1
|
Henry RK, Uppuluri A, Zarbin MA, Bhagat N. The Impact of Frailty Syndrome on Endogenous Endophthalmitis Development and Outcomes: A Population-Level Analysis. Ophthalmology 2022; 129:1440-1447. [PMID: 35843372 DOI: 10.1016/j.ophtha.2022.07.006] [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: 02/17/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Characterize the impact of frailty on endogenous endophthalmitis (EE) development and clinical outcomes among septicemic patients. DESIGN Population-level, retrospective cohort study. PARTICIPANTS Adult inpatients within the National Inpatient Sample (years 2002-2014) diagnosed with bacterial septicemia. METHODS Septicemic patients were classified as frail or nonfrail using the previously validated Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator, and diagnosis of EE was abstracted from International Classification of Diseases 9 codes. We used multivariable logistic regression to generate odds ratios (ORs) for rates of EE development and in-hospital mortality based on frailty status. We also examined the association between frailty and blood culture-proven organism class, inpatient length of stay, and total charges billed to insurance. MAIN OUTCOME MEASURES Incidence of EE among septicemic patients; rates of EE development among frail and nonfrail patients; blood culture-proven microbe type, length of stay, and total charges billed to insurance. RESULTS 9294 of 18 470 658 (0.05%) inpatients with bacteremia developed EE, 2102 (22.6%) of whom had at least 1 frailty-defining feature (predominantly malnutrition [68%]). Odds of developing EE were 16.7% higher for frail patients (OR, 1.167; 95% confidence interval, 1.108-1.229) when controlling for age, sex, race, concomitant human immunodeficiency virus/AIDS, pyogenic liver abscess, infectious endocarditis, cirrhosis, and diabetes with chronic complications. Frail EE patients had a 27.9% increased odds of in-hospital death, independent of age, sex, race, and Elixhauser comorbidity score (OR, 1.279; 95% confidence interval, 1.056-1.549). Higher rates of methicillin-resistant Staphylococcus aureus bacteremia (14.3% vs. 10.9%, P = 0.000016), gram-negative bacteremia (7.6% vs. 4.9%, P = 0.000003), and concomitant candidemia (10.4% vs. 7.0%, P = 0.0000004) were associated with frailty. Hospital stays were significantly longer (median, 14 days; interquartile range, 19 days; P < 0.00001) and total charges billed to insurance were significantly greater (median, $96 398; interquartile range, $154,682; P < 0.00001) among frail EE patients. CONCLUSIONS Frailty syndrome is independently associated with development of EE in the setting of bacterial septicemia; frailty-associated EE may occur in patients with malnutrition and particular bacterial subtypes, and it predisposes to higher rates of in-hospital death and health care resource usage.
Collapse
Affiliation(s)
- Roger K Henry
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Aditya Uppuluri
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Marco A Zarbin
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Neelakshi Bhagat
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey.
| |
Collapse
|
2
|
Association between the frailty index and vascular brain damage: The Treviso Dementia (TREDEM) registry. Exp Gerontol 2022; 167:111894. [PMID: 35843350 DOI: 10.1016/j.exger.2022.111894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE An association between frailty and vascular brain damage (VBD) has been described in older adults. However, most studies have identified frailty according to the phenotypic model. It is less clear whether frailty, operationalized as an accumulation of health deficits, is associated with the presence and severity of VBD. The present study was therefore undertaken to verify whether a 50-item frailty index (FI) is related to VBD in a large and relatively unselected cohort of attendees of a memory clinic. MATERIALS AND METHODS The TREDEM (Treviso Dementia) registry includes retrospective observational data of 1584 participants. A modified FI was calculated from 50 variables comprising diseases, disability, behavioral disorders, and blood biochemistry. The presence and severity of VBD, including leukoaraiosis, lacunes, larger infarctions and the hierarchical vascular rating scale (HVRS), were determined based on brain computerized tomography imaging. Multiple logistic regression models were built according to the stepwise method. RESULTS Mean age of the 1584 participants was 79.6 ± 7.5 years and 1033 (65.2 %) were females. The average number of health deficits was 11.6 ± 6.2, corresponding to an FI of 0.23 ± 0.12 (range: 0.00-0.56). Each 0.01-point increase in the FI was associated with an increased probability of leukoaraiosis (+2.3 %) and severe leukoaraiosis (+5 %), lacunas in the basal ganglia (+1.73 %), occipital lobes (+2.7 %), parietal lobes (+3 %), frontal lobes (+3.6 %), temporal lobes (+4.2 %), and thalamus (+4.4 %). Moreover, an increase of 0.01 points in the FI was associated with a 3.1 % increase in the probability of HVRS score (≥2). CONCLUSION An FI based on routine clinical and laboratory variables was associated with the presence, degree, and some localizations of VBD in a population of older adults with cognitive decline. This frailty assessment tool may therefore be used to identify individuals at risk of developing cerebrovascular disease and, consequently, to implement strategies for vascular risk factor control.
Collapse
|
3
|
Jung HW, Choi IY, Shin DW, Han K, Yoo JE, Chun S, Yi Y. Association between physical performance and incidence of end-stage renal disease in older adults: a national wide cohort study. BMC Nephrol 2021; 22:85. [PMID: 33691641 PMCID: PMC7945335 DOI: 10.1186/s12882-021-02291-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 03/02/2021] [Indexed: 11/23/2022] Open
Abstract
Background Physical frailty has previously been associated with adverse clinical outcomes in patients with end-stage renal disease (ESRD). This study aimed to determine whether impaired physical performance at baseline is associated with the incidence of ESRD, using a nationwide database. Methods The timed up-and-go (TUG) test was used to assess physical frailty in 1,552,781 66-year-old individuals, using health examination database records from the Korean National Health Insurance Service. As a primary endpoint, incident ESRD was defined operationally using healthcare claims data from the Korean Health Insurance Review and Assessment Service. Results Our results showed that baseline kidney function was significantly worse in individuals with TUG results of > 10 s compared to individuals with an intact TUG performance (≤10 s). Kaplan-Meier analysis showed a stepwise dose-response relationship between baseline physical performance and the incidence rate of ESRD (log-rank test P-value of < 0.001). An increasing ESRD incidence rate trend with poor physical performance remained significant after adjusting for characteristics such as baseline glomerular filtration rate and proteinuria. Conclusion Poor baseline physical performance was associated with an increased risk of ESRD, suggesting possible interactions between systemic frailty and vascular aging processes.
