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Zang E, Zhang Y, Wang Y, Wu B, Fried TR, Becher RD, Gill TM. Association Between Cognitive Trajectories and Subsequent Health Status, Depressive Symptoms, and Mortality Among Older Adults in the United States: Findings From a Nationally Representative Study. J Gerontol A Biol Sci Med Sci 2024; 79:glae143. [PMID: 38845419 PMCID: PMC11212484 DOI: 10.1093/gerona/glae143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Cognitive decline may be an early indicator of major health issues in older adults, though research using population-based data is lacking. Researchers objective was to assess the relationships between distinct cognitive trajectories and subsequent health outcomes, including health status, depressive symptoms, and mortality, using a nationally representative cohort. METHODS Data were drawn from the National Health and Aging Trends Study. Global cognition was assessed annually between 2011 and 2018. The health status of 4 413 people, depressive symptoms in 4 342 individuals, and deaths among 5 955 living respondents were measured in 2019. Distinct cognitive trajectory groups were identified using an innovative Bayesian group-based trajectory model. Ordinal logistic, Poisson, and logistic regression models were used to examine the associations between cognitive trajectories and subsequent health outcomes. RESULTS Researchers identified five cognitive trajectory groups with distinct baseline values and subsequent changes in cognitive function. Compared with the group with stably high cognitive function, worse cognitive trajectories (ie, lower baseline values and sharper declines) were associated with higher risks of poor health status, depressive symptoms, and mortality, even after adjusting for relevant covariates. CONCLUSIONS Among older adults, worse cognitive trajectories are strongly associated with subsequent poor health status, high depressive symptoms, and high mortality risks. Regular screening of cognitive function may help to facilitate early identification and interventions for older adults susceptible to adverse health outcomes.
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Affiliation(s)
- Emma Zang
- Department of Sociology, Yale University, New Haven, Connecticut, USA
| | - Yunxuan Zhang
- Department of Biostatistics, Yale University, New Haven, Connecticut, USA
| | - Yi Wang
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, USA
| | - Terri R Fried
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Robert D Becher
- Division of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Thomas M Gill
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA
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Fei Y, Niu S, Xi X, Tang W, Zhao Y, Zhang G, Yu X, Li C, Li X, Liu Y, Li Y, Yin Y, Cui Y, Li X. Physical frailty intensifies the positive association of oral frailty with poor global cognitive function and executive function among older adults especially for females: a cross-sectional study. BMC Geriatr 2024; 24:468. [PMID: 38811863 PMCID: PMC11134949 DOI: 10.1186/s12877-024-05056-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/08/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Oral frailty is reported to increase the risk of new onset of mild cognitive impairment. Whereas, the association of oral frailty with cognition among older adults in both physical frail and non-physical frail status has not been sufficiently explored, and whether there are sex differences in the association is unclear. This study investigated the association of oral frailty and physical frailty with global cognitive function and executive function among older adults, as well as the sex differences in such association. METHODS This cross-sectional study included 307 participants aged ≥ 60 years old from communities between June 2023 and August 2023, in Nanjing, China. Global cognitive function and executive function were assessed by using the Montreal Cognitive Assessment (MoCA) and Trail Making Tests A (TMT-A), respectively. Oral frailty was identified by the combination of natural tooth, Oral Frailty Index-8 (OFI-8), and oral diadochokinesis. Physical frailty was measured by using Fried phenotype model which contained 5 criteria: unintentional weight loss, weakness, exhaustion, slowness, and low physical activity. Multiple linear regression analyses for overall participants and stratified by sex and presence or absence of physical frailty were performed, respectively, to examine the association between oral frailty and cognitive functions. RESULTS The median age of participants was 70 years old. The study included 158 (51.5%) females, 53 (17.3%) individuals with physical frailty, and 65 (21.2%) participants with oral frailty. After adjustment, the association between oral frailty and global cognitive function was observed in the physical frailty group (B = -2.67, 95% Confidence Interval [CI]: -5.27 to -0.07, p = 0.045) and the females with physical frailty (B = -4, 95% CI: -7.41 to -0.58, p = 0.024). Oral frailty was associated with executive function in overall participants (B = 0.12, 95% CI: 0.01 to 0.22, p = 0.037), physical frailty group (B = 23.68, 95% CI: 1.37 to 45.99, p = 0.038). In the adjusted models, oral frailty was significantly associated with executive function in all females (B = 0.21, 95% CI: 0.05 to 0.36, p = 0.009), in females without physical frailty (B = 0.19, 95% CI: 0.02 to 0.36, p = 0.027), and in females with physical frailty (B = 48.69, 95% CI: 7.17 to 90.21, p = 0.024). CONCLUSIONS Physical frailty intensifies the positive association of oral frailty with poor global cognitive function and executive function among older adults, particularly among females. It is ponderable to consider sex differences and facilitate the management of physical frailty when it comes to promoting cognitive health based on the perspective of oral health among older adults.
