Effect of 24-month physical activity on cognitive frailty and the role of inflammation: the LIFE randomized clinical trial

METS-IR/HOMA-IR and MAFLD in U.S. adults: dose-response correlation and the effect mediated by physical activity

OBJECTIVES

Metabolic dysfunction-associated fatty liver disease (MAFLD), a globally prevalent disease, is closely linked to insulin resistance (IR). Physical activity (PA) is closely linked to both MAFLD and IR. We aim to explore the dose-response relationship between metabolic score for IR (METS-IR)/homeostasis model assessment of IR (HOMA-IR) and MAFLD, and investigate the relationship between PA, IR and MAFLD.

METHODS

Participants from the NHANES study were included in this cross-section study. Logistic regression and the receiver operating characteristic were used to assess the predictive performance of METS-IR/HOMA-IR for MAFLD. Restrictive cubic splines were performed to visualize their dose-response relationship. Decision tree analysis was used to identify high-risk populations of MAFLD. PA's mediating effect in the association between METS-IR/HOMA-IR and MAFLD was also examined.

RESULTS

Of all 1,313 participants, 693 had MAFLD (52.78%). There were a positive association between METS-IR (OR = 1.162, 95% CI = 1.126-1.199) and HOMA-IR (OR = 1.630, 95% CI = 1.431-1.856) and MAFLD risk. The AUCs of the METS-IR and HOMA-IR were 0.831 (0.809, 0.853) and 0.767 (0.741, 0.791), respectively, with significantly different predictive performance (P < 0.001). Adding METS-IR/HOMA-IR to the basic model greatly improved the statistical significance for MAFLD. Five high-risk subgroups were identified for MAFLD. PA mediated about 0.81% and 0.78% (indirect effect/total effect) in the association between METS-IR/HOMA-IR and MAFLD.

CONCLUSIONS

MAFLD risk might be predicted by METS-IR/HOMA-IR, among which METS-IR performed better. And PA mediated the association between them. More attention should be paid to the therapeutic effect of lifestyle changes on MAFLD.

HIGHLIGHTS

1. Positive associations were found between METS-IR and HOMA-IR and MAFLD risk. 2. METS-IR has better predictive performance for MAFLD risk than HOMA-IR. 3.Two high-risk subgroups were identified for MAFLD by METS-IR: individuals with METS-IR ≥ 40; Hispanic black individuals with 34 ≤ METS-IR < 40 and aged ≥ 46. 4. In the significant association between METS-IR/HOMA-IR and MAFLD, about 0.81% and 0.78% (indirect effect/total effect), respectively, were mediated by physical activity.

Frailty and biological age. Which best describes our aging and longevity?

Frailty and Biological Age are two closely related concepts; however, frailty is a multisystem geriatric syndrome that applies to elderly subjects, whereas biological age is a gerontologic way to describe the rate of aging of each individual, which can be used from the beginning of the aging process, in adulthood. If frailty reaches less consensus on the definition, it is a term much more widely used than this of biological age, which shows a clearer definition but is scarcely employed in social and medical fields. In this review, we suggest that this Biological Age is the best to describe how we are aging and determine our longevity, and several examples support our proposal.

A longitudinal study of factors associated with cognitive frailty in middle-aged and elderly population based on the health ecology model

BACKGROUND

Cognitive frailty (CF) is an important geriatric syndrome and is reversible. It is crucial to develop preventive interventions for CF. We aimed to explore the associations between CF and its associated factors in Chinese aged 45 years and above.

METHODS

Based on the available data of 3 waves in China Health and Retirement Longitudinal Study from 2011 to 2015, 16,071 individuals aged 45 years and above from 3 waves were included. Based on the health ecology model, the associated factors were classified as downstream, midstream and upstream factors. Generalized hierarchical linear model including time level, individual level, and province level was applied to analyze the associations between factors and CF.

