Relationship between frailty and cognitive decline in older Mexican Americans

Physical Frailty and cognitive performance in older populations, part I: systematic review with meta-analysis

The purpose of present study was to analyze the magnitude of the effect-size in the assessment of the cognitive status of populations over 60 years of age. The search strategy included PubMed, B-on, Ebsco, Ebsco Health, Scielo, Eric, Lilacs and Sportdiscus data bases. Only observational, cohort and cross-sectional studies were included in the meta-analysis. The central descriptors were elderly-frail, older adults, cognition and geriatric assessment and other additional terms. After applying the additional search criteria, 12 manuscripts were selected from an initial universe of 1,078 identified. When comparing the mean cognitive profile scores of the participants of the pre-frail (n =11,265) and frail (n = 2,460) groups, significant statistical differences were found (p<0,001), with lower mean scores emerging in frail-group. The results showed that cognitive decline is strongly associated with frailty, being a probable main clinical outcome. In this sense, any strategy aimed at mitigating or reversing the incidence of frailty with ageing should take into account that physical and cognitive frailty seem to have similar temporal trajectories.

The modifying effect of positive emotion on the relationship between cognitive impairment and disability among older Mexican Americans: a cohort study

OBJECTIVE

To determine if positive emotion modifies the relationship between cognitive impairment and activities of daily living disability status over 10 years in Mexican American adults aged 75 years and older.

METHODS

A retrospective cohort design using data from the Hispanic established populations for the epidemiologic studies of the elderly. About 2674 participants aged 75 years and older were included and followed over 10 years. Cognition was measured using the mini-mental state examination, positive emotion was measured using four questions from the Center for Epidemiologic Studies Depression Scale, and disability was measured using seven activities of daily living items. A series of generalized estimating equations models were used, with the initial analysis including those with disability at baseline and subsequent analyses excluding disability at baseline.

RESULTS

Positive emotion and cognitive impairment consistently decreased and increased risk for activities of daily living disability, respectively. Positive emotion was a significant modifier in the cross-sectional analysis, and was not a statistically significant modifier in the longitudinal or predictive series analysis.

CONCLUSIONS

Positive emotion and cognitive impairment differentially affect the risk of developing activities of daily living disability. Further research is needed to explore the interaction of positive emotion and cognitive impairment, and to identify appropriate interventions that address the specific cognitive and emotional needs of older Mexican Americans. Implications for rehabilitation Promoting emotional well-being may be protective against incident disability for older adults. Cognitive impairment significantly predicts incident disability in activities of daily living and should be considered an early indicator of impending disability for older adults.

Hericium erinaceus Improves Recognition Memory and Induces Hippocampal and Cerebellar Neurogenesis in Frail Mice during Aging

Frailty is a geriatric syndrome associated with both locomotor and cognitive decline, implicated in both poor quality of life and negative health outcomes. One central question surrounding frailty is whether phenotypic frailty is associated with the cognitive impairment during aging. Using spontaneous behavioral tests and by studying the dynamic change during aging, we demonstrated that the two form of vulnerability, locomotor and recognition memory decline, develop in parallel and therefore, integration of the motoric and cognitive evaluations are imperative. We developed an integrated frailty index based on both phenotypic and recognition memory performances. Hericium erinaceus (H. erinaceus) is a medicinal mushroom that improves recognition memory in mice. By using HPLC-UV-ESI/MS analyses we obtained standardized amounts of erinacine A and hericenones C and D in H. erinaceus extracts, that were tested in our animal model of physiological aging. Two-month oral supplementation with H. erinaceus reversed the age-decline of recognition memory. Proliferating cell nuclear antigen (PCNA) and doublecortin (DCX) immunohistochemistry in the hippocampus and cerebellum in treated mice supported a positive effect of an H. erinaceus on neurogenesis in frail mice.

Cognitive Assessment of Older People: Do Sensory Function and Frailty Matter?

Background: To examine the associations of visual and hearing functions, and frailty with subjective memory complaints (SMCs) in a community primary care pilot project of older people aged 60 years and over. Methods: The study was conducted in 24 community centers. A total of 1949 community-dwelling older people aged between 60⁻97 years were evaluated for which detailed information regarding socio-demographics, lifestyle, and clinical factors were documented at baseline and an average of 12 months later. SMCs were assessed using the 5-item Abbreviated Memory Inventory for the Chinese (AMIC). Visual and hearing functions were measured with two separate single questions. Frailty was assessed using a simple frailty question (FRAIL). Results: At baseline, 1685 (74.6%) participants had reported at least 3 SMCs (AMIC score ≥ 3). Of the 573 participants without / with 1⁻2 SMCs (AMIC score = 0⁻2) at baseline, 75 had incomplete data regarding SMCs and 190 developed at least 3 SMCs after 12 months. After adjustments for age, sex, marital status, educational level, hypertension, and diabetes at baseline, poor vision (OR 2.2 95% CI 1.8⁻2.7), poor hearing (OR 2.2 95% CI 1.8⁻2.8), and frailty (OR 4.6 95% CI 3.1⁻6.7) at baseline were each significantly associated with an increased risk of at least 3 SMCs at follow-up. After a further adjustment for baseline SMCs, the associations remained significant. Similar results were obtained when incident SMCs and improvement in subjective memory were used as the outcome variables; and Conclusions: In the care of older people, detection of sensory impairment and frailty through screening may allow formulation of strategies to prevent or delay the onset of cognitive decline.

Assessing the Impact of Frailty on Cognitive Function in Older Adults Receiving Home Care

It is commonly accepted that frailty and dementia-related cognitive decline are strongly associated. However, degree of this association is often debated, especially in homebound elders with disabilities. Therefore, this study aimed to investigate the association of frailty on cognitive function in older adults receiving homecare. A screening for frailty and cognitive function was conducted at 12 primary healthcare settings of the nationally funded program "Help at Home" in Heraklion Crete, Greece. Cognitive function and frailty were assessed using the Montreal Cognitive Assessment questionnaire and the SHARE-f index, respectively. Barthel-Activities of Daily Living and the Charlson Comorbidity Index were also used for the identification of disability and comorbidity, respectively. The mean age of the 192 participants (66% female) was 78.04 ± 8.01 years old. In depth-analysis using multiple linear regression, revealed that frailty was not significantly associated with cognitive decline (frail vs. non-frail (B'=-2.39, p=0.246) even after adjusting for depression and multi-comorbidity. Importantly, as protective factors for cognitive decline progression and thus dementia development, was scientifically correlated with annual individual income >4500 (B'=2.31, p=0.005) -poverty threshold-compared to those with <4500 and, higher education level as compared to Uneducated (B'=2.94, p=0.019). However, depression was associated with cognitive decline regardless of socioeconomic variables. In conclusion, our results suggest that health professionals caring for frail people with cognitive impairment, must focus on early recognition and management of depression.

