Keep it simple – Motoric Cognitive Risk Syndrome to screen for falls

Falls continue to be a major cause of injury and loss of independence in older people.  Therefore, screening for fall risk is an important part of geriatric care.   We previously identified that there is a cumulative effect on fall risk if people suffer from both poorer physical and cognitive function (https://www.ncbi.nlm.nih.gov/pubmed/23410920). The current study built further on these findings by only using clinical measures, which are quick and easy to administer (without the need of a qualified health professional) to make them feasible in a clinical setting. Therefore, we searched for a measure that incorporated both gait and cognition and was quick and easy to administer.

We used the Motoric Cognitive Risk (MCR) syndrome – developed by Prof Joe Verghese (Albert Einstein College of Medicine, USA) – which is characterised by both slow gait and presence of a subjective cognitive complaint, and therefore ideal for our purposes.

Our study aimed to examine if MCR increased the risk of falls and if the diagnosis of the combined MCR was a stronger risk factor for falls than its components (i.e. slow gait or cognitive complaint). Using data from five longitudinal population-based studies (n=6204), we found that 45% of participants reported a cognitive complaint, 13.8% had slow gait, 7.5% had a diagnosis of MCR, and 33.9% reported any fall (see Figure for individual study results).  MCR was associated with a 44% increase of falls in the pooled analysis of all studies.  This increased risk of falls of the combined MCR was higher than for gait speed (30%) or subjective cognitive complaints (25%) alone.

Figure MCR status plotted against the percentage of people who reported any fall

Reprinted from Journal of Alzheimers Disease, , 18;53(3): Callisaya ML,  Ayers E, Barzilai N et al. Motoric Cognitive Risk Syndrome and Falls A multi-center study1043-52. Copyright (2016), with permission from IOS Press”.  The publication is available at IOS Press through http://dx.doi.org/10.3233/JAD-160230

The simplicity and low cost of MCR makes this an attractive falls-risk screening tool for the busy clinician. People with MCR should then proceed to a more thorough multifactorial falls assessment, to understand the cause of the slow gait (e.g. balance assessment) and poor cognitive function (e.g. neuropsychological assessment), and guide a tailored intervention program.

Publication

Callisaya ML, Ayers E, Barzilai N, Ferrucci L, Guralnik JM, Lipton RB, Otahal P, Srikanth VK, Verghese J.  Motoric Cognitive Risk Syndrome and Falls Risk: A Multi-Center Study.

J Alzheimers Dis. 2016 Jun 18;53(3):1043-52. doi: 10.3233/JAD-160230.  http://dx.doi.org/10.3233/JAD-160230

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