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Affiliation(s)
- Yang Fei
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Shuzhen Niu
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Xueru Xi
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Wenping Tang
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Yue Zhao
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Ge Zhang
- Department of Geriatrics (Geriatric Neurology), the Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, China
| | - Xiaohong Yu
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Cheng Li
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Xinru Li
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Ying Liu
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Yaxin Li
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
| | - Yueheng Yin
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China.
| | - Yan Cui
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China.
| | - Xianwen Li
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, China
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Park HJ, Thapa N, Bae S, Yang JG, Choi J, Noh ES, Park H. Association between Physical Function, Mental Function and Frailty in Community-Dwelling Older Adults: A Cross-Sectional Study. J Clin Med 2024; 13:3207. [PMID: 38892918 PMCID: PMC11172678 DOI: 10.3390/jcm13113207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/25/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Background: This study examines the relationship between physical and mental function and frailty, independently and in conjunction with polypharmacy, among older adults. Methods: This cross-sectional study consisted of 368 participants aged ≥60 years. The participants were categorized into either robust or frail groups using Fried's frailty phenotype. Physical functions were assessed using grip strength, gait speed, Timed Up and Go (TUG), the Five Chair Sit to Stand Test (FCSST) and the Six-Minute Walk Test (SMWT). Mental functions were assessed using cognitive function and depression. Cognitive function was measured using Mini-Mental State Examination (MMSE). Depression was assessed with the Korean version of the Short Geriatric Depression Scale (SGDS). Results: The mean age of study population was 75.4 years. In this population, we identified 78.8% (n = 290) robust participants and 21.2% (n = 78) frail participants. The study examined frailty status (frail vs. non-frail) and frailty with and without polypharmacy using multivariate logistic regressions, adjusting for age and sex. In the logistic regression model estimating the risk of frailty, after adjustments for age, sex, BMI, and number of medications, individuals with low SMWT showed a significantly increased risk of frailty, with an odds ratio (OR) of 8.66 and a 95% confidence interval (CI) of 4.55-16.48. Additionally, global cognitive function was associated with a 1.97-fold increase in frailty risk (95% CI: 1.02-3.67). Moreover, in models adjusted for age, sex, and BMI to assess frailty risk linked to polypharmacy, the TUG, SMWT, and SGDS all showed increased risks, with ORs of 3.65 (95% CI: 1.07-12.47), 5.06 (95% CI: 1.40-18.32), and 5.71 (95% CI: 1.79-18.18), respectively. Conclusions: Physical function (SMWT, FCSST, TUG) and mental function (depression, cognition) were associated with frailty. By comprehensively examining these factors, we will gain valuable insights into frailty and enable more precise strategies for intervention and prevention.
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Affiliation(s)
| | | | | | | | | | | | - Hyuntae Park
- Department of Healthcare and Science, Dong-A University, Busan 49315, Republic of Korea; (H.-J.P.); (N.T.); (S.B.); (J.-G.Y.); (J.C.); (E.-S.N.)