Pre-Operative Frailty Status Is Associated with Cardiac Rehabilitation Completion: A Retrospective Cohort Study

While previous investigations have demonstrated the benefit of cardiac rehabilitation (CR) on outcomes after cardiac surgery, the association between pre-operative frailty and post-operative CR completion is unclear. The purpose of this retrospective cohort study was to determine if pre-operative frailty scores impacted CR completion post-operatively and if CR completion influenced frailty scores in 114 cardiac surgery patients. Frailty was assessed with the use of the Clinical Frailty Scale (CFS), the Modified Fried Criteria (MFC), the Short Physical Performance Battery (SPPB), and the Functional Frailty Index (FFI). A Mann-Whitney test was used to compare frailty scores between CR completers and non-completers and changes in frailty scores from baseline to 1-year post-operation. CR non-completers were more frail than CR completers at pre-operative baseline based on the CFS (p = 0.01), MFC (p < 0.001), SPPB (p = 0.007), and the FFI (p < 0.001). A change in frailty scores from baseline to 1-year post-operation was not detected in either group using any of the four frailty assessments. However, greater improvements from baseline to 1-year post-operation in two MFC domains (cognitive impairment and low physical activity) and the physical domain of the FFI were found in CR completers as compared to CR non-completers. These data suggest that pre-operative frailty assessments have the potential to identify participants who are less likely to attend and complete CR. The data also suggest that frailty assessment tools need further refinement, as physical domains of frailty function appear to be more sensitive to change following CR than other domains of frailty.

Prevalence and Prognosis of Coexisting Frailty and Cognitive Impairment in Patients on Continuous Ambulatory Peritoneal Dialysis

The aim of this study was to investigate the prevalence of coexisting frailty and cognitive impairment and its association with clinical outcomes in patients on continuous ambulatory peritoneal dialysis (CAPD). Patients on CAPD started to enroll from 2014 to 2016 and ended follow-up by 2017. Frailty was assessed by clinical frailty scale (CFS), and cognitive function was assessed by Montreal Cognitive Assessment (MoCA). Totally 784 CAPD patients were recruited, with median duration of PD 30.7 (8.9~54.3) months. The mean age was 48.8 ± 14.6 years, 320 (40.8%) patients were female and 130 (16.6%) had diabetic nephropathy. Patients with cognitive impairment were more than those with frailty (55.5% vs. 27.6%). Coexisting frailty and cognitive impairment was present in 23.9% patients. Pathway analysis showed that CFS score was negatively associated with MoCA score (β = −0.69, P < 0.001). Coexisting frailty and cognitive impairment was associated with decreased patient survival rate (Log-rank = 84.33, P < 0.001) and increased peritonitis rate (0.22 vs. 0.11, 0.15 and 0.12 episodes per patient year, respectively; all P < 0.001). It was concluded that there was a relatively high prevalence of coexisting frailty and cognitive impairment among patients on CAPD. Frailty was positively associated with cognitive impairment. Coexisting frailty and cognitive impairment increased the risk of adverse outcomes.

Age of Migration Differentials in Life Expectancy With Cognitive Impairment: 20-Year Findings From the Hispanic-EPESE

Background and Objectives

To examine differences in life expectancy with cognitive impairment among older Mexican adults according to nativity (U.S.-born/foreign-born) and among immigrants, age of migration to the United States.

Research Design and Methods

This study employs 20 years of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to estimate the proportion of life spent cognitively healthy and cognitively impaired prior to death among older Mexican adults residing in the southwestern United States. We combine age-specific mortality rates with age-specific prevalence of cognitive impairment, defined as a Mini-Mental Status Exam score of less than 21 points to calculate Sullivan-based life table models with and without cognitive impairment in later life.

Results

Foreign-born Mexican immigrants have longer total life expectancy and comparable cognitive healthy life expectancy regardless of gender compared to U.S.-born Mexican-Americans. However, the foreign-born spend a greater number of years after age 65 with cognitive impairment relative to their U.S.-born counterparts. Furthermore, we document an advantage in life expectancy with cognitive impairment and proportion of years after age 65 cognitively healthy among mid-life immigrant men and women relative to early- and late-life migrants.

Discussion and Implications

The relationship between nativity, age of migration, and life expectancy with cognitive impairment means that the foreign-born are in more need of support and time-intensive care in late life. This issue merits special attention to develop appropriate and targeted screening efforts that reduce cognitive decline for diverse subgroups of older Mexican-origin adults as they age.

The exerkine apelin reverses age-associated sarcopenia

Sarcopenia, the degenerative loss of skeletal muscle mass, quality and strength, lacks early diagnostic tools and new therapeutic strategies to prevent the frailty-to-disability transition often responsible for the medical institutionalization of elderly individuals. Herein we report that production of the endogenous peptide apelin, induced by muscle contraction, is reduced in an age-dependent manner in humans and rodents and is positively associated with the beneficial effects of exercise in older persons. Mice deficient in either apelin or its receptor (APLNR) presented dramatic alterations in muscle function with increasing age. Various strategies that restored apelin signaling during aging further demonstrated that this peptide considerably enhanced muscle function by triggering mitochondriogenesis, autophagy and anti-inflammatory pathways in myofibers as well as enhancing the regenerative capacity by targeting muscle stem cells. Taken together, these findings revealed positive regulatory feedback between physical activity, apelin and muscle function and identified apelin both as a tool for diagnosis of early sarcopenia and as the target of an innovative pharmacological strategy to prevent age-associated muscle weakness and restore physical autonomy.

Frailty Phenotype and Neuropsychological Test Performance: A Preliminary Analysis

Context

Frailty is a common problem that affects adults older than 65 years. Correlations between the frailty phenotype and neuropsychological impairment have not been thoroughly researched.

Objective

To examine the association between frailty phenotype, neuropsychological screening test results, and neuropsychological domains known to characterize patients with mild cognitive impairment and dementia.

Methods

This retrospective medical record analysis consisted of ambulatory patients aged 65 years or older seen in an outpatient geriatric practice. All patients were assessed with the Montreal Cognitive Assessment (MoCA). A portion of those patients also underwent a comprehensive neuropsychological evaluation that assessed executive control, naming/lexical access, and declarative memory expressed as 3 neuropsychological index scores. Frailty phenotype was determined using criteria by Fried et al.

Results

Simple correlation found that lower MoCA test scores were associated with a higher level of frailty (r=-0.34, P<.032). Regression analyses found that greater frailty was associated with worse performance on tests that assessed executive control and working memory (backward digit span; r2=0.267; β=-0.517; P<.011) and delayed recognition memory (r2=0.207; β=-0.455; P<.025).

Conclusion

A correlation was found between frailty and neuropsychological impairment, which suggests that frailty may be a potential indicator for the emergence of mild cognitive impairment and dementia.

Physical frailty and cognitive status over-60 age populations: A systematic review with meta-analysis

The aim of this meta-analysis was to analyse the magnitude of the effect-size of the cognitive status of populations over 60 years of age, when comparing nonfrail versus pre-frail and nonfrail versus frail subgroups. A systematic review of prospective studies published from 2000 to 2017 was completed in Medline, B-on, Ebsco, Ebsco Health, Scielo, ERIC, LILACS and Sport discus databases and observational, cohort and cross-sectional studies were selected. The Mini-Mental State Examination to screening cognitive status and the Fried phenotype for assess physical frailty state was used as clinical outcomes. After applying additional search criteria, 14 manuscripts (26,798 old participants) were selected from an initial universe of 1681 identified. When comparing the scores of cognitive status of the participants who were non-frail (n = 12,729, 47.4%) versus pre-frail (n = 11,559, 43.2%) and non-frail versus frail (n = 2452, 9.4%) subgroups, significant statistical differences were found for both comparisons (M ± SD = 0.60, 95%CI: 0.50-0.62, p < 0.001 and M ± SD = 3.43, 95%CI: 2.26-4.60, p < 0.001, respectively). It is clear that poor cognitive function is strongly closed associated with pre-frailty and frailty subgroups in older populations around the world.

