Co-occurrence of cognitive impairment and physical frailty, and incidence of dementia: Systematic review and meta-analysis

A State-of-the-Art Review on the Role of Cognitive and Motor Reserve on Quality of Life: A Focus on Cardiovascular Patients in a Lifespan Perspective

Cardiovascular diseases (CVDs) reflect a huge and diversified condition that influences patient quality of life (QoL) both in the physical and mental aspects, especially in older adults who often present comorbidities and may be affected by cognitive decline. The concept of cognitive reserve (CR), which is built through life course experiences, has widely been considered a protective factor against cognitive decline, while the results of QoL in the field of CVDs are still controversial. In particular, there is a lack of evidence that explicitly explores the effects of CR on the QoL in CVD cases since studies have considered only single CR proxies (e.g., education) or specific cardiovascular conditions. Moreover, none of them have considered the motor reserve (MR), another recent concept that considers the amount of physical activity carried out during a lifespan. Its potential role in preventing age-related diseases has been observed, but more clarification is needed given the importance of the physical component in CVDs. The present state-of-the-art review aims to (i) examine how the literature conceives CR and its proxies in CVDs relating to QoL and (ii) integrate the concept of MR in this framework. Implications for clinical practice will also be discussed.

Demographic and biological factors in interrelationships between physical, cognitive, psychological, and social frailty in community-dwelling older adults: Data from the Birjand Longitudinal Aging Study (BLAS)

Complex interrelationships may exist among different types of frailty. This study aimed to evaluate the demographic and biological factors that influence the different types of frailty in community-dwelling older adults in Iran through a cross-sectional analysis of data obtained from the Birjand Longitudinal Aging Study. This study is an ongoing cohort study of people aged 60 years and over and employed a multistage stratified cluster random sampling. Anthropometric measures were obtained by nurses. The "Fried frailty phenotype" was defined as physical frailty. Cognitive frailty was assessed using the Mini-Mental State Examination. Social frailty was evaluated by some questions, and psychological frailty was assessed using a patient health questionnaire. Blood samples were taken after overnight fasting. All statistical analyses were performed using Stata12 (Texas, USA) and Python. Some type of frailty had been experienced by 62.27 % of the older adults. Cognitive frailty was the dominant type of frailty (55.69 %). Based on multivariate regression analysis, age, sex, education, and marital status were the influencing factors in all types of frailty. Network analysis revealed that physical, cognitive, psychological, and social frailty had synergistic effects on each other, and age and sex had dominant interactions with frailty types. Cognitive frailty was dominant compared with other types of frailty, indicating the need to detect cognitive frailty at the earliest stage and to implement an appropriate program to manage cognitive frailty in older adults.

The Difficulties of Managing Pain in People Living with Frailty: The Potential for Digital Phenotyping

Pain and frailty are closely linked. Chronic pain is a risk factor for frailty, and frailty is a risk factor for pain. People living with frailty also commonly have cognitive impairment, which can make assessment of pain and monitoring of pain management even more difficult. Pain may be sub-optimally treated in people living with frailty, people living with cognitive impairment and those with both these factors. Reasons for sub-optimal treatment in these groups are pharmacological (increased drug side effects, drug-drug interactions, polypharmacy), non-pharmacological (erroneous beliefs about pain, ageism, bidirectional communication challenges), logistical (difficulty in accessing primary care practitioners and unaffordable cost of drugs), and, particularly in cognitive impairment, related to communication difficulties. Thorough assessment and characterisation of pain, related sensations, and their functional, emotional, and behavioural consequences ("phenotyping") may help to enhance the assessment of pain, particularly in people with frailty and cognitive impairment, as this may help to identify who is most likely to respond to certain types of treatment. This paper discusses the potential role of "digital phenotyping" in the assessment and management of pain in people with frailty. Digital phenotyping is concerned with observable characteristics in digital form, such as those obtained from sensing-capable devices, and may provide novel and more informative data than existing clinical approaches regarding how pain manifests and how treatment strategies affect it. The processing of extensive digital and usual data may require powerful algorithms, but processing these data could lead to a better understanding of who is most likely to benefit from specific and targeted treatments.

Poor oral health and dementia risk under time-varying confounding: A cohort study based on marginal structural models

BACKGROUND

Bidirectional association between oral health, including tooth loss and oral hypofunction, and cognitive impairment can induce time-varying confounding in association with dementia. This study aimed to investigate the association between oral health and the development of dementia among older adults, considering cognitive impairment as a time-varying confounder.

METHODS

This nine-year follow-up cohort study targeted independent older adults aged ≥65 years who participated in the Japan Gerontological Evaluation Study. The exposure variables were self-reported poor oral health (≤19 remaining teeth, edentulousness, chewing difficulty, swallowing problems, and xerostomia), which were assessed in 2010 and 2013. The outcome variable was the incidence of dementia between 2013 and 2019, which was obtained from the municipalities' administrative database. Furthermore, in 2010 and 2013, we considered cognitive impairment as a time-varying confounder and treated it based on a marginal structural model (MSM), including possible baseline confounders. Oral health and cognitive impairment were assessed using the items of Kihon checklist. We employed a Cox proportional hazards model with a stabilized inverse probability weight and estimated hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Among 37,556 participants (mean age: 72.8 years [1 SD = 5.5], males: 46.8%), the dementia incidence rate was 2.2/100 person-year. The proportions of those with ≤19 remaining teeth, edentulousness, chewing difficulty, swallowing problems, and xerostomia were 61.3%, 11.0%, 24.4%, 14.7%, and 19.2%, respectively. From the regression analysis based on MSM, ≤19 remaining teeth (HR = 1.12, 95% CI = 1.03-1.23), edentulousness (HR = 1.20, 95% CI = 1.09-1.32), chewing difficulty (HR = 1.11, 95% CI = 1.02-1.21), and xerostomia (HR = 1.10, 95% CI = 1.01-1.20) were significantly associated with an increased risk of dementia; however, swallowing problems were not significantly associated with dementia onset (p > 0.05).

CONCLUSIONS

Even after considering time-varying confounding by cognitive function at baseline and follow-up, we observed significant associations between poor oral health and increased risk of dementia among older adults.

Frailty and functional status among older adults with cognitive impairment: data from the second wave of the FIBRA study

Frailty is defined as a recognizable state of increased vulnerability resulting from age-associated decline of function in various physiological systems, such that the ability to deal with acute or everyday stressors is compromised.

Objective

The aim of the study was to characterize the sample of older adults with cognitive impairment, according to the frailty status indirectly assessed by family members, other clinical and sociodemographic variables; and to assess the overlap of clinical conditions evaluated in this sample with cognitive impairment.

Methods

Data were extracted from the follow-up database of the Frailty in Brazilian Older Adults (FIBRA) study (2016-2017). The sample consisted of 130 elderly people with cognitive impairment assessed by the Mini Mental State Examination (MMSE). The scores for the Clinical Dementia Scale (CDR), Cornell Scale for Depression in Dementia and Functional Activities Questionnaire were described. Frailty was indirectly measured through questions answered by family members about the five criteria that compose the frailty phenotype.

Results

The sample consisted mostly of older women (n=91) with a mean age of 82.4 (SD=5.3) years, mean schooling of 3.3 years (SD=3.07), widowed (47.7%) and who lived with children and/or grandchildren (68%). More than half had multimorbidity (74.90%), 39.5% had depression symptoms suggestive of major depression, 57% had impaired functionality, 49.3% were frail, 37.6% pre-frail, and 13.10% robust.

Conclusion

Among older adults with cognitive impairment, frailty and functional limitations are common.

Neuroinflammaging: A Tight Line Between Normal Aging and Age-Related Neurodegenerative Disorders

Aging in the healthy brain is characterized by a low-grade, chronic, and sterile inflammatory process known as neuroinflammaging. This condition, mainly consisting in an up-regulation of the inflammatory response at the brain level, contributes to the pathogenesis of age-related neurodegenerative disorders. Development of this proinflammatory state involves the interaction between genetic and environmental factors, able to induce age-related epigenetic modifications. Indeed, the exposure to environmental compounds, drugs, and infections, can contribute to epigenetic modifications of DNA methylome, histone fold proteins, and nucleosome positioning, leading to epigenetic modulation of neuroinflammatory responses. Furthermore, some epigenetic modifiers, which combine and interact during the life course, can contribute to modeling of epigenome dynamics to sustain, or dampen the neuroinflammatory phenotype. The aim of this review is to summarize current knowledge about neuroinflammaging with a particular focus on epigenetic mechanisms underlying the onset and progression of neuroinflammatory cascades in the central nervous system; furthermore, we describe some diagnostic biomarkers that may contribute to increase diagnostic accuracy and help tailor therapeutic strategies in patients with neurodegenerative diseases.