Collapse
Affiliation(s)
- Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - In Young Choi
- Total Healthcare Center, Kangbuk Samsung Hospital, B1, Samsung Main B/D, 67, Sejong-daero, Jung-gu, Seoul, 04514, South Korea
| | - Dong Wook Shin
- Total Healthcare Center, Kangbuk Samsung Hospital, B1, Samsung Main B/D, 67, Sejong-daero, Jung-gu, Seoul, 04514, South Korea. .,Department of Digital Health, SAIHST, Sungkyunkwan University, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea.
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Jung Eun Yoo
- Department of Family Medicine, Healthcare system Gangnam Center, Seoul National University Hospital, Seoul, South Korea
| | - Sohyun Chun
- International Healthcare Center, Samsung Medical Center, Seoul, South Korea
| | - Yongjin Yi
- Division of Nephrology, Dankook University Hospital, Cheonan-si, Chungcheongnam-do, South Korea
| |
Collapse
|
4
|
Lammers F, Zacharias N, Borchers F, Mörgeli R, Spies CD, Winterer G. Functional Connectivity of the Supplementary Motor Network Is Associated with Fried's Modified Frailty Score in Older Adults. J Gerontol A Biol Sci Med Sci 2021; 75:2239-2248. [PMID: 31900470 DOI: 10.1093/gerona/glz297] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Indexed: 01/22/2023] Open
Abstract
Frailty is a geriatric syndrome defined by coexistence of unintentional weight loss, low physical reserve, or activity and is associated with adverse health events. Neuroimaging studies reported structural white matter changes in frail patients. In the current study, we hypothesized that clinical frailty is associated also with functional changes in motion-related cortical areas, that is, (pre-)supplementary motor areas (SMA, pre-SMA). We expected that observed functional changes are related to motor-cognitive test performance. We studied a clinical sample of 143 cognitively healthy patients ≥65 years presenting for elective surgery, enrolled in the BioCog prospective multicentric cohort study on postoperative cognitive disorders. Participants underwent preoperative resting-state functional magnetic resonance imaging, motor-cognitive testing, and assessment of Fried's modified frailty criteria. We analyzed functional connectivity associations with frailty and motor-cognitive test performance. Clinically robust patients (N = 60) showed higher connectivity in the SMA network compared to frail (N = 13) and prefrail (N = 70) patients. No changes were found in the pre-SMA network. SMA connectivity correlated with motor speed (Trail-Making-Test A) and manual dexterity (Grooved Pegboard Test). Our results suggest that diminished functional connectivity of the SMA is an early correlate of functional decline in the older adults . The SMA may serve as a potential treatment target in frailty.
Collapse
Affiliation(s)
- Florian Lammers
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany
| | - Norman Zacharias
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany.,Pharmaimage Biomarker Solutions GmbH, Berlin, Germany
| | - Friedrich Borchers
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany
| | - Rudolf Mörgeli
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany
| | - Claudia Doris Spies
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany
| | - Georg Winterer
- Department of Anaesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany.,Pharmaimage Biomarker Solutions GmbH, Berlin, Germany
| |
Collapse
|
5
|
Suárez-Méndez I, Walter S, López-Sanz D, Pasquín N, Bernabé R, Castillo Gallo E, Valdés M, Del Pozo F, Maestú F, Rodríguez-Mañas L. Ongoing Oscillatory Electrophysiological Alterations in Frail Older Adults: A MEG Study. Front Aging Neurosci 2021; 13:609043. [PMID: 33679373 PMCID: PMC7935553 DOI: 10.3389/fnagi.2021.609043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/28/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The role of the central nervous system in the pathophysiology of frailty is controversial. We used magnetoencephalography (MEG) to search for abnormalities in the ongoing oscillatory neural activity of frail individuals without global cognitive impairment. Methods: Fifty four older (≥70 years) and cognitively healthy (Mini-Mental State Examination ≥24) participants were classified as robust (0 criterion, n = 34) or frail (≥ 3 criteria, n = 20) following Fried's phenotype. Memory, language, attention, and executive function were assessed through well-validated neuropsychological tests. Every participant underwent a resting-state MEG and a T1-weighted magnetic resonance imaging scan. We performed MEG power spectral analyses to compare the electrophysiological profiles of frail and robust individuals. We used an ensemble learner to investigate the ability of MEG spectral power to discriminate frail from robust participants. Results: We identified increased relative power in the frail group in the mu (p < 0.05) and sensorimotor (p < 0.05) frequencies across right sensorimotor, posterior parietal, and frontal regions. The ensemble learner discriminated frail from robust participants [area under the curve = 0.73 (95% CI = 0.49–0.98)]. Frail individuals performed significantly worse in the Trail Making Test, Digit Span Test (forward), Rey-Osterrieth Complex Figure, and Semantic Fluency Test. Interpretation: Frail individuals without global cognitive impairment showed ongoing oscillatory alterations within brain regions associated with aspects of motor control, jointly to failures in executive function. Our results suggest that some physical manifestations of frailty might partly arise from failures in central structures relevant to sensorimotor and executive processing.
