Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands.
Eur J Neurol. 2022 Jun;29(6):1587-1599. doi: 10.1111/ene.15281. Epub 2022 Feb 20.
This study was undertaken to compare risk factors, neuroimaging characteristics and prognosis between two clinical prodromes of dementia, namely, the motoric cognitive risk syndrome (MCRS) and mild cognitive impairment (MCI).
Between 2009 and 2015, dementia-free participants of the population-based Rotterdam Study were classified with a dementia prodrome if they had subjective cognitive complaints and scored >1 SD below the population mean of gait speed (MCRS) or >1.5 SD below the population mean of cognitive test scores (MCI). Using multinomial logistic regression models, we determined cross-sectional associations of risk factors and structural neuroimaging markers with MCRS and MCI, followed by subdistribution hazard models, to determine risk of incident dementia until 2016.
Of 3025 included participants (mean age = 70.4 years, 54.7% women), 231 had MCRS (7.6%), 132 had MCI (4.4%), and 62 (2.0%) fulfilled criteria for both. Although many risk factors were shared, a higher body mass index predisposed to MCRS, whereas male sex and hypercholesterolemia were associated with MCI only. Gray matter volumes, hippocampal volumes, white matter hyperintensities, and structural white matter integrity were worse in both MCRS and MCI. During a mean follow-up of 3.9 years, 71 individuals developed dementia and 200 died. Five-year cumulative risk of dementia was 7.0% (2.5%-11.5%) for individuals with MCRS, versus 13.3% (5.8%-20.8%) with MCI and only 2.3% (1.5%-3.1%) in unaffected individuals.
MCRS is associated with imaging markers of neurodegeneration and risk of dementia, even in the absence of MCI, highlighting the potential of motor function assessment in early risk stratification for dementia.
本研究旨在比较两种痴呆临床前体（运动认知风险综合征[MCRS]和轻度认知障碍[MCI]）的危险因素、神经影像学特征和预后。
在 2009 年至 2015 年间，基于人群的鹿特丹研究的无痴呆参与者，如果他们有主观认知主诉并且步态速度（MCRS）低于人群平均值的 1 个标准差以上或认知测试评分（MCI）低于人群平均值的 1.5 个标准差以上，则被归类为痴呆前体。使用多项逻辑回归模型，我们确定了危险因素和结构神经影像学标志物与 MCRS 和 MCI 的横断面关联，然后使用亚分布风险模型，确定了直至 2016 年的痴呆发病风险。
在 3025 名纳入的参与者中（平均年龄为 70.4 岁，54.7%为女性），231 名患有 MCRS（7.6%），132 名患有 MCI（4.4%），62 名（2.0%）同时符合两者的标准。尽管许多危险因素是共同的，但较高的体重指数易患 MCRS，而男性和高胆固醇血症仅与 MCI 相关。MCRS 和 MCI 患者的灰质体积、海马体积、白质高信号和结构白质完整性均较差。在平均 3.9 年的随访期间，71 人发生痴呆，200 人死亡。MCRS 患者的 5 年累积痴呆风险为 7.0%（2.5%-11.5%），MCI 患者为 13.3%（5.8%-20.8%），而未受影响的个体为 2.3%（1.5%-3.1%）。
即使在没有 MCI 的情况下，MCRS 也与神经退行性变的影像学标志物和痴呆风险相关，这突出了运动功能评估在痴呆早期风险分层中的潜力。