Association Between Frailty and HIV-Associated Neurodegenerative Disorders Among Older Adults Living with HIV

The population of aging adults living with human immunodeficiency virus (HIV) is growing worldwide and evidence suggests that frailty occurs prematurely among them. In turn, frailty has been associated with cognitive decline. It is unknown, however, if people with both frailty and HIV infection have a higher risk of cognitive impairment compared with nonfrail HIV-infected persons. Therefore, the main objective of this study was to determine the association between the phenotype of frailty and HIV-associated neurocognitive disorders (HAND) among adults aged 50 years or older living with HIV/AIDS. A cross-sectional study was conducted on 206 adults living with HIV receiving care in a university-affiliated tertiary care hospital in Mexico City. Frailty was defined as per the Fried criteria. The presence of HAND was established according to the Antinori criteria: HIV-associated asymptomatic neurocognitive impairment (ANI), HIV-associated mild neurocognitive disorder (MND), or cognitively nonimpaired. Multinomial logistic regression models were used to test the independent association between frailty and HAND adjusting for potential confounders. Mean age of participants was 60.5 ± 6.3 years and 84.9% were male. Prevalence of HAND and frailty phenotype was 66.0% and 2.9%, respectively. The unadjusted analysis showed that both prefrail and frail statuses were associated with MND but not with ANI. However, after adjustment, the association with MND remained significant only among prefrail participants and no longer for frail persons (risk ratio [RR] = 5.7, 95% confidence intervals [CI] 1.09-29.82; p = .039 and RR = 18.3, 95% CI 0.93-362.6; p = .056, respectively). Prefrailty is associated with symptomatic neurocognitive disorders in older adults living with HIV. The spectrum of the frailty phenotype in this already vulnerable population should serve as an indicator of concomitant cognitive decline.

Association Between Frailty and HIV-Associated Neurodegenerative Disorders Among Older Adults Living with HIV

The population of aging adults living with human immunodeficiency virus (HIV) is growing worldwide and evidence suggests that frailty occurs prematurely among them. In turn, frailty has been associated with cognitive decline. It is unknown, however, if people with both frailty and HIV infection have a higher risk of cognitive impairment compared with nonfrail HIV-infected persons. Therefore, the main objective of this study was to determine the association between the phenotype of frailty and HIV-associated neurocognitive disorders (HAND) among adults aged 50 years or older living with HIV/AIDS. A cross-sectional study was conducted on 206 adults living with HIV receiving care in a university-affiliated tertiary care hospital in Mexico City. Frailty was defined as per the Fried criteria. The presence of HAND was established according to the Antinori criteria: HIV-associated asymptomatic neurocognitive impairment (ANI), HIV-associated mild neurocognitive disorder (MND), or cognitively nonimpaired. Multinomial logistic regression models were used to test the independent association between frailty and HAND adjusting for potential confounders. Mean age of participants was 60.5 ± 6.3 years and 84.9% were male. Prevalence of HAND and frailty phenotype was 66.0% and 2.9%, respectively. The unadjusted analysis showed that both prefrail and frail statuses were associated with MND but not with ANI. However, after adjustment, the association with MND remained significant only among prefrail participants and no longer for frail persons (risk ratio [RR] = 5.7, 95% confidence intervals [CI] 1.09-29.82; p = .039 and RR = 18.3, 95% CI 0.93-362.6; p = .056, respectively). Prefrailty is associated with symptomatic neurocognitive disorders in older adults living with HIV. The spectrum of the frailty phenotype in this already vulnerable population should serve as an indicator of concomitant cognitive decline.

Increasing use of cognitive measures in the operational definition of frailty-A systematic review

Ageing is associated both with frailty and cognitive decline. The quest for a unifying approach has led to a new concept: cognitive frailty. This systematic review explores the contribution of cognitive assessment in frailty operationalization. PubMed, Web of Knowledge and PsycINFO were searched until December 2016 using the keywords aged; frail elderly; aged, 80 and over; frailty; diagnosis; risk assessment and classification, yielding 2863 hits. Seventy-nine articles were included, describing 94 frailty instruments. Two instruments were not sufficiently specified and excluded. 46% of the identified frailty instruments included cognition. Of these, 85% were published after 2010, with a significant difference for publication date (X² = 8.45, p < .05), indicating increasing awareness of the contribution of cognitive deficits to functional decline. This review identified 7 methods of cognitive assessment: dementia as co-morbidity; objective cognitive-screening instruments; self-reported; specific signs and symptoms; delirium/clouding of consciousness; non-specific cognitive terms and mixed assessments. Although cognitive assessment has been increasingly integrated in recently published frailty instruments, this has been heterogeneously operationalized. Once the domains most strongly linked to functional decline will have been identified and operationalized, this will be the groundwork for the identification of reversible components, and for the development of preventive interventional strategies.

Frailty and diabetes among Mexican American older adults

PURPOSE

Progressive physical frailty in older adults is associated with increased risk of falls, disability, institutionalization, and mortality. Although associations between diabetes and frailty have been observed, the impact of diabetes on frailty in older Hispanics is largely unexplored. We examine the association of diabetes on the odds of frailty among older Mexican Americans.

METHODS

Using data from the Hispanic Established Population for the Epidemiological Study of the Elderly from 1995 until 2012, frailty was assessed by slow gait, weak hand grip strength, exhaustion, and unexplained weight loss (n = 1327).

RESULTS

Logistic regression showed a large magnitude of effect of diabetes on the odds of frailty (odds ratio 1.47, 95% confidence interval 1.14-1.90). Other contributors to frailty included arthritis, heart attack, and hip fracture. Positive and negative effects had significant and opposing associations. Ordinal logit models assessed the odds of frail compared to nonfrail and prefrail. In these models, diabetes was associated with a 32% increase in the odds of a higher level of frailty.

CONCLUSIONS

Diabetes is a significant contributor to increased frailty in older Mexican Americans. Interventions to reduce frailty rates should focus on mitigating the effects of diabetes and shifting away from negative and toward positive effect.

Observational Evidence of the Association Between Handgrip Strength, Hand Dexterity, and Cognitive Performance in Community-Dwelling Older Adults: A Systematic Review

BACKGROUND

Deterioration of hand motor function is a possible risk factor of cognitive impairment in older adults. Despite a growing body of research, a lack of clarity exists regarding the relationships. This review offers a synthesis of existing observational studies evaluating the associations of handgrip strength and hand dexterity with cognitive performance in community-dwelling older adults.

METHODS

PubMed, PsycINFO, and ScienceDirect were systematically searched (search dates: 1990-2016), and relevant articles were cross-checked for related and relevant publications.

RESULTS

Twenty-two observational studies assessed the association of handgrip strength or hand dexterity with cognitive performance; none evaluated handgrip strength and hand dexterity together. Handgrip strength was associated with global cognition, mostly assessed using the Mini-Mental State Examination, cross-sectionally and longitudinally. Also, one cross-sectional and three longitudinal studies found an association with cognitive domains, such as language, memory, visuospatial ability, working memory, and processing speed. Hand dexterity was only assessed cross-sectionally in four studies. These studies found an association with cognitive domains, such as executive function.

CONCLUSIONS

Although handgrip strength was associated with cognitive performance, it is unclear which variable at baseline affects the other in the long-term. Cross-sectional studies indicate an association between hand dexterity and cognitive performance, yet longitudinal studies are needed to elucidate this association. The interaction effects of both decreased grip strength and hand dexterity on cognitive performance is still unclear; therefore, future studies will need to consider the interaction of the three variables cross-sectionally and longitudinally.