Comparison of Frailty and Chronological Age as Determinants of the Murine Gut Microbiota in an Alzheimer's Disease Mouse Model

The ageing of an organism is associated with certain features of functional decline that can be assessed at the cellular level (e.g., reduced telomere length, loss of proteostasis, etc.), but also at the organismic level. Frailty is an independent syndrome that involves increased multidimensional age-related deficits, heightens vulnerability to stressors, and involves physical deficits in mainly the locomotor/muscular capacity, but also in physical appearance and cognition. For sporadic Alzheimer's disease, age per se is one of the most relevant risk factors, but frailty has also been associated with this disease. Therefore, we aimed to answer the two following questions within a cross-sectional study: (1) do Alzheimer's model mice show increased frailty, and (2) what changes of the microbiota occur concerning chronological age or frailty? Indeed, aged 5xFAD mice showed increased frailty compared to wild type littermates. In addition, 5xFAD mice had significantly lower quantities of Bacteroides spp. when only considering frailty, and lower levels of Bacteroidetes in terms of both frailty and chronological age compared to their wild type littermates. Thus, the quality of ageing-as assessed by frailty measures-should be taken into account to unravel potential changes in the gut microbial community in Alzheimer's disease.

Association of cognitive frailty and abdominal obesity with cardiometabolic multimorbidity among middle-aged and older adults: A longitudinal study

BACKGROUND

Cognitive frailty and abdominal obesity are deemed to be important targets for disease prevention. However, a possible cardiometabolic multimorbidity (CMM) link with cognitive frailty and abdominal obesity is unknown. The aim of this study was to investigate the association of cognitive frailty and abdominal obesity with CMM in the middle-aged and older people.

METHODS

The sample comprised 11,503 participants aged 45 and over from the China Health and Retirement Longitudinal Study (CHARLS) 2011. Cognitive frailty was defined as the coexisting cognitive impairment and physical frailty. Abdominal obesity was assessed using waist circumference. CMM was defined as the presence of two or more cardiometabolic diseases (CMDs), including diabetes, heart disease, and stroke. A total of 9177 participants without CMM recruited from CHARLS 2011 and were followed up in 2018.

RESULTS

Compared with 0 CMD, coexisting cognitive frailty and abdominal obesity was associated with the risk of 1 CMD (OR: 1.734, 95 % CI: 1.133-2.655), and ≥ 2 CMDs (OR: 7.218, 95%CI: 3.216-16.198). Longitudinal analysis showed that individuals with both cognitive frailty and abdominal obesity (HR: 2.162, 95%CI: 1.032-4.531) were more likely to have new onset CMM than cognitive frailty alone peers (HR: 1.667, 95 % CI: 0.721-3.853). Among the participants with first CMD, the likelihood of CMM was substantially higher in the co-existence of cognitive frailty and abdominal obesity (HR: 3.073, 95%CI: 1.254-7.527) than in the abdominal obesity alone (HR: 1.708, 95%CI: 1.201-2.427). Cognitive frailty alone was not significantly associated with CMM.

CONCLUSION

Cognitive frailty is not independently associated with the risk of CMM, but cognitive frailty and abdominal obesity together has a greater risk of CMM.

Navigating and diagnosing cognitive frailty in research and clinical domains

While physical frailty has been recognized as a clinical entity for some time, the concept of cognitive frailty (CF) is now gaining increasing attention in the geriatrics research community. CF refers to the co-occurrence of physical frailty and cognitive impairment in older adults, which has been suggested as a potential precursor to both dementia and adverse physical outcomes. However, this condition represents a challenge for researchers and clinicians, as there remains a lack of consensus regarding the definition and diagnostic criteria for CF, which has limited its utility. Here, using insights from both the physical frailty literature and cognitive science research, we describe emerging research on CF. We highlight areas of agreement as well as areas of confusion and remaining knowledge gaps, and provide our perspective on fine-tuning the current construct, aiming to stimulate further discussion in this developing field.

Current Challenges in the Diagnosis of Progressive Neurocognitive Disorders: A Critical Review of the Literature and Recommendations for Primary and Secondary Care

Screening for early symptoms of cognitive impairment enables timely interventions for patients and their families. Despite the advances in dementia diagnosis, the current nosography of neurocognitive disorders (NCDs) seems to overlook some clinical manifestations and predictors that could contribute to understanding the conversion from an asymptomatic stage to a very mild one, eventually leading to obvious disease. The present review examines different diagnostic approaches in view of neurophysiological and neuropsychological evidence of NCD progression, which may be subdivided into: (1) preclinical stage; (2) transitional stage; (3) prodromal or mild stage; (4) major NCD. The absence of univocal criteria and the adoption of ambiguous or narrow labels might complicate the diagnostic process. In particular, it should be noted that: (1) only neuropathological hallmarks characterize preclinical NCD; (2) transitional NCD must be assessed through proactive neuropsychological protocols; (3) prodromal/mild NCDs are based on cognitive functional indicators; (4) major NCD requires well-established tools to evaluate its severity stage; (5) insight should be accounted for by both patient and informants. Therefore, the examination of evolving epidemiological and clinical features occurring at each NCD stage may orient primary and secondary care, allowing for more targeted prevention, diagnosis, and/or treatment of both cognitive and functional impairment.

Long-term trajectories of frailty phenotype in older cancer survivors: a nationally representative longitudinal cohort study

BACKGROUND

Frailty is a dynamic process associated with adverse health outcomes. However, little is known about the long-term trajectories of frailty in older cancer survivors.

OBJECTIVES

To describe the trajectories of frailty phenotype over time amongst older cancer survivors and examine the socio-demographic and health-related predictors of different trajectories.

DESIGN

Population-based longitudinal cohort study.

SETTING

Community-dwelling older adults in the United States.

SUBJECTS

1,763 older adults who were diagnosed with cancer from the National Health and Ageing Trends Study.

METHODS

Frailty was assessed by the Fried Frailty Phenotype. The group-based trajectory model was used to identify the trajectories of frailty. Multinomial logistic regression analyses were used to examine the socio-demographic and health-related predictors of different trajectories.

RESULTS

Three frailty trajectories were identified; 52.8% of older cancer survivors had a sustained low risk of frailty over time, 25.0% had a low frailty risk at baseline but the risk increased steadily, and 22.3% had a high frailty risk with a slight change in the observed period. Older cancer survivors were at a high-risk frailty trajectory if they were older, female, African American, had lower education status, had lower annual income, were underweight or obese, self-rated poorer health, had more chronic conditions and difficulties with activities of daily living (ADL), and had worse cognitive functions (P < 0.05).

CONCLUSIONS

Long-term frailty trajectories in older cancer survivors are heterogeneous. This study helps identify patients at high risk of sustained or deteriorating frailty and has the potential to inform targeted frailty management strategies addressing modifiable factors identified (e.g. body mass index, ADL).

Assessing frailty at the centers for dementia and cognitive decline in Italy: potential implications for improving care of older people living with dementia

INTRODUCTION

Frailty is strongly associated with the clinical course of cognitive impairment and dementia, thus arguing for the need of its assessment in individuals affected by cognitive deficits. This study aimed to retrospectively evaluate frailty in patients aged 65 years and older referred to two Centers for Cognitive Decline and Dementia (CCDDs).

METHODS

A total of 1256 patients consecutively referred for a first visit to two CCDDs in Lombardy (Italy) between January 2021 to July 2022 were included. All patients were evaluated by an expert physician in diagnosis and care of dementia according to a standardized clinical protocol. Frailty was assessed using a 24-items Frailty Index (FI) based on routinely collected health records, excluding cognitive decline or dementia, and categorized as mild, moderate, and severe.

RESULTS

Overall, 40% of patients were affected by mild frailty and 25% of the sample has moderate to severe frailty. The prevalence and severity of frailty increased with decreasing Mini Mental State Examination (MMSE) score and advancing age. Frailty was also detected in 60% of patients with mild cognitive impairment.

CONCLUSION

Frailty is common in patients referring to CCDDs for cognitive deficits. Its systematic assessment using a FI generated with readily available medical information could help develop appropriate models of assistance and guide personalization of care.

Alzheimer's disease with frailty: Prevalence, screening, assessment, intervention strategies and challenges

Alzheimer's disease (AD) is a neurodegenerative disorder that affects millions worldwide and is expected to surge in prevalence due to aging populations. Frailty, characterized by muscle function decline, becomes more prevalent with age, imposing substantial burdens on patients and caregivers. This paper aimed to comprehensively review the current literature on AD coupled with frailty, encompassing prevalence, screening, assessment, and treatment while delving into the field's challenges and future trajectories. Frailty and AD coexist in more than 30% of cases, with hazard ratios above 120% indicating a mutually detrimental association.Various screening tools have emerged for both frailty and AD, including the Fried Frailty Phenotype (FP), FRAIL scale, Edmonton Frailty Scale (EFS), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Clock Drawing Test (CDT), and General Practitioner Assessment of Cognition (GPCOG). However, none has solidified its role as the definitive gold standard. The convergence of electronic health records and brain aging biomarkers heralds a new era in AD with frailty screening and assessment. In terms of intervention, non-pharmacological strategies spanning nutrition, horticulture, exercise, and social interaction, along with pharmacological approaches involving acetylcholinesterase inhibitors (AChEIs), N-methyl-D-aspartate (NMDA) receptor antagonists, and anti-amyloid beta-protein medications, constituted cornerstones for treating AD coupled with frailty. Technological interventions like repetitive transcranial magnetic stimulation (rTMS) also entered the fold. Notably, multi-domain non-pharmacological interventions wield considerable potential in enhancing cognition and mitigating disability. However, the long-term efficacy and safety of pharmacological interventions necessitate further validation. Diagnosing and managing AD with frailty present several daunting challenges, encompassing low rates of early co-diagnosis, limited clinical trial evidence, and scarce integrated, pioneering service delivery models. These challenges demand heightened attention through robust research and pragmatic implementation.