Collapse
Affiliation(s)
- Isabel Suárez-Méndez
- Laboratory of Cognitive and Computational Neuroscience (Complutense University of Madrid - Universidad Politécnica de Madrid), Center for Biomedical Technology (CTB), Universidad Politécnica de Madrid (UPM), Madrid, Spain.,Department of Structure of Matter, Thermal Physics and Electronics, Complutense University of Madrid (UCM), Madrid, Spain.,Department of Experimental Psychology, Complutense University of Madrid (UCM), Madrid, Spain
| | - Stefan Walter
- Foundation for Biomedical Research, University Hospital of Getafe, Getafe, Spain.,Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), Spain.,Department of Medicine and Public Health, Rey Juan Carlos University, Madrid, Spain
| | - David López-Sanz
- Laboratory of Cognitive and Computational Neuroscience (Complutense University of Madrid - Universidad Politécnica de Madrid), Center for Biomedical Technology (CTB), Universidad Politécnica de Madrid (UPM), Madrid, Spain.,Department of Psychobiology and Methodology in Behavioral Sciences, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Natalia Pasquín
- Foundation for Biomedical Research, University Hospital of Getafe, Getafe, Spain
| | - Raquel Bernabé
- Foundation for Biomedical Research, University Hospital of Getafe, Getafe, Spain
| | | | - Myriam Valdés
- Foundation for Biomedical Research, University Hospital of Getafe, Getafe, Spain.,Geriatric Service, University Hospital of Getafe, Getafe, Spain
| | - Francisco Del Pozo
- Laboratory of Cognitive and Computational Neuroscience (Complutense University of Madrid - Universidad Politécnica de Madrid), Center for Biomedical Technology (CTB), Universidad Politécnica de Madrid (UPM), Madrid, Spain
| | - Fernando Maestú
- Laboratory of Cognitive and Computational Neuroscience (Complutense University of Madrid - Universidad Politécnica de Madrid), Center for Biomedical Technology (CTB), Universidad Politécnica de Madrid (UPM), Madrid, Spain.,Department of Experimental Psychology, Complutense University of Madrid (UCM), Madrid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Spain
| | - Leocadio Rodríguez-Mañas
- Foundation for Biomedical Research, University Hospital of Getafe, Getafe, Spain.,Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), Spain.,Geriatric Service, University Hospital of Getafe, Getafe, Spain
| |
Collapse
|
6
|
Jordan N, Gvalda M, Cody R, Galante O, Haywood C, Yates P. Frailty, MRI, and FDG-PET Measures in an Australian Memory Clinic Cohort. Front Med (Lausanne) 2021; 7:578243. [PMID: 33521008 PMCID: PMC7840574 DOI: 10.3389/fmed.2020.578243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/14/2020] [Indexed: 01/30/2023] Open
Abstract
Given that the global population is aging, the number of age-related syndromes, such as frailty, is expected to rise in conjunction. Frailty is characterized by the loss of homeostatic reserve, rendering the individual vulnerable to poor health outcomes. Many biological mechanisms have been proposed to contribute to frailty. However, few studies have assessed the associations between frailty and brain diseases or neuroimaging biomarkers. Aims: The aims of this study were to measure the prevalence of frailty in a memory clinic and to examine associations between frailty and brain changes found on magnetic resonance imaging (MRI) and 18-F deoxyglucose (FDG) positron emission tomography (PET) in memory clinic attendees. Methods: A 54-items Frailty Index was retrospectively assessed for all clinic attendees from 2014. Frailty was defined as FI > 0.25. MR images were analyzed for stroke, cerebral small vessel disease [CSVD, including cerebral microbleeds (CMBs), cortical superficial siderosis (CSS), and white matter hyperintensity (WMH)], and neurodegenerative changes [MRI: mesial temporal atrophy (MTA), FDG-PET: regional hypometabolism], blind to clinical findings. Results: There were 209 clinic attendees in 2014, of whom 121 had MRI performed. The prevalence of frailty (using FI) in the memory clinic in 2014 was 38.3% overall (patients without MRI: 43.2%, patients with MRI 34.7%, p = 0.25). Frailty was associated with presence of deep WMH, increased severity of periventricular WMH, and presence of CSS, but not neurodegeneration markers (MTA atrophy/FDG-PET hypometabolism). Conclusion: The findings support the idea that previously reported associations between frailty and imaging evidence of CSVD in other cohorts are also relevant to the Australian clinic setting. Given that a large proportion of memory clinic attendees are frail, there may be opportunities for interventions to reduce preventable adverse health outcomes, such as falls and fractures, and reduce the prevalence and impact of frailty in this cohort.
Collapse
Affiliation(s)
- Nan Jordan
- Department of Geriatric Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Matthew Gvalda
- Department of Geriatric Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Ross Cody
- Department of Geriatric Medicine, Austin Health, Heidelberg, VIC, Australia.,Department of Geriatric Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Olivia Galante
- Department of Geriatric Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Cilla Haywood
- Department of Geriatric Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Paul Yates
- Department of Geriatric Medicine, Austin Health, Heidelberg, VIC, Australia.,Department of Medicine, Eastern Health, Box Hill, VIC, Australia.,Department of Medicine, University of Melbourne, Heidelberg, VIC, Australia
| |
Collapse
|
7
|
Sugimoto T, Ono R, Kimura A, Saji N, Niida S, Toba K, Sakurai T. Cross-Sectional Association Between Cognitive Frailty and White Matter Hyperintensity Among Memory Clinic Patients. J Alzheimers Dis 2020; 72:605-612. [PMID: 31594230 DOI: 10.3233/jad-190622] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cognitive frailty (CF) is defined as simultaneous presence of physical frailty (PF) and cognitive impairment among older adults without dementia. Although white matter hyperintensities (WMH) as expressions of cerebral small vessel disease are associated with physical and cognitive decline and could manifest as CF, this association remains yet to be clarified. OBJECTS To clarify the association between CF and WMH among memory clinic patients. METHODS The subjects of this cross-sectional study were 121 cognitively normal (CN) and 212 mildly cognitively impaired (MCI) patients who presented to the Memory Clinic at the National Center for Geriatrics and Gerontology of Japan. PF status was defined based on the definition proposed by Fried and colleagues. CF was defined as simultaneous presence of pre-PF or PF and MCI. WMH volumes were measured using an automatic segmentation application. Multiple liner regression analyses with adjustment for cardiovascular risk factors were performed. RESULTS Of all subjects, 77 (63.6%) and 22 (18.2%) CN patients and 132 (62.3%) and 65 (30.7%) MCI patients were categorized into pre-PF and PF, respectively. Multiple liner regression analysis showed that those with CF had higher WMH volumes than those without (β= 0.23). When categorized into six groups according to PF and cognitive status, the PF/CN (β= 0.15), pre-PF/MCI (β= 0.41), and PF/MCI (β= 0.34) groups had higher WMH volumes than the non-PF/CN group. CONCLUSIONS This study showed increased WMH volumes in CF and PF, indicating that WMH could be one of the key underlying brain pathologies of CF.