RESULTS

Multilevel factors have different effects on physical and cognitive function. In the downstream, old age, female, underweight, chronic diseases, and depression were risk factors of reversible CF and potentially reversible CF, and overweight was their protective factor. In the midstream, short or long night sleep duration was their risk factor, and > 30 and ≤ 60 min afternoon naps, alcohol drinking, and participation in social activities were their protective factors. In the upstream, living in rural areas was their risk factor, and high educational level, household consumption and GDP per capita were their protective factors.

CONCLUSIONS

Physical function and cognitive function are affected differently by multiple factors. The occurrence and development of physical frailty and cognitive impairment may have some common mechanisms. CF can be influenced by multilevel factors, and multilevel and comprehensive management of CF should be achieved.

KEY POINTS

Cognitive frailty was correlated with multilevel factors, including downstream, midstream, and upstream factors. It is crucial to focus on individual interventions such as physiological factors, psychological factors and health behaviors, especially the elderly, women and those with depression. Socioeconomic status was associated with the lower prevalence of cognitive frailty.

Accelerometer-measured physical activity and sedentary behaviour are associated with C-reactive protein in US adults who get insufficient sleep: A threshold and isotemporal substitution effect analysis

This study aimed to investigate the association between physical activity, sedentary behaviour and chronic inflammation in short sleep adults. The study included 2,113 NHANES participants with self-reported insufficient sleep. C-reactive protein (CRP) was used as the inflammatory biomarker. Physical activity and sedentary behaviour were objectively measured by accelerometers. Weighted regression model, two - piecewise linear regression model, and restricted cubic splines were applied to evaluate associations mentioned above. An isotemporal substitution model was used to assess the modelled effects of replacing sedentary time (ST) with moderate-to-vigorous levels of physical activity (MVPA) or light physical activity (LPA). After adjusting for potential confounding factors, higher levels of ST and lower levels of LPA or MVPA were associated with higher CRP levels. Isotemporal substitution analysis indicated that replacing 30 minutes of ST with 30 minutes of MVPA was associated with a significant decrease in CRP levels. Saturation analysis suggested that the association between MVPA and CRP may plateau at over 20 minutes of MVPA per day. Findings of this study provides insight into the potential benefits of replacing ST with MVPA. This study also suggests that increasing MVPA beyond a certain point may not provide additional anti-inflammatory benefits in a short sleep population.

A Herbal Prescription of Insamyangyeongtang as a Therapeutic Agent for Frailty in Elderly: A Narrative Review

Frailty is a major geriatric syndrome with a multifactorial etiology that induces a decline in multiple physiological and psychological functions. In traditional East Asian medicine (TEAM), qi and blood deficiency clinically represent as fatigue, anemia, anorexia, decreased strength after illness, and weakness, commonly interpretated as frailty. An herbal prescription of Insamyangyeongtang (IYT, Ninjin'yoeito in Japanese, Ren-Shen-Yang-Rong-Tang in Chinese) tonifies qi and blood and has the potential to treat multiple targets caused by qi and blood deficiency. As the population ages and frailty increases, there is an increase in the potential effectiveness of IYT in frailty. This study reviewed relevant clinical trials to provide an updated view on the effect of IYT on frailty. IYT has therapeutic effects on frailty associated with chronic respiratory diseases (e.g., chronic obstructive pulmonary disease) and cognitive impairments (e.g., Alzheimer's disease) and improves respiratory symptoms and cognition. IYT also has therapeutic effects on weight gain, muscle mass, and strength, and improves nutritional status in frail elderly individuals who have decreased muscle mass and strength, loss of appetite, and weight loss. The same effect has been shown in frailty in elderly individuals with rehabilitation treatment and chronic diseases. IYT also improves frailty associated with symptoms such as intractable dizziness and genitourinary symptoms. The beneficial effects of IYT in several diseases could be important for medication replacement, reduction, and prevention of polypharmacy. Based on the results of this review, we suggest that IYT has the potential to be a therapeutic agent against frailty.