Relationship between Mild Cognitive Impairment, Pre-Frailty, Physical and Psychological Functioning, and Functional Capacity among Community-Dwelling Older Adults

Mild cognitive impairment (MCI) is associated with a high risk of dementia. Reportedly, 54.6% of older adults with MCI fall into the pre-frailty category. However, it is unclear what differences exist in older adults with regard to their physical, psychological, and functional capacities, which depend on MCI, pre-frailty, or a combination of the two. This study aimed to examine the differences between the association between physical function, psychological function, and functional capacity by examining a combination of MCI and pre-frailty among community-dwelling older Japanese individuals. The participants in the analysis were 236 older people living in the community. They were classified into four groups, as follows: normal, MCI only, pre-frailty only, and pre-frailty/MCI; furthermore, their physical, psychological, and functional capacities were compared. In addition, a multinomial logistic regression analysis was performed using MCI and pre-frailty as dependent variables. No associated factors were identified for MCI only, and a depressive mood was only associated with pre-frailty. When pre-frailty and MCI were combined, knee extension muscle strength, fastest gait speed, the s30 s chair stand test, depressed moods, and the instrumental activities of daily living (IADL) were correlated. Our results suggest that when MCI and pre-frailty are combined, declines in both physical and psychological functions and IADL are likely to occur.

Subjective Cognitive Decline and Frailty Trajectories and Influencing Factors in Japanese Community-Dwelling Older Adults: A Longitudinal Study

We studied frailty and subjective cognitive decline (SCD) trajectories in older Japanese adults and evaluated the influence of various factors on these trajectories. We analyzed data from 1157 non-demented adults aged 70 and above from 2013 to 2019. Frailty was assessed using the self-administered Kihon Checklist (KCL), a Japanese frailty index. SCD was evaluated using the questionnaire of the Subjective Memory Complaints scale. Through group-based joint trajectory models, we discerned three frailty trajectories: non-progressive (n = 775), moderate progressive (n = 312), and rapid progressive (n = 70); and three SCD trajectories: non-progressive (n = 302), moderate progressive (n = 625), and rapid progressive (n = 230). Individuals in the rapid progressive SCD trajectory had a 32.2% probability of also being in the rapid progressive frailty trajectory. In contrast, those in the non-progressive SCD trajectory had zero probability of being in the rapid progressive frailty trajectory. Both the rapid progressive frailty and SCD groups combined had a higher incidence of depressive symptoms and slow gait speed. Our results have found that frailty and SCD share a similar trajectory in Japanese older adults. Additionally, rapid progressive frailty and SCD were associated with the highest risk of depressive symptoms and slow gait speed. Thus, interventions targeting both frailty and cognitive decline should prioritize mental health enhancement and gait speed improvement.

A tool for safer prescribing in vulnerable adults: the continuing development of the Medichec app and website

AIMS AND METHOD

Adverse effects are a common concern when prescribing and reviewing medication, particularly in vulnerable adults such as older people and those with intellectual disability. This paper describes the development of an app giving information on side-effects, called Medichec, and provides a description of the processes involved in its development and how drugs were rated for each side-effect. Medications with central anticholinergic action, dizziness, drowsiness, hyponatraemia, QTc prolongation, bleeding and constipation were identified using the British National Formulary (BNF) and frequency of occurrence of these effects was determined using the BNF, product information and electronic searches, including PubMed.

RESULTS

Medications were rated using a traffic light system according to how commonly the adverse effect was known to occur or the severity of the effect.

CLINICAL IMPLICATIONS

Medichec can facilitate access to side-effects information for multiple medications, aid clinical decision-making, optimise treatment and improve patient safety in vulnerable adults.

Multimorbidity patterns and 18-year transitions from normal cognition to dementia and death: A population-based study

BACKGROUND

Several chronic diseases accelerate cognitive decline; however, it is still unknown how different patterns of multimorbidity influence individuals' trajectories across the cognitive continuum.

OBJECTIVES

We aimed to investigate the impact of multimorbidity and of specific multimorbidity patterns on the transitions across cognitive stages (normal cognition, cognitive impairment, no dementia [CIND], dementia) and death.

METHODS

We included 3122 dementia-free individuals from the Swedish National study on Aging and Care in Kungsholmen. Using fuzzy c-means cluster analysis, multimorbid participants were classified into mutually exclusive groups characterized by commonly coexisting chronic diseases. Participants were followed up to 18 years to detect incident CIND, dementia, or death. Transition hazard ratios (HRs), life expectancies, and time spent in different cognitive stages were estimated using multistate Markov models.

RESULTS

At baseline, five multimorbidity patterns were identified: neuropsychiatric, cardiovascular, sensory impairment/cancer, respiratory/metabolic/musculoskeletal, and unspecific. Compared to the unspecific pattern, the neuropsychiatric and sensory impairment/cancer ones showed reduced hazards of reverting from CIND to normal cognition (HR 0.53, 95% CI 0.33-0.85 and HR 0.60, 95% CI 0.39-0.91). Participants in the cardiovascular pattern exhibited an increased hazard of progression from CIND to dementia (HR 1.70, 95% CI 1.15-2.52) and for all transitions to death. Subjects with the neuropsychiatric and cardiovascular patterns showed reduced life expectancy at age 75, with an anticipation of CIND (up to 1.6 and 2.2 years, respectively) and dementia onset (up to 1.8 and 3.3 years, respectively).

CONCLUSIONS

Multimorbidity patterns differentially steer individual trajectories across the cognitive continuum of older adults and may be used as a risk stratification tool.

Impact of Pneumonia on Cognitive Aging: A Longitudinal Propensity-Matched Cohort Study

BACKGROUND

Acute clinical events, such as pneumonia, may impact physical functionality but their effect on cognition and the possible duration of this effect remains to be quantified. This study investigated the impact of pneumonia on cognitive trajectories and dementia development in older people.

METHODS

Data were obtained from 60+ years old individuals, who were assessed from 2001 to 2018 in the population-based SNAC-K study (Sweden). Participants were eligible if they were not institutionalized, had no dementia, and did not experience pneumonia 5 years prior to baseline (N = 2 063). A propensity score was derived to match 1:3 participants hospitalized with a diagnosis of pneumonia (N = 178), to nonexposed participants (N = 534). Mixed linear models were used to model cognitive decline. The hazard of dementia, clinically diagnosed by physicians following Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV, was estimated using Cox regression models.

RESULTS

We found a transient impact of pneumonia on cognitive decline in the first 2.5 years (B = -0.94, 95% confidence interval [CI] -1.75, -0.15). The hazard ratio (HR) for dementia was not statistically significantly increased in pneumonia participants (HR = 1.17, 95%CI 0.82, 1.66).

CONCLUSIONS

The transient impact of pneumonia on cognitive function suggests an increased need of health care for patients after a pneumonia-related hospitalization and reinforces the relevance of pneumonia prevention.

Health Conditions Associated with Alzheimer's Disease and Vascular Dementia

OBJECTIVE

We examined medical records to determine health conditions associated with dementia at varied intervals prior to dementia diagnosis in participants from the Baltimore Longitudinal Study of Aging (BLSA).

METHODS

Data were available for 347 Alzheimer's disease (AD), 76 vascular dementia (VaD), and 811 control participants without dementia. Logistic regressions were performed associating International Classification of Diseases, 9th Revision (ICD-9) health codes with dementia status across all time points, at 5 and 1 year(s) prior to dementia diagnosis, and at the year of diagnosis, controlling for age, sex, and follow-up length of the medical record.

RESULTS

In AD, the earliest and most consistent associations across all time points included depression, erectile dysfunction, gait abnormalities, hearing loss, and nervous and musculoskeletal symptoms. Cardiomegaly, urinary incontinence, non-epithelial skin cancer, and pneumonia were not significant until 1 year before dementia diagnosis. In VaD, the earliest and most consistent associations across all time points included abnormal electrocardiogram (EKG), cardiac dysrhythmias, cerebrovascular disease, non-epithelial skin cancer, depression, and hearing loss. Atrial fibrillation, occlusion of cerebral arteries, essential tremor, and abnormal reflexes were not significant until 1 year before dementia diagnosis.

INTERPRETATION

These findings suggest that some health conditions are associated with future dementia beginning at least 5 years before dementia diagnosis and are consistently seen over time, while others only reach significance closer to the date of diagnosis. These results also show that there are both shared and distinctive health conditions associated with AD and VaD. These results reinforce the need for medical intervention and treatment to lessen the impact of health comorbidities in the aging population. ANN NEUROL 2023;93:805-818.