The Effects of Combinations of Cognitive Impairment and Pre-frailty on Adverse Outcomes from a Prospective Community-Based Cohort Study of Older Chinese People

Objectives

To examine how various combinations of cognitive impairment (overall performance and specific domains) and pre-frailty predict risks of adverse outcomes; and to determine whether cognitive frailty may be defined as the combination of cognitive impairment and the presence of pre-frailty.

Design

Community-based cohort study.

Participants

Chinese men and women (n = 3,491) aged 65+ without dementia, Parkinson’s disease and/or frailty at baseline.

Measurements

Frailty was characterized using the Cardiovascular Health Study criteria. Overall cognitive impairment was defined by a Cantonese Mini-Mental Status Examination (CMMSE) total score (<21/24/27, depending on participants’ educational levels); delayed recall impairment by a CMMSE delayed recall score (<3); and language and praxis impairment by a CMMSE language and praxis score (<9). Adverse outcomes included poor quality of life, physical limitation, increased cumulative hospital stay, and mortality.

Results

Compared to those who were robust and cognitively intact at baseline, those who were robust but cognitively impaired were more likely to develop pre-frailty/frailty after 4 years (P < 0.01). Compared to participants who were robust and cognitively intact at baseline, those who were pre-frail and with overall cognitive impairment had lower grip strength (P < 0.05), lower gait speed (P < 0.01), poorer lower limb strength (P < 0.01), and poorer delayed recall at year 4 [OR, 1.6; 95% confidence interval (CI), 1.2–2.3]. They were also associated with increased risks of poor quality of life (OR, 1.5; 95% CI, 1.1–2.2) and incident physical limitation at year 4 (OR, 1.8; 95% CI, 1.3–2.5), increased cumulative hospital stay at year 7 (OR, 1.5; 95% CI, 1.1–2.1), and mortality over an average of 12 years (OR, 1.5; 95% CI, 1.0–2.1) after adjustment for covariates. There was no significant difference in risks of adverse outcomes between participants who were pre-frail, with/without cognitive impairment at baseline. Similar results were obtained with delayed recall and language and praxis impairments.

Conclusion

Robust and cognitively impaired participants had higher risks of becoming pre-frail/frail over 4 years compared with those with normal cognition. Cognitive impairment characterized by the CMMSE overall score or its individual domain score improved the predictive power of pre-frailty for poor quality of life, incident physical limitation, increased cumulative hospital stay, and mortality. Our findings support to the concept that cognitive frailty may be defined as the occurrence of both cognitive impairment and pre-frailty, not necessarily progressing to dementia.

Impact of Aging on the Auditory System and Related Cognitive Functions: A Narrative Review

Age-related hearing loss (ARHL), presbycusis, is a chronic health condition that affects approximately one-third of the world's population. The peripheral and central hearing alterations associated with age-related hearing loss have a profound impact on perception of verbal and non-verbal auditory stimuli. The high prevalence of hearing loss in the older adults corresponds to the increased frequency of dementia in this population. Therefore, researchers have focused their attention on age-related central effects that occur independent of the peripheral hearing loss as well as central effects of peripheral hearing loss and its association with cognitive decline and dementia. Here we review the current evidence for the age-related changes of the peripheral and central auditory system and the relationship between hearing loss and pathological cognitive decline and dementia. Furthermore, there is a paucity of evidence on the relationship between ARHL and established biomarkers of Alzheimer's disease, as the most common cause of dementia. Such studies are critical to be able to consider any causal relationship between dementia and ARHL. While this narrative review will examine the pathophysiological alterations in both the peripheral and central auditory system and its clinical implications, the question remains unanswered whether hearing loss causes cognitive impairment or vice versa.

Dual Task Gait Performance in Frail Individuals with and without Mild Cognitive Impairment

BACKGROUND

Several studies have stated that frailty is associated with cognitive impairment. Based on various studies, cognition impairment has been considered as a component of frailty. Other authors have shown that physical frailty is associated with low cognitive performance. Dual task gait tests are used as a strong predictor of falls in either dementia or frailty. Consequently, it is important to investigate dual task walking tests in elderly populations including control robust oldest old, frail oldest old with mild cognitive impairment (MCI) and frail oldest old without MCI.

METHODS

Dual task walking tests were carried out to examine the association between frailty and cognitive impairment in a population with advanced age. Forty-one elderly men and women participated in this study. The subjects from control, frail with MCI and frail without MCI groups, completed the 5-meter walk test at their own gait velocity. Arithmetic and verbal dual task walking performance was also assessed. Kinematic data were acquired from a unique tri-axial inertial sensor.

RESULTS

The spatiotemporal and frequency parameters related to gait disorders did not show any significant differences between frail with and without MCI groups.

CONCLUSIONS

The evaluation of these parameters extracted from the acceleration signals led us to conclude that these results expand the knowledge regarding the common conditions in frailty and MCI and may highlight the idea that the impairment in walking performance does not depend of frailty and cognitive status.

Physical Frailty Is Associated with Longitudinal Decline in Global Cognitive Function in Non-Demented Older Adults: A Prospective Study

OBJECTIVES

To assess the relationship between physical frailty and subsequent decline in global cognitive function in the non-demented elderly.

DESIGN AND SETTING

A prospective population-based study in a west Japanese suburban town, with two-year follow-up.

PARTICIPANTS

Community-dwellers aged 65 and older without placement in long-term care, and not having a history of dementia, Parkinson's disease and depression at baseline, who participated in the cohort of the Sasaguri Genkimon Study and underwent follow-up assessments two years later (N = 1,045).

MEASUREMENTS

Global cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Physical frailty was identified according to the following five components: weight loss, low grip strength, exhaustion, slow gait speed and low physical activities. Linear regression models were used to examine associations between baseline frailty status and the MoCA scores at follow-up. Logistic regression models were used to estimate the risk of cognitive decline (defined as at least two points decrease of MoCA score) according to baseline frailty status.

RESULTS

Seven hundred and eight non-demented older adults were included in the final analyses (mean age: 72.6 ± 5.5 years, male 40.3%); 5.8% were frail, and 40.8% were prefrail at baseline. One hundred and fifty nine (22.5%) participants experienced cognitive decline over two years. After adjustment for baseline MoCA scores and all confounders, being frail at baseline was significantly associated with a decline of 1.48 points (95% confidence interval [CI], -2.37 to -0.59) in MoCA scores, as compared with non-frailty. Frail persons were over two times more likely to experience cognitive decline (adjusted odds ratio 2.28; 95% CI, 1.02 to 5.08), compared to non-frail persons.

CONCLUSION

Physical frailty is associated with longitudinal decline in global cognitive function in the non-demented older adults over a period of two years. Physically frail older community-dwellers should be closely monitored for cognitive decline that can be sensitively captured by using the MoCA.

Characterisation of Physical Frailty and Associated Physical and Functional Impairments in Mild Cognitive Impairment

Objective

To characterize the physical frailty phenotype and its associated physical and functional impairments in mild cognitive impairment (MCI).

Method

Participants with MCI (N = 119), normal low cognition (NLC, N = 138), and normal high cognition (NHC, N = 1,681) in the Singapore Longitudinal Ageing Studies (SLAS-2) were compared on the prevalence of physical frailty, low lean body mass, weakness, slow gait, exhaustion and low physical activity, and POMA balance and gait impairment and fall risk.