Collapse
Affiliation(s)
- Taiki Sugimoto
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.,Medical Genome Center, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Rei Ono
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Ai Kimura
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.,Medical Genome Center, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Cognition and Behavior Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Saji
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shumpei Niida
- Medical Genome Center, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kenji Toba
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Cognition and Behavior Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
8
|
Jung HW, Jin T, Baek JY, Yoon S, Lee E, Guralnik JM, Jang IY. Functional Age Predicted by Electronic Short Physical Performance Battery Can Detect Frailty Status in Older Adults. Clin Interv Aging 2020; 15:2175-2182. [PMID: 33204082 PMCID: PMC7667698 DOI: 10.2147/cia.s280542] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/20/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose The importance of evaluating frailty status of older adults in clinical practice has been gaining attention with cumulative evidence showing its relevance in clinical outcomes and decision-making. We aimed to develop and validate whether the functional age predicted by an electronic continuous short physical performance battery (eSPPB) could predict frailty status. Patients and Methods We reviewed medical records of outpatients (N=834) of Asan Medical Center, aged 51-95 years. We used the eSPPB data of 717 patients as a development cohort, and that of 117 patients, who also underwent comprehensive geriatric assessments, as a validation cohort. Frailty index was calculated by counting deficits of 45 geriatric items including comorbidities, daily functions, mobility, mood, and cognition. For functional age, we used balance score (0-4), gait speed (m/s), and stand-up time (s) measured 5 times in the chair rise test. Results From the development cohort, we established a functional age using the formula (83.61 - 1.98*[balance score] - 5.21*[gait speed] + 0.23*[stand-up time]), by multivariate linear regression analysis with chronological age as a dependent variable (R2 = 0.233). In the validation cohort, the functional age positively correlated with frailty index (p < 0.001). C-statistics classifying frailty (defined as frailty index ≥0.25) was higher (p < 0.001) with functional age (0.912) than that with chronological age (0.637). A cut-off functional age of ≥77.2 years maximized Youden's J when screening for frailty, with sensitivity of 94.4% and specificity of 80.8%. Conclusion A newly developed functional age predictor using eSPPB parameters can predict the frailty status as defined by the deficit accumulation method and may serve as a physical biomarker of human aging.
Collapse
Affiliation(s)
- Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Taeyang Jin
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ji Yeon Baek
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seongjun Yoon
- Dyphi Research Institute, Dyphi Inc., Daejeon, Republic of Korea
| | - Eunju Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jack M Guralnik
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, Seoul, Republic of Korea
| |
Collapse
|
9
|
Suárez-Méndez I, Doval S, Walter S, Pasquín N, Bernabé R, Gallo EC, Valdés M, Maestú F, López-Sanz D, Rodríguez-Mañas L. Functional Connectivity Disruption in Frail Older Adults Without Global Cognitive Deficits. Front Med (Lausanne) 2020; 7:322. [PMID: 32733905 PMCID: PMC7360673 DOI: 10.3389/fmed.2020.00322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/02/2020] [Indexed: 12/11/2022] Open
Abstract
Frailty is a common representation of cumulative age-related decline that may precede disability in older adults. In our study, we used magnetoencephalography (MEG) to explore the existence of abnormalities in the synchronization patterns of frail individuals without global cognitive impairment. Fifty-four older (≥70 years) and cognitively healthy (Mini-Mental State Examination ≥24) adults, 34 robust (not a single positive Fried criterion) and 20 frail (≥3 positive Fried criteria) underwent a resting-state MEG recording and a T1-weighted magnetic resonance imaging scan. Seed-based functional connectivity (FC) analyses were used to explore group differences in the synchronization of fronto-parietal areas relevant to motor function. Additionally, we performed group comparisons of intra-network FC for key resting-state networks such as the sensorimotor, fronto-parietal, default mode, and attentional (dorsal and ventral) networks. Frail participants exhibited reduced FC between posterior regions of the parietal cortex (bilateral supramarginal gyrus, right superior parietal lobe, and right angular gyrus) and widespread clusters spanning mainly fronto-parietal regions. Frail participants also demonstrated reduced intra-network FC within the fronto-parietal, ventral attentional, and posterior default mode networks. All the FC results concerned the upper beta band, a frequency range classically linked to motor function. Overall, our findings reveal the existence of abnormalities in the synchronization patterns of frail individuals within central structures important for accurate motor control. This study suggests that alterations in brain connectivity might contribute to some motor impairments associated with frailty.
