1 Gait and Brain Laboratory Parkwood Institute Lawson Health Research Institute London Ontario Canada.
2 Division of Geriatric Medicine Department of Medicine Schulich School of Medicine and Dentistry London Ontario Canada.
3 Department of Epidemiology and Biostatistics University of Western Ontario London Ontario Canada.
4 Departments of Psychiatry Clinical Neurosciences and Community Health Sciences Hotchkiss Brain Institute and O'Brien Institute for Public Health University of Calgary Calgary Alberta Canada.
5 Centre for Research in Human Development Concordia University Montreal Quebec Canada.
6 Department of Psychology Concordia University Quebec Canada.
7 Division of Neurology Department of Medicine Sunnybrook Health Sciences Centre Toronto Ontario Canada.
8 School of Physiotherapy Dalhousie University Halifax Nova Scotia Canada.
9 Department of Medicine Dalhousie University Halifax Nova Scotia Canada.
10 Department of Neurology Albert Einstein College of Medicine Bronx New York USA.
11 Division of Neurology Department of Medicine University of Alberta Edmonton Alberta Canada.

Introduction: Cognitive impairment is the hallmark of Alzheimer's disease (AD) and related dementias. However, motor decline has been recently described as a prodromal state that can help to detect at-risk individuals. Similarly, sensory changes, sleep and behavior disturbances, and frailty have been associated with higher risk of developing dementia. These clinical findings, together with the recognition that AD pathology precedes the diagnosis by many years, raises the possibility that non-cognitive changes may be early and non-invasive markers for AD or, even more provocatively, that treating non-cognitive aspects may help to prevent or treat AD and related dementias.

Methods: A subcommittee of the Canadian Consensus Conference on Diagnosis and Treatment of Dementia reviewed areas of emerging evidence for non-cognitive markers of dementia. We examined the literature for five non-cognitive domains associated with future dementia: motor, sensory (hearing, vision, olfaction), neuro-behavioral, frailty, and sleep. The Grading of Recommendations Assessment, Development, and Evaluation system was used to assign the strength of the evidence and quality of the recommendations. We provide recommendations to primary care clinics and to specialized memory clinics, answering the following main questions: (1) What are the non-cognitive and functional changes associated with risk of developing dementia? and (2) What is the evidence that sensory, motor, behavioral, sleep, and frailty markers can serve as potential predictors of dementia?

Results: Evidence supported that gait speed, dual-task gait speed, grip strength, frailty, neuropsychiatric symptoms, sleep measures, and hearing loss are predictors of dementia. There was insufficient evidence for recommending assessing olfactory and vision impairments as a predictor of dementia.

Conclusions: Non-cognitive markers can assist in identifying people at risk for cognitive decline or dementia. These non-cognitive markers may represent prodromal symptoms and several of them are potentially amenable to treatment that might delay the onset of cognitive decline.