Altered cerebellar and caudate gray‐matter volumes and structural covariance networks preceding dual cognitive and mobility impairments in older people.

INTRODUCTION: The neuroanatomical changes driving both cognitive and mobility impairments, an emerging preclinical dementia syndrome, are not fully understood. We examined gray‐matter volumes (GMVs) and structural covariance networks (SCNs) abnormalities in community‐based older people preceding the conversion to physio‐cognitive decline syndrome (PCDS). METHODS: Voxel‐wise brain GMV and established SCNs were compared between PCDS and non‐PCDS converters. RESULTS: The study included 343 individuals (60.2 ± 6.9 years, 49.6% men) with intact cognitive and mobility functions. Over an average 5.6‐year follow‐up, 116 transitioned to PCDS. Identified regions with abnormal GMVs in PCDS converters were over cerebellum and caudate, which served as seeds for SCNs establishment. Significant differences in cerebellum‐based (to right frontal pole and left middle frontal gyrus) and caudate‐based SCNs (to right caudate putamen, right planum temporale, left precentral gyrus, right postcentral gyrus, and left parietal operculum) between converters and nonconverters were observed. DISCUSSION: This study reveals early neuroanatomic changes, emphasizing the cerebellum's role, in dual cognitive and mobility impairments. Highlights: Neuroanatomic precursors of dual cognitive and mobility impairments are identified.Cerebellar GMV reductions and increased right caudate GMV precede the onset of PCDS.Altered cerebellum‐ and caudate‐based SCNs drive PCDS transformation.This research establishes a foundation for understanding PCDS as a specific dementia syndrome. [ABSTRACT FROM AUTHOR]