Collapse
Affiliation(s)
- Isabel Suárez-Méndez
- Laboratory of Cognitive and Computational Neuroscience (UCM-UPM), Center for Biomedical Technology (CTB), Technical University of Madrid (UPM), Madrid, Spain.,Department of Structure of Matter, Thermal Physics and Electronics, Complutense University of Madrid (UCM), Madrid, Spain.,Department of Experimental Psychology, Complutense University of Madrid (UCM), Madrid, Spain
| | - Sandra Doval
- Laboratory of Cognitive and Computational Neuroscience (UCM-UPM), Center for Biomedical Technology (CTB), Technical University of Madrid (UPM), Madrid, Spain.,Department of Experimental Psychology, Complutense University of Madrid (UCM), Madrid, Spain
| | - Stefan Walter
- Foundation for Biomedical Research, University Hospital of Getafe, Madrid, Spain.,Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain.,Department of Medicine and Public Health, Rey Juan Carlos University, Madrid, Spain
| | - Natalia Pasquín
- Foundation for Biomedical Research, University Hospital of Getafe, Madrid, Spain
| | - Raquel Bernabé
- Foundation for Biomedical Research, University Hospital of Getafe, Madrid, Spain
| | | | - Myriam Valdés
- Foundation for Biomedical Research, University Hospital of Getafe, Madrid, Spain.,Geriatric Service, University Hospital of Getafe, Madrid, Spain
| | - Fernando Maestú
- Laboratory of Cognitive and Computational Neuroscience (UCM-UPM), Center for Biomedical Technology (CTB), Technical University of Madrid (UPM), Madrid, Spain.,Department of Experimental Psychology, Complutense University of Madrid (UCM), Madrid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - David López-Sanz
- Laboratory of Cognitive and Computational Neuroscience (UCM-UPM), Center for Biomedical Technology (CTB), Technical University of Madrid (UPM), Madrid, Spain.,Department of Experimental Psychology, Complutense University of Madrid (UCM), Madrid, Spain.,Department of Psychobiology, Faculty of Psychology, Complutense University of Madrid (UCM), Madrid, Spain
| | - Leocadio Rodríguez-Mañas
- Foundation for Biomedical Research, University Hospital of Getafe, Madrid, Spain.,Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain.,Geriatric Service, University Hospital of Getafe, Madrid, Spain
| |
Collapse
|
10
|
Hirose D, Shimizu S, Hirao K, Ogawa Y, Sato T, Kaneko Y, Takenoshita N, Namioka N, Fukasawa R, Umahara T, Sakurai H, Watanabe R, Hanyu H. Neuroimaging Characteristics of Frailty Status in Patients with Alzheimer's Disease. J Alzheimers Dis 2020; 67:1201-1208. [PMID: 30689570 DOI: 10.3233/jad-180701] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND/OBJECTIVE Although frailty is closely linked to dementia, particularly Alzheimer's disease (AD), underlying pathophysiology of frailty associated with AD remains uncertain. This study aimed to investigate differences in structural and functional brain imaging abnormalities between AD with and without frailty. METHODS A total of 191 outpatients with probable AD (men: 91; women: 100; age: 80.7±6.3 years) who underwent both magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) were enrolled in this study. Frailty was determined in accordance with the Obu study Health Promotion for the Elderly. We compared numbers of small infarctions in the subcortical gray and white matter and severity of white matter abnormalities (periventricular hyperintensity [PVH] and deep white matter hyperintensity [DWMH]) on MRI, and regional cerebral blood flow (rCBF) changes on SPECT between AD with and without frailty. RESULTS The prevalence of frailty was 43.4% in patients with AD. PVH and DWMH scores were significantly higher in AD with frailty compared to those without frailty. AD with frailty had a trend of decreased rCBF in the bilateral anterior cingulate gyrus, whereas those without frailty tend to have decreased rCBF in the left dominant parietal lobe and precuneus. CONCLUSION Our MRI and SPECT imaging studies suggest different underlying pathophysiology in the brain between AD with frailty and without frailty.
Collapse
Affiliation(s)
- Daisuke Hirose
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Soichiro Shimizu
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kentaro Hirao
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yusuke Ogawa
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Tomohiko Sato
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yoshitsugu Kaneko
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Naoto Takenoshita
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Nayuta Namioka
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Raita Fukasawa
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Takahiko Umahara
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hirofumi Sakurai
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Ryo Watanabe
- Kanagawa University of Human Services, Yokosuka City, Kanagawa Prefecture, Japan
| | - Haruo Hanyu
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| |
Collapse
|
11
|
Frailty and Its Correlates in Adults With Late Life Depression. Am J Geriatr Psychiatry 2020; 28:145-154. [PMID: 31734083 PMCID: PMC6997042 DOI: 10.1016/j.jagp.2019.10.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/07/2019] [Accepted: 10/07/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To investigate the rates of frailty and frailty characteristics and examine the clinical and neuropsychological correlates of frailty in adults with late life depression (LLD). METHODS Data were used from the evaluation of 134 individuals over the age of 60 years (45 men, 89 women) with a depressive diagnosis who enrolled in studies for the treatment of their depression. Depression, neuropsychological functioning, white matter hyperintensity (WMH) burden via magnetic resonance imaging, and characteristics of frailty were assessed. RESULTS Fried frailty burden (≥3 characteristics) was present in 25% of the sample, with this rate increasing to 45.5% when using clinically meaningful cut-scores for gait speed (<1 m/s) and physical activity levels (<1000 kcal/week). Moreover, 62% of the sample exhibited gait slowing (<1 m/s) or weakness (grip strength), with 29% demonstrating both. Greater frailty burden was associated with greater Hamilton Depression Rating Scale severity in covariate adjusted linear regression models (t127 = 2.41, p = 0.02). Greater frailty burden was not associated with neuropsychological dysfunction, nor was it associated with greater WMH burden. CONCLUSION Findings from this study show that frailty, specifically physical frailty deficits in mobility and strength, is highly comorbid in adults with LLD, associated with greater depressive symptom severity, and does not appear to be associated with the vascular depression subtype of LLD. Future research should investigate the relationship between frailty and antidepressant treatment response as well as test whether there are age-related biological processes that result in the manifestation of the frail-depressed subtype of LLD.
Collapse
|
12
|
Siejka TP, Srikanth VK, Hubbard RE, Moran C, Beare R, Wood A, Phan T, Balogun S, Callisaya ML. White Matter Hyperintensities and the Progression of Frailty—The Tasmanian Study of Cognition and Gait. J Gerontol A Biol Sci Med Sci 2020; 75:1545-1550. [DOI: 10.1093/gerona/glaa024] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
The contribution of cerebral small vessel disease (cSVD) to the pathogenesis of frailty remains uncertain. We aimed to examine the associations between cSVD with progression of frailty in a population-based study of older people.