Independent Association between Cognitive Frailty and Cardio-Ankle Vascular Index in Community-Dwelling Older Adults

INTRODUCTION

Although arterial stiffness has been suggested to be associated with poor physical function and mild cognitive impairment (MCI), its association with cognitive frailty (CF), a comorbidity of both, is unclear. This study aims to examine the association between CF and arterial stiffness in community-dwelling older adults.

METHODS

A cross-sectional analysis of 511 community-dwelling older adults aged 65 years or older (mean age 73.6 ± 6.2 years, 63.6% women), who participated in a community cohort study (Tarumizu Study, 2019), was conducted. Poor physical function was defined as either slowness (walking speed <1.0 m/s) or weakness (grip strength <28 kg for men and <18 kg for women). MCI was defined by the National Center for Geriatrics and Gerontology Functional Assessment Tool as a decline of at least 1.5 standard deviation from age- and education-adjusted baseline values in any one of the four cognitive domains (memory, attention, executive, and information processing). CF was defined as the combination of poor physical function and MCI. Arterial stiffness was measured using the Cardio-Ankle Vascular Index (CAVI), and the average of the left and right sides (mean CAVI) was used.

RESULTS

Multinomial logistic regression analysis adjusted for covariates was performed with the four groups of robust, poor physical function, MCI, and CF as dependent variables and mean CAVI as an independent variable. Using the robust group as reference, the poor physical function and MCI groups showed no significant relationship with the mean CAVI. The mean CAVI was significantly higher in the CF group (odds ratio 1.62, 95% confidence interval: 1.14-2.29).

CONCLUSION

A significant association was found between CF and the higher CAVI (progression of arterial stiffness). Careful observation and control of CAVI, which is also an indicator of arterial stiffness, may be a potential target for preventive interventions for CF.

Factors affecting cognitive frailty improvement and progression in Taiwanese older adults

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Development and validation of prediction model for older adults with cognitive frailty

OBJECTIVE

This study sought to develop and validate a 6-year risk prediction model in older adults with cognitive frailty (CF).

METHODS

In the secondary analysis of Chinese Longitudinal Healthy Longevity Survey (CLHLS), participants from the 2011-2018 cohort were included to develop the prediction model. The CF was assessed by the Chinese version of Mini-Mental State Exam (CMMSE) and the modified Fried criteria. The stepwise regression was used to select predictors, and the logistic regression analysis was conducted to construct the model. The model was externally validated using the temporal validation method via the 2005-2011 cohort. The discrimination was measured by the area under the curve (AUC), and the calibration was measured by the calibration plot. A nomogram was conducted to vividly present the prediction model.

RESULTS

The development dataset included 2420 participants aged 60 years or above, and 243 participants suffered from CF during a median follow-up period of 6.91 years (interquartile range 5.47-7.10 years). Six predictors, namely, age, sex, residence, body mass index (BMI), exercise, and physical disability, were finally used to develop the model. The model performed well with the AUC of 0.830 and 0.840 in the development and external validation datasets, respectively.

CONCLUSION

The study could provide a practical tool to identify older adults with a high risk of CF early. Furthermore, targeting modifiable factors could prevent about half of the new-onset CF during a 6-year follow-up.

Navigating and diagnosing cognitive frailty in research and clinical domains

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

Health factors associated with cognitive frailty in older adults living in the community

Introduction

This study aims to investigate the health factors associated with cognitive frailty in frail and pre-frail older adults living in the community.

Methods

A total of 233 older adults meeting Fried's criteria for pre-frailty or frailty were included. Cognitive status was evaluated using the Short Portable Mental Status Questionnaire. Health factors encompassed nutritional status (evaluated using the Mini Nutritional Assessment tool, body mass index, and waist, arm, and leg circumferences), physical function (assessed with the Short Physical Performance Battery), quality of life (measured with the total index of the EuroQoL 5-Dimension 5-Level questionnaire - EQoL-Index -, and the Visual-Analogue Scale - QoL-VAS - for today's health state), as well as sleep, physical activity, and inactivity estimated through wrist-worn accelerometers. Multivariable logistic regression analyses were conducted to identify potential predictors of cognitive frailty, considering age as a confounding factor.