Results

There were significantly higher prevalence of frailty in MCI (18.5%), than in NLC (8.0%) and NHC (3.9%), and pre-frailty in MCI (54.6%), NLC (52.9%) than in NHC (48.0%). Age, sex, and ethnicity-adjusted OR (95% CI) of association with MCI (versus NHC) for frailty were 4.65 (2.40–9.04) and for pre-frailty, 1.67 (1.07–2.61). Similar significantly elevated prevalence and adjusted ORs of association with MCI were observed for frailty-associated physical and functional impairments. Further adjustment for education, marital status, living status, comorbidities, and GDS significantly reduced the OR estimates. However, the OR estimates remained elevated for frailty: 3.86 (1.83–8.17), low body mass: 1.70 (1.08–2.67), slow gait: 1.84 (1.17–2.89), impaired gait: 4.17 (1.98–8.81), and elevated fall risk 3.42 (1.22–9.53).

Conclusion

Two-thirds of MCI were physically frail or pre-frail, most uniquely due to low lean muscle mass, slow gait speed, or balance and gait impairment. The close associations of frailty and physical and functional impairment with MCI have important implications for improving diagnostic acuity of MCI and targetting interventions among cognitively frail individuals to prevent dementia and disability.

Neuropsychological Correlates of Pre-Frailty in Neurocognitive Disorders: A Possible Role for Metacognitive Dysfunction and Mood Changes

Background

Recent studies have suggested that cognitive functions in patients with neurocognitive disorders have a significant role in the pathogenic mechanisms of frailty. Although pre-frailty is considered an intermediate, preclinical state, epidemiological research has begun to dislodge cognition and frailty into their specific subcomponents to understand the relationship among them. We aim to analyse the possible association between pre-frailty and neuropsychological variables to outline which factors can contribute to minor and major neurocognitive disorders.

Methods

60 subjects complaining of different cognitive deficits underwent a deep-in-wide frailty and neuropsychological assessment. We conducted three multiple linear regression analyses adjusted for a combination of demographic measures and involving several neuropsychological–behavioural parameters selected by the literature on physical frailty.

Results

We found a significant association between frailty—as measured by the multidimensional prognostic index (MPI)—and action monitoring and monetary gain (cognitive domain), depression and disinhibition (behavioural domain). Moreover, an association between MPI and impaired awareness for instrumental activities disabilities exists.

Conclusion

We propose a novel framework for understanding frailty associated with metacognitive–executive dysfunction.

Age of Migration and the Incidence of Cognitive Impairment: A Cohort Study of Elder Mexican-Americans

BACKGROUND AND OBJECTIVES

To explore nativity and age of migration differentials in the incidence of cognitive impairment among older Mexican-Americans.

RESEARCH DESIGN AND METHODS

We employ maximum-likelihood discrete time hazard models to estimate risk ratios of cognitive impairment in a sample of 2,708 Mexican-Americans 65 and older who were cognitively healthy at baseline over a follow-up period of up to 20 years.

RESULTS

Late-life immigrant women have a 46% higher risk of cognitive impairment compared to U.S.-born Mexican-American women. Conversely, midlife immigrant men have a 29% lower risk of cognitive impairment compared to U.S.-born Mexican-American men. The incidence of cognitive impairment did not differ for early-life and midlife immigrant women relative to U.S.-born women or for early- and late-life immigrant men compared to U.S.-born men.

DISCUSSION AND IMPLICATIONS

Differences in cognitive impairment risk between U.S.-born and foreign-born Mexican-American subgroups may be partly due to health selectivity. Cognitive impairment is more prevalent among immigrant groups which may result in a higher burden on family members and/or high dependency on public resources. Programs are needed that can detect decline at earlier stages and reduce the risk for cognitive impairment among older immigrants entering their last decades of life.

Handgrip Strength in Chronic Obstructive Pulmonary Disease. Associations with Acute Exacerbations and Body Composition

RATIONALE

Handgrip strength (HGS) predicts mortality in the elderly, but its determinants and clinical significance in chronic obstructive pulmonary disease (COPD) has not been defined.

OBJECTIVES

We tested associations of HGS with pectoralis muscle area (PMA), subcutaneous adipose tissue (SAT), imaging characteristics, and lung function in smokers with COPD, and evaluated the cross-sectional and longitudinal associations of HGS with acute respiratory events.

METHODS

We analyzed demographic, clinical, spirometry, HGS, and imaging data of 272 subjects with COPD, obtaining measures of airway thickness, emphysema, PMA, and SAT from chest computed tomography scans. We tested associations of lung function and imaging characteristics with HGS, using linear models. HGS association to acute respiratory events at enrollment and during follow-up (mean, 2.6 years) was analyzed using adjusted logistic models.

RESULTS

HGS correlated with PMA, SAT, forced expiratory volume, and airway thickness, but not with body mass index or emphysema severity. In adjusted regression models, HGS was directly (β, 1.5; 95% confidence interval [CI], 0.1-3.0) and inversely (β, -3.3; 95% CI, -5.1 to -0.9) associated with one standard deviation of PMA and SAT, respectively, independent of body mass index and emphysema. In regression models adjusted for age, sex, body mass index, race, pack-years smoked, current smoking, chronic bronchitis, FEV1% predicted, emphysema, and airway metrics, HGS was associated with exacerbation risk; in cross-sectional analyses, there was an increment of 5% in the risk of exacerbations for each 1-kg decrement in HGS (risk ratio, 1.05; 95% CI, 1.01-1.08), and there was a similar risk during follow-up (risk ratio, 1.04; 95% CI, 1.01-1,07).

CONCLUSIONS

In ever-smokers with COPD, HGS is associated with computed tomography markers of body composition and airway thickness, independent of body mass index and emphysema. Higher HGS is associated with lower exacerbation frequency.

Differences in handgrip strength protocols to identify sarcopenia and frailty - a systematic review

Background

Hand grip strength (HGS) is used for the diagnosis of sarcopenia and frailty. Several factors have been shown to influence HGS values during measurement. Therefore, variations in the protocols used to assess HGS, as part of the diagnosis of sarcopenia and frailty, may lead to the identification of different individuals with low HGS, introducing bias. The aim of this systematic review is to gather all the relevant studies that measured HGS to diagnose sarcopenia and frailty and to identify the differences between the protocols used.

Methods

A systematic review was carried out following the recommendations of The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. PubMed and Web of Science were systematically searched, until August 16, 2016. The evidence regarding HGS measurement protocols used to diagnose sarcopenia and frailty was summarised and the most recent protocols regarding the procedure were compared.

Results

From the described search 4393 articles were identified. Seventy-two studies were included in this systematic review, in which 37 referred to sarcopenia articles, 33 to frailty and two evaluated both conditions. Most studies presented limited information regarding the protocols used.

Conclusions

The majority of the studies included did not describe a complete procedure of HGS measurement. The high heterogeneity between the protocols used, in sarcopenia and frailty studies, create an enormous difficulty in drawing comparative conclusions among them.

Physical Frailty, Cognitive Impairment, and the Risk of Neurocognitive Disorder in the Singapore Longitudinal Ageing Studies

Background

The independent and combined effects of physical and cognitive domains of frailty in predicting the development of mild cognitive impairment (MCI) or dementia are not firmly established.

Methods

This study included cross-sectional and longitudinal analyses of physical frailty (Cardiovascular Health Study criteria), cognitive impairment (Mini-Mental State Examination [MMSE]), and neurocognitive disorder (DSM-5 criteria) among 1,575 community-living Chinese older adults from the Singapore Longitudinal Ageing Studies.

