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Zhang Y, Xia H, Jiang X, Wang Q, Hou L. Prevalence and Outcomes of Cognitive Frailty Among Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis. Res Gerontol Nurs 2024; 17:202-212. [PMID: 39047228 DOI: 10.3928/19404921-20240621-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
PURPOSE To systematically review the available evidence regarding the prevalence and outcomes of cognitive frailty-a clinical syndrome characterized by the combination of physical frailty and cognitive impairment, without dementia-in community-dwelling older adults. METHOD The following databases were searched: PubMed, Web of Science, Embase, EBSCO, Cochrane Central Register of Controlled Trials, ProQuest, CNKI, Wanfang, VIP, and CBMdisc (inception to October 2, 2023). RESULTS Twenty-four studies were included (N = 62,169) reporting a median prevalence of cognitive frailty among community-dwelling older adults of 12.2%. Frailty with cognitive impairment was independently associated with increased all-cause mortality (adjusted 8-year hazard ratio [HR] = 2.6, 95% confidence interval [CI] [2.05, 3.30]). There was evidence of increased risk of 3-year mortality for frailty (adjusted HR = 1.92, 95% CI [1.26, 2.93]) and prefrailty (adjusted HR = 1.79, 95% CI [1.33, 2.41]) with cognitive impairment. There was also evidence of increased risk of dementia for frailty (adjusted 24-month HR = 6.19, 95% CI [2.74, 13.99]; adjusted 4-year HR = 4.98, 95% CI [2.17, 11.41]) and prefrailty (adjusted 4-year HR = 5.21, 95% CI [2.95, 9.20]; adjusted 5-year HR = 14.5, 95% CI [1.68, 125.1]) with cognitive impairment. Activities of daily living (ADL) dependence was more frequent in individuals with cognitive impairment and frailty (adjusted 4-year odds ratio = 5.6, 95% CI [2.13, 14.72]). CONCLUSION Of community-dwelling older adults, 12.2% have cognitive frailty as well as increased risk of all-cause mortality, dementia, and ADL dependence. Further studies on prevention and treatment of cognitive frailty is warranted. Health care providers should formulate specific interventions to decrease the impact of cognitive frailty. [Research in Gerontological Nursing, 17(4), 202-212.].
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Inceer M, Boehnke JR, Brouillette MJ, Fellows LK, Mayo N. In Support of Multidimensional Frailty: A Structural Equation Model from the Canadian Positive Brain Health Now Cohort. AIDS Res Hum Retroviruses 2024. [PMID: 38877794 DOI: 10.1089/aid.2023.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
The objective of this study was to estimate the structure and relationships between four h ypothesized frailty dimensions (physical, emotional, cognitive, and social) and the extent to which personal and HIV-related factors and comorbidity associate with these frailty dimensions. This is a secondary analysis of an existing dataset arising from Positive Brain Health Now study (n = 856) in people aging with HIV (mean age: 52.3 ± 8.1 years). Structural equation modeling (SEM) models were applied to two cross-sections of the data: one at study entry and one at second visit, 9-month apart. Multidimensional frailty was modeled based on the combined Wilson-Cleary and International Classification of Functioning, Disability and Health framework. Four dimensions were operationalized with patient-reported and self-report measures from standardized questionnaires. The SEM model from the first visit was replicated using data from the second visit, testing measurement invariance. The proposed model showed acceptable fit at both visits (including no violation of measurement invariance). The final model for the first visit showed that sex, body mass index, HIV diagnosis pre-1997, current or nadir CD4 counts, and comorbidity did not associate with any frailty dimension; however, age (β range: 0.12-0.25), symptoms (β range: -0.35 to -0.58), and measured cognition (β range: 0.10-0.24) directly associated with all frailty dimensions. The model remained stable across the two visits. This study contributes evidence for operationalizing multidimensional frailty. Evidence-based interventions are available for many of the measures considered here, offering opportunities to improve the lives of people with frailty in the context of HIV.
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Affiliation(s)
- Mehmet Inceer
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Center for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Center, Montreal, Canada
| | - Jan R Boehnke
- School of Health Sciences, University of Dundee, Dundee, United Kingdom
| | - Marie-Josée Brouillette
- Center for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Center, Montreal, Canada
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Canada
- McGill University Health Center, Montreal, Canada
| | - Lesley K Fellows
- Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Nancy Mayo
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Center for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Center, Montreal, Canada
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Yuan Y, Chang J, Sun Q. Research Progress on Cognitive Frailty in Older Adults with Chronic Kidney Disease. Kidney Blood Press Res 2024; 49:302-309. [PMID: 38663363 DOI: 10.1159/000538689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/01/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND As the medical challenges posed by the ageing population become increasingly severe, the proportion of older people among patients with chronic kidney disease (CKD) is increasing every year. SUMMARY The prevalence of frailty in patients with CKD is significantly higher than that in the general population, and older patients are also a high-risk group for frailty and cognitive impairment. Cognitive frailty, as an important subtype of frailty, is a syndrome characterised by cognitive dysfunction caused by physiological factors, excluding Alzheimer's disease and other types of dementia. It is characterised by the coexistence of physical frailty and cognitive impairment. Previous studies have mainly focused on cognitive impairment, and there is limited research on cognitive frailty, particularly in older patients with CKD. KEY MESSAGES This article provides a comprehensive review of the concept, epidemiology, screening methods, prevention, and treatment measures and possible pathogenesis of cognitive frailty in patients with CKD.
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Affiliation(s)
- Yuqing Yuan
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jing Chang
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qianmei Sun
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Ren Y, Chu J, Zhang Z, Luo B. Research on the effect of different aerobic activity on physical fitness and executive function in primary school students. Sci Rep 2024; 14:7956. [PMID: 38575618 PMCID: PMC10995128 DOI: 10.1038/s41598-024-58009-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/25/2024] [Indexed: 04/06/2024] Open
Abstract
To evaluate the effect of 16 weeks of different aerobic activity on physical fitness and executive functions in primary school students. 90 right-handed students from China (Boys = 46; Girls = 44) participated in our study and were randomly separated into four groups: 20 in the control group (Con), 23 in the physical activity group (PA), 25 in the intellectual activity group (IA), 22 in the physical activity and intellectual activity group (PA + IA). The students in PA, IA and PA + IA group received aerobic exercise program lasted 40 min daily, 4 days a week for 16 weeks, regular physical activity in the PA group, intellectual activity in the IA group, physical activity couple with intellectual activity in the PA + IA group, respectively. All the students participate the experiment for body composition, physical fitness (cardiopulmonary fitness, muscle strength, speed sensitivity, flexibility quality), executive functions and saliva analysis test before and after 16 weeks. There was no significant effect of 16 weeks different aerobic exercise interventions on body composition before and after exercise interventions among four groups in children (p > 0.05). The results were obtained by inter-group and intra-group comparisons that different exercise interventions (physical activity, intellectual activity, physical combine with intellectual activity), all can significantly improve physical fitness parameters (cardiopulmonary fitness, muscle strength, speed sensitivity and flexibility quality), and executive functions parameters (inhibitory control, working memory, reaction time cognitive flexibility), as well as the concentration of saliva GH and IGF-I (p < 0.05) in children. Our experiment further demonstrated that the improvement effect of the two exercises together is more significant than that of the single exercise ways. Both physical and intellectual activity can effectively improve physical fitness and executive function in children, and the improvement effect of the two exercises together is more significant than that of the single exercise ways.
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Affiliation(s)
- Yue Ren
- Capital University of Physical Education and Sports, Beijing, 100191, China
| | - Jun Chu
- Capital University of Physical Education and Sports, Beijing, 100191, China
| | - Zhongyuan Zhang
- College of Art and Design, Zhengzhou University of Economics and Business, Zhengzhou, 451100, China
| | - Bingquan Luo
- Capital University of Physical Education and Sports, Beijing, 100191, China.
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Lee T, Chung J, Song K, Ji Y. Prevalence and associated factors of cognitive frailty in community-dwelling older adults: Results from the Korean longitudinal study of aging. Int J Older People Nurs 2023; 18:e12576. [PMID: 37776018 DOI: 10.1111/opn.12576] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/13/2023] [Accepted: 09/17/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Cognitive frailty, a condition characterized by physical frailty with cognitive impairment, is emerging as a determinant of adverse health outcomes in older adults. However, its prevalence and correlation with associated factors are unknown in the aging population of Korea. OBJECTIVES To estimate the prevalence of cognitive frailty and identify factors associated with it among older Korean adults. METHODS A secondary analysis was performed using the Korean Longitudinal Study of Aging seventh survey dataset collected in 2018. Multinomial logistic regression analyses were conducted to examine the association between cognitive frailty and demographic, psychosocial, oral health and physical function factors. Individuals aged ≥65 years and without dementia were included (N = 1024). Participants were classified into four groups based on the presence or absence of physical frailty and mild cognitive impairment. This article is executed in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. RESULTS The prevalence of cognitive frailty in the study sample was 11.2%. The results of multinomial logistic regression showed that advanced age, being female, lower education levels, heart disease, arthritis or rheumatoid arthritis, underweight, depression, non-social activity, poor oral health and functional limitation were significantly associated with cognitive frailty. CONCLUSIONS Cognitive frailty is prevalent among community-dwelling older adults in Korea. The findings provide primary care providers with insights about effective strategies for identifying at-risk individuals and will guide the development of population-level interventions to prevent or delay the onset of physical frailty and cognitive impairment in older adults. IMPLICATIONS FOR PRACTICE The findings provide practical information to healthcare providers for identifying cognitive frailty in older adults. The risk factors of cognitive frailty, such as psychosocial, oral health, and physical function factors, should be thoroughly monitored for older adults. Health personnel working in primary care have a critical role in identifying risk and beneficial factors and promoting preventative strategies that enhance health outcomes.
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Affiliation(s)
- Taewha Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| | - Jane Chung
- Virginia Commonwealth University School of Nursing, Richmond, Virginia, USA
| | - Kijun Song
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| | - Yoonjung Ji
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
- Brain Korea 21 FOUR Project, College of Nursing, Yonsei University, Seoul, South Korea
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de la Monte SM, Tong M, Hapel AJ. Concordant and Discordant Cerebrospinal Fluid and Plasma Cytokine and Chemokine Responses in Mild Cognitive Impairment and Early-Stage Alzheimer's Disease. Biomedicines 2023; 11:2394. [PMID: 37760836 PMCID: PMC10525668 DOI: 10.3390/biomedicines11092394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Neuroinflammation may be a pathogenic mediator and biomarker of neurodegeneration at the boundary between mild cognitive impairment (MCI) and early-stage Alzheimer's disease (AD). Whether neuroinflammatory processes are endogenous to the central nervous system (CNS) or originate from systemic (peripheral blood) sources could impact strategies for therapeutic intervention. To address this issue, we measured cytokine and chemokine immunoreactivities in simultaneously obtained lumbar puncture cerebrospinal fluid (CSF) and serum samples from 39 patients including 18 with MCI or early AD and 21 normal controls using a 27-plex XMAP bead-based enzyme-linked immunosorbent assay (ELISA). The MCI/AD combined group had significant (p < 0.05 or better) or statistically trend-wise (0.05 ≤ p ≤ 0.10) concordant increases in CSF and serum IL-4, IL-5, IL-9, IL-13, and TNF-α and reductions in GM-CSF, b-FGF, IL-6, IP-10, and MCP-1; CSF-only increases in IFN-y and IL-7 and reductions in VEGF and IL-12p70; serum-only increases in IL-1β, MIP-1α, and eotaxin and reductions in G-CSF, IL-2, IL-8 and IL-15; and discordant CSF-serum responses with reduced CSF and increased serum PDGF-bb, IL-17a, and RANTES. The results demonstrate simultaneously parallel mixed but modestly greater pro-inflammatory compared to anti-inflammatory or neuroprotective responses in CSF and serum. In addition, the findings show evidence that several cytokines and chemokines are selectively altered in MCI/AD CSF, likely corresponding to distinct neuroinflammatory responses unrelated to systemic pathologies. The aggregate results suggest that early management of MCI/AD neuroinflammation should include both anti-inflammatory and pro-neuroprotective strategies to help prevent disease progression.
