%), 16 for MCRslv (5.1%), 12 for MCRswv (3.8%), and 266 participants (84.7%) did not meet criteria for any MCR subtype. At baseline, MCRv was associated with deficits in attention and language as well as in overall cognitive status. MCRswv was associated with deficits in all cognitive domains including memory. Obesity and sedentariness were risk factors of MCRv, MCRsl, and MCRsw. MCRv status predicted incident cognitive impairment in global cognition (odds ratio: 3.59, p = .016), whereas MCRswv status predicted incident cognitive impairment in memory (odds ratio: 4.24, p = .048). CONCLUSIONS MCR subtypes based on individual gait parameters show commonalities and differences in cognitive profiles and risk factors. Future studies should investigate whether the MCR subtypes predict different subtypes of dementia.

Motoric cognitive risk syndrome and risk of mortality in older adults

Cognitive impairment is associated with increased mortality. We examined the association between motoric cognitive risk (MCR) syndrome, a predementia syndrome characterized by slow gait and cognitive complaints, and survival.

Brain activation in high-functioning older adults and falls Prospective cohort study

Objective: To determine whether brain activity over the prefrontal cortex measured in real time during walking predicts falls in high-functioning older adults. Method: We examined166 older persons (mean age 75 years, 51% women) enrolled in a prospective aging study. High-functioning status defined as the absence of dementia or disability with normal gait diagnosed by study clinicians. The magnitude of task-related changes in oxygenated hemoglobin levels over the prefrontal cortex was measured with functional near-infrared spectroscopy during motor (walking at normal pace) and cognitive (reciting alternate letters of the alphabet) single tasks and a dual-task condition (walking while reciting alternate letters of the alphabet). Incident falls were prospectively assessed over a 50-month study period. Results: Over a mean follow-up of 33.9 ± 11.9 months, 116 falls occurred. Higher levels of prefrontal cortical activation during the dual-task walking condition predicted falls (hazard ratio adjusted for age, sex, education, medical illnesses and general mental status 1.32, 95% confidence interval 1.03–1.70). Neither behavioral outcomes (velocity or letter rate) on the dual task nor brain activation patterns on the single tasks (normal walk or talk alone) predicted falls in this high-functioning sample. The results remained robust after accounting for multiple confounders and for cognitive status, slow gait, previous falls, and frailty. Conclusions: Prefrontal brain activity levels while performing a cognitively demanding walking condition predicted falls in high-functioning seniors. These findings implicate neurobiological processes early in the pathogenesis of falls.

Motoric Cognitive Risk Syndrome and Falls Risk: A Multi-Center Study

BACKGROUND The Motoric Cognitive Risk Syndrome (MCR) is characterized by slow gait speed and cognitive complaints. OBJECTIVES The objective of this study was to determine if the presence of MCR increases the risk of falls in older people. METHODS Individual participant data (n = 6,204) from five longitudinal studies from three countries were used for this analysis. MCR diagnosis was defined as both the presence of objectively measured slow gait speed and subjective cognitive complaints in those without dementia or mobility disability. Falls were prospectively ascertained using phone calls or questionnaires. Log binomial regression was performed to determine if MCR increased the risk of falls separately in each cohort. Random effects meta-analysis was used to pool results from all cohorts. RESULTS The mean age of participants was 74.9 (SD 6.8) years and 44% (n = 2728) were male. Overall 33.9% (n = 2104) reported a fall over follow-up. Pooled relative risk of MCR with any falls was RR 1.44 95% CI 1.16, 1.79. The components of MCR, slow gait (RR 1.30 95% CI 1.14, 1.47) and cognitive complaint (RR 1.25, 95% CI 1.07, 1.46) were also associated with an increased risk of any falls. In sub-analyses MCR was associated with any fall independent of previous falls (RR 1.29 95% CI 1.09, 1.53) and with multiple falls (RR 1.77, 95% CI 1.25, 2.51). CONCLUSION MCR is associated with an increased risk of falls. The increase in risk was higher than for its individual components. The simplicity of the MCR makes it an attractive falls risk screening tool for the clinic.

The role of postural instability/gait difficulty and fear of falling in predicting falls in non-demented older adults

INTRODUCTION Postural instability/gait difficulty (PIGD) and fear of falling (FoF) frequently co-exist, but their individual predictive values for falls have not been compared in aging. This study aims to determine both independent and combined effect of PIGD and FoF to falls in older adults without dementia. METHODS PIGD and other extrapyramidal signs were systematically assessed in 449 community-dwelling participants without Parkinsons disease (76.48±6.61 ys; 56.8% female) enrolled in this longitudinal cohort study. Presence of FoF was measured by a single-item question (Do you have a FoF?) and self-confidence by the Activities-specific Balance Confidence scale (ABC scale). RESULTS One hundred sixty-nine participants (38%) had an incident fall over a mean follow-up of 20.1±12.2months. PIGD was present in 32% and FoF in 23% of the participants. Both PIGD (adjusted hazard ratio (aHR): 2.28; p=0.016) and self-confidence (aHR: 0.99; p=0.040) predicted falls when entered simultaneously in the Cox model. However, presence of FoF (aHR: 1.99; p=0.021) and self-confidence (aHR: 0.98; p=0.006) predicted falls only in individuals with PIGD. CONCLUSIONS PIGD and FoF were associated with future falls in older adults without dementia but FoF was a falls predictor only in individuals with PIGD.