Engagement in a structured physical activity program and its effects upon health-related quality of life in elderly women: An observational study

Aging is a complex process associated with an impairment in functional capacity and low health-related quality of life (HRQoL) due to a high frequency of chronic diseases in the elderly population. Regular physical activity (PA) may limit some physiological effects of sedentary lifestyle and increase life expectancy. An observational was conducted to measure the HRQoL among older adults living in the community, by comparing a convenience sample of elderly females practicing a structured program of PA from 2 to 3 times per week in 60-min sessions (i.e., active females, AFs) to a sample of participants adopting lifestyle behaviors expending little energy (i.e., sedentary females, SFs). A validated questionnaire (the RAND 36-item) was used as outcome measure. All participants were assessed in terms of cognitive status (Montreal Cognitive Assessment, MoCA) to exclude mild cognitive impairment, divided attention/executive functioning (Trail Making Test, Stroop Test) and psychopathological dimensions of anxiety (Geriatric Anxiety Inventory, GAI), and depression (Geriatric Depression Scale, GDS). Non-parametric analysis revealed that AFs and SFs differed significantly in the RAND Energy/Fatigue (E/F), Emotional Wellbeing (EW), and Social Functioning (SoF), that was however influenced by education level. Moreover, E/F and EW were negatively associated to anxiety and depression, while SoF was influenced by divided attention. PA results in a healthful behavior for combating feelings of fatigue and low energy as well as emotional distress that can affect health status perception in older women.

Frailty detection among primary care older patients through the Primary Care Frailty Index (PC-FI)

The prompt identification of frailty in primary care is the first step to offer personalized care to older individuals. We aimed to detect and quantify frailty among primary care older patients, by developing and validating a primary care frailty index (PC-FI) based on routinely collected health records and providing sex-specific frailty charts. The PC-FI was developed using data from 308,280 primary care patients ≥ 60 years old part of the Health Search Database (HSD) in Italy (baseline 2013-2019) and validated in the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K; baseline 2001-2004), a well-characterized population-based cohort including 3363 individuals ≥ 60 years old. Potential health deficits part of the PC-FI were identified through ICD-9, ATC, and exemption codes and selected through an optimization algorithm (i.e., genetic algorithm), using all-cause mortality as the main outcome for the PC-FI development. The PC-FI association at 1, 3 and 5 years, and discriminative ability for mortality and hospitalization were tested in Cox models. The convergent validity with frailty-related measures was verified in SNAC-K. The following cut-offs were used to define absent, mild, moderate and severe frailty: < 0.07, 0.07-0.14, 0.14-0.21, and ≥ 0.21. Mean age of HSD and SNAC-K participants was 71.0 years (55.4% females). The PC-FI included 25 health deficits and showed an independent association with mortality (hazard ratio range 2.03-2.27; p < 0.05) and hospitalization (hazard ratio range 1.25-1.64; p < 0.05) and a fair-to-good discriminative ability (c-statistics range 0.74-0.84 for mortality and 0.59-0.69 for hospitalization). In HSD 34.2%, 10.9% and 3.8% were deemed mildly, moderately, and severely frail, respectively. In the SNAC-K cohort, the associations between PC-FI and mortality and hospitalization were stronger than in the HSD and PC-FI scores were associated with physical frailty (odds ratio 4.25 for each 0.1 increase; p < 0.05; area under the curve 0.84), poor physical performance, disability, injurious falls, and dementia. Almost 15% of primary care patients ≥ 60 years old are affected by moderate or severe frailty in Italy. We propose a reliable, automated, and easily implementable frailty index that can be used to screen the primary care population for frailty.

Grip strength, gait speed, and trajectories of cognitive function in community-dwelling older adults: A prospective study

Introduction

This study investigated whether grip strength and gait speed predict cognitive aging trajectories and examined potential sex-specific associations.

Methods

Community-dwelling older adults (n = 19,114) were followed for up to 7 years, with regular assessment of global function, episodic memory, psychomotor speed, and executive function. Group-based multi-trajectory modeling identified joint cognitive trajectories. Multinomial logistic regression examined the association of grip strength and gait speed at baseline with cognitive trajectories.

Results

High performers (14.3%, n = 2298) and low performers (4.0%, n = 642) were compared to the average performers (21.8%, n = 3492). Grip strength and gait speed were positively associated with high performance and negatively with low performance (P-values < 0.01). The association between grip strength and high performance was stronger in women (interaction P < 0.001), while gait speed was a stronger predictor of low performance in men (interaction P < 0.05).

Discussion

Grip strength and gait speed are associated with cognitive trajectories in older age, but with sex differences.

Highlights

There is inter-individual variability in late-life cognitive trajectories.Grip strength and gait speed predicted cognitive trajectories in older age.However, sex-specific associations were identified.In women, grip strength strongly predicted high, compared to average, trajectory.In men, gait speed was a stronger predictor of low cognitive performance trajectory.

Prevalence and risk factors of cognitive frailty in community-dwelling older adults with diabetes: A systematic review and meta-analysis

AIMS

Cognitive frailty can increase the risk of adverse health outcomes in older adults. Estimates of the prevalence of cognitive frailty among older adults with diabetes varied widely in literature. This study aimed to conduct a systematic review and meta-analysis to assess the pooled prevalence of cognitive frailty and risk factors in community-dwelling older adults with diabetes, providing evidence for healthcare professionals to better understand the status of cognitive frailty and help develop effective interventions.

METHODS

Databases of PubMed, Web of Science, Cochrane Library, Embase, Cumulative Index of Nursing and Allied Health, Proquest, China National Knowledge Infrastructure and China Biology Medicine were searched from inception to February 10th, 2022. The reviewers independently selected studies, extracted data and assessed the quality of studies. Pooled prevalence of cognitive frailty and risk factors were estimated. Subgroup analysis, meta-regression analysis, sensitivity analysis and publication bias were also conducted.

RESULTS

A total of 15 studies with 6391 participants were included in this review. The pooled prevalence of cognitive frailty was 11% (95%CI = 7.9-14%) in community-dwelling older adults with diabetes. Pooled estimates showed that increasing age, higher level of HbA1c, shorter night sleep duration and depression were risk factors, and regular exercise was the protective factor of cognitive frailty in community-dwelling older adults with diabetes.

CONCLUSION

Cognitive frailty was common in community-dwelling older adults with diabetes. Routine screening of cognitive frailty and effective interventions should be implemented for this population in community settings.

REGISTRATION

PROSPERO ID CRD42021276973.

Adherence to a Mediterranean Diet is associated with physical and cognitive health: A cross-sectional analysis of community-dwelling older Australians

Poor cognitive function is associated with reduced functional independence, risk of institutionalization and reduced health-related quality of life. The ability to independently perform instrumental activities of daily living (iADLs) is compromised in patients with mild cognitive impairment (MCI) or dementia. Emerging evidence suggests that adherence to a Mediterranean diet (MedDiet), may play an important protective role against cognitive decline and dementia risk, whilst preserving functional status. This cross-sectional study aimed to explore the independent associations between MedDiet adherence, cognitive risk, and functional status in community-dwelling older adults living in Australia. MedDiet adherence was assessed using the Mediterranean Diet Adherence Screener (MEDAS); a modified Lawton's iADL scale was used for the assessment of functional status and risk of cognitive impairment was assessed using the AD8 dementia screening intervention. A total of n = 294 participants were included in the final analyses (70.4 ± 6.2 years; Females, n = 201; Males, n = 91; n = 2 unspecified). Adherence to a MedDiet was positively associated with functional ability (β = 0.172; CI: 0.022, 0.132; P = 0.006) independent of age, gender, Body Mass Index (BMI), smoking status, sleep duration, physical activity duration, diabetes status, and level of education. Furthermore, MedDiet adherence was inversely associated with cognitive risk (β = -0.134; CI: -0.198, -0.007; P = 0.035) independent of all covariates. However, our sensitivity analyses further showed that adherence to a MedDiet was not associated with cognitive risk in older adults free from cognitive impairment. We showed that adherence to a MedDiet is associated with healthy physical and cognitive aging. Nevertheless, exploration of these findings in larger cohorts, using longitudinal analyses and controlling for important confounders to ascertain the direction of the relationship is warranted.

Impact of frailty, mild cognitive impairment and cognitive frailty on adverse health outcomes among community-dwelling older adults: A systematic review and meta-analysis

Aims

This study analyzes the impact of frailty, mild cognitive impairment, and cognitive frailty on adverse outcomes in community-dwelling older adults.

Methods

This systematic review and meta-analysis were conducted using the PRISMA guidelines and MOOSE statement. We developed a specific search strategy for each electronic database and searched PubMed, Web of Science, MEDLINE, and Embase from initial records to July 2021. The studies on adverse outcomes of frailty, pre-frailty, mild cognitive impairment, and mild cognitive impairment with pre-frailty and cognitive frailty were included. Two researchers independently extracted data based on a spreadsheet and assessed the risk of bias. The primary outcomes were mortality, dementia, disability, and hospitalization. The second outcome included quality of life and falls. All analysis was conducted by using Review Manager (RevMan) 5.3 software.