Results

At baseline, 2% were frail, 32% were prefrail, and 9% had cognitive impairment (MMSE score < 23). Frailty at baseline was significantly associated with prevalent cognitive impairment. Physical frailty categories were not significantly associated with incident NCD, but continuous physical frailty score and MMSE score showed significant individual and joint associations with incident mild NCD and dementia. Compared with those who were robust and cognitively normal, prefrail or frail old adults without cognitive impairment had no increased risk of incident NCD, but elevated odds of association with incident NCD were observed for robust with cognitive impairment (odds ratio [OR] = 4.04, p < .001), prefrail with cognitive impairment (OR = 2.22, p = .044), and especially for frail with cognitive impairment (OR = 6.37, p = .005). The prevalence of co-existing frailty and cognitive impairment (cognitive frailty) was 1% (95% confidence interval [CI]: 0.5-1.4), but was higher among participants aged 75 and older at 5.0% (95% CI: 1.8-8.1).

Conclusions

Physical frailty is associated with increased prevalence and incidence of cognitive impairment, and co-existing physical frailty and cognitive impairment confers additionally greater risk of incident NCD.

Cognitive Frailty in Italian Community-Dwelling Older Adults: Prevalence Rate and Its Association with Disability

Cognitive frailty is the simultaneous clinical manifestation of both physical frailty and cognitive impairment. This paper aimed to propose and test an operational definition of cognitive frailty. The following specific aims were pursued: (i) to rate the prevalence of cognitive frailty; (ii) to evaluate differences in cognitive functioning among robust, pre-frail, and frail individuals; (iii) to examine the association of cognitive frailty with disability, in a sample of Italian community-dwelling older adults. Five hundred and ninety-four older adults (mean age 73.6 years, SD=5.8) were involved in this cross-sectional study. Cognitive frailty was operationalized using the Mini Mental State Examination (cut-off score equal or less than 25) for the evaluation of cognitive functions and the five criteria of the Cardiovascular Health Study (cut-off score equal or higher than 3) for the evaluation of physical frailty. Participants positive for both instruments were classified as cognitively frail. The outcome was disability measured with the Groningen Activity Restriction Scale. Descriptive statistics, one-way and two-way analysis of covariance (ANCOVA) were carried out. The prevalence rate of cognitive frailty was 4.4%. The one-way ANCOVA, controlling for age and gender, showed a significant difference (p< .001) among robust, pre-frail, and frail participants for the cognitive functioning. Moreover, cognitively frail individuals showed a difference (p<.001) in disability in comparison with non-frail participants. Our results are significant and provide empirical evidence about the usefulness of the cognitive frailty concept.

Development of the interRAI home care frailty scale

Background

The concept of frailty, a relative state of weakness reflecting multiple functional and health domains, continues to receive attention within the geriatrics field. It offers a summary of key personal characteristics, providing perspective on an individual’s life course.

There have been multiple attempts to measure frailty, some focusing on physiologic losses, others on specific diseases, disabilities or health deficits. Recently, multidimensional approaches to measuring frailty have included cognition, mood and social components. The purpose of this project was to develop and evaluate a Home Care Frailty Scale and provide a grounded basis for assessing a person’s risk for decline that included functional and cognitive health, social deficits and troubling diagnostic and clinical conditions.

Methods

A secondary analysis design was used to develop the Home Care Frailty Scale. The data set consisted of client level home care data from service agencies around the world. The baseline sample included 967,865 assessments while the 6-month follow-up sample of persons still being served by the home care agencies consisted of 464,788 assessments. A pool of 70 candidate independent variables were screened for possible inclusion and 16 problem outcomes referencing accumulating declines and clinical complications served as the dependent variables. Multiple regression techniques were used to analyze the data.

Results

The resulting Home Care Frailty Scale consisted of a final set of 29 items. The items fall across 6 categories of function, movement, cognition and communication, social life, nutrition, and clinical symptoms. The prevalence of the items ranged from a high of 87% for persons requiring help with meal preparation to 3.7% for persons who have experienced a recent decline in the amount of food eaten.

Conclusions

The interRAI Home Care Frailty Scale is based on a strong conceptual foundation and in our analysis, performed as expected. Given the use of the interRAI Home Care Assessment System in multiple, diverse countries, the Home Care Frailty Scale will have wide applicability to support program planning and policy decision-making impacting home care clients and their formal and informal caregivers throughout the world.

Tall stature in coronary heart disease patients is associated with decreased risk of frailty in late life

AIM

We investigated the possible inverse association between tall stature and subsequent late-life frailty.

METHODS

A subset of surviving men with coronary heart disease (n = 1232; mean age at baseline 57.0 ± 6.0 years), who previously participated in the Bezafibrate Infarction Prevention clinical trial (1990-1997) were reassessed during 2004-2008 (T1; n = 558) and 2011-2013 (T2; n = 351) at the mean ages of 72.6 ± 6.4 years and 77.2 ± 6.4 years, respectively. Frailty status was measured at T2 according to the physical phenotype developed by Fried, and was categorized into non-frail, prefrail and frail. We estimated the odds ratios of increasing frailty by tertiles of height at baseline.

RESULTS

Among 351 patients, 117 (33.3%) were classified as non-frail, 134 (38.2%) as prefrail and 100 (28.5%) as frail. Frailty was found among 21% of participants at the highest tertile, 33% at the middle tertile and 46% at the lowest tertile for height (P for trend = 0.002). Adjusting for age, weight, place of birth, education, blood pressure, New York Heart Association classification functional class and comorbidity score, the estimated OR for increasing frailty for participants in the highest tertile was 0.32 (95% CI 0.17-0.59) and for those at the middle tertile 0.46 (95% CI 0.27-0.79), as compared with the lowest tertile. An increment of 1 SD of height was associated with a 38% (95% CI 18-53%) decrease in frailty odds.

CONCLUSION

Among men with coronary heart disease, tall stature was associated with lower adjusted odds of late-life frailty. Geriatr Gerontol Int 2017; 17: 1270-1277.

The Association between Frailty and Cognition in Elderly Women

Background

Frailty refers to the loss of physiologic complexity and the associated decline in ability to withstand stressors as one gets older. It is defined as unintentional weight loss, exhaustion, weakness, slow walking speed, and low physical activity. According to several western studies, frailty is associated with cognitive impairment, but there have been few studies about the relationship between frailty and cognitive impairment in Korea. Thus, the purpose of this study is to analyze the relationship between cognition and factors related to frailty such as grip strength, walking speed, physical activity, and depression, among female patients older than 65 in Korea.

Methods

A total of 121 subjects among the outpatients of the department of family medicine at Kangbuk Samsung Hospital who did not meet the exclusion criteria were included in this study. We divided the participants into 2 groups, according to the Korean version of the Montreal Cognitive Assessment (MoCA) score: 1 group with subjects that had normal cognition and the other group with patients that had impaired cognition. A comparison was made between the 2 groups in regards to the factors related to frailty, and we completed equation that predicting cognition from the frailty related factors.

Results

Compared with the impaired cognition group, the subjects in the normal cognition group had higher hand strength, and walked faster (P<0.001). There was no statistically significant difference in physical activity between the 2 groups (P=0.19). When multiple linear regression analysis was performed using age, grip strength, and walking speed as the predictor variables and MoCA score as the dependent variable, the regression coefficients were calculated to be: -0.2015, 0.2294, 1.2372, and -0.1436, respectively (P<0.05).

Conclusion

In Korean female patients who are older than 65 years of age, cognition tends to decline as grip strength decreases, walking speed gets slower, depression becomes more severe, and as age increases.

