The systemic Ben Brik score, MAROC 22: A mechanism-anchored bedside instrument for the surveillance of reversible cognitive burden in octogenarians—A single-center pilot

Abstract

BackgroundCognitive decline in octogenarians is routinely attributed to irreversible neurodegeneration, yet a substantial fraction is driven by partly reversible physiological mechanisms. Oxidative and mitochondrial damage are among the earliest events in Alzheimer's disease pathology, upstream of amyloid deposition, and this framework has not been operationalized into a bedside instrument for the oldest-old.ObjectiveTo present the SBG-MAROC 22-a 310-point, 22-parameter, seven-pillar bedside matrix whose item weights are anchored to published hazard ratios for incident dementia-and to report preliminary single-center data on its feasibility and capacity to flag reversible contributors and acute decompensation.MethodsSingle-center, single-author, retrospective pilot. Forty-seven consecutive patients aged ≥ 80 years [mean age 83.7 ± 2.9 years; 55.3% female; baseline Montreal Cognitive Assessment (MoCA) 16.2 ± 4.1] were assessed with the SBG-MAROC 22 alongside the MoCA. A subgroup (n = 11) received the PD-GOLD protocol with MoCA reassessment at ∼45 days. No power calculation or concurrent control group; reporting followed STROBE.ResultsThe score showed a preliminary association with concurrent MoCA (r≈0.78), within-pilot inter-rater agreement (κ≈0.85), and at least one reversible contributor in 89.4% of patients. The treated subgroup gained a mean +6.0 MoCA points at 45 days (95% CI +3.0 to +9.0; prediction interval -3.1 to +15.1, crossing zero). An exploratory FXTAS-versus-Alzheimer's area under the curve was 0.92. All values are internal, uncontrolled pilot estimates, not validation.ConclusionsThe SBG-MAROC 22 is a clinically feasible, MRI-independent bedside instrument whose hypothesis-generating profile warrants independent, blinded, prospective multicenter validation before any clinical use. Claims of validated discrimination or therapeutic efficacy are not made.