Association between activities of daily living and motoric cognitive risk syndrome in Chinese older adults: The mediating effect of depression

Background Motoric cognitive risk syndrome (MCR) is a newly identified pre-dementia (e.g., for Alzheimer's disease) syndrome characterized by the coexistence of gait slowing and subjective cognitive complaint. Objective This study investigates the association of activities of daily living (ADL) with MCR and the mediating effect of depression. Methods We used data from the 2011–2015 waves of CHARLS. ADL was measured at baseline, including basic ADL (BADL) and instrumental ADL (IADL). MCR was defined as subjective cognitive complaint plus objectively measured gait slowing. Depression was assessed using the Center for Epidemiologic Studies Depression Scale-10. Logistic regression and Cox proportional hazards models assessed cross-sectional and longitudinal associations between ADL dysfunction and MCR. Mediation analysis assessed the mediating role of depression. Results In the cross-sectional analysis, 4937 participants were included, with a prevalence of MCR of 12.8%. All models revealed that dysfunction in ADL, BADL, and IADL was significantly associated with an increased likelihood of MCR. In the follow-up analysis, MCR prevalence was 6.8% among 3953 participants. Similarly, in all models, dysfunction in ADL, BADL, and IADL remained significantly associated with a higher risk of MCR. Mediation analysis showed that depression explained 36.8%, 50.3%, and 34.2% of the associations of ADL, BADL, and IADL dysfunction with MCR risk, respectively. Conclusions The study suggests that early identification of ADL dysfunction and depression may help facilitate interventions to reduce the incidence of MCR in older adults and mitigate the progression of cognitive decline to dementia.