Multiple modes of assessment of gait are better than one to predict incident falls

BACKGROUND Though gait evaluation is recommended as a core component of fall risk assessments, a systematic examination of the predictive validity of different modes of gait assessments for falls is lacking. OBJECTIVE To compare three commonly employed gait assessments - self-reported walking difficulties, clinical evaluation, and quantitative gait - to predict incident falls. MATERIALS AND METHODS 380 community-dwelling older adults (mean age 76.5 ± 6.8 y, 55.8% female) were evaluated with three independent gait assessment modes: patient-centered, quantitative, and clinician-diagnosed. The association of these three gait assessment modes with incident falls was examined using Cox proportional hazards models. RESULTS 23.2% of participants self-reported walking difficulties, 15.5% had slow gait, and 48.4% clinical gait abnormalities. 30.3% had abnormalities on only one assessment, whereas only 6.3% had abnormalities on all three. Over a mean follow-up of 24.2 months, 137 participants (36.1%) fell. Those with at least two abnormal gait assessments presented an increased risk of incident falls (hazard ratio (HR): 1.61, 95% confidence interval (CI): 1.04-2.49) in comparison to the 169 participants without any abnormalities on any of the three assessments. CONCLUSIONS Multiple modes of gait evaluation provide a more comprehensive mobility assessment than only one assessment alone, and better identify incident falls in older adults.

Locomotion, cognition and influences of nutrition in ageing

Gait and cognitive impairments in older adults can reflect the simultaneous existence of two syndromes that affect certain brain substrates and pathologies. Nutritional deficiencies, which are extremely common among elderly population worldwide, have potential to impact the existence and rehabilitation of both syndromes. Gait and cognition are controlled by brain circuits which are vulnerable to multiple age-related pathologies such as vascular diseases, inflammation and dementias that may be caused or accentuated by poor nutrition or deficiencies that lead to cognitive, gait or combined cognitive and gait impairments. The following review aims to link gait and cognitive classifications and provide an overview of the potential impact of nutritional deficiencies on both neurological and gait dysfunctions. The identification of common modifiable risk factors, such as poor nutrition, may serve as an important preventative strategy to reduce cognitive and mobility impairments and moderate the growing burden of dementia and disability worldwide.

Association of exceptional parental longevity and physical function in aging

Offspring of parents with exceptional longevity (OPEL), who are more likely to carry longevity-associated genotypes, may age more successfully than offspring of parents with usual survival (OPUS). Maintenance of physical function is a key attribute of successful aging. While many genetic and non-genetic factors interact to determine physical phenotype in aging, examination of the contribution of exceptional parental longevity to physical function in aging is limited. The LonGenity study recruited a relatively genetically homogenous cohort of Ashkenazi Jewish (AJ) adults age 65 and older, who were defined as either OPEL (having at least one parent who lived to age 95 or older) or OPUS (neither parent survived to age 95). Subjective and objective measures of physical function were compared between the two groups, accounting for potential confounders. Of the 893 LonGenity subjects, 365 were OPEL and 528 were OPUS. OPEL had better objective and subjective measures of physical function than OPUS, especially on unipedal stance (p = 0.009) and gait speed (p = 0.002). Results support the protective role of exceptional parental longevity in preventing decline in physical function, possibly via genetic mechanisms that should be further explored.

Symptoms of apathy independently predict incident frailty and disability in community-dwelling older adults

OBJECTIVE Although depressive symptoms are widely recognized as a predictor of functional decline among older adults, little is known about the predictive utility of apathy in this population. We prospectively examined apathy symptoms as predictors of incident slow gait, frailty, and disability among non-demented, community-dwelling older adults. METHODS We examined 2 independent prospective cohort studies-the LonGenity study (N = 625, 53% women, mean age = 75.2 years) and the Central Control of Mobility in Aging (CCMA) study (N = 312, 57% women, mean age = 76.4 years). Individuals were recruited from 2008 to 2014. Apathy was assessed using 3 items from the Geriatric Depression Scale. Slow gait was defined as 1 standard deviation or more below age- and sex-adjusted mean values, frailty was defined using the Cardiovascular Health Study criteria, and disability was assessed with a well-validated disability scale. RESULTS The prevalence of apathy was 20% in the LonGenity cohort and 26% in the CCMA cohort. The presence of apathy at baseline, independent of depressive symptoms (besides apathy), increased the risk of developing incident slow gait (hazard ratio [HR] = 2.10; 95% CI, 1.36-3.24; P = .001), frailty (HR = 2.86; 95% CI, 1.96-4.16; P < .001), and disability (HR = 3.43; 95% CI, 1.73-6.79; P < .001) in the pooled sample. These associations remained significant when accounting for demographics, medical illnesses, and cognitive function. CONCLUSIONS Apathy is associated with increased risk of developing slow gait, frailty, and disability, independent of other established risk factors, in non-demented older adults. Apathy should be screened for as a potentially preventable cause of functional decline in clinical psychiatric settings.