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Affiliation(s)
- Suzanne M. de la Monte
- Departments of Pathology (Neuropathology), Neurology, and Neurosurgery, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI 02903, USA
- Department of Medicine, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI 02903, USA;
| | - Ming Tong
- Department of Medicine, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI 02903, USA;
| | - Andrew J. Hapel
- Department of Genome Biology, John Curtin School of Medical Research, Australian National University, Canberra 2601, Australia;
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Kwan RYC, Liu JYW, Lee PH, Sin OSK, Wong JSW, Fu MR, Suen LKP. The effects of an e-health brisk walking intervention in increasing moderate-to-vigorous physical activity in physically inactive older people with cognitive frailty: study protocol for a randomized controlled trial. Trials 2023; 24:339. [PMID: 37198670 DOI: 10.1186/s13063-023-07335-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/29/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Cognitive frailty is a risk for many adverse health outcomes that are commonly observed in older people. Physical activity is known to be effective to reserve cognitive frailty but the prevalence of physical inactivity is still high in older people. E-health enhances behavioural change effects through an innovative way to deliver behavioural change methods that can enhance the behavioural change effects. However, its effects on older people with cognitive frailty, its effects compared with conventional behavioural change methods, and the sustainability of the effects are unclear. METHODS This study employs a single-blinded, two-parallel-group, non-inferiority, randomized controlled trial design with a 1:1 group allocation ratio. Eligible participants are aged 60 years or above, have cognitive frailty and physical inactivity, and possess a smartphone for more than six months. The study will be conducted in community settings. In the intervention group, participants will receive a 2-week brisk-walking training followed by a 12-week e-health intervention. In the control group, participants will receive a 2-week brisk-walking training followed by a 12-week conventional behavioural change intervention. The primary outcome is minutes of moderate-to-vigorous physical activity (MVPA). This study aims to recruit a total of 184 participants. Generalized estimating equations (GEE) will be used to examine the effects of the intervention. ETHICS AND DISSEMINATION The trial has been registered at ClinicalTrials.gov (Identifier: NCT05758740) on 7th March 2023, https://clinicaltrials.gov/ct2/show/NCT05758740 , and all items come from the World Health Organization Trial Registration Data Set. It has been approved by the Research Ethics Committee of Tung Wah College, Hong Kong (reference number: REC2022136). The findings will be disseminated in peer-reviewed journals and presented at international conferences relevant to the subject fields. TRIAL REGISTRATION The trial has been registered at ClinicalTrials.gov (Identifier: NCT05758740) and all items come from the World Health Organization Trial Registration Data Set. The latest version of the protocol was published online on 7th March 2023.
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Affiliation(s)
| | - Justina Yat Wa Liu
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Paul Hong Lee
- Clinical Trials Unit, University of Southampton, Southampton, UK
| | | | | | - Mei Rosemary Fu
- School of Nursing, George Washington University, Washington, USA
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Sargent L, Smitherman J, Sorenson M, Brown R, Starkweather A. Cognitive and physical impairment in spinal cord injury: A scoping review and call for new understanding. J Spinal Cord Med 2023; 46:343-366. [PMID: 36441038 PMCID: PMC10114976 DOI: 10.1080/10790268.2022.2134634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Study Design: Scoping review.Objective: To examine potential underlying mechanisms of cognitive and physical impairment in patients with spinal cord injury and identify current research gaps.Methods: A scoping review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews to identify primary studies that explored mechanisms of cognitive and/or physical impairment after spinal cord injury. The databases searched were PubMed/MEDLINE, EMBASE (OVID), Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCO), Web of Science, Scopus, and PsycInfo. These databases were searched from inception through December 20, 2021.Results: Accumulating research suggests that neuroinflammation and neurodegeneration after a traumatic event may be possible mechanisms for cognitive impairment among patients with SCI. In addition, lack of physical activity due to impaired mobility is associated with an increased risk of cognitive impairment.Conclusion: While the results establish a foundation for understanding how cognitive impairment, mental health, and physical function independently affect patients with SCI, further research is warranted to understand how these factors systemically impact the patient and discover refined targets for future rehabilitation therapies. Studies should also explore potential predisposing factors for the relationship between cognitive and physical impairment among patients with SCI.
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Affiliation(s)
- Lana Sargent
- School of Nursing, Virginia Commonwealth University, Richmond, USA
- Geriatric Pharmacotherapy Program, Virginia Commonwealth University, Richmond, USA
- Institute for Inclusion, Inquiry & Innovation iCubed Health and Wellness in Aging Transdisciplinary Core, Richmond, USA
| | - Jonice Smitherman
- Institute for Inclusion, Inquiry & Innovation iCubed Health and Wellness in Aging Transdisciplinary Core, Richmond, USA
| | | | - Roy Brown
- Health Sciences Library, VCU Libraries, Richmond, USA
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de la Monte SM. Malignant Brain Aging: The Formidable Link Between Dysregulated Signaling Through Mechanistic Target of Rapamycin Pathways and Alzheimer's Disease (Type 3 Diabetes). J Alzheimers Dis 2023; 95:1301-1337. [PMID: 37718817 PMCID: PMC10896181 DOI: 10.3233/jad-230555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Malignant brain aging corresponds to accelerated age-related declines in brain functions eventually derailing the self-sustaining forces that govern independent vitality. Malignant brain aging establishes the path toward dementing neurodegeneration, including Alzheimer's disease (AD). The full spectrum of AD includes progressive dysfunction of neurons, oligodendrocytes, astrocytes, microglia, and the microvascular systems, and is mechanistically driven by insulin and insulin-like growth factor (IGF) deficiencies and resistances with accompanying deficits in energy balance, increased cellular stress, inflammation, and impaired perfusion, mimicking the core features of diabetes mellitus. The underlying pathophysiological derangements result in mitochondrial dysfunction, abnormal protein aggregation, increased oxidative and endoplasmic reticulum stress, aberrant autophagy, and abnormal post-translational modification of proteins, all of which are signature features of both AD and dysregulated insulin/IGF-1-mechanistic target of rapamycin (mTOR) signaling. This article connects the dots from benign to malignant aging to neurodegeneration by reviewing the salient pathologies associated with initially adaptive and later dysfunctional mTOR signaling in the brain. Effective therapeutic and preventive measures must be two-pronged and designed to 1) address complex and shifting impairments in mTOR signaling through the re-purpose of effective anti-diabetes therapeutics that target the brain, and 2) minimize the impact of extrinsic mediators of benign to malignant aging transitions, e.g., inflammatory states, obesity, systemic insulin resistance diseases, and repeated bouts of general anesthesia, by minimizing exposures or implementing neuroprotective measures.
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Affiliation(s)
- Suzanne M. de la Monte
- Departments of Pathology and Laboratory Medicine, Medicine, Neurology and Neurosurgery, Rhode Island Hospital, Lifespan Academic Institutions, and the Warren Alpert Medical School of Brown University, Providence, RI, USA
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Hui Z, Wang X, Zhou Y, Li Y, Ren X, Wang M. Global Research on Cognitive Frailty: A Bibliometric and Visual Analysis of Papers Published during 2013–2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138170. [PMID: 35805829 PMCID: PMC9265998 DOI: 10.3390/ijerph19138170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022]
Abstract
This study analyzed the current status, hotspots, and emerging trends of global research on cognitive frailty, in order to provide new research ideas for researchers. Articles and reviews related to cognitive frailty, published from 2013 to 2021, were retrieved from the Web of Science Core Collection (WoSCC) database on 26 November 2021. CiteSpace 5.8.R3 was employed for data analyses. A total of 2077 publications were included. There has been a rapid growth of publications on cognitive frailty research since 2016. The United States, Italy, England, and Australia have been the leading research centers of cognitive frailty; however, China has also recently focused on this topic. The National Center for Geriatrics and Gerontology, and Shimada H. were found to be the most prolific institution and author, respectively. Co-citation analysis identified 16 clusters, of which the largest was cognitive frailty. The keywords which occurred most frequently were “older adult”, followed by “cognitive impairment”, “frailty”, “risk”, “dementia”, “prevalence”, “mortality”, “health”, and “Alzheimer’s disease”. Burst keyword detection revealed a rising interest in cognitive frailty models. By analyzing these publications from recent years, this study provides a comprehensive analysis of cognitive frailty research.
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Affiliation(s)
- Zhaozhao Hui
- School of Public Health, Health Science Center, Xi’an Jiaotong University, 76 Yanta West Road, Xi’an 710061, China; (Z.H.); (Y.L.)
| | - Xiaoqin Wang
- School of Nursing, Health Science Center, Xi’an Jiaotong University, 76 Yanta West Road, Xi’an 710061, China; (X.W.); (X.R.)
| | - Ying Zhou
- Office of Cadre Health Care, The First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Road, Xi’an 710061, China;
| | - Yajing Li
- School of Public Health, Health Science Center, Xi’an Jiaotong University, 76 Yanta West Road, Xi’an 710061, China; (Z.H.); (Y.L.)
| | - Xiaohan Ren
- School of Nursing, Health Science Center, Xi’an Jiaotong University, 76 Yanta West Road, Xi’an 710061, China; (X.W.); (X.R.)
| | - Mingxu Wang
- School of Public Health, Health Science Center, Xi’an Jiaotong University, 76 Yanta West Road, Xi’an 710061, China; (Z.H.); (Y.L.)
- Correspondence:
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Yuan M, Xu C, Fang Y. The transitions and predictors of cognitive frailty with multi-state Markov model: a cohort study. BMC Geriatr 2022; 22:550. [PMID: 35778705 PMCID: PMC9248089 DOI: 10.1186/s12877-022-03220-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive frailty (CF) is characterized by the simultaneous presence of physical frailty and cognitive impairment. Previous studies have investigated its prevalence and impact on different adverse health-related outcomes. Few studies have focused on the progression and reversibility of CF and their potential predictors. METHODS Data were derived from the China Health and Retirement Longitudinal Study (CHARLS). A total of 4051 older adults with complete data on three waves of the survey (2011, 2013, and 2015) were included and categorized into four groups: normal state (NS), cognitive impairment (CI) only, physical frailty (PF) only and CF (with both PF and CI). A multi-state Markov model was constructed to explore the transitions and predicting factors of CF. RESULTS The incidence and improvement rates of CF were 1.70 and 11.90 per 100 person-years, respectively. The 1-year transition probability of progression to CF in those with CI was higher than that in the PF population (0.340 vs. 0.054), and those with CF were more likely to move to PF (0.208). Being female [hazard ratio (HR) = 1.46, 95%CI = 1.06, 2.02)], dissatisfied with life (HR = 4.94, 95%CI = 1.04, 23.61), had a history of falls (HR = 2.36, 95%CI = 1.02, 5.51), rural household registration (HR = 2.98, 95%CI = 1.61, 5.48), multimorbidity (HR = 2.17, 95%CI = 1.03, 4.59), and depression (HR = 1.75, 95%CI = 1.26, 2.45) increased the risk of progression to CF, whereas literacy (HR = 0.46, 95%CI = 0.33, 0.64) decreased such risk. Depression (HR = 0.43, 95%CI = 0.22, 0.84) reduced the likelihood of CF improvement, whereas literacy (HR = 2.23, 95%CI = 1.63, 3.07) increased such likelihood. CONCLUSIONS Cognitive frailty is a dynamically changing condition in older adults. Possible interventions aimed at preventing the onset and facilitating the recovery of cognitive frailty should focus on improving cognitive function in older adults.