Results

Cognitive frail participants exhibited advanced age, heightened self-reported exhaustion, diminished overall physical performance, reduced leg perimeter, decreased engagement in moderate-to-vigorous physical activity, and higher levels of inactivity (all p<0.05). However, after adjusting for age, only QoL-VAS emerged as a cognitive frailty risk factor (Odds ratio: 1.024), while the EQoL-Index, calf perimeter, and levels of moderate-to-vigorous physical activity were identified as protective factors (Odds ratios: 0.025, 0.929, and 0.973, respectively).

Discussion

This study highlights the complex relationship between non-modifiable factors such as age, and modifiable factors including quality of life, nutritional status, and physical activity in the development of cognitive frailty among older adults with a frailty phenotype living in the community.

Depressive and Biopsychosocial Frailty Phenotypes: Impact on Late-life Cognitive Disorders

 In older age, frailty is a detrimental transitional status of the aging process featuring an increased susceptibility to stressors defined by a clinical reduction of homoeostatic reserves. Multidimensional frailty phenotypes have been associated with all-cause dementia, mild cognitive impairment (MCI), Alzheimer's disease (AD), AD neuropathology, vascular dementia, and non-AD dementias. In the present article, we reviewed current evidence on the existing links among depressive and biopsychosocial frailty phenotypes and late-life cognitive disorders, also examining common pathways and mechanisms underlying these links. The depressive frailty phenotype suggested by the construct of late-life depression (LLD) plus physical frailty is poorly operationalized. The biopsychosocial frailty phenotype, with its coexistent biological/physical and psychosocial dimensions, defines a biological aging status and includes motivational, emotional, and socioeconomic domains. Shared biological pathways/substrates among depressive and biopsychosocial frailty phenotypes and late-life cognitive disorders are hypothesized to be inflammatory and cardiometabolic processes, together with multimorbidity, loneliness, mitochondrial dysfunction, dopaminergic neurotransmission, specific personality traits, lack of subjective/objective social support, and neuroendocrine dysregulation. The cognitive frailty phenotype, combining frailty and cognitive impairment, may be a risk factor for LLD and vice versa, and a construct of depressive frailty linking physical frailty and LLD may be a good dementia predictor. Frailty assessment may enable clinicians to better target the pharmacological and psychological treatment of LLD. Given the epidemiological links of biopsychosocial frailty with dementia and MCI, multidomain interventions might contribute to delay the onset of late-life cognitive disorders and other adverse health-related outcomes, such as institutionalization, more frequent hospitalization, disability, and mortality.

Risk Factors of Progression to Cognitive Frailty: Singapore Longitudinal Ageing Study 2

INTRODUCTION

Cognitive frailty is associated with higher risk of dementia and adverse health outcomes. However, multidimensional factors that influence cognitive frailty transitions are not known. We aimed to investigate risk factors of incident cognitive frailty.

METHODS

Prospective cohort study participants were community-dwelling adults without dementia and other degenerative disorders and baseline and follow-up, including N = 1,054 participants aged ≥55 free of cognitive frailty at baseline, with complete baseline (March 6, 2009, to June 11, 2013) and follow-up data at 3-5 years later (January 16, 2013, to August 24, 2018). Incident cognitive frailty was defined by one or more criteria of the physical frailty phenotype and <26 of Mini-Mental State Examination (MMSE) score. Potential risk factors assessed at baseline included demographic, socioeconomic, medical, psychological and social factors, and biochemical markers. Data were analyzed using least absolute shrinkage selection operator (LASSO) multivariable logistic regression models.

RESULTS

A total of 51 (4.8%) participants, including 21 (3.5%) of the cognitively normal and physically robust participants, 20 (4.7%) of the prefrail/frail only, and 10 (45.4%) of cognitively impaired only, transited to cognitive frailty at follow-up. Risk factors for transition to cognitive frailty were having eye problem (OR = 2.6, 95% CI 1.24-5.43) and low HDL cholesterol (OR = 4.1, 95% CI 2.03-8.40), while protective factors for cognitive frailty transition were higher levels of education (OR = 0.3, 95% CI 0.10-0.74) and participation in cognitive stimulating activities (OR = 0.4, 95% CI 0.17-0.82).