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Hong J, Chu NM, Cockey SG, Long J, Cronin N, Ghildayal N, Hall RK, Huisingh-Scheetz M, Scherer J, Segev DL, McAdams-DeMarco MA. Frailty, but not cognitive impairment, improves mortality risk prediction among those with chronic kidney disease-a nationally representative study. BMC Nephrol 2024; 25:177. [PMID: 38778286 PMCID: PMC11112880 DOI: 10.1186/s12882-024-03613-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Though older adults with chronic kidney disease (CKD) have a greater mortality risk than those without CKD, traditional risk factors poorly predict mortality in this population. Therefore, we tested our hypothesis that two common geriatric risk factors, frailty and cognitive impairment, and their co-occurrence, might improve mortality risk prediction in CKD. METHODS Among participants aged ≥ 60 years from National Health and Nutrition Examination Survey (2011-2014), we quantified associations between frailty (physical frailty phenotype) and global/domain-specific cognitive function (immediate-recall [CERAD-WL], delayed-recall [CERAD-DL], verbal fluency [AF], executive function/processing speed [DSST], and global [standardized-average of 4 domain-specific tests]) using linear regression, and tested whether associations differed by CKD using a Wald test. We then tested whether frailty, global cognitive impairment (1.5SD below the mean), or their combination improved prediction of mortality (Cox models, c-statistics) compared to base models (likelihood-ratios) among those with and without CKD. RESULTS Among 3,211 participants, 1.4% were cognitively impaired, and 10.0% were frail; frailty and cognitive impairment co-occurrence was greater among those with CKD versus those without (1.2%vs.0.1%). Frailty was associated with worse global cognitive function (Cohen's d = -0.26SD,95%CI -0.36,-0.17), and worse cognitive function across all domains; these associations did not differ by CKD (pinteractions > 0.05). Mortality risk prediction improved only among those with CKD when accounting for frailty (p[likelihood ratio test] < 0.001) but not cognitive impairment. CONCLUSIONS Frailty is associated with worse cognitive function regardless of CKD status. While CKD and frailty improved mortality prediction, cognitive impairment did not. Risk prediction tools should incorporate frailty to improve mortality prediction among those with CKD.
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Affiliation(s)
- Jingyao Hong
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Nadia M Chu
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Samuel G Cockey
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Jane Long
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Nicolai Cronin
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Nidhi Ghildayal
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Rasheeda K Hall
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Megan Huisingh-Scheetz
- Department of Medicine, University of Chicago, Section of Geriatrics and Palliative Medicine, Chicago, IL, USA
| | - Jennifer Scherer
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Dorry L Segev
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Mara A McAdams-DeMarco
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA.
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
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Gao X, Wu Q, Long Y, Hu X, Yang Z, Huang L. Interaction between plant-based dietary pattern and frailty on cognitive decline: a longitudinal analysis of the Chinese Longitudinal Healthy Longevity Survey cohort. Age Ageing 2024; 53:afae002. [PMID: 38275096 DOI: 10.1093/ageing/afae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/09/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVES Frailty is a risk factor for faster cognitive decline, while plant-based dietary patterns are associated with decreased risk of cognitive decline. We aimed to explore their interaction with cognitive function among older adults. METHODS We used data from the Chinese Longitudinal Healthy Longevity Survey between 2008 and 2018. Frailty was evaluated based on the frailty index (FI), and the plant-based diet index (PDI) was calculated using food frequency questionnaire at baseline. Repeated measures of the Mini-Mental State Examination (MMSE) were utilised to assess cognitive function. We used linear mixed models to estimate regression coefficients (β) and 95% confidence intervals (CI). RESULTS We included 7,166 participants with a median follow-up of 5.8 years. Participants in pre-frail (β = -0.18, 95% CI: -0.24, -0.13) and frail (β = -0.39, 95% CI: -0.48, -0.30) groups experienced an accelerated decline in MMSE score compared with the robust group. The PDI modified the above association, with corresponding associations with frailty being much more pronounced among participants with a lower PDI (frail vs. robust β = -0.44, 95% CI: -0.56, -0.32), compared with those with a higher PDI (frail vs. robust β = -0.27, 95% CI: -0.40, -0.13). In addition, A combination of frailty and a low PDI was strongly associated with a faster decline in MMSE score (β = -0.52, 95% CI: -0.63, -0.41). CONCLUSION Adherence to plant-based dietary patterns attenuates the association between frailty and cognitive decline. If the observed association is causal, promoting plant-based dietary patterns may be a strategy to reduce the effects of frailty on neurological health.
