Specific cognitive domains and frailty trajectories among older Taiwanese adults

The correlation between frailty trajectories and adverse outcomes in older patients: A systematic review

INTRODUCTION

Frailty is a geriatric syndrome that is highly susceptible to adverse health outcomes and is a major burden that exacerbates society's medical care. By investigating the frailty trajectory within the older demographic and initially recognizing its clinical outcomes, we will have more tactics to manage the at-risk population.

METHODS

We executed a systematic review of trajectory studies elucidating the connection between frailty and adverse outcomes among older individuals (≥ 65 years) and explored articles published in English and Chinese from the inception of the database until Jun 30, 2024, in PubMed, Web of Science, Embase, The Cochrane Library, CINAHL, Scopus, CNKI, China Online Journals, VIP Information, and SinoMed.

RESULTS

The database survey unearthed 3522 articles, of which 21 were deemed eligible. The majority incorporated distinct assessment tools and statistical methodologies to classify frailty trajectories into three groups. Although these frailty trajectories produced inconsistent clinical outcomes, they did reveal trends in the frailty status of older adults.

CONCLUSION

The link between frailty trajectories and adverse outcome is a multifaceted and complex process that is currently understudied. More comprehensive and in-depth longitudinal studies should be conducted to explore the mechanism of interaction between the two to obstruct the progression of the frailty trajectory and bolster support for interventions.

Abnormalities of resting-state EEG microstates in older adults with cognitive frailty

This study aims to analyze the characteristics of EEG microstates across different cognitive frailty (CF) subtypes, providing insights for the prevention and early diagnosis of CF. This study included 60 eligible older adults. Their resting-state EEG microstates were analyzed using agglomerative adaptive hierarchical clustering. Microstate temporal parameters were extracted through global field power peak-based backfitting. Spearman's partial correlation analysis and linear mixed-effects models were employed to investigate the relationship between microstate temporal parameters and CF. Statistical differences were observed in transition probabilities (TPs) from microstate B to A between healthy controls (HCs) and reversible cognitive frailty (RCF) group (t = -2.076, P = 0.042). Potentially reversible cognitive frailty (PRCF) and RCF group also exhibited statistical differences in the TPs from microstate B to A (t = 3.122, P = 0.003). In the RCF group, the occurrence of microstates A and B differed significantly from microstate C (tAC = 3.455, PAC = 0.002; tBC = 3.108, PBC = 0.004). In the PRCF group, the occurrence of microstates A, B, and C differed significantly from microstate D (tAD = -3.688, PAD = 0.001; tBD = -3.334, PBD = 0.002; tCD = -4.188, PCD < 0.001). The neural networks and processing modes engaged by microstate D during executive memory tasks differ between RCF and PRCF. A decreased occurrence of microstate C and higher TPs of microstates A and B may serve as early warning signals for RCF. Conversely, an increased occurrence of microstate D and decreased TPs of microstates C and D indicate the onset of PRCF.

Factors affecting cognitive frailty improvement and progression in Taiwanese older adults

BACKGROUND

Knowledge of predictors of cognitive frailty (CF) trajectories is required to develop preventive strategies to delay or reverse the progression from CF to dementia and other adverse outcomes. This 2-year prospective study aimed to investigate factors affecting the progression and improvement of CF in older Taiwanese adults.

METHODS

In total, 832 community-dwelling people aged ≥ 65 years were eligible. Fried's five frailty criteria were used to measure prefrailty and frailty, while cognitive performance was assessed by the Clinical Dementia Rating and Mini-Mental State Examination. Each component of reversible CF and potentially reversible CF was assigned a score, with a total score ranging 0 to 5 points. Two annual follow-up CF assessments were conducted. The group-based trajectory model was applied to identify latent CF trajectory groups, and a multinomial logistic regression was used to examine relationships of explanatory variables with CF trajectories.

RESULTS

According to data on 482 subjects who completed the two annual follow-ups, three CF trajectories of robust, improvement, and progression were identified. After adjusting for the baseline CF state, CF progression was significantly associated with an older age (odds ratio [OR] = 1.08; 95% confidence interval [CI], 1.02 ~ 1.14), a lower Tinetti balance score (OR = 0.72; 95% CI, 0.54 ~ 0.96), a slower gait (OR = 0.98; 95% CI, 0.97 ~ 0.99), and four or more comorbidities (OR = 2.65; 95% CI, 1.19 ~ 5.90), while CF improvement was not significantly associated with any variable except the baseline CF state. In contrast, without adjusting for the baseline CF state, CF progression was significantly associated with an older age, female sex, balance scores, gait velocity, regular exercise, the number of comorbidities, and depression, while CF improvement was significantly associated with female sex, balance scores, and the number of comorbidities.

CONCLUSIONS

The baseline CF state, an older age, poorer balance, slower gait, and a high number of comorbidities may contribute to CF progression, while the baseline CF state may account for associations of engaging in regular exercise and depression with CF development.