Low tech medicine has not died yet. A simple, minutes-long test of older adults performed in a physician’s office may correctly diagnose the early stages of dementia, a new study finds. The test, which measures motoric cognitive risk syndrome (MCR), amounts to timing a patient's walking speed and asking whether she or he has any cognitive difficulties. “All that’s needed to assess MCR is a stopwatch and a few questions, so primary care physicians could easily incorporate it into examinations of their older patients,” says Dr. Verghese, the Murray D. Gross Memorial Faculty Scholar in Gerontology at Albert Einstein School of Medicine.
Previously, Verghese and his colleagues studied how abnormal gait patterns might accurately predict whether a patient will go on to develop dementia. “As a young researcher, I examined hundreds of patients and noticed that if an older person was walking slowly, there was a good chance that his cognitive tests were also abnormal,” says Verghese. Hoping to improve on this basic concept, Verghese and his team evaluated whether a patient’s walking speed combined with cognitive difficulties might forecast dementia.
The new study examined the prevalence of MCR among 26,802 adults enrolled in 22 studies in 17 countries. All of the adults were over the age of 60 and none suffered from either dementia or disability. Still, a significant number — just under 10 percent — met the criteria for MCR in that they walked abnormally slow and complained of cognitive difficulties. For this study, a slow walking speed was considered to be less than 2.2 miles per hour. After analyzing the results, the researchers found MCR to be equally common among men and women, while those with less education were more likely to test positive.
Next, the researchers focused on a subset of four of the 22 studies. These four studies included a total of 4,812 patients who had been evaluated for MCR, so the researchers continued to track them annually over an average follow-up period of 12 years. What did the researchers discover? Over the 12 year period, those who met the criteria for MCR were nearly twice as likely to develop dementia than those who had not met the criteria.
Alone, a slow walking speed is not sufficient for a diagnosis of MCR — after all, a condition such as arthritis could affect a patient’s gait without leading to cognitive troubles. To meet the criteria for MCR, Verghese emphasizes, a patient must also demonstrate cognitive problems. “Our assessment method could enable many more people to learn if they’re at risk for dementia, since it avoids the need for complex testing and doesn’t require that the test be administered by a neurologist,” says Verghese. “The potential payoff could be tremendous — not only for individuals and their families, but also in terms of healthcare savings for society.”
Source: Verghese J, Annweiler C, Ayers E, et al. Motoric cognitive risk syndrome: Multi-country prevalence and dementia risk. Neurology. 2014.