Results

A total of 22 cohort studies (71,544 older adults with mean age ranging from 65.1 to 93.6 years) were included with a low risk of bias and high methodological quality with a NOS score ≥7. Compared to robust elders, individuals identified as frailty were associated with a higher risk of mortality (RR = 2.11, 95% CI: 1.57–2.83) and disability (RR = 5.91, 95% CI: 2.37–14.74). Mild cognitive impairment with pre-frailty was associated with mortality (RR = 1.74, 95% CI: 1.48–2.05) and dementia (RR = 4.15, 95% CI: 1.87–9.20). Pre-frailty was associated with a higher risk of mortality (RR = 1.29, 95% CI: 1.11–1.50). Cognitive frailty was associated with higher risk of incident mortality (RR = 2.41, 95% CI: 1.97–2.94), dementia (RR = 3.67, 95% CI: 2.81–4.78), disability (RR = 11.32, 95% CI: 4.14–30.97), and hospitalization (RR = 2.30, 95% CI: 1.60–3.32), as well as poor quality of life.

Conclusion

Cognitive frailty could be a comprehensive psychosomatic predictor for adverse outcomes among older people. Interactions between frailty, mild cognitive impairment, and cognitive frailty on adverse outcomes must be further explored.

Systematic review registration

[https://inplasy.com/inplasy-2022-5-0064/], identifier [INPLASY202250064].

Potential association between frailty and pTau in community-dwelling older adults

Background

Frailty is a geriatric syndrome characterized by a decline in physiological reserves, and multiple factors contribute to the occurrence and development of frailty. Growing evidence supports a strong link and overlap between frailty and cognitive impairment, but the mechanisms involved have not yet been fully elucidated.

Aim

To identify associations between 12 plasma cognition-related biomarkers and frailty in community-dwelling older adults.

Methods

A total of 375 participants (age 70.9 ± 5.8, 165 men and 210 women) were included in this study. Frailty was assessed using the modified Fried frailty phenotype. Participants were divided into not-frail group (n = 313) and frail group (n = 62). Twelve plasma cognitive biomarkers were detected by enzyme-linked immunosorbent assay (ELISA). Multinomial logistic regression was used to explore the association between different biomarkers and frailty status.

Results

Among the 12 biomarkers, only pTau was higher in frail individuals than in their not-frail peers (471.3 ± 58.1 pg/mL vs. 451.9 ± 61.1 pg/mL, p = 0.022). No other biomarkers had any significant association with frailty, including total-Tau (tTau), neurofilament light (NFL), amyloid-β 40 (Aβ40), amyloid-β 40 (Aβ42), S100 calcium binding protein B (S100B), visinin-like protein 1 (VLP-1), Alzheimer-associated neuronal thread protein (AD7cNTP), β-amyloid precursor protein (βAPP), chitinase-3-like-1 (CHI3L1), soluble complement receptor 1 (sCR1) and heart-type fatty acid binding protein (hFABP). Furthermore, pTau was compared between negative and positive subject groups for each individual criterion of frailty. Significantly higher levels of pTau were observed in those who were positive for the criteria of low grip strength (451.2 ± 61.4 pg/mL vs. 469.1 ± 57.6 pg/mL, p = 0.019), exhaustion (451.2 ± 61.6 pg/mL vs. 466.4 ± 58.4 pg/mL, p = 0.035) and low physical activity (451.1 ± 60.7 pg/mL vs. 465.7 ± 60.7 pg/mL, p = 0.034) when compared to those who were negative for each corresponding criterion. Finally, in the multivariable-adjusted analysis, the association between pTau and frailty was statistically significantly associated (OR: 1.40, 95% CI: 1.04–1.89), even after adjusting.

Conclusions

The present study found a potential association between pTau and frailty. Future works should monitor the longitudinal trajectory of changes of pTau concentrations in frailty older adults. A better understanding of the molecular mechanisms behind will contribute to biomarker research in frailty.

Derivation and validation of a 90-day unplanned hospital readmission score in older patients discharged form a geriatric ward

PURPOSE

To derive and validate a 90-day unplanned hospital readmission (UHR) score based on information available to non-hospital based care providers.

METHODS

Retrospective longitudinal study with cross-validation method. Participants were older adults (≥ 65 years) admitted to a geriatric short-stay department in a general hospital in France. Patients were split into a derivation cohort and a validation cohort. We recorded demographic information, medical history, and concurrent clinical characteristics. The main outcome was 90-day UHR. Data obtained from hospital discharge letters were used in a logistic regression model to construct a predictive score, and to identify risk groups for 90-day UHR.

RESULTS

In total, 750 and 250 aged adults were included in both the derivation and the validation cohorts. Mean age was 87.2 ± 5.2 years, most were women (68.1%). Independent risk factors for 90-day UHR were: use of mobility aids (p = .02), presence of dementia syndrome (p = .02), history of recent hospitalisation (p = .03), and discharge to domiciliary home (p = .005). From these four risk factors, three groups were determined: low-risk group (score < 4), medium-risk group (score between 4 and 6), and high-risk group (score ≥ 6). In the derivation cohort the 90-day UHR rates increased significantly across risk groups (14%, 22%, and 30%, respectively). The 90-day UHR score had the same discriminant power in the derivation cohort (c-statistic = 0.63) as in the validation cohort (c-statistic = 0.63).

CONCLUSIONS

This score makes it possible to identify aged adults at risk of 90-day UHR and to target multidisciplinary interventions to limit UHR for patients discharged from a Geriatric Short-Stay Unit.

Brain Changes and Fast Cognitive and Motor Decline in Older Adults

BACKGROUND

To identify brain magnetic resonance imaging (MRI) signatures characterizing people with different patterns of decline in cognition and motor function.

METHODS

In the Swedish National Study on Aging and Care in Kungsholmen, Stockholm, 385 participants had available repeated brain MRI examinations, where markers of brain volumes and white matter integrity were assessed. The speed of cognitive and motor decline was estimated as the rate of a Mini-Mental State Examination and gait speed decline over 12 years (linear mixed models), and further dichotomized into the upper (25% fastest rate of decline) versus the lower quartiles. Participants were grouped in slow/no decliners (reference), isolated motor decliners, isolated cognitive decliners, and cognitive and motor decliners. We estimated the associations between changes in brain markers (linear mixed models) and baseline diffusion tensor imaging measures (linear regression model) and the 4 decline patterns.

RESULTS

Individuals with concurrent cognitive and motor decline (n = 51) experienced the greatest loss in the total brain (β: -12.3; 95% confidence interval [CI]: -18.2; -6.38) and hippocampal (β: -0.25; 95% CI: -0.34; -0.16) volumes, the steepest accumulation of white matter hyperintensities (β: 1.61; 95% CI: 0.54; 2.68), and the greatest ventricular enlargement (β: 2.07; 95% CI: 0.67; 3.47). Compared to the reference, those only experiencing cognitive decline presented with steeper hippocampal volume loss, whereas those exhibiting only motor decline displayed a greater white matter hyperintensities burden. Lower microstructural white matter integrity was associated with concurrent cognitive and motor decline.

CONCLUSION

Concurrent cognitive and motor decline is accompanied by rapidly evolving and complex brain pathology involving both gray and white matter. Isolated cognitive and motor declines seem to exhibit brain damage with different qualitative features.

Potential modifiable factors associated with late-life cognitive trajectories

Objective

There is variability across individuals in cognitive aging. To investigate the associations of several modifiable factors with high and low cognitive performance.

Methods

Data came from 17,724 community-dwelling individuals aged 65-98 years. Global cognition, verbal fluency, episodic memory, and psychomotor speed were assessed over up to seven years. Group-based multi-trajectory modeling identified distinct cognitive trajectories. Structural equation modeling examined the direct/indirect associations of social/behavioral factors and several chronic conditions with cognitive trajectories.

Results

Seven trajectory subgroups were identified. In the structural equation modeling we compared two subgroups-participants with the highest (14.2%) and lowest (4.1%) cognitive performance with the average subgroup. Lower education, never alcohol intake, and frailty directly predicted increased risk of low performance, and decreased likelihood of high performance. Hypertension (RR: 0.69, 95%CI: 0.60-0.80), obesity (RR: 0.84, 95%CI: 0.73-0.97), diabetes (RR: 0.69, 95%CI: 0.56-0.86) and depression (RR: 0.68, 95%CI: 0.54-0.85) only predicted lower likelihood of high cognitive performance, while dyslipidemia was only associated with low performance (RR: 1.30, 95%CI: 1.07-1.57). Living alone predicted increased risk of low cognitive performance and several comorbidities. Smoking did not predict cognitive trajectories but was associated with increased risk of diabetes, obesity and frailty. Findings were similar when examining the direct associations between modifiable risk factors and all seven cognitive subgroups.

Conclusions

Although several modifiable factors were associated with high performance, and reversely with low performance, this was not observed for obesity, hypertension and dyslipidemia. Further, health behaviors may affect cognitive function indirectly, via geriatric conditions. This indicates that strategies to promote healthy cognitive aging, may be distinct from those targeting dementia prevention.

