Motoric Cognitive Syndrome and Risk of Dementia

Motoric cognitive syndrome is a newly described pre-dementia syndrome characterized by slow gait and cognitive complaints. 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 one has dementia but is indicative of being well on the way towards it.

Motoric cognitive risk (MCR) syndrome is a fairly new ‘predementia assessment.’ It is characterized by cognitive complaints such as slow gait that 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.

Risk of Dementia

Geriatrics professor Joe Verghese involved thousands of older people from 17 different countries and after assessment published his report on the prevalence of motoric cognitive risk syndrome, newly characterized by slow walking and cognitive complaints, in several countries of the world. He also studied its association with dementia risk in the journal Neurology.

 

Indeed 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 – scientists at the Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center opine.

Potential differences in health, behavior and lifestyle factors influence dementia risk between races in different countries. Some risk factors that can increase a person’s chance of developing one or more kinds of dementia are:

  • Age: Risk goes up with advanced age.
  • Alcohol use: Alcohol abuse increases the risk of dementia while drinking a moderated amount may be protective.
  • Atherosclerosis: The accumulation of fats and cholesterol in the lining of arteries coupled with inflammatory process leads to thickening of the vessels which can hinder blood flow to the brain. This can lead to stroke or other brain injury. Bad cholesterol can raise the risk for vascular dementia.
  • Diabetes: Those with diabetes appear to have higher risk for dementia although the evidence for this association is modest. Poorly controlled diabetes is a well – proven risk factor for stroke and cardiovascular disease-related events – which in turn increase the risk for vascular dementia.
  • Down syndrome: Many develop early-onset AD with signs of dementia by the time they reach middle age.
  • Genetics: Likelihood of developing genetically linked form of dementia increases when more than one family member has the disorder. Sometimes, when one parent carries a mutation, it increases the risk of inheriting the condition. Genetic mutations may underlie dementia in specific populations. A mutation of the gene TREM2 found common among people with a form of early onset frontotemporal dementia runs in Turkish families.
  • Hypertension or high blood pressure is linked to cognitive decline, stroke, and types of dementia that affect the white matter regions of the brain.
  • Mental illness: Depression has been associated with mild mental impairment and cognitive function decline.
  • Smoking: Smokers are prone to diseases that slow or stop blood from getting to the brain.

 

Age remains the strongest risk factor for dementia, particularly for Alzheimer’s disease. The incidence of AD doubles every 10 years after the age of 60. A number of studies have found that dementia incidence continues to increase with age after 85 years.

Identifying the early risk factors for dementia could help ward off the crippling disease, according to researchers from Albert Einstein College of Medicine and Montefiore Medical Center. Those with MCR can ward off their risk of dementia by eating right, exercising, maintaining healthy weight and engaging the brain in activity. Healthy people can also ward off dementia in much the same way.

 

Talking of identified potentially modifiable risk factors associated with MCR, research reveals that obesity was associated with 39% greater risk for slow gait and cognitive complaint and sedentary lifestyle was associated with 79% increase risk.

And it was found that slowing gait combined with cognitive complaint has a greater predictive value in patients at risk for dementia than if they feature alone. Patients who had both slow gait and cognitive complaints were nearly twice as likely to develop dementia over 12 years of follow-up. The following predicted a risk of incident MCR:

  • Strokes
  • Parkinson’s disease
  • Depressive symptoms
  • Sedentary lifestyle
  • Obesity

 

The simple strategy of asking older patients if they have memory complaints and timing their walking over 8 and 10 seconds could help predict their risk for developing dementia. A walking speed slower than 1m per second which is about 2.2 miles per hour is considered slow gait and less than 0.6 m per second is considered abnormal.

As spinal fluid, imaging, bio markers and other tools for diagnosing cognitive decline are good but not very actionable for many clinicians, these simple tools as outlined above can help identify people at risk for dementia.

Leg Strength and Aging Brain

An interesting finding from a survey done by Kings College London has shown a surprising link between leg power and brain health. Of course genes and environment also play a role in brain health. The study was done with 324 female twins.