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Affiliation(s)
- Manqiong Yuan
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, 361102, Fujian, China.,Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, China
| | - Chuanhai Xu
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, China
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, 361102, Fujian, China. .,Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, China.
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Beauchet O, Cooper-Brown LA, Hayashi Y, Deveault M, Launay CP. Improving the mental and physical health of older community-dwellers with a museum participatory art-based activity: results of a multicentre randomized controlled trial. Aging Clin Exp Res 2022; 34:1645-1654. [PMID: 35578103 DOI: 10.1007/s40520-022-02139-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/13/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this randomized controlled trial (RCT) was to examine the mental and physical effects of a participatory art-based activity carried out at museums in older community-dwellers. METHODS Based on a bicentre (the Montreal Museum of Fine Arts (MMFA), Montreal, Quebec, Canada; the Fuji Museum, Tokyo, Japan) single-blind RCT in two parallel groups (intervention group versus control group), 228 community-dwelling older adults (mean age 71.1 ± 5.4 years, 76.3% female) were enrolled. The intervention was a participatory art-based activity carried out at the MMFA and the Fuji Museum. The intervention group met weekly for 2 h over a 12-week period. The control group did not participate in any art-based intervention over the study period. Well-being was assessed before and after the first (M0) and the twelfth (M3) workshops, and quality of life and frailty before workshops at M0 and M3. These outcomes were assessed with standardized questionnaires with the same schedule in both groups. RESULTS Well-being and quality of life improved significantly in the intervention group compared to the control group. Mixed results were observed with frailty. Although there were significantly more vigorous and fewer mildly frail participants by the end of the session when comparing intervention to control group participants, only a trend was observed in the decrease in mean value of the intervention group's frailty score. INTERPRETATION This RCT confirmed that a participatory art-based activity performed weekly over a 3-month period may improve both mental and physical health in older community-dwellers. TRIAL REGISTRATION NCT03679715; Title: A-Health RCT: Effects of Participatory Art-Based Activity on Health of Older Community Dwellers; First posted date: September 20, 2018; prospectively registered: https://clinicaltrials.gov/ct2/show/NCT03679715.
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Affiliation(s)
- Olivier Beauchet
- Departments of Medicine, University of Montreal, Montreal, QC, Canada.
- Research Center of the Geriatric University Institute of Montreal, Montreal, QC, Canada.
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
| | - Liam A Cooper-Brown
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada
| | - Yoko Hayashi
- Faculty of Informatics for Arts Department of Information Expression, Shobi University, Kawagoe, Japan
| | - Melanie Deveault
- Education and Wellness Department of the Montreal Museum of Fine Arts, Montreal, QC, Canada
| | - Cyrille P Launay
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada
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13
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Sugimoto T, Arai H, Sakurai T. An update on cognitive frailty: Its definition, impact, associated factors and underlying mechanisms, and interventions. Geriatr Gerontol Int 2021; 22:99-109. [PMID: 34882939 DOI: 10.1111/ggi.14322] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 11/02/2021] [Accepted: 11/17/2021] [Indexed: 01/10/2023]
Abstract
Since the concept and operational definition of "cognitive frailty" (simultaneous presence of physical frailty and cognitive impairment without concurrent dementia) were proposed by the International Academy of Nutrition and Aging and the International Association of Gerontology and Geriatrics, cognitive frailty has been widely investigated. This review is intended to address the operational definition of cognitive frailty, its consequences, contributing factors and underlying mechanisms, as well as interventions for cognitive frailty. Although the definitions and assessments of cognitive frailty vary among researchers, older adults with both physical frailty and cognitive impairment are shown to be at higher risk of adverse health outcomes, including death, disability, hospitalization and incident dementia, than those with either condition alone. While the underlying mechanisms of cognitive frailty are still unclear, factors shown to be associated with cognitive frailty include sociodemographic factors, social status, nutritional status, geriatric syndrome, physical and cognitive activities, functional status, comorbidities, medication use, gut-derived metabolites and structural changes in the brain. Accumulating evidence indicates the need for comprehensive geriatric assessment that helps identify the possible causes of cognitive frailty and develop a multimodal individualized intervention to prevent adverse health outcomes for older adults with cognitive frailty. Further studies are required to clarify the mechanisms through which physical frailty and cognitive impairment interact to accelerate adverse health outcomes, particularly cognitive outcomes. In addition, for older adults with cognitive frailty, an effective flow diagram from primary screening through comprehensive assessment to multidimensional intervention needs to be developed for future implementation in both clinical and community settings. Geriatr Gerontol Int 2021; ••: ••-••.
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Affiliation(s)
- Taiki Sugimoto
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan.,Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takashi Sakurai
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan.,Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Cognition and Behavior Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
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14
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Yuan Y, Lapane KL, Tjia J, Baek J, Liu SH, Ulbricht CM. Physical frailty and cognitive impairment in older nursing home residents: a latent class analysis. BMC Geriatr 2021; 21:487. [PMID: 34493211 PMCID: PMC8425049 DOI: 10.1186/s12877-021-02433-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/25/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Little is known about the heterogeneous clinical profile of physical frailty and its association with cognitive impairment in older U.S. nursing home (NH) residents. METHODS Minimum Data Set 3.0 at admission was used to identify older adults newly-admitted to nursing homes with life expectancy ≥6 months and length of stay ≥100 days (n = 871,801). Latent class analysis was used to identify physical frailty subgroups, using FRAIL-NH items as indicators. The association between the identified physical frailty subgroups and cognitive impairment (measured by Brief Interview for Mental Status/Cognitive Performance Scale: none/mild; moderate; severe), adjusting for demographic and clinical characteristics, was estimated by multinomial logistic regression and presented in adjusted odds ratios (aOR) and 95% confidence intervals (CIs). RESULTS In older nursing home residents at admission, three physical frailty subgroups were identified: "mild physical frailty" (prevalence: 7.6%), "moderate physical frailty" (44.5%) and "severe physical frailty" (47.9%). Those in "moderate physical frailty" or "severe physical frailty" had high probabilities of needing assistance in transferring between locations and inability to walk in a room. Residents in "severe physical frailty" also had greater probability of bowel incontinence. Compared to those with none/mild cognitive impairment, older residents with moderate or severe impairment had slightly higher odds of belonging to "moderate physical frailty" [aOR (95%CI)moderate cognitive impairment: 1.01 (0.99-1.03); aOR (95%CI)severe cognitive impairment: 1.03 (1.01-1.05)] and much higher odds to the "severe physical frailty" subgroup [aOR (95%CI)moderate cognitive impairment: 2.41 (2.35-2.47); aOR (95%CI)severe cognitive impairment: 5.74 (5.58-5.90)]. CONCLUSIONS Findings indicate the heterogeneous presentations of physical frailty in older nursing home residents and additional evidence on the interrelationship between physical frailty and cognitive impairment.
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Affiliation(s)
- Yiyang Yuan
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Jennifer Tjia
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Jonggyu Baek
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Shao-Hsien Liu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Christine M Ulbricht
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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15
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Ponvel P, Shahar S, Singh DKA, Ludin AFM, Rajikan R, Rajab NF, Ai-Vyrn C, Din NC, Ibrahim N, Subramaniam P, Haron H, Ismail A, Sharif R, Ramasamy K, Majeed ABA, Ali NM, Mohamad M, Noah SAM, Ibrahim AM, Safien AM, Khalid NM, Fadzil NHM, Mangialasche F, Kivipelto M. Multidomain Intervention for Reversal of Cognitive Frailty, Towards a Personalized Approach (AGELESS Trial): Study Design. J Alzheimers Dis 2021; 82:673-687. [PMID: 34092633 PMCID: PMC8385532 DOI: 10.3233/jad-201607] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Cognitive frailty (CF) is identified as one of the main precursors of dementia. Multidomain intervention has been found to delay or prevent the onset of CF. Objective: The aim of our present study is to determine the effectiveness of a comprehensive, multidomain intervention on CF; to evaluate its cost effectiveness and the factors influencing adherence toward this intensive intervention. Methods: A total of 1,000 community dwelling older adults, aged 60 years and above will be screened for CF. This randomized controlled trial involves recruitment of 330 older adults with CF from urban, semi-urban, and rural areas in Malaysia. Multidomain intervention comprised of physical, nutritional, cognitive, and psychosocial aspects will be provided to participants in the experimental group (n = 165). The control group (n = 165) will continue their usual care with their physician. Primary outcomes include CF status, physical function, psychosocial and nutritional status as well as cognitive performance. Vascular health and gut microbiome will be assessed using blood and stool samples. A 24-month intensive intervention will be prescribed to the participants and its sustainability will be assessed for the following 12 months. The effective intervention strategies will be integrated as a personalized telerehabilitation package for the reversal of CF for future use. Results: The multidomain intervention developed from this trial is expected to be cost effective compared to usual care as well as able is to reverse CF. Conclusion: This project will be part of the World-Wide FINGERS (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability) Network, of which common identifiable data will be shared and harmonized among the consortia.
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Affiliation(s)
- Pavapriya Ponvel
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Suzana Shahar
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Devinder Kaur Ajit Singh
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Arimi Fitri Mat Ludin
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Roslee Rajikan
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nor Fadilah Rajab
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Chin Ai-Vyrn
- Geriatric Division, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Normah Che Din
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norhayati Ibrahim
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ponnusamy Subramaniam
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Hasnah Haron
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Aniza Ismail
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Razinah Sharif
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | | | | | - Mazlyfarina Mohamad
- Centre for Diagnostic, Therapeutic & Investigative Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Shahrul Azman Mohd Noah
- Centre for Artificial Intelligence Technology, Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, Malaysia
| | - Azianah Mohd Ibrahim
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Aisyah Mohd Safien
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norhayati Mustafa Khalid
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nurul Hidayah Md Fadzil
- Centre for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Francesca Mangialasche
- Division of Clinical Geriatrics, Alzheimer Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Alzheimer Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
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16
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Huang W, Jiang S, Geng L, Li C, Tao M. Correlation between menopausal symptoms and everyday cognition in Chinese (peri)menopausal women. Gynecol Endocrinol 2021; 37:655-659. [PMID: 33645380 DOI: 10.1080/09513590.2021.1892629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the relationship between the severity of menopausal symptoms and everyday cognitive decline in Chinese peri and postmenopausal women. METHODS The peri and postmenopausal Chinese Han female who first visited the menopausal clinic of Shanghai Jiao Tong University Affiliated Sixth People's Hospital was selected as the study participants. The general questionnaire was used to obtain the sociodemographic characteristics of the study participants. The menopausal rating scale (MRS) was used to assess the severity of menopausal symptoms. The short version of the Everyday Cognition (ECog-12) scales was used to assess everyday cognitive performance. RESULTS A total of 295 women were included, with an average age of 51.12 ± 5.15 years. The average ECog scores were 1.51 ± 0.49 and the average MRS scores were 6.89 ± 4.77. In multiple linear regression analysis, after adjusting for confounding factors age, body mass index (BMI), monthly income, occupational status, education level, menopausal status, parity, regular exercise, and history of chronic diseases, complaints of anxiety and physical/mental fatigue were positively correlated with everyday cognitive decline. CONCLUSIONS Menopausal anxiety and physical/mental fatigue were the independent predictors of everyday cognition.