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Affiliation(s)
- Xia Gao
- Department of Gerontology, Daping Hospital, Army Medical University, Chongqing, China
| | - Qianrong Wu
- Department of Prevention and Health Care, Daping Hospital, Army Medical University, Chongqing, China
| | - Yan Long
- Department of Gerontology, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiaotong Hu
- Department of Gerontology, Daping Hospital, Army Medical University, Chongqing, China
| | - Zongming Yang
- Department of Public Health, Zhejiang University School of Medicine, Hangzhou, China
- Department of Endocrinology of the Children's Hospital, National Clinical Research Center for Children's Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Liang Huang
- Department of Gerontology, Daping Hospital, Army Medical University, Chongqing, China
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Saeki N, Mizutani M, Tanimura S, Nishide R. Types and frequency of social participation and comprehensive frailty among community-dwelling older people in Japan. Prev Med Rep 2023; 36:102443. [PMID: 38021414 PMCID: PMC10656264 DOI: 10.1016/j.pmedr.2023.102443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 12/01/2023] Open
Abstract
Although research has established social participation as important for preventing frailty in older people, the association between the type and frequency of social participation and comprehensive frailty remains unclear. This study aimed to reveal the associations between types and frequency of social participation and comprehensive frailty among community-dwelling older people. This was a cross-sectional study conducted in four cities and towns (Inabe City, Nabari City, Odai Town, and Kiho Town) of Mie Prefecture, Japan, among adults who were: (i) aged ≥65 years and (ii) not certified as needing long-term care. We measured comprehensive frailty using the participants' total scores on the Kihon Checklist, developed by Ministry of Health, Labour and Welfare of Japan, which divides frailty status into three categories: robust (0-3 points), prefrail (4-7), and frail (8-25). Types and frequency of social participation were explanatory variables, and ordered logistic regression analysis adjusted for potential confounding factors identified the associations. The frailty status of the 296 participants (age 65-74 years: 44.3 %; female: 74.0 %) was as follows: frail, 21.3 %; prefrail, 40.2 %; and robust, 38.5 %. Lower level of frailty was associated with interaction using smartphones 2-3 times per month, participating in sports ≥4 times per week, participating in local improvement activities several times per year, and engaging in activities for children 2-4 times per month. Social participation among older adults at appropriate frequencies were associated with the lower level of comprehensive frailty. However, future longitudinal studies are needed using populations from more diverse countries or regions and from different cultures.
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Affiliation(s)
- Nanako Saeki
- Department of Public Health Nursing, Mie University Graduate School of Medicine, Japan
| | - Mayumi Mizutani
- Department of Public Health Nursing, Mie University Graduate School of Medicine, Japan
| | - Susumu Tanimura
- Department of Public Health Nursing, Mie University Graduate School of Medicine, Japan
| | - Ritsuko Nishide
- Department of Public Health Nursing, Mie University Graduate School of Medicine, Japan
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Cui K, Meng W, Li Z, Zeng X, Li X, Ge X. Dynamics, association, and temporal sequence of cognitive function and frailty: a longitudinal study among Chinese community-dwelling older adults. BMC Geriatr 2023; 23:658. [PMID: 37833637 PMCID: PMC10571451 DOI: 10.1186/s12877-023-04328-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Little is known about the association of longitudinal dynamics between cognitive function and frailty in Chinese older adults. The temporal sequences between cognitive function and frailty remains unclear. Our study investigates this directionality association using longitudinal data. METHODS Latent growth and multivariate latent growth models were employed to examine dynamics of cognition and frailty and their association among 2824 older adults in China. Cross-lagged panel analyses were used to assess the temporal sequences between frailty and cognition. The relation between cognitive domains and frailty was also examined using aforementioned methods. RESULTS Cognitive function was negatively associated with frailty status. Higher initial level of cognition indicated lower baseline level (β=-0.175, P < 0.001) and change rate (β=-0.041, P = 0.002) of frailty. We observed a reciprocal association between frailty and cognitive function rather than a unidirectional causal relationship. The initial cognitive performance for all components were negatively associated with baseline (β ranged between - 0.098 to -0.023) and change rate (β ranged between - 0.007 to -0.024) of frail status. No consistent associations between change rate of cognitive components and either initial level or change rate of frailty were detected. CONCLUSIONS Our study detected a reciprocal association between cognition and frailty rather than a unidirectional causal relationship. Our results also revealed different connections between cognitive performance and frailty across diverse cognitive domains.
