Ask the Doctor: Motoric Cognitive Risk Syndrome; Chronic Fatigue Syndrome; Afib & Stroke Risk

Find out what effect regular exercise can have on motoric cognitive risk syndrome.

Q: Our geriatrician has diagnosed my husband with motoric cognitive risk syndrome and recommended regular exercise to reduce his risk for dementia. What is MCR?

A: Motoric cognitive risk syndrome (MCR) is a newly recognized pre-dementia syndrome that is characterized by a combination of slowing gait speed and cognitive complaints. Research published in November 2014 in the online issue of Neurology suggests that older individuals who meet the criteria for MCR may face two to three times the normal risk for dementia. The study authors propose measuring the walking speed of older adults who have complaints about their memories as a simple clinical tool to help identify individuals at higher risk for dementia. A walking speed of less than one meter (3.28 feet) per second is considered slow, and a speed of 0.6 meters per second is considered abnormal. Older individuals with Parkinson’s disease or a history of stroke are at higher risk for MCR, as are individuals with potentially modifiable risk factors such as depression, obesity, or a sedentary lifestyle. These risk factors may possibly be reversed or reduced if addressed with effective treatment or a change in diet or behavior.

Q: Is it true that researchers have identified brain anomalies that may help explain what causes chronic fatigue syndrome? What are these abnormalities?

A: Chronic fatigue syndrome is characterized by constant, debilitating fatigue that lasts six months or more, and by various other symptoms that may include headaches, pain in the joints and muscles, and gastrointestinal complaints. New research published in the Oct. 28, 2014 issue of Radiology compared the brain scans of 15 individuals with chronic fatigue syndrome to the scans of a group of healthy individuals and found a number of differences. Results showed that participants with chronic fatigue syndrome, but not the healthy participants, had reduced amounts of white matter—the “wiring” in the brain that forms communications networks among brain cells—a possible indication of chronic inflammation; increased volume of gray matter in two brain regions; and a particular abnormality in a brain area that connects the frontal lobe and temporal lobes of the brain. The scientists found that increased severity of this abnormality was linked to increased severity of chronic fatigue syndrome symptoms. These findings may eventually lead to better diagnosis of the condition; however more work must be done before scientists understand precisely how the brain abnormalities trigger disease symptoms.

Q: I have Afib and I read recently that it increases my risk for strokes that occur without any symptoms. Can you tell me more?

A: Atrial fibrillation (Afib), a type of heart arrhythmia, is an electrical malfunction that causes the upper chambers of the heart to beat erratically. The irregular heartbeat can cause blood to pool and coagulate in the heart, and sometimes leads to a clot that breaks free, travels to the brain, blocks circulation, and causes damage to brain tissue. Afib is known to increase risk for symptomatic stroke by a factor of four. On Nov. 4, 2014, MGH researchers published a study online in the Annals of Internal Medicine that suggests that Afib may also double the risk for silent cerebral infarctions, or “silent strokes”—asymptomatic strokes that nevertheless result in brain damage that is visible in brain scans. Silent strokes, which can affect cognition and impair memory, may help explain why Afib is associated with a 40 percent increased risk for cognitive impairment and dementia independent of symptomatic stroke history and other health issues. Further research is necessary to determine whether treatment with anticoagulants or blood thinners would reduce the risk of silent stroke as it does for symptomatic stroke.

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