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Affiliation(s)
- Wenjun Huang
- Department of Gynecology and Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, PR China
| | - Susu Jiang
- Department of Gynecology and Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, PR China
| | - Lulu Geng
- Department of Gynecology and Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, PR China
| | - Changbin Li
- Department of Gynecology and Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, PR China
| | - Minfang Tao
- Department of Gynecology and Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, PR China
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17
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Mantovani E, Zucchella C, Schena F, Romanelli MG, Venturelli M, Tamburin S. Towards a Redefinition of Cognitive Frailty. J Alzheimers Dis 2021; 76:831-843. [PMID: 32568197 PMCID: PMC7504985 DOI: 10.3233/jad-200137] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: The progressive aging of the population will dramatically increase the burden of dementia related to Alzheimer’s disease (AD) and other neurodegenerative disorders in the future. Because of the absence of drugs that can modify the neuropathological substrate of AD, research is focusing on the application of preemptive and disease-modifying strategies in the pre-symptomatic period of the disease. In this perspective, the identification of people with cognitive frailty (CF), i.e., those individuals with higher risk of developing dementia, on solid pathophysiological bases and with clear operational clinical criteria is of paramount importance. Objective/Methods: This hypothesis paper reviews the current definitions of CF, presents and discusses some of their limitations, and proposes a framework for updating and improving the conceptual and operational definition of the CF construct. Results: The potential for reversibility of CF should be supported by the assessment of amyloid, tau, and neuronal damage biomarkers, especially in younger patients. Physical and cognitive components of frailty should be considered as separate entities, instead of part of a single macro-phenotype. CF should not be limited to the geriatric population, because trajectories of amyloid accumulation are supposed to start earlier than 65 years in AD. Operational criteria are needed to standardize assessment of CF. Conclusion: Based on the limitations of current CF definitions, we propose a revised one according to a multidimensional subtyping. This new definition might help stratifying CF patients for future trials to explore new lifestyle interventions or disease-modifying pharmacological strategies for AD and dementia.
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Affiliation(s)
- Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Chiara Zucchella
- Section of Neurology, Department of Neurosciences, Verona University Hospital, Verona, Italy
| | - Federico Schena
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maria Grazia Romanelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Massimo Venturelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Section of Neurology, Department of Neurosciences, Verona University Hospital, Verona, Italy
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18
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Pan Y, Zhang Y, Liu N, Lu W, Yang J, Li Y, Liu Z, Wei Y, Lou Y, Kong J. Vitamin D Attenuates Alzheimer-like Pathology Induced by Okadaic Acid. ACS Chem Neurosci 2021; 12:1343-1350. [PMID: 33818056 DOI: 10.1021/acschemneuro.0c00812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Many elderly individuals suffer from Alzheimer's disease (AD), which causes a growing concern. We investigated the mechanism underlying the effects of vitamin D (VD) as a prophylactic treatment. A mouse model of okadaic-acid-induced AD-like pathology was used in vivo and in vitro. Morris water maze and field trials were used to assess cognitive function. The expression levels of VDR, MTHFR, LCMT-1, PP2A, p-TAU (Thr396), and T-TAU and the methylation level of PP2A were measured by Western blotting, and a reversal of the increase in the levels of these proteins in an AD cell model was observed. We used MTHFR-knockdown SH-SY5Y cells to further test the effects of VD, treated these cells with cycloheximide and MG132, and used RT-PCR to explore the mechanism underlying MTHFR targeting. We found that the effects of VD on AD were impaired by MTHFR knockdown through a pretranscriptional mechanism. In addition, VD attenuated AD-induced cognitive impairment and significantly suppressed the expression of TAU. Our findings indicated that VD treatment alleviated TAU accumulation and rescued methylated PP2A by increasing the expression of LCMT-1 and MTHFR.
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Affiliation(s)
- Yiming Pan
- Department of Clinical Nutrition, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Yalin Zhang
- Department of Clinical Nutrition, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Ning Liu
- Department of Clinical Nutrition, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Wanyi Lu
- Department of Clinical Nutrition, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Jingxin Yang
- Department of Clinical Nutrition, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Ye Li
- Department of Clinical Nutrition, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Zuwang Liu
- Department of Clinical Nutrition, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Yinghong Wei
- Department of Clinical Nutrition, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Yan Lou
- Department of Computer Science, China Medical University, Shenyang 110013, China
| | - Juan Kong
- Department of Clinical Nutrition, Shengjing Hospital of China Medical University, Shenyang 110004, China
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19
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Sargent L, Nalls M, Amella EJ, Mueller M, Lageman SK, Bandinelli S, Colpo M, Slattum PW, Singleton A, Ferrucci L. Anticholinergic Drug Induced Cognitive and Physical Impairment: Results from the InCHIANTI Study. J Gerontol A Biol Sci Med Sci 2021; 75:995-1002. [PMID: 30590397 DOI: 10.1093/gerona/gly289] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aims of this study were to evaluate the relationship between anticholinergic drug burden (ACB) cognitive impairment, physical frailty, and cognitive frailty, and to determine if ACB is predictive of these phenotypes when modeled with biological and genomic biomarkers. METHODS In a retrospective cohort study, a total of 1,453 adults aged 20-102 years were used to examine ACB as a predictor for cognitive impairment, physical frailty, and cognitive frailty. Anticholinergic burden is examined as a predictor for all phenotypes in a cross-sectional analysis using logistic, ordinal regression models, and Extreme Gradient Boosting for population predictive modeling. RESULTS A significant association was found between ACB and cognitive decline (p = .02), frailty (p < .001), and cognitive frailty (p < .001). The odds of cognitive impairment increased by 1.21 (95% confidence interval [CI] = 1.06-1.37, p < .001), odds of being frail increased by 1.33 (95% CI = 1.18-1.50, p < .001), and odds of having cognitive frailty increased by 1.36 (95% CI = 1.21-1.54, p < .001). Population modeling results indicated ACB score as one of the stronger predictors for cognitive impairment, physical frailty, and cognitive frailty with area under the curves ranging from 0.81 to 0.88. CONCLUSIONS Anticholinergic medications are a potentially modifiable risk factor for the prevention of cognitive and physical decline. Identification of reversible causes for cognitive and physical impairment is critical for the aging population. These findings encourage new research that may lead to effective interventions for deprescribing programs for the prevention of cognitive and physical decline in older adults.
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Affiliation(s)
- Lana Sargent
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland.,Virginia Commonwealth University School of Nursing, Richmond, Virginia.,Medical University of South Carolina School of Nursing, Charleston, South Carolina
| | - Mike Nalls
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland.,Department of Neurology, Virginia Commonwealth School of Medicine, Richmond, Virginia
| | - Elaine J Amella
- Medical University of South Carolina School of Nursing, Charleston, South Carolina
| | - Martina Mueller
- Medical University of South Carolina School of Nursing, Charleston, South Carolina
| | - Sarah K Lageman
- Laboratory of Clinical Epidemiology, InCHIANTI Study Group, Local Health Unit Tuscany Center, Florence, Italy
| | | | - Marco Colpo
- Data Tecnica International, Glen Echo, Maryland
| | - Patricia W Slattum
- Department of Pharmacotherapy & Outcome Science, Virginia Commonwealth School of Pharmacy, Richmond, Virginia
| | - Andrew Singleton
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, Maryland
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20
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Kim GM, Kim BK, Kim DR, Liao Y, Park JH, Park H. An Association between Lower Extremity Function and Cognitive Frailty: A Sample Population from the KFACS Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031007. [PMID: 33498760 PMCID: PMC7908491 DOI: 10.3390/ijerph18031007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/28/2020] [Accepted: 01/19/2021] [Indexed: 11/29/2022]
Abstract
The present study aimed to define the physical function and lipid profile for physical and cognitive frailty in community-dwelling Korean older adults. A total of 229 participants (age = 76.76 ± 3.72 years; body mass index = 24.83 ± 3.15) were classified into four groups: robust, pre-frailty, cognitive decline, and cognitive frailty. An analysis on the four groups was performed to measure their physical and cognitive function, as well as blood biomarkers. The area under (AUC) the receiver operating characteristic curve (ROC) indicated that the 6-min Walk Test (6MWT), Timed Up and Go test (TUG), and Five Times Sit-to-Stand test (FTSS) had the potential to distinguish the capacity of an old adult to predict cognitive frailty. The 6MWT had a higher sensitivity and the TUG and FTSS tests had greater specificity. With cognitive frailty as a categorical variable, cognitive frailty status was a significant predictor of the TUG (odds ratio (OR) 2.897; 95% confidence interval (CI), 1.283–6.541), FTSS (OR 3.337; 95% CI 1.451–7.673), and 6MWT (OR 0.204; 95% CI 0.070–0.591) tests. Our findings indicate that the 6MWT, TUG, and FTSS tests are closely related to cognitive frailty and can provide potential prognostic cutoff points.
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Affiliation(s)
- Gwon-Min Kim
- Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea; (G.-M.K.); (D.-R.K.)
| | - Bo-Kun Kim
- Faculty of Sports Health Care, In-je University, Gimhae 50834, Korea;
| | - Du-Ri Kim
- Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea; (G.-M.K.); (D.-R.K.)
- Department of Occupational Therapy, Graduate School of Inje University, Gimhae 50834, Korea
| | - Yung Liao
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei 106, Taiwan;
| | - Jong-Hwan Park
- Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea; (G.-M.K.); (D.-R.K.)
- Correspondence: (J.-H.P.); (H.P.); Tel.: +82-51-240-7071 (J.-H.P.); +82-51-200-7979 (H.P.)
| | - Hyuntae Park
- Department of Health Sciences, Graduate School, Dong-A University, Busan 49315, Korea
- Correspondence: (J.-H.P.); (H.P.); Tel.: +82-51-240-7071 (J.-H.P.); +82-51-200-7979 (H.P.)