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Affiliation(s)
- Kai Cui
- School of Public Health, Jinzhou Medical University, 40 Songpo Road, Jinzhou, 121000, P. R. China
| | - Weihan Meng
- School of Public Health, Jinzhou Medical University, 40 Songpo Road, Jinzhou, 121000, P. R. China
| | - Zhiqiang Li
- School of Public Health, Jinzhou Medical University, 40 Songpo Road, Jinzhou, 121000, P. R. China
| | - Xinning Zeng
- School of Public Health, Jinzhou Medical University, 40 Songpo Road, Jinzhou, 121000, P. R. China
| | - Xiaozhe Li
- School of Public Health, Jinzhou Medical University, 40 Songpo Road, Jinzhou, 121000, P. R. China
| | - Xiaoyan Ge
- School of Public Health, Jinzhou Medical University, 40 Songpo Road, Jinzhou, 121000, P. R. China.
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Allwright M, Mundell HD, McCorkindale AN, Lindley RI, Austin PJ, Guennewig B, Sutherland GT. Ranking the risk factors for Alzheimer's disease; findings from the UK Biobank study. AGING BRAIN 2023; 3:100081. [PMID: 37384134 PMCID: PMC10293768 DOI: 10.1016/j.nbas.2023.100081] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/30/2023] Open
Abstract
Background The cause of the most common form of dementia, sporadic Alzheimer's disease (AD), remains unknown. This may reflect insufficiently powered studies to date for this multi-factorial disorder. The UK Biobank dataset presents a unique opportunity to rank known risk factors and determine novel variables. Methods A custom machine learning approach for high dimensionality data was applied to explore prospectively associations between AD in a sub-cohort of 156,209 UK Biobank participants aged 60-70 including more than 2,090 who were subsequently diagnosed with AD. Results After the possession of the APOE4 allele, the next highest ranked risk factors were other genetic variants within the TOMM40-APOE-APOC1 locus. When stratified by their apolipoprotein epsilon 4 (APOE4) carrier status, the most prominent risk factors in carriers were AST:ALT ratio, the "number of treatments/ medications" taken as well as "time spent in hospital" while protection was conferred by "Sleeplessness/Insomnia". In non-APOE carriers, lower socioeconomic status and fewer years of education were highly ranked but effect sizes were small relative to APOE4 carriers. Conclusions Possession of the APOE4 allele was confirmed as the most important risk factor in AD. Other TOMM40-APOE-APOC1 locus variants further moderate the risk of AD in APOE4 carriers. Liver pathology is a novel risk factor in APOE4 carriers while "Sleeplessness/Insomnia" is protective in AD irrespective of APOE4 status. Other factors such as "Number of treatments/ medications" suggest that multimorbidity is an important risk factor for AD. Future treatments aimed at co-morbidities, including liver disease, may concomitantly lower the risk of sporadic AD.
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Affiliation(s)
- Michael Allwright
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Hamish D Mundell
- Charles Perkins Centre and School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Andrew N McCorkindale
- Charles Perkins Centre and School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Richard I. Lindley
- Westmead Applied Research Centre, Sydney Medical School, University of Sydney, NSW 2006 and George Institute for Global Health, Newtown, NSW 2042, Australia
| | - Paul J. Austin
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Boris Guennewig
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Greg T Sutherland
- Charles Perkins Centre and School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
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Ge ML, Chu NM, Simonsick EM, Kasper JD, Xue QL. Order of Onset of Physical Frailty and Cognitive Impairment and Risk of Repeated Falls in Community-Dwelling Older Adults. J Am Med Dir Assoc 2023; 24:482-488.e4. [PMID: 36852758 PMCID: PMC10167733 DOI: 10.1016/j.jamda.2023.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVES To examine whether physical frailty onset before, after, or in concert with cognitive impairment is differentially associated with fall incidence in community-dwelling older adults. DESIGN A longitudinal observational study. SETTING AND PARTICIPANTS Data from 1337 older adults age ≥65 years and free of physical frailty or cognitive impairment at baseline were obtained from the National Health Aging Trends Study (2011‒2017), a nationally representative cohort study of US older adult Medicare beneficiaries. METHODS Participants were assessed annually for frailty (physical frailty phenotype) and cognitive impairment (bottom quintile of clock drawing test or immediate and delayed recall; or proxy-report of diagnosis of dementia or AD8 score of ≥2). Incident falls were ascertained annually via self-report. Multinomial logistic regression was performed to estimate the association between order of first onset of cognitive impairment and/or frailty and incident single or repeated falls in the 1-year interval following their first onset. RESULTS Of the 1,337, 832 developed cognitive impairment first (termed "CI first"), 286 developed frailty first (termed "frailty first") and 219 had co-occurrence of cognitive impairment and frailty within one year (termed "CI-frailty co-occurrence") over 5 years. Overall, 491 (34.5%) had at least 1 fall during the 1-year interval following the onset of physical frailty and/or cognitive impairment. After adjustment, "CI-frailty co-occurrence" was associated with a more than 2-fold increased risk of repeated falls than "CI first" (odds ratio 2.35, 95% confidence interval 1.51‒3.67; P < .001). No significant difference was found between participants with "frailty first" and "CI first" (P = .07). In addition, the order of onset was not associated with risk of a single fall. CONCLUSIONS AND IMPLICATIONS Older adults experiencing "CI-frailty co-occurrence" had the greatest risk of repeated falls compared with those with "CI first" and "frailty first". Fall risk screening should consider the order and timing of onset of physical frailty and cognitive impairment.