Biomarkers of Frailty: miRNAs as Common Signatures of Impairment in Cognitive and Physical Domains

The past years have seen an increasing concern about frailty, owing to the growing number of elderly people and the major impact of this syndrome on health and social care. The identification of frail people passes through the use of different tests and biomarkers, whose concerted analysis helps to stratify the populations of patients according to their risk profile. However, their efficiency in prognosis and their capability to reflect the multisystemic impairment of frailty is discussed. Recent works propose the use of miRNAs as biological hallmarks of physiological impairment in different organismal districts. Changes in miRNAs expression have been described in biological processes associated with phenotypic outcomes of frailty, opening intriguing possibilities for their use as biomarkers of fragility. Here, with the aim of finding reliable biomarkers of frailty, while considering its complex nature, we revised the current literature on the field, for uncovering miRNAs shared across physical and cognitive frailty domains. By applying in silico analyses, we retrieved the top-ranked shared miRNAs and their targets, finally prioritizing the most significant ones. From this analysis, ten miRNAs emerged which converge into two main biological processes: inflammation and energy homeostasis. Such markers, if validated, may offer promising capabilities for early diagnosis of frailty in the elderly population.

Global Research on Cognitive Frailty: A Bibliometric and Visual Analysis of Papers Published during 2013–2021

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.

The Flexibility of Physio-Cognitive Decline Syndrome: A Longitudinal Cohort Study

The mutual presence of impairments in physical and cognitive functions in older adults has been reported to predict incident disability, dementia, and mortality. The longitudinal transitions of phenotypes between these functional impairments, either individually or in combination, remain unclear. To investigate the natural course and prevalence of physical and/or cognitive impairments (CIs), we enrolled participants from a community-based population. Data were retrieved from the first (August 2011 and December 2012) and second wave (August 2013 and June 2015) of the I-Lan Longitudinal Aging Study (ILAS). All participants were classified into four groups: robust, mobility impairment (MI), CI, and physio-cognitive decline syndrome (PCDS). MI was diagnosed with weakness and/or slowness. CI was diagnosed if a subject met a cutoff below 1.5 standard deviations (SDs) of age-, sex-, and education-matched norms of any neuropsychological assessments. PCDS was combined with MI and CI. Our results showed that 38, 14, 30, and 18% of the participants were on the robust, MI, CI, and PCDS at the first wave, respectively. After 2.5 years, 17% robust, 29% MI, and 37% CI progressed to PCDS. In contrast, 33% of PCDS was reversed to non-PCDS. Predictors of conversion to PCDS included worse memory and language functions, older age, lower muscle mass, and the presence of diabetes. In PCDS, a stronger hand-grip strength, younger age, and better memory functions predicted reversion to non-PCDS status. In summary, we probed the transition of PCDS. The skeletal muscle mass/function and memory function are crucial factors associated with PCDS reversion or progression.

The global prevalence of oropharyngeal dysphagia in different populations: a systematic review and meta-analysis

Background

Oropharyngeal dysphagia (OD) refers to any abnormality in the physiology of swallowing in the upper gastrointestinal tract, which leads to the related clinical complications, such as malnutrition, dehydration, and sever complication, such as aspiration pneumonia, suffocation, and eventually, premature death. The previous studies indicated a various range of prevalence of OD. The present systematic review and meta-analysis aimed to standardize the global prevalence of OD in different populations.

Methods

A systematic literature review was conducted using Embase, Scopus, PubMed, Web of Science (WoS) databases, and Google Scholar motor engine using related MeSH/Emtree and Free Text words, with no time limitation until November 2021. The heterogeneity among studies was quantified using I² index and the random effects model was used, due to the high heterogeneity among the results of studies included in the meta-analysis.

Results

The systematic literature search retrieved 2092 studies. After excluding the irrelevant studies, ultimately 27 articles with a sample size of 9841 were included in the meta-analysis. After combining the studies, the overall estimate of the global prevalence rate of OD was 43.8% (95% CI 33.3–54.9%) and the highest prevalence rate was estimated in Africa with 64.2% (95% CI 53.2–73.9%). Given the subgroup analysis based on the study population, the highest prevalence of OD was related to Dementia with 72.4% (95% CI 26.7–95.0%). The results of meta-regression indicated that the prevalence of OD has an increasing trend with the enhancement of year of publication and mean age.

Conclusion

The results of the present systematic review and meta-analysis revealed that the prevalence of OD is high in different populations and its trend has been increasing in recent years. Therefore, the appropriate strategies should be applied to reduce the prevalence of OD by finding its causation and monitoring at all levels, as well as providing feedback to hospitals.

Interaction Between Diet and Microbiota in the Pathophysiology of Alzheimer's Disease: Focus on Polyphenols and Dietary Fibers

Animal studies increasingly indicate that the gut microbiota composition and function can be involved in the pathophysiology and progression of Alzheimer's disease (AD) at multiple levels. However, few studies have investigated this putative gut-brain axis in human beings, and none of them considered diet as a determinant of intestinal microbiota composition. Epidemiological studies highlight that a high intake of fruit and vegetables, such as that typical of the Mediterranean diet, can modulate AD progression. Thus, nutritional interventions are being increasingly studied as a possible non-pharmacological strategy to slow down the progression of AD. In particular, polyphenols and fibers represent the nutritional compounds with the higher potential of counterbalancing the pathophysiological mechanisms of dementia due to their antioxidant, anti-inflammatory, and anti-apoptotic properties. These actions are mediated by the gut microbiota, that can transform polyphenols and fibers into biologically active compounds including, among others, phenyl-γ-valerolactones, urolithins, butyrate, and other short-chain fatty acids. In this review, the complex mechanisms linking nutrition, gut microbiota composition, and pathophysiology of cognitive decline in AD are discussed, with a particular focus on the role of polyphenols and fibers. The gaps between pre-clinical and clinical studies are particularly emphasized, as well as the urgent need for studies comprehensively evaluating the link between nutrition, microbiome, and clinical aspects of AD.

Air pollution as a risk factor for Cognitive Impairment no Dementia (CIND) and its progression to dementia: A longitudinal study

BACKGROUND AND AIM

Accumulation of evidence has raised concern regarding the harmful effect of air pollution on cognitive function, but results are diverging. We aimed to investigate the longitudinal association of long-term exposure to air pollutants and cognitive impairment and its further progression to dementia in older adults residing in an urban area.

METHODS

Data were obtained from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Cognitive impairment, no dementia (CIND) was assessed by a comprehensive neuropsychological battery (scoring ≥1.5 standard deviations below age-specific means in ≥1 cognitive domain). We assessed long-term residential exposure to particulate matters (PM_2.5 and PM₁₀) and nitrogen oxides (NO_x) with dispersion modeling. The association with CIND was estimated using Cox proportional hazards models with 3-year moving average air pollution exposure. We further estimated the effect of long-term air pollution exposure on the progression of CIND to dementia using Cox proportional hazards models.

RESULTS

Among 1987 cognitively intact participants, 301 individuals developed CIND during the 12-year follow-up. A 1-μg/m³ increment in PM_2.5 exposure was associated with a 75% increased risk of incident CIND (HR = 1.75, 95 %CI: 1.54, 1.99). Weaker associations were found for PM₁₀ (HR for 1-μg/m³ = 1.08, 95 %CI: 1.03-1.14) and NO_x (HR for 10 μg/m³ = 1.18, 95 %CI: 1.04-1.33). Among those with CIND at baseline (n = 607), 118 participants developed dementia during follow-up. Results also show that exposure to air pollution was a risk factor for the conversion from CIND to dementia (PM_2.5: HR for 1-μg/m³ = 1.90, 95 %CI: 1.48-2.43; PM₁₀: HR for 1-μg/m³ = 1.14, 95 %CI: 1.03-1.26; and NO_x: HR for 10 μg/m³ = 1.34, 95 %CI: 1.07-1.69).

CONCLUSION

We found evidence of an association between long-term exposure to ambient air pollutants and incidence of CIND. Of special interest is that air pollution also was a risk factor for the progression from CIND to dementia.

Relationships Among Cognitive Function, Frailty, and Health Outcome in Community-Dwelling Older Adults

Background

Frailty and cognitive impairment are significant problems faced by older adults, which have a significant impact on their activities of daily living, social activities, and quality of life.

Design

Cross-sectional study.

Methods

A total of 252 older adults in two communities in Yangzhou were randomly selected. The cognitive function of the elderly was assessed using the Memory and Executive Screening (MES). The frailty phenotype was used to evaluate the frail situation of older adults. The activity of daily living (ADL), functional activities questionnaire (FAQ), and European quality of 5-dimensions (EQ-5D) were used to evaluate health outcomes in the elderly. SEM was used to explore the direct and indirect relationship among cognitive function, frailty and health outcomes.

Results

There was a significant direct correlation between cognitive function and frailty; the direct effect was −0.521. The influence path of cognitive function on health outcomes included direct and indirect effects; the total effect was −0.759. The effect of frailty on health outcomes included direct and indirect effects; the total effect was 0.440.

Conclusion

According to SEM, cognitive function interacts with frailty and may reduce the quality of life, the ADL, and social activities among older adults directly and indirectly, so future assessments of older adults should consider both cognitive function and frailty, so as to further improve the health outcome of the elderly. When formulating relevant intervention measures in the future, we need to consider that it cannot only improve the cognitive function, but also improve the frail situation, so as to jointly improve the health outcomes of older adults.

