Dissertations, Theses, and Capstone Projects

Date of Degree

9-2024

Document Type

Dissertation

Degree Name

Ph.D.

Program

Psychology

Advisor

Laura Rabin

Committee Members

Veronica Hinton

Justin Storbeck

Desiree Byrd

Anjali Krishnan

Subject Categories

Psychiatry and Psychology

Keywords

SubjNeuropsychology, Subjective Cognitive Decline, Slow Gait Speed, Dementia, Aging Epidemiology

Abstract

Motoric Cognitive Risk Syndrome (MCR) is a predementia condition that combines two clinical presentations associated with dementia: slow gait speed and subjective cognitive concerns (SCC). MCR diagnosis is associated with increased risk for dementia over its individual components of SCC or slow gait alone, making it a valuable marker of early neurodegenerative changes. MCR does not require expensive, time-consuming assessments to be diagnosed, broadening accessibility in remote or under-resourced settings. At present, there is no consistent method to assess SCC in MCR – a key diagnostic feature of the syndrome. The lack of understanding about SCC in MCR may limit sensitivity to dementia-risk. This project sought to holistically analyze the feasibility of SCC assessment in a cohort of demographically diverse community-dwelling older adults with MCR to predict cognitive and clinical decline. A multifaceted SCC assessment approach was employed, including an expanded version of a widely used paper-and-pencil questionnaire and daily diary evaluation (over 16 days) via smartphone. This project had the following aims: 1. Characterize the current state of SCC classification in the MCR field through a comprehensive analysis of all identified published original research studies on MCR. 2. Investigate a method of classifying SCC in MCR optimized to predict transition from normal cognitive status to cognitive decline. 3. Explore a novel, smartphone-based assessment for the SCC criterion of MCR diagnosis to detect clinical status in MCR. 4. Compare and contrast SCC in MCR and within other predementia diagnoses, including subjective cognitive decline (SCD) and mild cognitive impairment (MCI), cross sectionally and to predict cognitive decline among these clinical groups. Results showed a striking lack of clarity and variability in how the SCC criteria have been operationalized, as revealed through comprehensive analysis of current SCC practices across all published studies. We identified that a multi-item, multi-cognitive domain SCC assessment in MCR was optimized to predict decline; however, this was largely inconsistent with the most common practices in the MCR field. We also demonstrated that a novel, smartphone-based assessment of SCC was comparable to traditional in-person SCC methods for detecting clinical status in MCR, laying the groundwork for establishing a fully remote MCR diagnostic approach. We identified that SCC may be a uniquely useful marker for detecting both concurrent cognitive vulnerabilities and risk for future cognitive decline in MCR, which is in contrast with what we uncovered for other predementia conditions (e.g., SCD and MCI). Taken together, this research highlights the need for attention to SCC in the MCR field and contributes to refined SCC assessment approaches that are easily and remotely administered, and able to detect risk for decline in health disparity, underserved individuals.

Download

This work is embargoed and will be available for download on Tuesday, September 30, 2025

Share

COinS