Leg strength was measured by asking the participants to be seated and press on a pedal much like the brake of a car with as much power as they could expend. Other tests encompassed lung function test and grip strength. Of course vital parameters such as blood pressure, blood sugar and cholesterol were checked.

 

Correlation between leg strength and the brain health

The leg muscles are the largest muscle group in the body and any good fitness regimen must include exercises to develop and train them. Other benefits associated with physical activity such as better blood circulation and improved immunity also contribute towards lesser age-related cognitive decline.

 

Exercise releases chemicals and hormones in the body, some of which help boost brain health. Nerve cell growth is encouraged and this plays the key role in maintaining better cognitive function.

Sturdy legs could mean healthy brains, according to a new study of British twins. Older persons with comparatively stronger leg muscles have better mobility than those with weak legs. Loss of muscle strength is also associated with the risk of Alzheimer’s disease (AD) or mild cognitive impairment (MCI).

 

Exercise gives your body a dose of serotonin, dopamine and noradrenaline, all of which work towards making you feel good. There is increased production of BDNF or brain-derived neurotropic factor. This is essential in new brain cell and connection formation in the hippocampus. This growth hormone also offers protection against stress-related brain damage.

 

In fact the journal Neurology quoted a study which recorded that lack of exercise in your 30s and 40s can lead to shrinking brains.

Building your leg muscles and improving lower body strength could go a long way in strengthening your mind too. Keep up the walking. In fact, run or even dance! Squats and lunges could be added to your fitness routine.

Metabolically Healthy Obesity

What is Metabolically Healthy Obesity?

BMI or Body Mass Index is widely used as a measure of weight or obesity. The factors taken into consideration for arriving at your BMI are your weight and height. A BMI between 25 and 30 is considered indicative of being overweight. BMI over 30 is considered obesity.

But BMI is skewed because it doesn’t take into factor many important considerations that characterize an obese person:

  • Physical fitness
  • Fat tissue percentage
  • Waist and hip measurements
  • Insulin resistance
  • Blood pressure, cholesterol and blood sugar levels

It can label a muscular fit person as overweight or even obese. Muscle being denser weighs more. But higher muscle mass ensures a higher metabolic rate. Fat deposition is largely determined by genes. While some pack the pounds around their hips and thighs, others tend to store fat around the abdomen. Abdominal fat increases your fat risk manifold. So merely judging a person by BMI alone is not only inaccurate, it can be counter-productive.

Metabolically Healthy Obesity

A person is considered overweight if he/she has BMI greater than 25. A BMI over 30 puts you in the obese category. Obesity has a close link with cardiovascular risk, raised blood pressure and diabetes. In some cases, it leads to premature death. Fatty liver is most often the cause for metabolic disturbances.

Understanding MHO

Metabolically Healthy Obese or MHO refers to those who classify as overweight or obese by BMI but do not suffer any metabolic abnormalities. In spite of being significantly overweight, they exhibit normal cholesterol levels, healthy blood pressure levels and no signs of diabetes.

MHO persons are obese but with favorable metabolic profile. They are a subgroup of obese persons but whose fat accumulation has not led to adverse metabolic effects such as insulin resistance, hypertension, dyslipidemia and impaired glucose tolerance.

They do not exhibit the typical metabolic red flags that nearly always accompany obesity. Studies show that most persons who are metabolically healthy obese might be in a transient state heading down the road to metabolic disturbances if they do not make lifestyle changes.

The healthy obese tend to carry their fat in the subcutaneous layer, where it is not so harmful. It was also noticed that they did not have fatty livers thereby maintaining normal metabolic health. Do not confuse the metabolically healthy obese with those suffering from lipodystrophy – lack of fat cells. They might appear lean and sans fat, but they are most likely to have fatty livers and ectopic fat.

Obesity is not at all desirable due to its effects on all organs and metabolism. Metabolic dysfunction is the main fallout of obesity. Make lifestyle changes to shed extra weight and you can see manifold benefits. While weight and height might not be the most accurate measure of a person’s health profile, it is always better to shed extra weight as it can lead to lifestyle problems such as painful knees and reduced ability to be active.

 

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