Accumulated cognitive impairment, frailty, burden, and perceived stress and the risk of hospitalization and mortality in older caregivers

Combination of cognitive impairment, frailty, perceived stress, and excessive burden poses a risk to the health of caregivers.

Aging-related Alzheimer's disease-like neuropathology and functional decline in captive vervet monkeys (Chlorocebus aethiops sabaeus)

Age-related neurodegeneration characteristic of late-onset Alzheimer's disease (LOAD) begins in middle age, well before symptoms. Translational models to identify modifiable risk factors are needed to understand etiology and identify therapeutic targets. Here, we outline the evidence supporting the vervet monkey (Chlorocebus aethiops sabaeus) as a model of aging-related AD-like neuropathology and associated phenotypes including cognitive function, physical function, glucose handling, intestinal physiology, and CSF, blood, and neuroimaging biomarkers. This review provides the most comprehensive multisystem description of aging in vervets to date. This review synthesizes a large body of evidence that suggests that aging vervets exhibit a coordinated suite of traits consistent with early AD and provide a powerful, naturally occurring model for LOAD. Notably, relationships are identified between AD-like neuropathology and modifiable risk factors. Gaps in knowledge and key limitations are provided to shape future studies to illuminate mechanisms underlying divergent neurocognitive aging trajectories and to develop interventions that increase resilience to aging-associated chronic disease, particularly, LOAD.

Prevalence of cognitive impairment in Chinese older inpatients and its relationship with 1-year adverse health outcomes: a multi-center cohort study

BACKGROUND

Previous studies on the relationship between cognitive impairment and adverse outcomes among geriatric inpatients are not representative of older inpatients in China because of insufficient sample sizes or single-center study designs. The purpose of our study was to examine the prevalence of cognitive impairment and the relationship between cognitive impairment and 1-year adverse health outcomes in older inpatients.

METHODS

This study was a large-scale multi-center cohort study conducted from October 2018 to February 2020. Six tertiary hospitals across China were selected using a two-stage cluster sampling method, and eligible older inpatients were selected for the baseline survey and follow-up. The Mini Cognitive Scale and the FRAIL scale were used to screen for cognitive impairment and frailty, respectively. The EuroQol-5 Dimension-5 Level questionnaire was used to assess health-related quality of life (HRQoL). We used a generalized estimating model to evaluate the relationship between cognitive impairment and adverse outcomes.

RESULTS

The study included 5008 men (58.02%) and 3623 women (41.98%), and 70.64% were aged 65-75 years, and 26.27% were aged 75-85 years. Cognitive impairment was observed in 1756 patients (20.35%). There were significant differences between participants with cognitive impairment and those with normal cognitive function for age, gender, surgery status, frailty, depression, handgrip strength and so on. After adjusting for multiple covariates, compared with patients with normal cognitive function, the odds ratio for 1-year mortality was 1.216 (95% confidence interval [CI]: 1.076-1.375) and for 1-year incidence of frailty was 1.195 (95% CI: 1.037-1.376) in patients with cognitive impairment. Similarly, the regression coefficient of 1-year HRQoL was - 0.013 (95% CI: - 0.024-- 0.002). In the stratified analysis, risk of adverse outcome within 1 year was higher in older patients with cognitive impairment aged over 75 years than those aged 65-74 years.

CONCLUSIONS

We revealed that cognitive impairment was highly correlated with occurrence of 1-year adverse health outcomes (death, frailty, and decreased HRQoL) in older inpatients, which provides a basis for formulating effective intervention measures.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR1800017682 , registered 09 August 2018.

Predicting cognitive function based on physical performance: findings from the China Health and Retirement Longitudinal Study

BACKGROUND

Physical performance tests are simple means of predicting an individual's risk of cognitive decline.

AIMS

This study aimed to assess the predictive value of physical performance tests and develop predictive models for cognitive function.

METHODS

Cognitive function was tested biennially and calculated for mental intactness, episodic memory, and global cognition. Using a generalized estimating equation (GEE), we examined each baseline physical performance test as a predictor of cognitive decline. Using a multivariate linear regression model (MLRM), we developed predictive models for cognitive function. Bland-Altman analysis was performed to analyze the agreement between estimated and measured cognition. We validated the predictive model internally with 1000 bootstrap resamples.

RESULTS

Better physical performance test results, except for standing balance, were associated with a slower cognitive decline over time and better cognitive function at follow-up. Regarding the predictive models, all physical performance tests were included in men; only five chair stands test was included in women. Bland-Altman analysis showed that measured cognition was equivalent to estimated cognition in men (mean bias, 0; 95% limits of agreement, - 8.56 to 8.56) and women (mean bias, 0; 95% limits of agreement - 8.79 to 8.7). Bootstrap analysis showed that predictors were selected in 78.4-100% for men and 64.5-100% for women.

DISCUSSION

Bland-Altman and bootstrap analysis demonstrated good agreement and stability of the predictive models.

CONCLUSIONS

Physical performance tests are simple, easily obtainable, and clinically relevant markers for cognitive function with aging; predictive models based on physical performance can be used to predict cognitive function.

Serial frailty assessments following allogeneic stem cell transplant in older adults: A pilot study

INTRODUCTION

Increasing numbers of older adults undergo allogeneic stem cell transplantation (SCT) as the only chance of meaningful survival for hematologic malignancies. However, toxicities in vulnerable patients may offset the benefits of SCT. Frailty and abnormal geriatric assessment (GA) prior to SCT have been associated with decreased overall survival in persons aged 60 and older. The purpose of this pilot study was to determine the prevalence of baseline GA deficits and frailty, the prevalence of frailty or death at three and six months after allogeneic SCT, and associations between baseline assessments and the presence of frailty or death post-SCT.

METHODS

We enrolled 50 patients aged 60 years and older and completed a baseline GA including comorbidity, polypharmacy, nutrition, physical performance, functional status, social support, depression and anxiety, and cognition. Frailty was defined as three or more abnormalities of gait speed, grip strength, weight loss, physical activity, and exhaustion, and was assessed at baseline, three months, and six months after SCT. A composite outcome of frailty or death at three months and six months was analyzed.

RESULTS

Frailty was present in 11/50 (22%) of patients at baseline. Ten patients did not complete three- month follow-up, and twelve patients did not complete six-month follow-up. Of those with follow-up data, 22 patients (55%) were frail or deceased three months after SCT, and 27 patients (71%) were frail or deceased six months after SCT. Frailty at baseline was not significantly associated with frailty or death at three or six months after SCT. However, the study's small enrollment limits conclusions on these associations.

CONCLUSION

GA deficits and frailty are prevalent in older adult SCT recipients at baseline and after transplant. Future studies should aim for larger enrollment in order to validate associations between these deficits and outcomes, especially survival, functional status, and quality of life following SCT.

Fostering healthy aging: The interdependency of infections, immunity and frailty

Untangling the interdependency of infections, immunity and frailty may help to clarify their roles in the maintenance of health in aging individuals, and the recent COVID-19 pandemic has further highlighted such priority. In this scoping review we aimed to systematically collect the evidence on 1) the impact of common infections such as influenza, pneumonia and varicella zoster on frailty development, and 2) the role played by frailty in the response to immunization of older adults. Findings are discussed under a unifying framework to identify knowledge gaps and outline their clinical and public health implications to foster a healthier aging. Twenty-nine studies (113,863 participants) selected to answer the first question provided a moderately strong evidence of an association between infections and physical as well as cognitive decline - two essential dimensions of frailty. Thirteen studies (34,520 participants) investigating the second aim, showed that frailty was associated with an impaired immune response in older ages, likely due to immunosenescence. However, the paucity of studies, the absence of tools to predict vaccine efficacy, and the lack of studies investigating the efficacy of newer vaccines in presence of frailty, strongly limit the formulation of more personalized immunization strategies for older adults. The current evidence suggests that infections and frailty repeatedly cross each other pathophysiological paths and accelerate the aging process in a vicious circle. Such evidence opens to several considerations. First, the prevention of both conditions pass through a life course approach, which includes several individual and societal aspects. Second, the maintenance of a well-functioning immune system may be accomplished by preventing frailty, and vice versa. Third, increasing the adherence to immunization may delay the onset of frailty and maintain the immune system homeostasis, beyond preventing infections.

Temporal emergence of age-associated changes in cognitive and physical function in vervets (Chlorocebus aethiops sabaeus)

Dual declines in gait speed and cognitive performance are associated with increased risk of developing dementia. Characterizing the patterns of such impairments therefore is paramount to distinguishing healthy from pathological aging. Nonhuman primates such as vervet/African green monkeys (Chlorocebus aethiops sabaeus) are important models of human neurocognitive aging, yet the trajectory of dual decline has not been characterized. We therefore (1) assessed whether cognitive and physical performance (i.e., gait speed) are lower in older aged animals; (2) explored the relationship between performance in a novel task of executive function (Wake Forest Maze Task-WFMT) and a well-established assessment of working memory (delayed response task-DR task); and (3) examined the association between baseline gait speed with executive function and working memory at 1-year follow-up. We found (1) physical and cognitive declines with age; (2) strong agreement between performance in the novel WFMT and DR task; and (3) that slow gait is associated with poor cognitive performance in both domains. Our results suggest that older aged vervets exhibit a coordinated suite of traits consistent with human aging and that slow gait may be a biomarker of cognitive decline. This integrative approach provides evidence that gait speed and cognitive function differ across the lifespan in female vervet monkeys, which advances them as a model that could be used to dissect relationships between trajectories of dual decline over time.

