Motoric Cognitive Risk Syndrome
Original Editor - Lucinda hampton
Top Contributors - Lucinda hampton
Introduction
Motoric cognitive risk syndrome (MCR) is a syndrome that develops prior to dementia. The syndrome consists of a slower gait, cognitive deficits and a is risk factor for various geriatric syndromes including frailty and falls.[1]
- New research is showing that gait dysfunction can be a forerunner of dementia.[2]
- MCR is an independent risk factor for both incident ADL and IADL disability, and confers a higher risk for disability than memory impairment.[3]
The co-existence of gait impairment and cognitive decline in Motoric Cognitive Risk (MCR) syndrome involves pathological changes in frontal subcortical circuits and executive functions. Understanding MCR's underlying mechanisms could aid early dementia detection and prevention strategies in older adults. Investigating vascular and non-vascular components may reveal how MCR leads to dementia and mortality, potentially informing interventions for age-related cognitive and functional decline. Given the strong link between immobility and dementia, further research into their relationship is crucial. Comprehensive studies on subjective cognition in MCR are needed to improve detection methods and overall patient care[4].
Epidemiology
MCR amongst older persons (60 + age bracket):
- Estimated to be 10% in the 60 + age group, giving this population a higher risk of future disability.
- Prevalence of MCR in Europe is around 8.0%, 7.0% in the United States, and 6.3% in Japan.[5]
As the global burden of dementia increases tools are needed to identify those vulnerable to dementia and instigate a preventative management plan.
Pathology
The pathology of MCR is due to frontal lacunar infarcts, for example:
- White matter hyperintensity (predicts an increased risk of stroke, dementia, and death[6]).
- Pre-motor and pre-frontal gray matter atrophy in the pre-motor and pre-frontal cortex
- Inflammatory changes
- Genetic factors.
Cerebrovascular lesions and cardiovascular disorders amplify the pathological changes. [7]
However the underlying pathogenesis of MCR remains poorly understood.[8]
Risk Factors
Research has shown these group to be at risk of having the MCR syndrome:women; if you live in a rural areas; obesity; diabetes; heart disease; or having cancer.[9]
Research has found a direct link between vitamin D deficiency and MCR in older adults without dementia, particularly when vitamin D levels fall below 42 nmol/L.[10]
Diagnosis
The diagnosis of MCR is an involved process comprising neuropsychological tests, biomarker assays (blood-based biomarkers potentially improve the accuracy by which specific causes of dementia can be diagnosed in vivo)[11], imaging studies, questionnaire-based evaluation, and motor function tests. [7]
Both neurological and non-neurological clinical abnormalities occur.
- Gait irregularities and accelerated functional decline (eg postural and balance dysfunction, memory loss, cognitive decline) stem from altered afferent sensory and efferent motor responses.
- Confusing visual, vestibular, and proprioceptive inputs. [7]
Management
Management of MCR is multimodal, including
- Lifestyle habits known to limit the disease progression. Similar to dementia recommendations. eg Cognitive, physical, and social activities
- Exercise
- Diet, nutritional supplements and vitamins known to support motor and cognitive improvement. eg vit D. A 2022 sudy showed identified that there is direct association between vitamin D deficeincy and MCR syndrome in older adults without dementia, and supplementation is advised.[1]
- Symptomatic drug treatment eg anti depressants
- Psychotherapeutic counselling[7]
Recovery
A strong interconnection exists among gait, motor tasks, cognitive functions, sensory processing, and decision-making in the elderly.
- Gait and posture are strongly linked to motor tasks, with less cognitive input required.
- Fine motor coordination relates to cortical sensory functioning.
- Cognitive management can improve planning, problem-solving, executive function, and self-awareness.
- The orbitofrontal cortex controls decision-making and is related to working memory.
- Reducing gait disorders can potentially impact cognitive functions and dementia.
- Executive function significantly influences gait and mobility.
- Improved executive function and attention can enhance spatial orientation and reduce fall risk.
- Practice can simultaneously improve posture and working memory in both young and older adults.
- Enhanced neuroplasticity can reduce age-related links between cognitive decline and gait speed, and improve balance.[4]
Physiotherapy
See Physiotherapy for dementia.