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Affiliation(s)
- Mei-Ling Ge
- The Center of Gerontology and Geriatrics (National Clinical Research Center for Geriatrics), West China Hospital, Sichuan University, Chengdu, China
| | - Nadia M Chu
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Eleanor M Simonsick
- Intramural Research Program, Longitudinal Studies Section, the National Institute on Aging, Baltimore, MD, USA
| | - Judith D Kasper
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Qian-Li Xue
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Li F, Yan Y, Zheng L, Wang C, Guan X, Hong S, Guo H. Frailty and its combined effects with lifestyle factors on cognitive function: a cross-sectional study. BMC Geriatr 2023; 23:79. [PMID: 36747124 PMCID: PMC9900934 DOI: 10.1186/s12877-023-03761-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/19/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Frailty describes an age-related state of deterioration in biological function. This study aimed to investigate the association between frailty and cognitive function and its combined effects with lifestyles. METHODS A total of 3,279 participants from the Dongfeng-Tongji (DFTJ) cohort were tested the cognitive function by using the Chinese version of Mini-mental State Examination (MMSE). Frailty was evaluated based on a 35-item frailty index (FI). Frailty status was dichotomized into robust (FI < 0.15) and frail (FI ≥ 0.15). Multivariate generalized linear regression models and logistic regression models were used to estimate the associations of frailty with MMSE score and cognitive impairment. We also analysed the modification and combined effects of lifestyle factors, including smoking status, drinking status, and regular physical exercise, on the above associations. RESULTS FI was significantly associated with lower MMSE score [β (95%Cl) = -0.28 (-0.43, -0.13)] and cognitive impairment [OR (95%Cl) = 1.19 (1.04, 1.35)]. The association of frailty status with MMSE were found to be stronger among ever smokers [β(95%Cl) = -1.08 (-1.64, -0.51)] and physical inactive individuals [β(95%Cl) = -1.59 (-2.63, -0.54)] while weaker or not significant among never smokers [β(95%Cl) = -0.30 (-0.62, 0.01)] and physical active individuals [β(95%Cl) = -0.37 (-0.65, -0.08))]. There were significant combined effects of frailty status with unhealthy lifestyles including smoking, alcohol drinking, and physical inactive on cognitive impairment. CONCLUSIONS Frailty was associated with cognitive impairment among Chinese middle-aged and elderly people, while smoking cessation and regular physical exercise could attenuate the above associations, which highlight the potential preventive interventions.
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Affiliation(s)
- Fangqing Li
- grid.33199.310000 0004 0368 7223Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030 Hubei China
| | - Yike Yan
- grid.33199.310000 0004 0368 7223Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030 Hubei China
| | - Lei Zheng
- grid.33199.310000 0004 0368 7223Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030 Hubei China
| | - Chenming Wang
- grid.33199.310000 0004 0368 7223Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030 Hubei China
| | - Xin Guan
- grid.33199.310000 0004 0368 7223Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030 Hubei China
| | - Shiru Hong
- grid.33199.310000 0004 0368 7223Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030 Hubei China
| | - Huan Guo
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, Hubei, China.
