Cerebral Small Vessel Disease and Motoric Cognitive Risk Syndrome: Results from the Kerala-Einstein Study

Abstract

Background The contribution of cerebral small vessel disease to cognitive decline, especially in non-Caucasian populations, is not well established. Objective We examined the relationship between cerebral small vessel disease and motoric cognitive risk syndrome (MCR), a recently described pre-dementia syndrome, in Indian seniors. Methods 139 participants (mean age 66.6 ± 5.4 y, 33.1% female) participating in the Kerala-Einstein study in Southern India were examined in a cross-sectional study. The presence of cerebral small vessel disease (lacunar infarcts and cerebral microbleeds (CMB)) and white matter hyperintensities on MRI was ascertained by raters blinded to clinical information. MCR was defined by the presence of cognitive complaints and slow gait in older adults without dementia or mobility disability. Results Thirty-eight (27.3%) participants met MCR criteria. The overall prevalence of lacunar infarcts and CMB was 49.6% and 9.4%, respectively. Lacunar infarcts in the frontal lobe, but no other brain regions, were associated with MCR even after adjusting for vascular risk factors and presence of white matter hyperintensities (adjusted Odds Ratio (aOR): 4.67, 95% CI: 1.69–12.94). Frontal lacunar infarcts were associated with slow gait (aOR: 3.98, 95% CI: 1.46–10.79) and poor performance on memory test (β: −1.24, 95% CI: −2.42 to −0.05), but not with cognitive complaints or non-memory tests. No association of CMB was found with MCR, individual MCR criterion or cognitive tests. Conclusions Frontal lacunar infarcts are associated with MCR in Indian seniors, perhaps, by contributing to slow gait and poor memory function.

White Matter Hyperintensities in Older Adults and Motoric Cognitive Risk Syndrome

“…This study also found that BMI was significantly associated with MCR in the French cohort, as demonstrated in previous work [3]. The prevalence of WMH was also consistent with previous studies [14, 22, 24, 39–44]. However, the French cohort did have a higher prevalence of WMH overall.…”

“…This finding suggests that vascular mechanisms other than WMH may contribute to the pathophysiology of MCR, as was previously suggested in the case of regional lacunar infarcts [14]. Wang et al [14] reported that WMH overall were not associated with MCR and our study replicated these findings. Our study further evaluated this by assessing regional WMH in the context of MCR in two independent cohorts of non-demented older adults.…”

“…The prevalence of MCR in this study was within the range of previously published MCR studies [1, 2, 4, 14], but higher than the estimated global prevalence [3]. This study also found that BMI was significantly associated with MCR in the French cohort, as demonstrated in previous work [3].…”

“…Considering previous work suggesting that MCR is predictive of vascular dementia [1, 26], that cerebrovascular disease shares common risk factors with MCR and WMH [1, 3], and that regional WMH have cognitive consequences [3, 4, 20, 21], we hypothesized that MCR would be associated with regional WMH perhaps in the frontal region, as found previously for lacunar infarcts [14]. In this study, we evaluate whether MCR is associated with regional WMH in two large cohorts of non-demented older adults from a developed country, France, and lower-middle income country, India.…”

Motoric Cognitive Risk Syndrome and Falls Risk: A Multi-Center Study

“…Alternatively it is plausible that the combination of slow gait and subjective cognitive complaints increases an individual’s risk of falling by reducing their overall ability to compensate for physical impairments with adequate cognitive function or vice versa. Finally, the few studies examining correlates of MCR have reported associations with higher levels of chronic disease, dementia, depression, hypertension, diabetes, obesity, and sedentariness as well as stroke [12, 13, 38], suggesting MCR may be a good marker of overall health. A number of these factors provide potential targets for therapeutic interventions to prevent falls.…”