Brain Changes and Fast Cognitive and Motor Decline in Older Adults

• Published in: The journals of gerontology. Series A, Biological sciences and medical sciences Biological sciences and medical sciences, 2023-02, Vol.78 (2), p.326-332
• Main Authors: Grande, Giulia, Vetrano, Davide Liborio, Kalpouzos, Grégoria, Welmer, Anna-Karin, Laukka, Erika J, Marseglia, Anna, Fratiglioni, Laura, Rizzuto, Debora
• Format: Article
• Language: English
• Subjects: Aged; Biomarkers; Brain; Brain - diagnostic imaging; Brain - pathology; Brain injury; Brain lesions; Cognition; Cognitive ability; Cognitive decline; Cognitive Dysfunction - pathology; Diffusion Tensor Imaging; Gait; Gait speed decline; Hippocampus; Humans; Magnetic Resonance Imaging; Medicin och hälsovetenskap; Motor ability; Neuroimaging; Older people; Population-based study; Substantia alba; THE JOURNAL OF GERONTOLOGY: Medical Sciences; Ventricle; White Matter - diagnostic imaging; White Matter - pathology
• ISSN: 1079-5006; 1758-535X; 1758-535X
• DOI: 10.1093/gerona/glac177

To identify brain magnetic resonance imaging (MRI) signatures characterizing people with different patterns of decline in cognition and motor function. In the Swedish National Study on Aging and Care in Kungsholmen, Stockholm, 385 participants had available repeated brain MRI examinations, where markers of brain volumes and white matter integrity were assessed. The speed of cognitive and motor decline was estimated as the rate of a Mini-Mental State Examination and gait speed decline over 12 years (linear mixed models), and further dichotomized into the upper (25% fastest rate of decline) versus the lower quartiles. Participants were grouped in slow/no decliners (reference), isolated motor decliners, isolated cognitive decliners, and cognitive and motor decliners. We estimated the associations between changes in brain markers (linear mixed models) and baseline diffusion tensor imaging measures (linear regression model) and the 4 decline patterns. Individuals with concurrent cognitive and motor decline (n = 51) experienced the greatest loss in the total brain (β: -12.3; 95% confidence interval [CI]: -18.2; -6.38) and hippocampal (β: -0.25; 95% CI: -0.34; -0.16) volumes, the steepest accumulation of white matter hyperintensities (β: 1.61; 95% CI: 0.54; 2.68), and the greatest ventricular enlargement (β: 2.07; 95% CI: 0.67; 3.47). Compared to the reference, those only experiencing cognitive decline presented with steeper hippocampal volume loss, whereas those exhibiting only motor decline displayed a greater white matter hyperintensities burden. Lower microstructural white matter integrity was associated with concurrent cognitive and motor decline. Concurrent cognitive and motor decline is accompanied by rapidly evolving and complex brain pathology involving both gray and white matter. Isolated cognitive and motor declines seem to exhibit brain damage with different qualitative features.