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21
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Chung CP, Lee WJ, Peng LN, Shimada H, Tsai TF, Lin CP, Arai H, Chen LK. Physio-Cognitive Decline Syndrome as the Phenotype and Treatment Target of Unhealthy Aging. J Nutr Health Aging 2021; 25:1179-1189. [PMID: 34866145 DOI: 10.1007/s12603-021-1693-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In this era of unprecedented longevity, healthy aging is an important public health priority. Avoiding or shortening the period of disability or dementia before death is critical to achieving the defining objectives of healthy aging, namely to develop and maintain functional capabilities that enable wellbeing in older age. The first step is to identify people who are at risk and then to implement effective primary interventions. Geriatricians have identified a distinct clinical phenotype of concurrent physical frailty and cognitive impairment, which predicts high risk of incident dementia and disability and is potentially reversible. Differing operational definitions for this phenotype include "cognitive frailty", "motoric cognitive risk syndrome" and the recently proposed "physio-cognitive decline syndrome (PCDS)". PCDS is defined as concurrent mobility impairment no disability (MIND: slow gait or/and weak handgrip) and cognitive impairment no dementia (CIND: ≥1.5 SD below the mean for age-, sex-, and education-matched norms in any cognitive domain but without dementia). By these criteria, PCDS has a prevalence of 10-15% among community-dwelling older persons without dementia or disability, who are at increased risk for incident disability (HR 3.9, 95% CI 3.0-5.1), incident dementia (HR 3.4, 95% CI 2.4-5.0) and all-cause mortality (HR 6.7, 95% CI 1.8-26.1). Moreover, PCDS is associated with characteristic neuroanatomic changes in the cerebellum and hippocampus, and their neurocircuitry, which are distinct from neuroimaging features in normal aging and common dementia syndromes. Basic research and longitudinal clinical studies also implicate a hypothetical muscle-brain axis in the pathoetiology of PCDS. Most important, community-dwelling elders with PCDS who participated in a multidomain intervention had significant improvements in global cognitive function, and especially in the subdomains of naming and concentration. Our proposed operational definition of PCDS successfully identifies an appreciable population of at-risk older people, establishes a distinct phenotype with an apparently unique pathoetiology, and is potentially reversible. We now need further studies to elucidate the pathophysiology of PCDS, to validate neuroimaging features and muscle-secreted microRNA biomarkers, and to evaluate the effectiveness of sustained multidomain interventions.
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Affiliation(s)
- C-P Chung
- Prof. Liang-Kung Chen, Aging and Health Research Center, National Yang Ming Chiao Tung University Yangming Campus, No. 155, Section 2, Linong St, Beitou District, Taipei City, 112, Taiwan. Tel: +886-2-28757830, E-mail:
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Cognitive frailty in relation to adverse health outcomes independent of multimorbidity: results from the China health and retirement longitudinal study. Aging (Albany NY) 2020; 12:23129-23145. [PMID: 33221750 PMCID: PMC7746379 DOI: 10.18632/aging.104078] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/05/2020] [Indexed: 12/25/2022]
Abstract
Our objectives were to evaluate: 1) the associations of cognitive frailty with various health outcomes including disability, hospitalization, and death; 2) whether the associations differed by multimorbidity. We included data of 5113 Chinese older adults (aged 60+ years) who had baseline cognition and physical frailty assessments (2011 wave) and follow-up for 4 years. About 16.0% (n=820) had cognitive impairment; 6.7% (n=342) had physical frailty; and 1.6% (n=82) met criteria for cognitive frailty. Both cognitive impairment (odds ratios (ORs) range: 1.41 to 2.11) and physical frailty (ORs range: 1.51 to 2.43) were independently associated with basic activities of daily living (BADL), instrumental ADL (IADL), mobility disability, hospitalization, and death among participants without that corresponding outcome at baseline, even after accounting for covariates. Relative to participants who had normal cognition and were nonfrail, those with cognitive frailty had the highest risk for IADL disability (OR=3.40, 95% CI, 1.23–9.40) and death (OR=3.89, 95% CI, 2.25–6.47). We did not find significant interaction effects between cognitive frailty and multimorbidity (Pinteractions>0.05). Overall, cognitive frailty was associated with disability and death, independent of multimorbidity. This highlights the importance of assessing cognitive frailty in the community to promote primary and secondary preventions for healthy aging.
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23
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Bartoli M, Palermo S, Cipriani GE, Amanzio M. A Possible Association Between Executive Dysfunction and Frailty in Patients With Neurocognitive Disorders. Front Psychol 2020; 11:554307. [PMID: 33262722 PMCID: PMC7685991 DOI: 10.3389/fpsyg.2020.554307] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/23/2020] [Indexed: 01/04/2023] Open
Abstract
Frailty is an age-related dynamic status, characterized by a reduced resistance to stressors due to the cumulative decline of multiple physiological systems. Several researches have highlighted a relationship between physical frailty and cognitive decline; however, the role of specific cognitive domains has not been deeply clarified yet. Current studies have hypothesized that physical frailty and neuropsychological deficits may share systemic inflammation and increased oxidative stress in different neurodegenerative disorders, such as Alzheimer’s and Parkinson’s disease. However, the role of the executive dysfunction should be investigated in a more detailed way using a multidimensional approach. With this aim, we conducted a review of the literature on the few experimental articles published to discuss the existence of a relationship between frailty and cognitive impairment in neurocognitive disorders, particularly focusing on the domain of executive dysfunction. The data suggest that physical frailty and cognitive decline, especially executive dysfunction, are two aspects strongly linked in mild and major neurocognitive disorders due to Alzheimer’s and Parkinson’s disease. In light of this, a new framework linking aging, cognitive decline, and neurodegenerative diseases is needed. In order to analyze the effects that aging processes have on neural decline and neurocognitive disease, and to identify relevant groups of users and patients, future longitudinal studies should adopt a multidimensional approach, in the field of primary prevention and in the continuum from mild to major neurocognitive disorder.
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Affiliation(s)
| | - Sara Palermo
- Department of Psychology, University of Turin, Turin, Italy.,European Innovation Partnership on Active and Healthy Ageing, Brussels, Belgium
| | | | - Martina Amanzio
- Department of Psychology, University of Turin, Turin, Italy.,European Innovation Partnership on Active and Healthy Ageing, Brussels, Belgium
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24
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Murukesu RR, Singh DKA, Shahar S, Subramaniam P. A Multi-Domain Intervention Protocol for the Potential Reversal of Cognitive Frailty: "WE-RISE" Randomized Controlled Trial. Front Public Health 2020; 8:471. [PMID: 33014971 PMCID: PMC7495818 DOI: 10.3389/fpubh.2020.00471] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/27/2020] [Indexed: 12/20/2022] Open
Abstract
Following the rapid increase of the aging population, health promotion and prevention of physical disability and dementia in older persons are essential for healthy aging. For example, there may be a potential to prevent or reverse cognitive frailty, the co-existence of both physical frailty and cognitive impairment in older persons. However, evidence-based interventions targeting the prevention or potential reversibility of cognitive frailty among community dwelling older adults are scarce. In this paper, we described the rationale, development and delivery of a multi-domain intervention comprising multi-component physical exercise prescription, cognitive training, dietary counseling and promotion of psychosocial support, called the WE-RISE trial. The aim of WE-RISE intervention is to potentially reverse cognitive frailty. This is a two-armed, single blinded, randomized controlled trial conducted over a duration of 6 months, at senior citizen activity centers within the Klang Valley, Malaysia. Ambulating, community dwelling older adults aged 60 years and above with cognitive frailty are randomized into two groups; (1) intervention group: which receives an instructor based "WE-RISE" intervention for the first 3 months, and then a home-based "WE-RISE at Home" intervention for the following 3 months; (2) control group: usual care with no modifications to their daily routine. Primary outcome is cognitive frailty status and secondary outcome include physical function, cognitive performance, nutritional status, psychosocial status and quality of life which are obtained during baseline screening and subsequent follow ups at 3rd and 6th month. Description of the intervention is done using the template for intervention description and replication (TIDieR) checklist. This trial protocol has received approval from Research Ethics Committee of Universiti Kebangsaan Malaysia (UKM PPI/111/8/JEP-2018-558) and the Department of Social Welfare Malaysia (MyResearch Reference: JKMM 100/12/5/2: 2018/405). Trial registration number: ACTRN12619001055190.
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Affiliation(s)
- Resshaya Roobini Murukesu
- Physiotherapy Programme and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Devinder Kaur Ajit Singh
- Physiotherapy Programme and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Suzana Shahar
- Dietetic Program and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ponnusamy Subramaniam
- Health Psychology Programme and Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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25
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Sezgin D, Liew A, O'Donovan MR, O'Caoimh R. Pre-frailty as a multi-dimensional construct: A systematic review of definitions in the scientific literature. Geriatr Nurs 2020; 41:139-146. [DOI: 10.1016/j.gerinurse.2019.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022]
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26
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Insulin signaling pathway and related molecules: Role in neurodegeneration and Alzheimer's disease. Neurochem Int 2020; 135:104707. [PMID: 32092326 DOI: 10.1016/j.neuint.2020.104707] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 12/14/2022]
Abstract
Alzheimer's disease (AD) is one of the most common neurodegenerative diseases. Its major pathological hallmarks, neurofibrillary tangles (NFT), and amyloid-β plaques can result from dysfunctional insulin signaling. Insulin is an important growth factor that regulates cell growth, energy utilization, mitochondrial function, autophagy, oxidative stress, synaptic plasticity, and cognitive function. Insulin and its downstream signaling molecules are located majorly in the regions of cortex and hippocampus. The major molecules involved in impaired insulin signaling include IRS, PI3K, Akt, and GSK-3β. Activation or inactivation of these major molecules through increased or decreased phosphorylation plays a role in insulin signaling abnormalities or insulin resistance. Insulin resistance, therefore, is considered as a major culprit in generating the hallmarks of AD arising from neuroinflammation and oxidative stress, etc. Moreover, caspases, Nrf2, and NF-κB influence this pathway in an indirect way. Various studies also suggest a strong link between Diabetes Mellitus and AD due to the impairment of insulin signaling pathway. Moreover, studies also depict a strong correlation of other neurodegenerative diseases such as Parkinson's disease and Huntington's disease with insulin resistance. Hence this review will provide an insight into the role of insulin signaling pathway and related molecules as therapeutic targets in AD and other neurodegenerative diseases.
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27
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Arai H, Kozaki K, Kuzuya M, Matsui Y, Satake S. Chapter 2 Frailty concepts. Geriatr Gerontol Int 2020; 20 Suppl 1:14-19. [PMID: 32050302 DOI: 10.1111/ggi.13831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Koichi Kozaki
- Department of Geriatric Medicine, Kyorin University, School of Medicine, Mitaka, Japan
| | - Masafumi Kuzuya
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasumoto Matsui
- Center for Frailty and Locomotive Syndrome, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shosuke Satake
- Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
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28
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Akhtar A, Dhaliwal J, Saroj P, Uniyal A, Bishnoi M, Sah SP. Chromium picolinate attenuates cognitive deficit in ICV-STZ rat paradigm of sporadic Alzheimer's-like dementia via targeting neuroinflammatory and IRS-1/PI3K/AKT/GSK-3β pathway. Inflammopharmacology 2020; 28:385-400. [PMID: 31898080 DOI: 10.1007/s10787-019-00681-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/16/2019] [Indexed: 02/05/2023]
Abstract
Alzheimer's disease (AD) is prevalent in old age people and is one of the most common brain diseases. Brain insulin resistance, neuroinflammation, oxidative stress, and mitochondrial and cholinergic dysfunction are key features of the disease. In our study, streptozotocin (STZ) in a dose of 3 mg/kg was injected in male Wistar rats bilaterally through the intracerebroventricular (ICV) route on stereotaxic apparatus. Chromium picolinate (CrPic) was tested at doses of 1 mg/kg, 2 mg/kg, and 4 mg/kg, while rivastigmine (2 mg/kg) was used as reference standard drug. Cognitive dysfunction induced by STZ was assessed by behavioral tests like Morris water maze and novel object recognition test. Treatment with CrPic revealed attenuation of cognitive deficit. This was confirmed by behavioral tests, biochemical estimations of antioxidant enzymes, oxidative stress, nitrosative stress, and cholinergic and mitochondrial activity. CrPic did not change AchE activity significantly. STZ-induced neuroinflammation evident by increased TNF-α, IL-6, and CRP levels was also significantly decreased by CrPic. Dysfunctional insulin signaling after ICV-STZ was demonstrated by reduced IRS-1, PI3K, AKT, BDNF gene expression, and increased GSK-3β, NF-κB gene expression with the help of qRT-PCR. CrPic treatment produced an improvement in insulin signaling revealed by increased gene expression of IRS-1, PI3-K, AKT, BDNF, and decreased gene expression of GSK-3β and NF-κB. It was concluded that CrPic reversed AD pathology revealed by improved memory, reduced oxidative stress, neuroinflammation, mitochondrial dysfunction, and upregulated insulin signaling.