The relationship between depression and frailty syndrome: a systematic review

OBJECTIVES

Frailty is a geriatric syndrome characterised by the clinical presentation of identifiable physical alterations such as loss of muscle mass and strength, energy and exercise tolerance, and decreased physiological reserve. Frailty and depressive symptoms are common issues facing older adults and may be associated. It is not clear if the depression facilitates the appearance of frailty syndrome or vice versa or these two coexist independently in the same individuals.

METHOD

We performed searches in several databases (Embase, PubMed, CINAHL, Scopus, and PsycINFO) papers published between November 2003 to February 2014 about frailty syndrome and depression in people aged 65 and older published and the reference lists of from the articles retrieved were pearled in order to identify any which may have been missed in the initial search. Two independent reviewers extracted descriptive information on the prevalence and co-occurrence of frailty and depression in older individuals and of frailty criteria among depressed patients.

RESULTS

Depression and frailty occur in a significant proportion of frail older individuals. Common pathophysiological alterations and biomarkers in the two syndromes have been recently described.

CONCLUSION

Studies on the causal relationship between the two syndromes are clearly necessary in the future.

Examining the relationship between fatigue and cognition after stroke: A systematic review

Many stroke survivors experience fatigue, which is associated with a variety of factors including cognitive impairment. A few studies have examined the relationship between fatigue and cognition and have obtained conflicting results. The aim of the current study was to review the literature on the relationship between fatigue and cognition post-stroke. The following databases were searched: EMBASE (1980-February, 2014), PsycInfo (1806-February, 2014), CINAHL (1937-February, 2014), MEDLINE (1946-February, 2014), Ethos (1600-February, 2014) and DART (1999-February, 2014). Reference lists of relevant papers were screened and the citation indices of the included papers were searched using Web of Science. Studies were considered if they were on adult stroke patients and assessed the following: fatigue with quantitative measurements (≥ 3 response categories), cognition using objective measurements, and the relationship between fatigue and cognition. Overall, 413 papers were identified, of which 11 were included. Four studies found significant correlations between fatigue and memory, attention, speed of information processing and reading speed (r = -.36 to .46) whereas seven studies did not. Most studies had limitations; quality scores ranged from 9 to 14 on the Critical Appraisal Skills Programme Checklists. There was insufficient evidence to support or refute a relationship between fatigue and cognition post-stroke. More robust studies are needed.

Diabetes and Frailty: Two Converging Conditions?

Diabetes mellitus is a disabling, chronic cardiovascular and medical disease with a tremendous health, social and economic burden in our ageing communities. It has a prevalence of 10% to 30% in people older than 65 years of age, and more than half of all subjects with diabetes in the United States are older than 60 years of age. The main impact of diabetes in older adults stems from its effect on function, both physical and cognitive, that finally impairs their quality of life, although the impact on survival is modest. Frailty has emerged during the past 2 decades as the most powerful predictor of disability and other adverse outcomes, including mortality, disability and institutionalization in older adults. In this article we explore the relationship between diabetes and frailty, and we recognize that they are intimately related chronic medical conditions that result in huge societal and personal health burdens.

Do frailty and cognitive impairment affect dual-task cost during walking in the oldest old institutionalized patients?

The objective of this study was to investigate dual-task costs in several elderly populations, including robust oldest old, frail oldest old with MCI, frail oldest old without MCI, and frail elderly with dementia. Sixty-four elderly men and women categorized into frail without MCI (age 93.4 ± 3.2 years, n = 20), frail with MCI (age 92.4 ± 4.2 years, n = 13), robust (age 88.2 ± 4.1 years, n = 10), and patients with dementia (age 88.1 ± 5.1 years, n = 21). Five-meter gait ability and timed-up-and-go (TUG) tests with single and dual-task performance were assessed in the groups. Dual-task cost in both 5-m habitual gait velocity test and TUG test was calculated by the time differences between single and dual-task performance. The robust group exhibited better 5-m gait and TUG test performances in the single and dual-task conditions compared with the other three groups (P < 0.001), and the frail and frail + MCI groups exhibited better performances than the dementia group (P < 0.001). No significant differences were observed between the frail and frail + MCI groups. However, all groups exhibited lower gait velocities in the verbal and arithmetic task conditions, but the dual-task cost of the groups were similar. Robust individuals exhibited superior single and dual-task walking performances than the other three groups, and the frail and frail + MCI individuals exhibited performances that were superior to those of the patients with dementia. However, the dual-task costs, i.e., the changes in gait performance when elderly participants switch from a single to a dual task, were similar among all four of the investigated groups. Therefore, these results demonstrated that the magnitude of the impairment in gait pattern is independent of frailty and cognitive impairment status.

Cognitive Frailty: A Systematic Review of Epidemiological and Neurobiological Evidence of an Age-Related Clinical Condition

Advancing age is the focus of recent studies on familial and sporadic Alzheimer's disease (AD), suggesting a prolonged pre-clinical phase several decades before the onset of dementia symptoms. Influencing some age-related conditions, such as frailty, may have an impact on the prevention of late-life cognitive disorders. Frailty reflects a nonspecific state of vulnerability and a multi-system physiological change with increased risk for adverse health outcomes in older age. In this systematic review, frailty indexes based on a deficit accumulation model were associated with late life cognitive impairment and decline, incident dementia, and AD. Physical frailty constructs were associated with late-life cognitive impairment and decline, incident AD and mild cognitive impairment, vascular dementia, non-AD dementias, and AD pathology in older persons with and without dementia, thus also proposing cognitive frailty as a new clinical condition with co-existing physical frailty and cognitive impairment in non-demented older subjects. Considering both physical frailty and cognitive impairment as a single complex phenotype may be central in the prevention of dementia and its subtypes with secondary preventive trials on cognitive frail older subjects. The mechanisms underlying the cognitive-frailty link are multi-factorial, and vascular, inflammatory, nutritional, and metabolic influences may be of major relevance. There is a critical need for randomized controlled trials of intervention investigating the role of nutrition and/or physical exercise on cognitive frail subjects with the progression to dementia as primary outcome. These preventive trials and larger longitudinal population-based studies targeting cognitive outcomes could be useful in further understanding the cognitive-frailty interplay in older age.

Global cognitive performance and frailty in non-demented community-dwelling older adults: Findings from the Sasaguri Genkimon Study

AIM

To investigate the associations of global cognitive performance with frailty and pre-frailty in non-demented community-dwelling older adults.

METHOD

A cross-sectional study was carried out using data from the baseline survey of the Sasaguri Genkimon Study in 2011. The study sample consisted of 1565 older adults with complete data and no evidence of dementia. Global cognitive performance was evaluated using the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE). Frailty state was defined using the Cardiovascular Health Study criteria, based on five components: unintentional weight loss, low grip strength, exhaustion, low gait speed and low physical activity.

RESULTS

Total MoCA and MMSE scores, and their domain-specific scores decreased across the non-frail, pre-frail and frail groups. Poorer total MoCA and MMSE scores, as well as their domain-specific scores, were associated with the greater likelihood of being frail, but not with pre-frailty after full adjustment. The strength of the association with frailty was greater for total MoCA score than for total MMSE score. Domain-specific scores for visuospatial abilities and attention domains in both of the MoCA and MMSE were consistently associated with the likelihood of pre-frailty and frailty, even after being mutually adjusted for all domains.