Methods
People aged between 60 and 85 years were randomly selected form the electoral roll to participate in the Tasmanian Study of Cognition and Gait. Participants underwent self-reported questionnaires, objective gait, cognitive and sensorimotor testing over three phases ranging between 2005 and 2012. These data were used to calculate a 41-item frailty index (FI) at three time points. Baseline brain magnetic resonance imaging was performed on all participants to measure cSVD. Generalized mixed models were used to examine associations between baseline cSVD and progression of frailty, adjusted for confounders of age, sex, level of education, and total intracranial volume.
Results
At baseline (n = 388) mean age was 72 years (SD = 7.0), 44% were female, and the median FI score was 0.20 (interquartile range [IQR] 0.12, 0.27). In fully adjusted models higher burden of baseline white matter hyperintensity (WMH) was associated with frailty progression over 4.4 years (β = 0.03, 95% CI: 0.01, 0.05; p = .004) independent of other SVD markers. Neither baseline infarcts (p = .23), nor microbleeds at baseline (p = .65) were associated with progression of frailty.
Conclusions
We provide evidence for an association between baseline WMHs and progression of frailty. Our findings add to a growing body of literature suggesting WMH is a marker for frailty.
Collapse
Affiliation(s)
- Timothy P Siejka
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Velandai K Srikanth
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ruth E Hubbard
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Chris Moran
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Richard Beare
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Amanda Wood
- School of Life and Health Sciences & Aston Brain Centre, Aston University, Birmingham, UK
- School of Psychology, Faculty of Health, Melbourne Burwood Campus, Deakin University, Geelong, Victoria, Australia
| | - Thanh Phan
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Saliu Balogun
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Michele L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
13
|
Palmer K, Vetrano DL, Padua L, Romano V, Rivoiro C, Scelfo B, Marengoni A, Bernabei R, Onder G. Frailty Syndromes in Persons With Cerebrovascular Disease: A Systematic Review and Meta-Analysis. Front Neurol 2019; 10:1255. [PMID: 31849819 PMCID: PMC6896936 DOI: 10.3389/fneur.2019.01255] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/12/2019] [Indexed: 01/11/2023] Open
Abstract
Background: Frailty can change the prognosis and treatment approach of chronic diseases. Among others, frailty has been associated with cerebrovascular diseases such as stroke. However, the extent to which the two conditions are related is unclear, and no systematic review of the literature has been conducted. Objectives: To conduct a systematic review and meta-analysis assessing the association of cerebrovascular diseases and frailty, as well as prefrailty, in observational studies. The project was carried out on behalf of the Joint Action ADVANTAGE WP4 group. Methods: The review was performed according to PRISMA guidelines. We searched PubMed, Web of Science, and Embase from 01/01/2002-26/05/2019. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity was assessed with the I2 statistic. Publication bias was assessed with Egger's and Begg's tests. Results: Of 1027 studies searched, 18 studies were included (n = 48,009 participants). Stroke was the only cerebrovascular disease studied in relation to frailty syndromes. All studies except one reported an association between stroke and prefrailty or frailty. However, most studies were not of high quality and there was heterogeneity between results. The pooled prevalence of prefrailty and frailty in stroke patients was 49% (95% CI = 42-57) and 22% (95% CI = 16-27), respectively. The prevalence of frailty was 2-fold in persons with stroke compared to those without stroke (pooled odds ratio = 2.32, 95% CI = 2.11-2.55). Only two studies longitudinally examined the association between stroke and frailty, producing conflicting results. Conclusions: Frailty and prefrailty are common in persons with stroke. These results may have clinical implications, as they identify the need to assess frailty in post-stroke survivors and assess how it may affect prognosis. Better quality, longitudinal research that examines the temporal relationship between stroke and frailty are needed, as well as studies on other types of cerebrovascular disease.
Collapse
Affiliation(s)
- Katie Palmer
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide L. Vetrano
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Luca Padua
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valeria Romano
- Health Technology Assessment Department of the Institute for Economic and Social Research of Regione Piemonte, Turin, Italy
| | - Chiara Rivoiro
- Health Technology Assessment Department of the Institute for Economic and Social Research of Regione Piemonte, Turin, Italy
| | - Bibiana Scelfo
- Health Technology Assessment Department of the Institute for Economic and Social Research of Regione Piemonte, Turin, Italy
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Lombardy, Italy
| | - Roberto Bernabei
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Graziano Onder
- Department of Cardiovascular, Metabolic and Aging Diseases, Istituto Superiore di Sanità, Rome, Italy
| |
Collapse
|
14
|
López-Sanz D, Suárez-Méndez I, Bernabé R, Pasquín N, Rodríguez-Mañas L, Maestú F, Walter S. Scoping Review of Neuroimaging Studies Investigating Frailty and Frailty Components. Front Med (Lausanne) 2018; 5:284. [PMID: 30349819 PMCID: PMC6186819 DOI: 10.3389/fmed.2018.00284] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/17/2018] [Indexed: 01/10/2023] Open
Abstract
Background: Neuroimaging techniques are a cornerstone for diagnosing and investigating cognitive decline and dementia in the elderly. In frailty research, the physical as opposed to the cognitive domain of the aging process, neuroimaging studies are less common. Here we systematically review the use of neuroimaging techniques in frailty research. Methods: We searched PUBMED for any publication reporting the association between neuroimaging markers and frailty, following Fried's original definition, as well as its determining phenotypes: gait speed, grip strength, fatigue and recent weight loss in the non-diseased population older than 65 years. Results: The search returned a total of 979 abstracts which were independently screened by 3 reviewers. In total, 17 studies met the inclusion criteria. Of these, 12 studies evaluated gait speed, 2 grip strength, and 3 frailty (2 Fried Frailty, 1 Frailty Index). An association between increased burden of white matter lesions, lower fractional anisotropy, and higher diffusivity has been associated consistently to frailty and worse performance in the different frailty components. Conclusions: White matter lesions were significantly associated to frailty and frailty components thus highlighting the potential utility of neuroimaging in unraveling the underlying mechanisms of this state. However, considering small sample size and design effects, it is not possible to completely rule out reverse causality between frailty and neuroimaging findings. More studies are needed to clarify this important clinical question.