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Affiliation(s)
- Ansab Akhtar
- Pharmacology Division, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, 160014, India
| | - Jatinder Dhaliwal
- Pharmacology Division, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, 160014, India
| | - Priyanka Saroj
- Pharmacology Division, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, 160014, India
| | - Ankit Uniyal
- Pharmacology Division, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, 160014, India
| | - Mahendra Bishnoi
- National Agri-Food Biotechnology Institute (NABI), Sector-81, SAS Nagar, Mohali, Punjab, 140306, India
| | - Sangeeta Pilkhwal Sah
- Pharmacology Division, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, 160014, India.
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29
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Anker MS, Anker SD, Coats AJ, von Haehling S. The Journal of Cachexia, Sarcopenia and Muscle stays the front-runner in geriatrics and gerontology. J Cachexia Sarcopenia Muscle 2019; 10:1151-1164. [PMID: 31821753 PMCID: PMC6903443 DOI: 10.1002/jcsm.12518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Markus S. Anker
- Division of Cardiology and Metabolism, Department of CardiologyCharité Universitätsmedizin BerlinBerlinGermany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT)BerlinGermany
- German Centre for Cardiovascular Research (DZHK) partner site BerlinBerlinGermany
- Department of CardiologyCharité Campus Benjamin FranklinBerlinGermany
| | - Stefan D. Anker
- Division of Cardiology and Metabolism, Department of CardiologyCharité Universitätsmedizin BerlinBerlinGermany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT)BerlinGermany
- German Centre for Cardiovascular Research (DZHK) partner site BerlinBerlinGermany
- Department of Cardiology (CVK)Charité Universitätsmedizin BerlinBerlinGermany
- Charité Universitätsmedizin BerlinBerlinGermany
| | | | - Stephan von Haehling
- Department of Cardiology and Pneumology, Heart Center GöttingenUniversity of Göttingen Medical Center, Georg‐August‐UniversityGöttingenGermany
- German Center for Cardiovascular Medicine (DZHK), partner site GöttingenGöttingenGermany
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30
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Miyamura K, Fhon JRS, Bueno ADA, Fuentes-Neira WL, Silveira RCDCP, Rodrigues RAP. Frailty syndrome and cognitive impairment in older adults: systematic review of the literature. Rev Lat Am Enfermagem 2019; 27:e3202. [PMID: 31664410 PMCID: PMC6818658 DOI: 10.1590/1518-8345.3189.3202] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 06/29/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to synthesize the knowledge about the association of frailty syndrome and cognitive impairment in older adults. METHOD the Joanna Briggs Institute's systematic review of etiology and risk factors was adopted. The search for the studies was conducted by two independent reviewers in the databases MEDLINE, Embase, CINAHL and LILACS and by manual search was performed by tow reviewers independently. The measures of association Odds Ratio and Relative Risk were used in the meta-analysis. The software R version 3.4.3 and the meta-analysis package Metafor 2.0 were used for figure analysis. RESULTS three studies identified the association of frailty syndrome and cognitive impairment through Odds Ratio values show that frail older adults are 1.4 times more likely to present cognitive impairment than non-frail older adults. Four studies analyzed the association through the measure of Relative Risk and found no statistical significance, and four studies used mean values. CONCLUSION despite of the methodological differences of the studies and the lack of definition of an exact proportion in the cause and effect relationship, most studies indicate Frailty Syndrome as a trigger for Cognitive decline.
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Affiliation(s)
- Karen Miyamura
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Center for Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Jack Roberto Silva Fhon
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Center for Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Alexandre de Assis Bueno
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Center for Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | | | | | - Rosalina Aparecida Partezani Rodrigues
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Center for Nursing Research Development, Ribeirão Preto, SP, Brazil
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Downer B, Al Snih S, Howrey BT, Raji MA, Markides KS, Ottenbacher KJ. Combined effects of cognitive impairment and pre-frailty on future frailty and death in older Mexican Americans. Aging Ment Health 2019; 23:1405-1412. [PMID: 30472880 PMCID: PMC6534489 DOI: 10.1080/13607863.2018.1493719] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/19/2018] [Accepted: 06/24/2018] [Indexed: 01/19/2023]
Abstract
Objectives: Impaired cognition and pre-frailty are associated with poor health outcomes. However, research has not examined the combined impact of cognitive impairment and pre-frailty on future frailty and mortality among older Mexican Americans. Methods: Data for this analysis came from the 2006-2007 and 2010-2011 waves of the Hispanic EPESE. The final sample included 639 Mexican Americans aged ≥77 years who were non-frail or pre-frail in 2006-2007. Frailty measure included weight loss, exhaustion, weakness, and slow walking speed. Participants were classified as non-frail (0 criteria) and pre-frail (1 criterion) at baseline. Cognitive impairment was defined as <21 points on the MMSE. At baseline, participants were grouped as: cognitively intact non-frail, cognitively intact pre-frail, cognitively impaired non-frail, and cognitively impaired pre-frail. Logistic and hazard regression models were used to evaluate the odds of being frail in 2010-2011 and risk for 10-year mortality. Results: Cognitively impaired pre-frail participants were more likely to become frail (OR = 4.82, 95% CI = 2.02-11.42) and deceased (HR = 1.99, 95% CI = 1.42-2.78). Cognitively impaired non-frail participants had significantly higher risk for mortality (HR = 1.55, 95% CI = 1.12-2.19) but not frailty (OR = 1.29, 95% CI = 0.50-3.11). Being cognitively intact and pre-frail at baseline was not significantly associated with being frail at follow-up (OR = 1.62, 95% CI = 0.83-3.19) or mortality (HR = 1.29, 95% CI = 0.97-1.71). Conclusions: Comorbid cognitive impairment and pre-frailty is associated with future frailty and mortality in older Mexican Americans. Screening for cognitive impairment may be effective for identifying pre-frail Mexican Americans who are at the highest risk of frailty and mortality.
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Affiliation(s)
- Brian Downer
- University of Texas Medical Branch, Division of Rehabilitation Sciences
| | - Soham Al Snih
- University of Texas Medical Branch, Division of Rehabilitation Sciences
- University of Texas Medical Branch, Department of Internal Medicine / Division of Geriatric Medicine
- University of Texas Medical Branch, Sealy Center on Aging
| | - Bret T. Howrey
- University of Texas Medical Branch, Department of Family Medicine
| | - Mukaila A. Raji
- University of Texas Medical Branch, Department of Internal Medicine / Division of Geriatric Medicine
- University of Texas Medical Branch, Sealy Center on Aging
| | | | - Kenneth J. Ottenbacher
- University of Texas Medical Branch, Division of Rehabilitation Sciences
- University of Texas Medical Branch, Sealy Center on Aging
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Bekić S, Babič F, Filipčić I, Trtica Majnarić L. Clustering of Mental and Physical Comorbidity and the Risk of Frailty in Patients Aged 60 Years or More in Primary Care. Med Sci Monit 2019; 25:6820-6835. [PMID: 31507272 PMCID: PMC6753844 DOI: 10.12659/msm.915063] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background This study aimed to identify the clustering of comorbidities, cognitive, and mental factors associated with increased risk of pre-frailty and frailty in patients ≥60 years in a primary healthcare setting in eastern Croatia. Material/Methods There were 159 patients included in the cluster analysis who were ≥60 years and who underwent four-month follow-up. The first cluster contained 50 patients, the second cluster contained 74 patients, and the third cluster contained 35 patients. Clinical parameters were identified from electronic health records and patient questionnaires. Laboratory tests, anthropometric measurements, the number of chronic diseases, the number of prescribed medications were recorded. Frailty was determined using the five criteria of Fried’s phenotype model. Levels of anxiety and depression were recorded using the Geriatric Anxiety Scale (GAS) and the Geriatric Depression Scale (GDS), and the Mini-Mental State Examination (MMSE) score assessed cognitive impairment. Logistic regression models were used to identify predictors of frailty and pre-frailty. Results Three overlapping clusters of phenotypes predicted frailty, and included obesity (n=50), multimorbidity with mental impairment (n=74), and decline in renal function with cognitive impairment (n=35). The predictors of outcome included increasing age, number of chronic diseases, inflammation, anemia, anxiety, and cognitive impairment, and reduced muscle mass. Conclusions In patients ≥60 years in a primary healthcare setting, multimorbidity predictors of pre-frailty and frailty included a decline in cognitive function and renal function.
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Affiliation(s)
- Sanja Bekić
- General Medicine Private Practice Enterprise, Osijek, Croatia.,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - František Babič
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, Košice, Slovakia
| | - Igor Filipčić
- Department of Psychological Medicine, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Ljiljana Trtica Majnarić
- Department of Internal Medicine, Family Medicine and The History of Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Department of Public Health, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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Panza F, Lozupone M, Solfrizzi V, Sardone R, Dibello V, Di Lena L, D'Urso F, Stallone R, Petruzzi M, Giannelli G, Quaranta N, Bellomo A, Greco A, Daniele A, Seripa D, Logroscino G. Different Cognitive Frailty Models and Health- and Cognitive-related Outcomes in Older Age: From Epidemiology to Prevention. J Alzheimers Dis 2019; 62:993-1012. [PMID: 29562543 PMCID: PMC5870024 DOI: 10.3233/jad-170963] [Citation(s) in RCA: 194] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Frailty, a critical intermediate status of the aging process that is at increased risk for negative health-related events, includes physical, cognitive, and psychosocial domains or phenotypes. Cognitive frailty is a condition recently defined by operationalized criteria describing coexisting physical frailty and mild cognitive impairment (MCI), with two proposed subtypes: potentially reversible cognitive frailty (physical frailty/MCI) and reversible cognitive frailty (physical frailty/pre-MCI subjective cognitive decline). In the present article, we reviewed the framework for the definition, different models, and the current epidemiology of cognitive frailty, also describing neurobiological mechanisms, and exploring the possible prevention of the cognitive frailty progression. Several studies suggested a relevant heterogeneity with prevalence estimates ranging 1.0–22.0% (10.7–22.0% in clinical-based settings and 1.0–4.4% in population-based settings). Cross-sectional and longitudinal population-based studies showed that different cognitive frailty models may be associated with increased risk of functional disability, worsened quality of life, hospitalization, mortality, incidence of dementia, vascular dementia, and neurocognitive disorders. The operationalization of clinical constructs based on cognitive impairment related to physical causes (physical frailty, motor function decline, or other physical factors) appears to be interesting for dementia secondary prevention given the increased risk for progression to dementia of these clinical entities. Multidomain interventions have the potential to be effective in preventing cognitive frailty. In the near future, we need to establish more reliable clinical and research criteria, using different operational definitions for frailty and cognitive impairment, and useful clinical, biological, and imaging markers to implement intervention programs targeted to improve frailty, so preventing also late-life cognitive disorders.
