Sex differences in the prevalence and incidence of motoric cognitive risk syndrome: a systematic review and meta-analysis

Abstract

Motoric cognitive risk (MCR) syndrome, a pre-dementia construct combining subjective cognitive complaints with slow gait speed, shows inconsistent sex differences in prevalence and incidence across studies, possibly reflecting differences in gait speed diagnostic criteria rather than biological differences. We conducted a systematic review and meta-analysis (PRISMA 2020; PubMed, Web of Science, Embase, and Scopus; January 2013–March 2026), pooling sex-difference risk ratios (RR, male vs. female) with random-effects models (Hartung–Knapp–Sidik–Jonkman adjustment); subgroup analyses and meta-regression examined gait speed criteria, age, region, and study quality. Sixty prevalence cohorts ( N  = 170,930) and 18 incidence cohorts ( N  = 35,006) were included. Pooled MCR prevalence was 9.13%, with significant female predominance (RR = 0.90, 95% CI: 0.83–0.98, p  = 0.015) that varied by gait speed criteria (QB p  = 0.043): significant under absolute thresholds (RR = 0.76) but attenuated under standard deviation–based definitions (RR = 0.95). Incidence showed a similar, non-significant trend (RR = 0.93, p  = 0.085), and the sex difference was significant in younger ( < 75 years) but not older cohorts. This female predominance co-varies with gait speed criteria type, suggesting an anthropometric measurement artifact as a partial contributor; MCR studies should specify diagnostic criteria and report sex-stratified estimates under both threshold types.