- Motor function tests for diagnosis and as treatment outcome measures include: including walking speed, dual-task gait tests, and ambulation ability.[7]
- Exercise has been to shown to have a role in preventing cognitive decline. Exercise can be used in the prevention of dementia and minimising the effects of dementia e.g. reduced mobility and pain.
- Home-based exercises (with telephonic coaching ideall;y) are both safe feasible treatment option for patients with Motoric Cognitive Risk syndrome[12]
References
- ↑ 1.0 1.1 Le Floch M, Gautier J, Annweiler C. Vitamin D Concentration and Motoric Cognitive Risk in Older Adults: Results from the Gait and Alzheimer Interactions Tracking (GAIT) Cohort. International Journal of Environmental Research and Public Health. 2022 Oct 12;19(20):13086.Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9602422/ (accessed 13.4.2023)
- ↑ Meiner Z, Ayers E, Verghese J. Motoric cognitive risk syndrome: a risk factor for cognitive impairment and dementia in different populations. Annals of geriatric medicine and research. 2020 Mar;24(1):3.Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370775/(accessed 12.4.2023)
- ↑ Bai A, Bai W, Ju H, Xu W, Lin Z. Motoric cognitive risk syndrome as a predictor of incident disability: A 7 year follow-up study. Frontiers in Aging Neuroscience. 2022 Sep 8.Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9493455/ (accessed 13.4.2023)
- ↑ 4.0 4.1 Xiang K, Liu Y, Sun L. Motoric cognitive risk syndrome: symptoms, pathology, diagnosis, and recovery. Frontiers in Aging Neuroscience. 2022 Feb 2;13:728799.Available:https://pmc.ncbi.nlm.nih.gov/articles/PMC8847709/#s6 (accessed 20.4.2025)
- ↑ Maggio M, Lauretani F. Prevalence, incidence, and clinical impact of cognitive–motoric risk syndrome in Europe, USA, and Japan: facts and numbers update 2019. Journal of cachexia, sarcopenia and muscle. 2019 Oct;10(5):953-5.Available:https://pubmed.ncbi.nlm.nih.gov/31408280/ (accessed 14.4.2023)
- ↑ Debette S, Markus HS. The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. Bmj. 2010 Jul 26;341.Available:https://www.bmj.com/content/341/bmj.c3666 (accessed 13.4.2023)
- ↑ 7.0 7.1 7.2 7.3 7.4 Xiang K, Liu Y, Sun L. Motoric cognitive risk syndrome: symptoms, pathology, diagnosis, and recovery. Frontiers in Aging Neuroscience. 2022 Feb 2;13:728799.Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8847709/ (accessed 12.4.2023)
- ↑ Semba RD, Tian Q, Carlson MC, Xue QL, Ferrucci L. Motoric cognitive risk syndrome: Integration of two early harbingers of dementia in older adults. Ageing research reviews. 2020 Mar 1;58:101022.Available:https://pubmed.ncbi.nlm.nih.gov/31996326/ (accessed 13.4.2023)
- ↑ Lau H, Mat Ludin AF, Shahar S, Badrasawi M, Clark BC. Factors associated with motoric cognitive risk syndrome among low-income older adults in Malaysia. BMC Public Health. 2019 Jun;19:1-7.Available:https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-6869-z (accessed 13.4.2023)
- ↑ Le Floch M, Gautier J, Annweiler C. Vitamin D concentration and motoric cognitive risk in older adults:Available:https://pmc.ncbi.nlm.nih.gov/articles/PMC9602422/#sec5-ijerph-19-13086 (accessed 20.4..2025)
- ↑ Ahmed RM, Paterson RW, Warren JD, Zetterberg H, O'brien JT, Fox NC, Halliday GM, Schott JM. Biomarkers in dementia: clinical utility and new directions. Journal of Neurology, Neurosurgery & Psychiatry. 2014 Dec 1;85(12):1426-34.Available:https://jnnp.bmj.com/content/85/12/1426(Accessed 13.4.2023)
- ↑ Ambrose AF, Gulley E, Verghese T, Verghese J. Home-based exercise program for older adults with Motoric Cognitive Risk syndrome: feasibility study. Neurodegenerative disease management. 2021 Jun;11(03):221-8.Available:https://www.futuremedicine.com/doi/full/10.2217/nmt-2020-0064 (accessed 12.4.2023)