Development and Validation of a Nomogram Based on Motoric Cognitive Risk Syndrome for Cognitive Impairment

Objective

To develop and validate a prediction nomogram based on motoric cognitive risk syndrome for cognitive impairment in healthy older adults.

Methods

Using two longitudinal cohorts of participants (aged ≥ 60 years) with 4-year follow-up, we developed (n = 1,177) and validated (n = 2,076) a prediction nomogram. LASSO (least absolute shrinkage and selection operator) regression model and multivariable Cox regression analysis were used for variable selection and for developing the prediction model, respectively. The performance of the nomogram was assessed with respect to its calibration, discrimination, and clinical usefulness.

Results

The individualized prediction nomogram was assessed based on the following: motoric cognitive risk syndrome, education, gender, baseline cognition, and age. The model showed good discrimination [Harrell’s concordance index (C-index) of 0.814; 95% confidence interval, 0.782–0.835] and good calibration. Comparable results were also seen in the validation cohort, which includes good discrimination (C-index, 0.772; 95% confidence interval, 0.776–0.818) and good calibration. Decision curve analysis demonstrated that the prediction nomogram was clinically useful.

Conclusion

This prediction nomogram provides a practical tool with all necessary predictors, which are accessible to practitioners. It can be used to estimate the risk of cognitive impairment in healthy older adults.

Baseline Neurocognitive Impairment (NCI) Is Associated With Incident Frailty but Baseline Frailty Does Not Predict Incident NCI in Older Persons With Human Immunodeficiency Virus (HIV)

BACKGROUND

Neurocognitive impairment (NCI) and frailty are more prevalent among persons with human immunodeficiency virus (HIV, PWH) compared to those without HIV. Frailty and NCI often overlap with one another. Whether frailty precedes declines in neurocognitive function among PWH or vice versa has not been well established.

METHODS

AIDS Clinical Trials Group (ACTG) A5322 is an observational cohort study of older PWH. Participants undergo annual assessments for NCI and frailty. ACTG A5322 participants who developed NCI as indexed by tests of impaired executive functioning and processing speed during the first 3 years were compared to persons who maintained normal cognitive function; those who demonstrated resolution of NCI were compared to those who had persistent NCI. Participants were similarly compared by frailty trajectory. We fit multinomial logistic regression models to assess associations between baseline covariates (including NCI) and frailty, and associations between baseline covariates (including frailty) and NCI.

RESULTS

In total, 929 participants were included with a median age of 51 years (interquartile range [IQR] 46-56). At study entry, 16% had NCI, and 6% were frail. Over 3 years, 6% of participants developed NCI; 5% developed frailty. NCI was associated with development of frailty (odds ratio [OR] = 2.06; 95% confidence interval [CI] = .94, 4.48; P = .07). Further adjustment for confounding strengthened this association (OR = 2.79; 95% CI = 1.21, 6.43; P = .02). Baseline frailty however was not associated with NCI development.

CONCLUSIONS

NCI was associated with increased risk of frailty, but frailty was not associated with development of NCI. These findings suggest that the presence of NCI in PWH should prompt monitoring for the development of frailty and interventions to prevent frailty in this population.

Frailty in heart transplantation: Report from the heart workgroup of a consensus conference on frailty

A consensus conference on frailty in solid organ transplantation took place on February 11, 2018, to discuss the latest developments in frailty, adopt a standardized approach to assessment, and generate ideas for future research. The findings and consensus of the Frailty Heart Workgroup (American Society of Transplantation's Thoracic and Critical Care Community of Practice) are presented here. Frailty is defined as a clinically recognizable state of increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiologic systems such that the ability to cope with every day or acute stressors is compromised. Frailty is increasingly recognized as a distinct biologic entity that can adversely affect outcomes before and after heart transplantation. A greater proportion of patients referred for heart transplantation are older and have more complex comorbidities. However, outcomes data in the pretransplant setting, particularly for younger patients, are limited. Therefore, there is a need to develop objective frailty assessment tools for risk stratification in patients with advanced heart disease. These tools will help to determine appropriate recipient selection for advanced heart disease therapies including heart transplantation and mechanical circulatory support, improve overall outcomes, and help distinguish frailty phenotypes amenable to intervention.

Cumulative health deficits, APOE genotype, and risk for later-life mild cognitive impairment and dementia

OBJECTIVE

To determine whether health-deficit accumulation is associated with the risks of mild cognitive impairment (MCI) and dementia independently of APOE genotype.

METHODS

A frailty index was calculated using the deficit-accumulation approach in participants aged 50 years and older from the National Alzheimer's Coordinating Center. Cognitive status was determined by clinical evaluation. Using multistate transition models, we assessed the extent to which an increasing degree of frailty affected the probabilities of transitioning between not cognitively impaired (NCI), MCI, and dementia.

RESULTS

Participants (n=14 490) had a mean age of 72.2 years (SD=8.9 years; range=50-103 years). Among those NCI at baseline (n=9773), each 0.1 increment increase in the frailty index was associated with a higher risk of developing MCI and a higher risk of progressing to dementia. Among those with MCI at baseline (n=4717), higher frailty was associated with a higher risk of progressing to dementia, a lower probability of being reclassified as NCI, and a higher likelihood of returning to MCI in those that were reclassified as NCI. These risk effects were present and similar in both carriers and non-carriers of the APOE ε4 allele.

CONCLUSION

Among older Americans, health-deficit accumulation affects the likelihood of progressive cognitive impairment and the likelihood of cognitive improvement independently of a strong genetic risk factor for dementia. Frailty represents an important risk factor for cognitive dysfunction and a marker of potential prognostic value.

Multimorbidity burden and dementia risk in older adults: The role of inflammation and genetics

Introduction

We investigate dementia risk in older adults with different disease patterns and explore the role of inflammation and apolipoprotein E (APOE) genotype.

Methods

A total of 2,478 dementia‐free participants with two or more chronic diseases (ie, multimorbidity) part of the Swedish National study on Aging and Care in Kungsholmen (SNAC‐K) were grouped according to their multimorbidity patterns and followed to detect clinical dementia. The potential modifier effect of C‐reactive protein (CRP) and apolipoprotein E (APOE) genotype was tested through stratified analyses.

Results

People with neuropsychiatric, cardiovascular, and sensory impairment/cancer multimorbidity had increased hazards for dementia compared to the unspecific (Hazard ration (HR) 1.66, 95% confidence interval [CI] 1.13‐2.42; 1.61, 95% CI 1.17‐2.29; 1.32, 95% CI 1.10‐1.71, respectively). Despite the lack of statistically significant interaction, high CRP increased dementia risk within these patterns, and being APOE ε4 carriers heightened dementia risk for neuropsychiatric and cardiovascular multimorbidity.

Discussion

Individuals with neuropsychiatric, cardiovascular, and sensory impairment/cancer patterns are at increased risk for dementia and APOE ε4, and inflammation may further increase the risk. Identifying such high‐risk groups might allow tailored interventions for dementia prevention.

Time from dementia diagnosis to nursing-home admission and death among persons with dementia: A multistate survival analysis

Objectives

To estimate transition times from dementia diagnosis to nursing-home (NH) admission or death and to examine whether sex, education, marital status, level of cognitive impairment and dementia aetiology are associated with transition times.

Design

Markov multistate survival analysis and flexible parametric models.

Setting

Participants were recruited from the Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog) in specialist healthcare between 2008 and 2017 and followed until August 2019, a maximum of 10.6 years follow-up time (mean 4.4 years, SD 2.2). Participants’ address histories, emigration and vital status were retrieved from the National Population Registry from time of diagnosis and linked to NorCog clinical data.

Participants

2,938 home-dwelling persons with dementia, ages 40–97 years at time of diagnosis (mean 76.1, SD 8.5).

Results

During follow-up, 992 persons (34%) were admitted to nursing-homes (NHs) and 1,556 (53%) died. Approximately four years after diagnosis, the probability of living in a NH peaked at 19%; thereafter, the probability decreased due to mortality. Median elapsed time from dementia diagnosis to NH admission among those admitted to NHs was 2.28 years (IQR 2.32). The probability of NH admission was greater for women than men due to women´s lower mortality rate. Persons living alone, particularly men, had a higher probability of NH admission than cohabitants. Age, dementia aetiology and severity of cognitive impairment at time of diagnosis did not influence the probability of NH admission. Those with fewer than 10 years of education had a lower probability of NH admission than those with 10 years or more, and this was independent of the excess mortality in the less-educated group.

Conclusion

Four years after diagnosis, half of the participants still lived at home, while NH residency peaked at 19%. Those with fewer than 10 years of education were less often admitted to NH.