Motoric cognitive risk syndrome

Motoric Cognitive Risk Syndrome or MCR is a clinical approach to identify older adults who are at risk of converting to dementia. However, being diagnosed with MCR does not automatically mean that a person has dementia but is on the pathway.

Motoric cognitive risk (MCR) syndrome is a fairly new 'pre-dementia assessment'. It is characterized by the presence of cognitive complaints such as slow gait and cognitive complaints which are simple and easy to identify and assess in older adults.

In all, there are four subtypes of MCR defined by substituting slow gait with short stride length (MCRs1), slow swing time (MCRsW), high stride length variability (MCRslv) and high swing time variability (MCRswv). MCR subtypes are not mutually exclusive.

A simple test that measures how fast people walk and whether they have any cognitive issues can determine how likely they are to develop dementia, which can cause Alzheimer's within 12 years according to scientists at the Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center.

Criteria for MCR

The prevalence of MCR is higher with older age, but there are no gender differences. Motoric cognitive risk in older adults is an early predictor of cognitive decline ultimately leading to Alzheimer's. As the elderly population continues to increase, the number of dementia patients are also likely to increase. MCR is a new symptom that identifies the probability of acquiring dementia. Studies reveal that those who develop MCR were approximately twice more likely to develop dementia. Those who have this disorder also appear to be at greater risk of developing cognitive impairment that leads to Alzheimer's disease among other forms of dementia. Typical symptoms include slow gait, memory lapses and instances of getting lost.

Diagnosis of MCR

Motoric cognitive risk syndrome is diagnosed by simple questions related to memory. Measuring gait speed over a fixed distance is another way of diagnosis. Independent of cognitive tests, MCR has been assessed by various study methods.

Gait speed is measured by the fixed distance that a person walks within a fixed given period of time. The average or mean gait speed is 81.8 cm/s which is slightly less than three feet traveled per second. Those with lesser walking speed than the standard deviation time are viewed as slow walkers. Those diagnosed with MCR perform very badly on most cognitive tests. Those with MCR also exhibit a higher prevalence of vascular disease. Many forms of dementia demonstrate motor issue as the disease progresses due to further damage of brain tissue.

MCR and determining risk of dementia

Diagnosing MCR is simple and can easily be implemented in a clinical setting without advanced neuro-imaging or spinal fluid examinations. Test for MCR can be done by a trained healthcare worker, not necessarily by a doctor. This way an adult at risk for dementia can be identified even without an MRI machine or the latest amyloid PET (Positron Emission Tomography) scan.

Risk factors of MCR are defined and selected risk factors are checked for in older people considering medical illnesses, lifestyle choices, activity level, weight and level of education all of which have been linked to risk of dementia. Stroke, Parkinson's disease, depression, limited activity and obesity turn out to be significant predictors of MCR. If someone meets the criteria, there is a need to investigate the causes and suggest preventive strategies. The MCR approach has been tested successfully in several countries and has been found to be a strong predictor for dementia.

Importance of MCR

MCR is important because it predicts dementia so that the goal would be to act on these risk factors. Early detection of risk factors can help reduce people's risk of stroke by getting them to exercise or putting them on aspirin. Being sedentary is a risk factor of MCR and it is therefore recommended to increase exercise levels in older people, and thus potentially reduce the risk of MCR and ultimately of dementia.

As there are no medications to prevent risk of dementia or cure it, the main intervention would be healthy lifestyle measures, increased physical activity, engaging in cognitively stimulating activities and partaking a healthy diet. Controlling medical risk factors especially vascular disease, lowering blood pressure and cholesterol, reducing weight - all these would have an impact on reducing the risk of dementia. However, it is essential to remember that identifying MCR is not the same as diagnosing that an older person has dementia. MCR is a red flag - an opportunity for clinicians and researchers to reduce the number of people who convert to dementia.