Subjective Cognition in Motoric Cognitive Risk Syndrome: Enhancing Cerebrovascular Risk Detection in Health Disparity Populations

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Around the globe, the population is aging at an unprecedented rate, motivating early identification of older adults at-risk for cognitive and functional decline. Unfortunately, for health disparity populations, dementia is frequently underdiagnosed or detected in advanced disease stages, when it is too late to implement preventative measures. In response to growing public health concerns, Motoric Cognitive Risk Syndrome (MCR) was characterized in 2013 as a predementia condition that combines two clinical presentations independently associated with dementia: slow gait speed and subjective cognitive concerns (SCC). MCR is associated with increased risk for dementia over its individual components of SCC or slow gait alone, making it a valuable marker of early neurodegenerative changes. MCR does not require expensive, complex assessments to assign diagnosis, broadening its accessibility to detect dementia in remote or under-resourced settings. MCR predicts risk for both Alzheimer’s disease (AD) and vascular cognitive impairment/dementia (VCID). However, MCR demonstrates unique sensitivity to early cerebrovascular alterations, so it is most predictive of VCID. At present, there is no consistent method to assess SCC in MCR – a key diagnostic feature of the syndrome. The majority of studies query memory concerns using a single item from a geriatric depression scale, which has become the standard approach in the field. However, a prior study led by the applicant failed to find an association between memory concerns and MCR, calling into question the current methodology. The lack of understanding about SCC in individuals with MCR may greatly limit sensitivity to risk for future decline. Given these critical gaps in knowledge, this proposal will build upon the applicant’s preliminary work to holistically analyze the assessment of SCC in a demographically diverse cohort with MCR. In collaboration with the Einstein Aging Study (EAS), a longitudinal study of community-dwelling older adults, 600 participants will be enrolled to determine the feasibility of SCC assessment to predict: (1) cognitive decline; (2) functional decline and disability; and (3) compare and contrast SCC in MCR and another predementia condition, mild cognitive impairment (MCI). A novel, multifaceted approach will be employed to assess SCC, including an expanded version of a widely used paper-and-pencil questionnaire, telephone interview, and daily diary evaluation (over 14 days) via smartphone. Results will yield a validated SCC screen that is easily administered, interpreted, and able to detect cerebrovascular risk for cognitive decline and disability. Because of MCR’s far-reaching applicability, results may have meaningful public health implications around the globe, as they would facilitate early detection of VCID, AD, and/or mixed dementias, and intervention opportunities for at-risk individuals. In addition, the proposed training plan will advance the applicant’s goal of becoming an independent clinical scientist, serving to promote methods of early dementia detection that lead to the reduction of health disparities for vulnerable populations.