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Affiliation(s)
- Francesco Panza
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy.,Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Madia Lozupone
- Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Vincenzo Solfrizzi
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari "Aldo Moro", Bari, Italy
| | - Rodolfo Sardone
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte Bari, Italy
| | - Vittorio Dibello
- Interdisciplinary Department of Medicine (DIM), Section of Dentistry, University of Bari Aldo Moro, Bari, Italy
| | - Luca Di Lena
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte Bari, Italy
| | - Francesca D'Urso
- Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Foggia, Foggia, Italy
| | - Roberta Stallone
- Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Massimo Petruzzi
- Interdisciplinary Department of Medicine (DIM), Section of Dentistry, University of Bari Aldo Moro, Bari, Italy
| | - Gianluigi Giannelli
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte Bari, Italy
| | | | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Foggia, Foggia, Italy
| | - Antonio Greco
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
| | - Davide Seripa
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Giancarlo Logroscino
- Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
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Sezgin D, O’Donovan M, Cornally N, Liew A, O’Caoimh R. Defining frailty for healthcare practice and research: A qualitative systematic review with thematic analysis. Int J Nurs Stud 2019; 92:16-26. [DOI: 10.1016/j.ijnurstu.2018.12.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/13/2018] [Accepted: 12/17/2018] [Indexed: 12/22/2022]
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Ma L, Zhang L, Sun F, Li Y, Tang Z. Cognitive function in Prefrail and frail community-dwelling older adults in China. BMC Geriatr 2019; 19:53. [PMID: 30813907 PMCID: PMC6391822 DOI: 10.1186/s12877-019-1056-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 02/04/2019] [Indexed: 12/19/2022] Open
Abstract
Background Physical frailty, characterized by reduced physiologic complexity and ability to cope with stressors, is closely associated with cognitive impairment, which increases the risk of poor clinical outcomes. To better capture the association between frailty and cognitive impairment, a new construct, cognitive frailty, has been proposed. Cognitive frailty is a clinical condition characterized by the simultaneous presence of physical frailty and cognitive impairment. There is little evidence on the relationship between physical frailty and cognition, as well as cognitive frailty, in Chinese older adults. We aimed to elucidate whether physical frailty is associated with cognitive impairment in an older Chinese population. Methods Data were obtained from the China Comprehensive Geriatric Assessment Study. The sample comprised 3202 community-dwelling adults, aged 60 years and older, from seven Chinese cities. Physical frailty was assessed using a modified, four-item version of the Fried criteria, according to frailty phenotype. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Results The prevalence of physical frailty, prefrailty, cognitive impairment, and cognitive frailty was 9.9, 33.9, 7.5, and 2.3%, respectively (weighted: 8.8, 33.8, 6.5, and 2.0%). The prevalence of the combination of prefrail/frail and cognitive impairment was 5.1% (weighted 4.5%). Frail participants performed worse on global cognition and all cognitive domains than robust and prefrail participants. The MMSE total score was positively correlated with walking speed and negatively correlated with age and frailty. A multivariate logistic regression revealed that after adjusting for age, gender, education level, living area, and chronic diseases, frailty, exhaustion, slowness, and inactivity were significantly associated with poor global cognition. Conclusions The standard prevalence of physical frailty, prefrailty, cognitive impairment, and cognitive frailty in community-dwelling older adults in China was 8.8, 33.8, 6.5, and 2.0%, respectively. Frailty, exhaustion, slowness, and inactivity were significantly associated with poor global cognition.
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Affiliation(s)
- Lina Ma
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.,Beijing Geriatric Healthcare Center, Xuanwu Hospital, Capital Medical University, Beijing Institute of Geriatrics, Key Laboratory on Neurodegenerative Disease of Ministry of Education, Beijing Institute for Brain Disorders, China National Clinical Research Center for Geriatric Disorders, Beijing, 100053, China
| | - Li Zhang
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Fei Sun
- Beijing Geriatric Healthcare Center, Xuanwu Hospital, Capital Medical University, Beijing Institute of Geriatrics, Key Laboratory on Neurodegenerative Disease of Ministry of Education, Beijing Institute for Brain Disorders, China National Clinical Research Center for Geriatric Disorders, Beijing, 100053, China
| | - Yun Li
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Zhe Tang
- Beijing Geriatric Healthcare Center, Xuanwu Hospital, Capital Medical University, Beijing Institute of Geriatrics, Key Laboratory on Neurodegenerative Disease of Ministry of Education, Beijing Institute for Brain Disorders, China National Clinical Research Center for Geriatric Disorders, Beijing, 100053, China.
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Borges MK, Canevelli M, Cesari M, Aprahamian I. Frailty as a Predictor of Cognitive Disorders: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2019; 6:26. [PMID: 30838210 PMCID: PMC6389599 DOI: 10.3389/fmed.2019.00026] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/28/2019] [Indexed: 02/01/2023] Open
Abstract
Background/Aim: Current evidence in the literature supports associations between frailty, cognitive impairment, and dementia. The study aim was to describe the risk of cognitive disorders associated with physical frailty in older adults from community-based studies. Methods: We performed a systematic review and meta-analysis, using MEDLINE, PsycINFO, Scopus, and Web of Science as databases for the search. Cohort and longitudinal studies were included in qualitative analysis and quantitative synthesis. For inclusion, studies had to assess dementia and cognitive impairment as a primary or secondary outcome, and describe the prevalence of frailty among participants at baseline and follow-up. Results: Of the 2,210 studies retrieved by the systematic review, 6 relevant studies were included in a meta-analysis. Baseline frailty was significantly associated with an increased risk of geriatric cognitive disorders (pooled OR = 1.80, 95% CI = 1.11–2.92; p = 0.02). Heterogeneity across the studies was significant (I2 = 79%). Conclusions: The analyses confirmed that frail older adults were at higher risk of incident cognitive disorders than non-frail elders. Frailty status seems to be most associated with the risk of incident dementia. Frailty may represent a risk factor for dementia and could constitute a novel modifiable target in early cognitive impairment.
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Affiliation(s)
- Marcus Kiiti Borges
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marco Canevelli
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Matteo Cesari
- Fondazione IRCCS Ca' Granda Ospedadale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Ivan Aprahamian
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Geriatrics and Psychiatry Division, Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
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Liu LK, Chen CH, Lee WJ, Wu YH, Hwang AC, Lin MH, Shimada H, Peng LN, Loh CH, Arai H, Chen LK. Cognitive Frailty and Its Association with All-Cause Mortality Among Community-Dwelling Older Adults in Taiwan: Results from I-Lan Longitudinal Aging Study. Rejuvenation Res 2019; 21:510-517. [PMID: 29644921 DOI: 10.1089/rej.2017.2038] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The definition of cognitive frailty and its prediction for adverse outcome of community-living older adults remains controversial. This study aims to evaluate the association between cognitive frailty and all-cause mortality among community-living older adults. Data of the I-Lan Longitudinal Aging Study (ILAS) were retrieved for study. Frailty was defined by Fried's criteria, and a series of neuropsychological assessments, including the Mini-Mental State Examination, Center for Epidemiology Studies-Depression, the delayed free recall in the Chinese Version Verbal Learning Test, the Boston Naming Test, the category (animal) Verbal Fluency Test, the Taylor Complex Figure Test, the digital backward, and the Clock Drawing Test were performed. All participants received blood sampling after 10-hour overnight fast for various biochemical markers. Cognitive frailty was defined as the concomitant presence of dynapenia and cognitive declines in any domains. Overall, data of 678 participants aged 65 years and older (mean age: 73.3 ± 5.3 years) were obtained for the study. The prevalence of cognitive frailty in this study was 13.3%. People with cognitive frailty were significantly older, having higher multimorbidity burden, more likely to be women, and had less skeletal muscle mass. Adjusted for age and gender, both dynapenia without cognitive impairment (hazard ratio [HR]: 5.402; 95% confidence interval [CI]: 1.463-19.954; p = 0.011) and cognitive frailty (HR: 6.682; 95% CI: 1.803-26.116; p = 0.005) were significantly associated with all-cause mortality. The prevalence of cognitive frailty was 13.3% in Taiwan and was predictive for all-cause mortality. Further study is needed to explore the pathophysiology and reversibility of cognitive frailty.
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Affiliation(s)
- Li-Kuo Liu
- 1 Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,2 Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,3 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Hung Chen
- 1 Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,4 Department of Family Medicine, Taipei City Hospital Hoping Branch, Taipei, Taiwan
| | - Wei-Ju Lee
- 1 Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,2 Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,5 Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yilan, Taiwan
| | - Yi-Hui Wu
- 1 Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,2 Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,3 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - An-Chun Hwang
- 1 Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,2 Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,3 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Hsien Lin
- 1 Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,2 Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,3 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Li-Ning Peng
- 1 Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,2 Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,3 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Hui Loh
- 1 Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,7 Hualien Tzu Chi Hospital, Hualien, Taiwan
| | - Hidenori Arai
- 6 National Center for Geriatrics and Gerontology, Obu, Japan
| | - Liang-Kung Chen
- 1 Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,2 Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,3 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
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Liu Z, Hsu FC, Trombetti A, King AC, Liu CK, Manini TM, Fielding RA, Pahor M, Newman AB, Kritchevsky S, Gill TM. Effect of 24-month physical activity on cognitive frailty and the role of inflammation: the LIFE randomized clinical trial. BMC Med 2018; 16:185. [PMID: 30352583 PMCID: PMC6199791 DOI: 10.1186/s12916-018-1174-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 09/12/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Whether physical activity can reduce cognitive frailty-a relatively new "compound" phenotype proposed in 2013-and whether the effect of physical activity differs based on levels of inflammation are unknown. Therefore, this study aimed to evaluate the effect of physical activity on cognitive frailty and whether baseline interleukin-6 (IL-6) levels modified this effect. METHODS We used data from the Lifestyle Interventions and Independence for Elders (LIFE) Study, a multicenter, single-blinded randomized trial conducted at eight US field centers between February 2010 and December 2013. The main outcome was cognitive frailty at 24 months, expressed as an ordinal variable based on the six combinations of its two components: frailty (non-frail, pre-frail, and frail) and mild cognitive impairment (yes, no). Frailty and cognition were assessed by the Study of Osteoporotic Fractures (SOF) index and the Modified Mini-Mental State Examination (3MSE) scale, respectively. Plasma IL-6 was measured at baseline. Of the 1635 original randomized sedentary participants (70-89 years), this study included 1298 participants with data on both cognitive frailty and IL-6 assessments at baseline. RESULTS After adjusting for field center, sex, and baseline levels of cognitive frailty, the ordinal logistic regression model revealed that participants in the physical activity group had 21% lower odds (odds ratio, 0.79; 95% confidence interval, 0.64-0.98) of worsening cognitive frailty over 24 months than those in the health education group. The effect of physical activity on cognitive frailty did not differ according to baseline IL-6 levels (P for interaction = 0.919). The results did not change after additional adjustment for IL-6 subgroups and the inverse probability of remaining in the study. Comparable results were observed according to age, sex, ethnicity/race, and short physical performance battery score (P for interaction = 0.835, 0.536, 0.934, and 0.458, respectively). CONCLUSIONS A 24-month structured, moderate-intensity physical activity program reduced cognitive frailty compared with a health education program in sedentary older persons, and this beneficial effect did not differ according to baseline levels of inflammatory biomarker IL-6. These findings suggest that the new cognitive frailty construct is modifiable and highlight the potential of targeting cognitive frailty for promoting healthy aging. TRIAL REGISTRATION Clinicaltrials.gov, NCT01072500.