CONCLUSIONS

The MoCA performance is more strongly associated with the odds of frailty than the MMSE performance in the relatively functional and non-demented older adult population. The present findings could contribute to further exploration of possible common pathways that can be targeted in the prevention and management for both of these two conditions. Geriatr Gerontol Int 2015; ●●: ●●-●●.

Cumulative impact of health deficits, social vulnerabilities, and protective factors on cognitive dynamics in late life: a multistate modeling approach

Introduction

Many factors influence late-life cognitive changes, and evaluating their joint impact is challenging. Typical approaches focus on average decline and a small number of factors. We used multistate transition models and index variables to look at changes in cognition in relation to frailty (accumulation of health deficits), social vulnerability, and protective factors in the Honolulu-Asia Aging Study (HAAS).

Methods

The HAAS is a prospective cohort study of 3,845 men of Japanese descent, aged 71 to 93 years at baseline. Cognitive function was measured using the Cognitive Abilities Screening Instrument (CASI). Baseline index variables were constructed of health deficits (frailty), social vulnerabilities, and protective factors. The chances of improvement/stability/decline in cognitive function and death were simultaneously estimated using multistate transition modeling for 3- and 6-year transitions from baseline.

Results

On average, CASI scores declined by 5.3 points (standard deviation (SD) = 10.0) over 3 years and 9.5 points (SD = 13.9) over 6 years. After adjusting for education and age, baseline frailty was associated with an increased risk of cognitive decline at 3 years (β = 0.18, 95% confidence interval (CI), 0.08 to 0.29) and 6 years (β = 0.40, 95% CI, 0.27 to 0.54). The social vulnerability index was associated with 3-year changes (β = 0.16, 95% CI, 0.09 to 0.23) and 6-year changes (β = 0.14, 95% CI, 0.05 to 0.24) in CASI scores. The protective index was associated with reductions in cognitive decline over the two intervals (3-year: β = −0.16, 95% CI, −0.24 to −0.09; 6-year: β = −0.21, 95% CI, −0.31 to –0.11,).

Conclusions

Research on cognition in late life needs to consider overall health, the accumulation of protective factors, and the dynamics of cognitive change. Index variables and multistate transition models can enhance understanding of the multifactorial nature of late-life changes in cognition.

Electronic supplementary material

The online version of this article (doi:10.1186/s13195-015-0120-7) contains supplementary material, which is available to authorized users.

Correlation between Frailty and Cognitive Function in Non-Demented Community Dwelling Older Koreans

Background

Frailty and cognitive impairment are considered the most common and yet least understood conditions in older adults. This study was conducted to investigate the correlation between frailty and cognitive function in non-demented older Koreans.

Methods

Korean Mini-Mental Status Examination (K-MMSE) scores and Cardiovascular Health Study Frailty Indices were obtained for 486 older adults aged 65 and over who registered at six senior welfare centers in Seoul and Gyeonggi province. Multiple linear regression was performed to identify the association between frailty and K-MMSE scores.

Results

Of the 486 older adults, 206 (42.4%) were robust, 244 (50.2%) were prefrail, and 36 (7.4%) were frail. Prevalence of cognitive impairment (K-MMSE ≤ 23) was 6.3% in the robust group, 16.8% in the prefrail group, and 30.6% in the frail group (P < 0.001), and mean K-MMSE score was 27.5 ± 2.2, 26.5 ± 3.1, and 23.7 ± 5.3, respectively (P < 0.001). Frailty tended to be associated with lower MMSE scores (B = -1.92, standard error, 0.52; P < 0.001).

Conclusion

Frailty was found to be correlated with cognitive impairment in non-demented older Koreans. However, further cohort studies are required to determine the association between frailty and cognitive function.

Cognitive function and associated factors among older people in Taiwan: age and sex differences

PURPOSE

The aim of this study was to examine cognitive function and the risk and the protective factors by age and sex among Taiwanese older people.

METHODS

The data were from a nation-representative panel of older people in Taiwan. The participants completing both the 2003 and 2007 waves were included for analysis in this study (n=3228). Descriptive analysis and generalized linear model were applied, and the samples were stratified by age groups and by sex.

RESULTS

The factors related to higher cognitive function at the intercept included being younger, male, higher education, and doing unpaid work. At the time slope, the age effect and physical function difficulties would reduce the cognitive function across time, while education and providing informational support would increase the cognitive function across time. There were age- and sex-differences in the factors related to cognitive function, particularly on the working status and social participation.

CONCLUSION

Different health promotion strategies to target these populations should be accordingly developed.

[Cognitive performance and frailty in older adults clients of a private health care plan]

OBJECTIVE

To investigate the association between frailty syndrome and cognitive performance in the older adults and the effect of schooling and age on this association.

METHODS

Data on frailty in older adults from Phase 1 of the FIBRA-RJ Study were analyzed, relating to 737 customers of a private health care provider, aged 65 and over, living in Rio de Janeiro, Southeastern Brazil, between January 2009 and January 2010. Data on socioeconomic and demographic characteristics, medical conditions and functional capacity were collected. Cognitive performance was assessed using the Mini-Mental State Examination (MMSE). Individuals who exhibited three or more of the following features were considered to be frail: unintentional weight loss (≥ 4.5 kg in the last year); feeling self-reported exhaustion, low grip strength, low physical activity level and slowness. The association between frailty and cognitive performance was evaluated using multivariate logistic regression, with adjustment for medical conditions, activities of daily living and socioeconomic variables. We evaluated the age and schooling as possible effect modifiers in this association.

RESULTS

The frail subjects had a higher prevalence of low cognitive performance, compared to not frail or pre-frail, in the three age groups studied (65-74; 75-84; ≥ 85 years), p < 0.001. After adjustment, the association between frailty and cognitive performance was found among older adults individuals aged 75 and older, with an OR(adj)= 2.78 (95%CI 1.23;6.27) for those aged 75 to 84 and OR(adj)= 15.62 (95%CI 2.20;110.99) for 85 and older. The age variable was an effect modifier in the association between frailty and cognitive performance, χ²(5) = 806.97, p < 0.0001; the same was not the case with schooling.

CONCLUSIONS

Frailty syndrome is associated with cognitive performance in the aging. Age proved to be an effect modifier in this association. The oldest patients showed a more significant association between the two phenomena.

Functional capacity, muscle fat infiltration, power output, and cognitive impairment in institutionalized frail oldest old

This study examined the neuromuscular and functional performance differences between frail oldest old with and without mild cognitive impairment (MCI). In addition, the associations between functional capacities, muscle mass, strength, and power output of the leg muscles were also examined. Forty-three elderly men and women (91.9±4.1 years) were classified into three groups--the frail group, the frail with MCI group (frail+MCI), and the non-frail group. Strength tests were performed for upper and lower limbs. Functional tests included 5-meter habitual gait, timed up-and-go (TUG), dual task performance, balance, and rise from a chair ability. Incidence of falls was assessed using questionnaires. The thigh muscle mass and attenuation were assessed using computed tomography. There were no differences between the frail and frail+MCI groups for all the functional variables analyzed, except in the cognitive score of the TUG with verbal task, which frail showed greater performance than the frail+MCI group. Significant associations were observed between the functional performance, incidence of falls, muscle mass, strength, and power in the frail and frail+MCI groups (r=-0.73 to r=0.83, p<0.01 to p<0.05). These results suggest that the frail oldest old with and without MCI have similar functional and neuromuscular outcomes. Furthermore, the functional outcomes and incidences of falls are associated with muscle mass, strength, and power in the frail elderly population.