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Association between frailty and cognitive function in older Chinese people: A moderated mediation of social relationships and depressive symptoms. J Affect Disord 2022; 316:223-232. [PMID: 35988782 DOI: 10.1016/j.jad.2022.08.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND To date, few studies have focused on examining either the direct or indirect effect of physical frailty on cognitive impairment. This study aimed to investigate the moderating effects of social relationships, including their individual components in the role of depressive symptoms as a mediator between frailty and cognitive impairment. METHODS This study included a total of 7525 Chinese older adults from the 2017-2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Mediation analyses and moderated mediation effect analysis fully adjusted for all potential confounding factors were conducted. RESULTS Significant correlations were found between frailty, depression, social relationships, and cognitive function. Depression partially mediated the association of frailty with cognitive function [B = -0.198; 95 % confidence interval (CI): (-0.258, -0.143)]. Social relationships moderated the effect of frailty on cognitive function through both path b (depression-cognitive function) [B = 0.137; 95 % CI: (0.045, 0.230)], and path c' (frailty-cognitive function) [B = 0.870; 95 % CI: (0.562, 1.178)]. In addition, social activities and social networks moderated both the direct and indirect effect of the moderated mediation model. Social support only moderated the direct effect. LIMITATIONS The cross-sectional design of this study precludes any conclusion from the results as to the causality of cognitive impairment. CONCLUSIONS Social relationships moderated both the direct and indirect effects of depressive symptoms on the association between frailty and cognitive impairment. The findings suggest that interventions, such as paying attention to the mental health of old people and improving the quality of social relationships, may help break the link between frailty and cognitive impairment.
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Xiong J, Xue WX. The role of vitamin D in the link between physical frailty and cognitive function: A mediation analysis in community-dwelling Chinese older adults. Front Nutr 2022; 9:922673. [PMID: 35958260 PMCID: PMC9359101 DOI: 10.3389/fnut.2022.922673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Physical frailty and cognitive aging have important influences on poor clinical outcomes in older adults. Many studies have investigated the association between frailty and cognitive function, but whether vitamin D mediates the association between frailty and cognitive function is unclear. We explored the mediating role of vitamin D on the cross-sectional association between physical frailty and cognitive function using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Methods We analyzed data from 1944 subjects aged 60 years and older from the 2011 CLHLS cohort. Frailty status was identified by the Osteoporotic Fracture Study (SOF) index. The Chinese version of the Mini-Mental State Examination (MMSE) was used to assess cognitive function. Linear regression models were used to examine the association between frailty, vitamin D, and cognition, adjusted for a range of covariates. Mediation analyses tested the indirect effects of vitamin D on physical frailty and cognitive function. Result Physical frailty was negatively associated with vitamin D levels and scores on the MMSE, and vitamin D levels were positively associated with scores on the MMSE. Linear regression analysis showed that physical frailty and serum vitamin D concentration were significant predictors of cognitive function. Importantly, mediation analysis showed that serum vitamin D concentration significantly mediated the relationship between physical frailty and cognitive function. Conclusion The association between physical frailty and cognitive function appears to be mediated by vitamin D. Future studies should explore whether serum vitamin D concentrations may mediate the association between physical frailty and cognitive decline and whether this mediating role is moderated by other factors.
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Affiliation(s)
- Jian Xiong
- Department of Rehabilitation, Affiliated Zhangjiagang Hospital of Soochow University, Suzhou, China
| | - Wen-Xiong Xue
- Department of Rehabilitation, Affiliated Zhangjiagang Hospital of Soochow University, Suzhou, China
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Risk factors and a nomogram for frailty in Chinese older patients with Alzheimer's disease: A single-center cross-sectional study. Geriatr Nurs 2022; 47:47-54. [PMID: 35850031 DOI: 10.1016/j.gerinurse.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/20/2022]
Abstract
This study aimed to determine the risk factors of frailty in Chinese older patients with Alzheimer's disease (AD) and then construct a nomogram for frailty in this population. A total of 205 eligible older AD patients were recruited. Patients' general demographic characteristics were collected through a self-designed questionnaire. A nomogram was constructed for frailty based on the risk factors identified from the multivariate analysis. The discrimination and calibration capabilities of this nomogram were assessed with the C-index and calibration curve, respectively. The results showed that older age, no regular exercise habit, severe cognitive decline, and low social support were identified as important risk factors of frailty in AD patients. The C-index of the nomogram was 0.884 by bootstrapping validation, and the calibration curve of the nomogram showed high coherence between the predicted and actual probabilities of frailty. In conclusion, this nomogram was validated to have favorable discrimination and calibration capabilities.