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Affiliation(s)
- Zuyun Liu
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Fang-Chi Hsu
- Department of Biostatistical Sciences, Wake Forest University Health Sciences, Winston Salem, NC, USA
| | - Andrea Trombetti
- Division of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.,Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Abby C King
- Department of Health Research and Policy and the Stanford Prevention Research Center, Department of Medicine, Stanford University, School of Medicine, Stanford, CA, USA
| | - Christine K Liu
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA.,Section of Geriatrics, Boston University School of Medicine, Boston, MA, USA
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Roger A Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephen Kritchevsky
- Sticht Center on Aging, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
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De Roeck EE, Dury S, De Witte N, De Donder L, Bjerke M, De Deyn PP, Engelborghs S, Dierckx E. CFAI-Plus: Adding cognitive frailty as a new domain to the comprehensive frailty assessment instrument. Int J Geriatr Psychiatry 2018; 33:941-947. [PMID: 29637620 DOI: 10.1002/gps.4875] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 01/09/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Cognitive frailty is characterized by the presence of cognitive impairment in exclusion of dementia. In line with other frailty domains, cognitive frailty is associated with negative outcomes. The Comprehensive Frailty Assessment Instrument (CFAI) measures 4 domains of frailty, namely physical, psychological, social, and environmental frailty. The absence of cognitive frailty is a limitation. METHOD An expert panel selected 6 questions from the Informant Questionnaire on Cognitive Decline that were, together with the CFAI and the Montreal cognitive assessment administered to 355 older community dwelling adults (mean age = 77). RESULTS After multivariate analysis, 2 questions were excluded. All the questions from the original CFAI were implemented in a principal component analysis together with the 4 cognitive questions, showing that the 4 cognitive questions all load on 1 factor, representing the cognitive domain of frailty. By adding the cognitive domain to the CFAI, the reliability of the adapted CFAI (CFAI-Plus), remains good (Cronbach's alpha: .767). CONCLUSIONS This study showed that cognitive frailty can be added to the CFAI without affecting its good psychometric properties. In the future, the CFAI-Plus needs to be validated in an independent cohort, and the interaction with the other frailty domains needs to be studied.
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Affiliation(s)
- Ellen Elisa De Roeck
- Department of Clinical and Lifespan Psychology, Vrije Universiteit Brussel, Brussels, Belgium.,Laboratory of Neurochemistry and Behavior, University of Antwerp, Antwerp, Belgium
| | - Sarah Dury
- Department of Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium.,Research Foundation Flanders (FWO), Egmontstraat 5, 1000, Brussels, Belgium
| | - Nico De Witte
- Department of Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium.,Faculty of Education, Health and Social Work, University College Ghent, Ghent, Belgium
| | - Liesbeth De Donder
- Department of Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Maria Bjerke
- Laboratory of Neurochemistry and Behavior, University of Antwerp, Antwerp, Belgium
| | - Peter Paul De Deyn
- Laboratory of Neurochemistry and Behavior, University of Antwerp, Antwerp, Belgium.,Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Hoge Beuken and Middelheim, Antwerp, Belgium
| | - Sebastiaan Engelborghs
- Laboratory of Neurochemistry and Behavior, University of Antwerp, Antwerp, Belgium.,Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Hoge Beuken and Middelheim, Antwerp, Belgium
| | - Eva Dierckx
- Department of Clinical and Lifespan Psychology, Vrije Universiteit Brussel, Brussels, Belgium
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Vella Azzopardi R, Beyer I, Vermeiren S, Petrovic M, Van Den Noortgate N, Bautmans I, Gorus E. Increasing use of cognitive measures in the operational definition of frailty-A systematic review. Ageing Res Rev 2018; 43:10-16. [PMID: 29408342 DOI: 10.1016/j.arr.2018.01.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 01/14/2018] [Accepted: 01/18/2018] [Indexed: 01/27/2023]
Abstract
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.
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Yoon DH, Lee JY, Song W. Effects of Resistance Exercise Training on Cognitive Function and Physical Performance in Cognitive Frailty: A Randomized Controlled Trial. J Nutr Health Aging 2018; 22:944-951. [PMID: 30272098 DOI: 10.1007/s12603-018-1090-9] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cognitive frailty is defined as the presence of both physical frailty and cognitive impairment (clinical dementia rating score = 0.5), in the absence of dementia. It is characterized by concurrent physical frailty and potentially reversible cognitive impairment. In this study, we sought to elucidate the effects of high-speed resistance exercise training on cognitive function and physical performance in older adults with cognitive frailty. METHODS We conducted a parallel-group, randomized controlled trial involving community-living older adults with cognitive frailty. The participants' mean age was 73.9 (± 4.3 SD) years, and 69.8% (n=30) were female. Two different 4-month interventions included high-speed resistance exercise training group (n=22) and a control group (balance and band stretching, n=23). Frailty score, cognitive function (memory, processing speed, cognitive flexibility, working memory, executive function), physical function (SPPB, TUG, gait speed), and muscle strength (grip strength, knee extension strength) were assessed at baseline, 8 weeks, and 16 weeks. RESULTS Statistical analysis showed that exercise improved performance significantly in the tests for cognitive function (processing speed and executive function, both p < 0.05), physical function (SPPB, TUG, gait speed, both p < 0.05), and muscle strength (grip strength, knee extension strength, both p < 0.05). However, no significant changes in frailty score were observed between intervention and either control group (p < 0.05). CONCLUSION In conclusion, our findings indicate that high-speed resistance exercise training approaches are effective in improving cognitive function and physical performance in older adults with cognitive frailty. This study shows that it is feasible to identify older adults with cognitive frailty in the community and primary care setting for effective intervention to reduce their level of frailty and cognitive impairment.
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Affiliation(s)
- D H Yoon
- Jun-Young Lee, M.D., Ph.D, Associate Professor, Department of Psychiatry and Neuroscience Research Institute, Seoul National University College of Medicine. SMG-SNU Boramae Medical Center, 5-20, Boramae-Ro, Dongjak-gu, Seoul 07061, Korea, E-mail: , Phone: 82-2-870-2462
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Affiliation(s)
- B Vellas
- John E. Morley, MB,BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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Amanzio M, Palermo S, Zucca M, Rosato R, Rubino E, Leotta D, Bartoli M, Rainero I. Neuropsychological Correlates of Pre-Frailty in Neurocognitive Disorders: A Possible Role for Metacognitive Dysfunction and Mood Changes. Front Med (Lausanne) 2017; 4:199. [PMID: 29188218 PMCID: PMC5694746 DOI: 10.3389/fmed.2017.00199] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 10/31/2017] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Martina Amanzio
- Department of Psychology, University of Turin, Turin, Italy.,European Innovation Partnership on Active and Healthy Ageing, Brussels, Belgium
| | - Sara Palermo
- Department of Psychology, University of Turin, Turin, Italy
| | - Milena Zucca
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Rosalba Rosato
- Department of Psychology, University of Turin, Turin, Italy.,Unit of Cancer Epidemiology, "Città della Salute e della Scienza" Hospital and CPO Piemonte, Turin, Italy
| | - Elisa Rubino
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | | | | | - Innocenzo Rainero
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
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Albala C, Lera L, Sanchez H, Angel B, Márquez C, Arroyo P, Fuentes P. Frequency of frailty and its association with cognitive status and survival in older Chileans. Clin Interv Aging 2017; 12:995-1001. [PMID: 28721027 PMCID: PMC5498773 DOI: 10.2147/cia.s136906] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Age-associated brain physiologic decline and reduced mobility are key elements of increased age-associated vulnerability. Objective To study the frequency of frailty phenotype and its association with mental health and survival in older Chileans. Methods Follow-up of ALEXANDROS cohorts designed to study disability associated with obesity in community-dwelling people 60 years and older living in Santiago, Chile. At baseline, 2,098 (67% women) of 2,372 participants were identified as having the frailty phenotype: weak handgrip dynamometry, unintentional weight loss, fatigue/exhaustion, five chair-stands/slow walking speed and difficulty walking (low physical activity). After 10–15 years, 1,298 people were evaluated and 373 had died. Information regarding deaths was available for the whole sample. Results The prevalence of frailty at baseline (≥3 criteria) in the whole sample was 13.9% (women 16.4%; men 8.7%) and the pre-frailty prevalence (1–2 criteria) was 63.8% (65.0% vs 61.4%), respectively. Frailty was associated with cognitive impairment (frail 48.1%; pre-frail 21.7%; nonfrail 20.5%, P<0.001) and depression (frail 55.1%; pre-frail 27.3%; nonfrail 18.8%, P<0.001). Logistic regression models for frailty adjusted for sex and age showed a strong association between frailty and mild cognitive impairment (MCI) (odds ratio [OR] =3.93; 95% CI: 1.41–10.92). Furthermore, an important association was found for depression and frailty (OR =2.36; 95% CI 1.82–3.06). Age- and sex-adjusted hazard ratios (HRs) for death showed an increased risk with increasing frailty: pre-frail HR =1.56 (95% CI: 1.07–2.29), frail HR =1.91 (95% CI: 1.15–3.19); after adjustment by age and sex, a higher risk of death was observed for people identified as frail (HR =1.56, P=0.014) and pre-frail (HR =1.30, P=0.065). MCI and dementia were also risk factors for death (MCI: HR =1.69, P<0.027; dementia: HR =1.66, P=0.016). Conclusion Frailty is highly prevalent and strongly associated with cognitive impairment and depression in older Chileans. The risk for death was higher for frail people, but underlying cognitive impairment is a key component of the lower survival rate.
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Affiliation(s)
- Cecilia Albala
- Public Health Nutrition Unit, Institute of Nutrition and Food Technology (INTA), University of Chile
| | - Lydia Lera
- Public Health Nutrition Unit, Institute of Nutrition and Food Technology (INTA), University of Chile
| | - Hugo Sanchez
- Public Health Nutrition Unit, Institute of Nutrition and Food Technology (INTA), University of Chile
| | - Barbara Angel
- Public Health Nutrition Unit, Institute of Nutrition and Food Technology (INTA), University of Chile
| | - Carlos Márquez
- Public Health Nutrition Unit, Institute of Nutrition and Food Technology (INTA), University of Chile
| | - Patricia Arroyo
- Faculty of Medicine, Clinical Hospital, University of Chile, Santiago, Chile
| | - Patricio Fuentes
- Faculty of Medicine, Clinical Hospital, University of Chile, Santiago, Chile
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