From Dual Decline to Clinical Consequences: Mechanistic Pathways and Health Outcomes of Motoric Cognitive Risk Syndrome

Motoric cognitive risk (MCR) syndrome, defined by the coexistence of slow gait and subjective cognitive decline (SCD), is increasingly recognized as an intermediate stage between normal aging and overt cognitive impairment. Its prevalence varies across populations, largely shaped by demographic, socioeconomic, and lifestyle factors. Neuroimaging evidence further supports this construct, demonstrating gray matter atrophy in prefrontal and premotor regions alongside white matter hyperintensities, both of which have been linked to motor and cognitive deficits in individuals with MCR. The pathogenesis of MCR is likely multifactorial, involving metabolic, inflammatory, and genetic mechanisms that interact to accelerate vulnerability to neurodegeneration. Importantly, MCR has been shown to predict adverse outcomes, including dementia, falls, frailty, and increased mortality, underscoring its potential utility as an early clinical marker of neurodegenerative progression. Given these implications, recent studies have explored preventive and therapeutic strategies, such as aerobic exercise, dual-task cognitive training, dietary interventions, and pharmacological approaches targeting inflammation and metabolic dysfunction, that may mitigate MCR-related risks. Future research should aim to refine diagnostic criteria, integrate multimodal assessments, and develop personalized interventions to more effectively prevent or delay cognitive and motor decline in aging populations.