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Ohikere K, Veracruz N, Wong RJ. Cognitive Impairment and Cirrhosis in Older Patients: A Systematic Review. Gerontol Geriatr Med 2022; 8:23337214221122520. [PMID: 36105374 PMCID: PMC9465583 DOI: 10.1177/23337214221122520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/27/2022] [Accepted: 08/08/2022] [Indexed: 11/15/2022] Open
Abstract
Prevalence of cirrhosis and hepatic encephalopathy (HE) in older patients receiving care in long-term care settings is unknown. This systematic review aimed to identify potential factors associated with HE and cognitive impairment in older patients with cirrhosis. A PubMed search of English-language articles published between January 1, 2000, and November 3, 2021, was conducted to identify studies in adults with cirrhosis relevant to cognitive impairment and/or HE (e.g., fall, frailty, and sarcopenia). Of 2,879 English-language publications, 24 were included. In patients with cirrhosis, falls were increased in the presence of HE and were associated with increased injury risk. Frailty was associated with HE development and cognitive impairment in patients with cirrhosis. Further, cognitive impairment and frailty were predictive of HE-related hospitalizations. Sarcopenia increased the risk of developing HE. Furthermore, specific medications increased the risk of developing HE. Risk reduction and management of patients with HE are critical to prevent negative outcomes.
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Affiliation(s)
- Kabiru Ohikere
- San Francisco Department of Public Health, San Francisco, CA, USA
| | | | - Robert J Wong
- Stanford University School of Medicine and Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA
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Chu NM, Chen X, Gross AL, Carlson MC, Garonzik-Wang JM, Norman SP, Mathur A, Abidi MZ, Brennan DC, Segev DL, McAdams-DeMarco MA. Cognitive impairment burden in older and younger adults across the kidney transplant care continuum. Clin Transplant 2021; 35:e14425. [PMID: 34272777 PMCID: PMC8595550 DOI: 10.1111/ctr.14425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/26/2021] [Accepted: 07/06/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Younger kidney transplant (KT) candidates and recipients may have cognitive impairment due to chronic diseases and reliance on dialysis. METHODS To quantify cognitive impairment burden by age across the KT care continuum, we leveraged a two-center cohort study of 3854 KT candidates at evaluation, 1114 recipients at admission, and 405 recipients at 1-year post-KT with measured global cognitive performance (3MS) or executive function (Trail Making Test). We also estimated burden of severe cognitive impairment that affects functional dependence (activities of daily living [ADL] < 6 or instrumental activities of daily living [IADL] < 8). RESULTS Among KT candidates, global cognitive impairment (18-34 years: 11.1%; 35-49 years: 14.0%; 50-64 years: 19.5%; ≥65 years: 22.0%) and severe cognitive impairment burden (18-34 years: 1.1%; 35-49 years: 3.0%; 50-64 years: 6.2%; ≥65 years: 7.7%) increased linearly with age. Among KT recipients at admission, global cognitive impairment (18-34 years: 9.1%; 35-49 years: 6.1%; 50-64 years: 9.3%; ≥65 years: 15.7%) and severe cognitive impairment burden (18-34 years: 1.4%; 35-49 years: 1.4%; 50-64 years: 2.2%; ≥65 years: 4.6%) was lower. Despite lowest burden of cognitive impairment among KT recipients at 1-year post-KT across all ages (18-34 years: 1.7%; 35-49 years: 3.4%; 50-64 years: 4.3%; ≥65 years: 6.5%), many still exhibited severe cognitive impairment (18-34 years: .0%; 35-49 years: 1.9%; 50-64 years: 2.4%; ≥65 years: 3.5%). CONCLUSION Findings were consistent for executive function impairment. While cognitive impairment increases with age, younger KT candidates have a high burden comparable to community-dwelling older adults, with some potentially suffering from severe forms. Transplant centers should consider routinely screening patients during clinical care encounters regardless of age.
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Affiliation(s)
- Nadia M Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Xiaomeng Chen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michelle C Carlson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Silas P Norman
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Aarti Mathur
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maheen Z Abidi
- Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Daniel C Brennan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mara A McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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