Collapse
Affiliation(s)
- David López-Sanz
- Laboratory of Cognitive and Computational Neuroscience (UCM-UPM), Centre for Biomedical Technology (CTB), Technical University of Madrid (UPM), Madrid, Spain.,Department of Experimental Psychology, Complutense University of Madrid (UCM), Madrid, Spain
| | - Isabel Suárez-Méndez
- Laboratory of Cognitive and Computational Neuroscience (UCM-UPM), Centre for Biomedical Technology (CTB), Technical University of Madrid (UPM), Madrid, Spain
| | - Raquel Bernabé
- Fundación Para la Investigación Biomédica, Getafe University Hospital, Madrid, Spain
| | - Natalia Pasquín
- Fundación Para la Investigación Biomédica, Getafe University Hospital, Madrid, Spain
| | - Leocadio Rodríguez-Mañas
- Fundación Para la Investigación Biomédica, Getafe University Hospital, Madrid, Spain.,Geriatrics Department, Getafe University Hospital, Madrid, Spain.,Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Fernando Maestú
- Laboratory of Cognitive and Computational Neuroscience (UCM-UPM), Centre for Biomedical Technology (CTB), Technical University of Madrid (UPM), Madrid, Spain.,Department of Experimental Psychology, Complutense University of Madrid (UCM), Madrid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain
| | - Stefan Walter
- Fundación Para la Investigación Biomédica, Getafe University Hospital, Madrid, Spain.,Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
15
|
Kant IMJ, de Bresser J, van Montfort SJT, Aarts E, Verlaan JJ, Zacharias N, Winterer G, Spies C, Slooter AJC, Hendrikse J. The association between brain volume, cortical brain infarcts, and physical frailty. Neurobiol Aging 2018; 70:247-253. [PMID: 30048892 PMCID: PMC6135646 DOI: 10.1016/j.neurobiolaging.2018.06.032] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/29/2018] [Accepted: 06/25/2018] [Indexed: 11/28/2022]
Abstract
Physical frailty is an age-associated syndrome of decreased reserve leading to vulnerability to physiological stressors and associated with negative outcomes. The underlying structural brain abnormalities of physical frailty are unclear. We investigated the association between brain volume, cortical brain infarcts, and physical frailty. In this multicenter study, 214 nondemented participants were classified as frail (n = 32), prefrail (n = 107), or nonfrail (n = 75) based on the Fried frailty phenotype. The associations between frailty and brain volumes and cortical brain infarcts were investigated by linear or logistic regression analyses. Participants in the frail group showed a lower total brain volume (−19.67 mL [95% confidence interval −37.84 to −1.50]) and lower gray matter volume (−12.19 mL [95% confidence interval −23.84 to −0.54]) compared to nonfrail participants. Frailty was associated with cortical brain infarcts [frail 16% [n = 5], prefrail 11% [n = 12], and nonfrail 3% [n = 2]). Reduced total brain volume and gray matter volume and increased cortical brain infarcts seem therefore to be part of the structural substrate of the physical frailty phenotype.
Collapse
Affiliation(s)
- Ilse M J Kant
- Department of Intensive Care, UMC Utrecht, Utrecht, The Netherlands; Department of Radiology, UMC Utrecht, Utrecht, The Netherlands.
| | - Jeroen de Bresser
- Department of Radiology, UMC Utrecht, Utrecht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Ellen Aarts
- Department of Intensive Care, UMC Utrecht, Utrecht, The Netherlands; Department of Radiology, UMC Utrecht, Utrecht, The Netherlands
| | | | - Norman Zacharias
- Experimental and Clinical Research Center (ECRC), Charité - Universitätsmedizin Berlin, Berlin, Germany; PharmaImage Biomarker Solutions GmbH, Berlin, Germany; Department of Anesthesiology and Operative Intensive Care Medicine (CCM,CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Georg Winterer
- Experimental and Clinical Research Center (ECRC), Charité - Universitätsmedizin Berlin, Berlin, Germany; PharmaImage Biomarker Solutions GmbH, Berlin, Germany; Department of Anesthesiology and Operative Intensive Care Medicine (CCM,CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany; Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM,CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | |
Collapse
|
16
|
|
17
|
Aprahamian I, Lin SM, Suemoto CK, Apolinario D, Oiring de Castro Cezar N, Elmadjian SM, Filho WJ, Yassuda MS. Feasibility and Factor Structure of the FRAIL Scale in Older Adults. J Am Med Dir Assoc 2017; 18:367.e11-367.e18. [PMID: 28214239 DOI: 10.1016/j.jamda.2016.12.067] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 12/23/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The aim of the present study was to (1) evaluate a geriatric outpatient sample with the FRAIL scale; (2) investigate the psychometric properties of the scale; and (3) characterize different associations of the subdimensions of the scale with demographic and clinical data. DESIGN Cross-sectional observational study. SETTING Geriatric outpatient center a university-based hospital in São Paulo, Brazil. PARTICIPANTS A total of 811 men and women aged 60 years or older evaluated between March 2015 and September 2015. MEASUREMENTS A translated version of the FRAIL scale was used to evaluate frailty. A review of sociodemographic data, medical records, medication, and laboratory data was conducted. A multivariate ordinal logistic regression model was used to investigate the association between frailty categories and clinical variables. Exploratory factor analysis and 2-parameter logistic item response theory was used to evaluate the psychometric properties of the FRAIL scale. RESULTS The sample was distributed as 13.6% robust, 48.7% prefrail, and 37.7% frail older adults. Most participants reported fatigue (72.3%). Frailty was associated with older age (P = .02), depression (P = .02), dementia (P < .001), and number of medications taken (P < .001). A 2-factor model of the FRAIL scale ("ambulation" and "resistance" namely physical performance; "fatigue," "weight loss," and "illnesses" namely health status) provided independent classifications of frailty status. Physical performance (ambulation and resistance) was strongly associated with higher age and dementia, whereas health status (fatigue, weight loss, and illnesses) was more associated with female sex and depression. CONCLUSIONS Our results suggest the existence of 2 subdimensions of the scale, suggesting different pathways to frailty. Frailty was associated with older age, depression, dementia, and number of medications in this outpatient sample.
