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

在全球范围内，人口正在以前所未有的速度老龄化，这促使人们及早发现存在认知和功能衰退风险的老年人。不幸的是，对于健康差距人群来说，痴呆症经常被低估或在疾病晚期被发现，那时实施预防措施已经太晚了。为了应对日益增长的公共健康问题，运动性认知风险综合征(MCR)于2013年被描述为一种痴呆前期疾病，它结合了两种与痴呆独立相关的临床表现：步速缓慢和主观认知问题(SCC)。MCR与其单独的SCC或慢步态组件患痴呆症的风险增加有关，使其成为早期神经退行性变化的有价值的标志。MCR不需要昂贵、复杂的评估来分配诊断，从而扩大了其可访问性，可以在偏远或资源不足的情况下检测痴呆症。MCR预测阿尔茨海默病(AD)和血管认知障碍/痴呆(VCID)的风险。然而，MCR对早期脑血管改变表现出独特的敏感性，因此它是预测VCID的最好方法。目前，还没有一致的方法来评估MCR中的SCC-这是该综合征的关键诊断特征。大多数研究都涉及到使用老年抑郁量表中的一个条目来询问记忆，这已经成为该领域的标准方法。然而，由申请人领导的一项先前的研究未能发现记忆问题和MCR之间的联系，对当前的方法提出了质疑。MCR患者对SCC缺乏了解可能极大地限制了对未来下降风险的敏感性。鉴于这些严重的知识差距，这项建议将建立在申请人的初步工作的基础上，全面分析人口统计学上不同的MCR队列中对SCC的评估。与爱因斯坦老龄化研究(EAS)合作，一项针对社区老年人的纵向研究将招募600名参与者，以确定SCC评估的可行性，以预测：(1)认知衰退；(2)功能衰退和残疾；以及(3)比较和对比MCR和另一种痴呆前疾病-轻度认知障碍(MCI)的SCC。将使用一种新颖的、多方面的方法来评估SCC，包括广泛使用的纸笔问卷的扩展版本、电话采访和通过智能手机进行的每日日记评估(超过14天)。结果将产生一个有效的SCC筛查，该筛查易于管理和解释，并能够检测认知能力下降和残疾的脑血管风险。由于MCR的深远适用性，结果可能在全球范围内对公共卫生产生重大影响，因为它们将有助于VCID、AD和/或混合性痴呆的早期发现，并为高危个人提供干预机会。此外，拟议的培训计划将推进申请者成为一名独立临床科学家的目标，有助于促进早期发现痴呆症的方法，从而减少弱势群体的健康差距。

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.