Collapse
Affiliation(s)
- Ivan Aprahamian
- Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil; Institute and Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, State of São Paulo, Brazil; Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, State of São Paulo, Brazil.
| | - Sumika Mori Lin
- Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Claudia Kimie Suemoto
- Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Daniel Apolinario
- Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Natália Oiring de Castro Cezar
- Institute and Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, State of São Paulo, Brazil
| | - Serpui Marie Elmadjian
- Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Wilson Jacob Filho
- Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Mônica Sanches Yassuda
- Department of Neurology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil; School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
18
|
Avila-Funes JA, Pelletier A, Meillon C, Catheline G, Periot O, Treviño-Frenk I, Gonzalez-Colaço M, Dartigues JF, Pérès K, Allard M, Dilharreguy B, Amieva H. Vascular Cerebral Damage in Frail Older Adults: The AMImage Study. J Gerontol A Biol Sci Med Sci 2017; 72:971-977. [DOI: 10.1093/gerona/glw347] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 12/22/2016] [Indexed: 11/15/2022] Open
|
19
|
Wu HQ, Wu H, Shi LL, Yu LY, Wang LY, Chen YL, Geng JS, Shi J, Jiang K, Dong JC. The association between retinal vasculature changes and stroke: a literature review and Meta-analysis. Int J Ophthalmol 2017; 10:109-114. [PMID: 28149786 DOI: 10.18240/ijo.2017.01.18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/05/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To determine the association between retinal vasculature changes and stroke. METHODS MEDLINE and EMBASE were searched for relevant human studies to September 2015 that investigated the association between retinal vasculature changes and the prevalence or incidence of stroke; the studies were independently examined for their qualities. Data on clinical characteristics and calculated summary odds ratios (ORs) were extracted for associations between retinal microvascular abnormalities and stroke, including stroke subtypes where possible, and adjusted for key variables. RESULTS Nine cases were included in the study comprising 20 659 patients, 1178 of whom were stroke patients. The retinal microvascular morphological markers used were hemorrhage, microaneurysm, vessel caliber, arteriovenous nicking, and fractal dimension. OR of retinal arteriole narrowing and retinal arteriovenous nicking and stroke was 1.42 and 1.91, respectively, indicating that a small-caliber retinal arteriole and retinal arteriovenous nicking were associated with stroke. OR of retinal hemorrhage and retinal microaneurysm and stroke was 3.21 and 3.83, respectively, indicating that retinal microvascular lesions were highly associated with stroke. Results also showed that retinal fractal dimension reduction was associated with stroke (OR: 2.28 for arteriole network, OR: 1.80 for venular network). CONCLUSION Retinal vasculature changes have a specific relationship to stroke, which is promising evidence for the prediction of stroke using computerized retinal vessel analysis.
Collapse
Affiliation(s)
- Hui-Qun Wu
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China; Nantong University Division of Cooperative Research Center on Evidence-based Medicine by Ministry of Education in China, Nantong 226001, Jiangsu Province, China
| | - Huan Wu
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China; Nantong University Division of Cooperative Research Center on Evidence-based Medicine by Ministry of Education in China, Nantong 226001, Jiangsu Province, China
| | - Li-Li Shi
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China; Nantong University Division of Cooperative Research Center on Evidence-based Medicine by Ministry of Education in China, Nantong 226001, Jiangsu Province, China
| | - Li-Yuan Yu
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China; Nantong University Division of Cooperative Research Center on Evidence-based Medicine by Ministry of Education in China, Nantong 226001, Jiangsu Province, China
| | - Li-Yuan Wang
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China; Nantong University Division of Cooperative Research Center on Evidence-based Medicine by Ministry of Education in China, Nantong 226001, Jiangsu Province, China
| | - Ya-Lan Chen
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China; Nantong University Division of Cooperative Research Center on Evidence-based Medicine by Ministry of Education in China, Nantong 226001, Jiangsu Province, China
| | - Jin-Song Geng
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China; Nantong University Division of Cooperative Research Center on Evidence-based Medicine by Ministry of Education in China, Nantong 226001, Jiangsu Province, China
| | - Jian Shi
- Department of Ophthalmology, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Kui Jiang
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China; Nantong University Division of Cooperative Research Center on Evidence-based Medicine by Ministry of Education in China, Nantong 226001, Jiangsu Province, China
| | - Jian-Cheng Dong
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China; Nantong University Division of Cooperative Research Center on Evidence-based Medicine by Ministry of Education in China, Nantong 226001, Jiangsu Province, China
| |
Collapse
|
20
|
Cerebral microbleeds are associated with physical frailty: a community-based study. Neurobiol Aging 2016; 44:143-150. [DOI: 10.1016/j.neurobiolaging.2016.04.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/16/2016] [Accepted: 04/20/2016] [Indexed: 11/21/2022]
|
21
|
Del Brutto OH, Mera RM, Cagino K, Fanning KD, Milla-Martinez MF, Nieves JL, Zambrano M, Sedler MJ. Neuroimaging signatures of frailty: A population-based study in community-dwelling older adults (the Atahualpa Project). Geriatr Gerontol Int 2016; 17:270-276. [DOI: 10.1111/ggi.12708] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Oscar H Del Brutto
- School of Medicine; Universidad Espíritu Santo - Ecuador; Guayaquil Ecuador
| | | | - Kristen Cagino
- School of Medicine; Stony Brook University; New York New York USA
| | | | | | | | | | - Mark J Sedler
- School of Medicine; Stony Brook University; New York New York USA
| |
Collapse
|