CONCLUSION

Multi-domain modifiable factors especially related to leisure activities predict cognitive frailty transition and may be targeted for prevention of dementia and associated adverse health outcomes.

The effects of an e-health brisk walking intervention in increasing moderate-to-vigorous physical activity in physically inactive older people with cognitive frailty: study protocol for a randomized controlled trial

BACKGROUND

Cognitive frailty is a risk for many adverse health outcomes that are commonly observed in older people. Physical activity is known to be effective to reserve cognitive frailty but the prevalence of physical inactivity is still high in older people. E-health enhances behavioural change effects through an innovative way to deliver behavioural change methods that can enhance the behavioural change effects. However, its effects on older people with cognitive frailty, its effects compared with conventional behavioural change methods, and the sustainability of the effects are unclear.

METHODS

This study employs a single-blinded, two-parallel-group, non-inferiority, randomized controlled trial design with a 1:1 group allocation ratio. Eligible participants are aged 60 years or above, have cognitive frailty and physical inactivity, and possess a smartphone for more than six months. The study will be conducted in community settings. In the intervention group, participants will receive a 2-week brisk-walking training followed by a 12-week e-health intervention. In the control group, participants will receive a 2-week brisk-walking training followed by a 12-week conventional behavioural change intervention. The primary outcome is minutes of moderate-to-vigorous physical activity (MVPA). This study aims to recruit a total of 184 participants. Generalized estimating equations (GEE) will be used to examine the effects of the intervention.

ETHICS AND DISSEMINATION

The trial has been registered at ClinicalTrials.gov (Identifier: NCT05758740) on 7th March 2023, https://clinicaltrials.gov/ct2/show/NCT05758740 , and all items come from the World Health Organization Trial Registration Data Set. It has been approved by the Research Ethics Committee of Tung Wah College, Hong Kong (reference number: REC2022136). The findings will be disseminated in peer-reviewed journals and presented at international conferences relevant to the subject fields.

TRIAL REGISTRATION

The trial has been registered at ClinicalTrials.gov (Identifier: NCT05758740) and all items come from the World Health Organization Trial Registration Data Set. The latest version of the protocol was published online on 7th March 2023.

Association of depression with cognitive frailty: A systematic review and meta-analysis

BACKGROUND AND AIM

The relationship between cognitive frailty and depression is unclear and quantitative analyses are lacking. We conducted a systematic review and meta-analysis to investigate the relationship between cognitive frailty and depression.

METHODS

We systematically searched Embase, PubMed, Medline (Ovid), Web of Science, and APA PsycInfo (American Psychological Association PsycInfo) databases until April 2022. Meta-analysis was performed using the Stata software. The prevalence between cognitive frailty and depression them was estimated by extracting the proportion of cognitive frailty and depression in the total number of patients. We extracted odds ratios (ORs) and 95 % confidence intervals (CI) to estimate the relationship between cognitive frailty and depression.

RESULTS

A meta-analysis of 15 studies revealed that cognitive frailty in older adults was associated with a higher risk of depression (OR = 2.06, 95 % CI = 1.72-2.48, p = 0.001). Eight studies involved the prevalence of cognitive frailty and depression, with an overall prevalence of depression of 46 % (95 % CI, 30 % -62 %; p < 0.0001) in cognitively frail patients.

LIMITATION

Differences in definitions and assessment methods for cognitive frailty across studies.

CONCLUSION

The prevalence of cognitive frailty combined with depression in the elderly is high wherein both are mutually affected. More prospective studies are needed to investigate the relationship between cognitive frailty and depression and to propose targeted treatment options and preventive measures to improve the quality of life of the elderly population.

Prediction model for cognitive frailty in older adults: A systematic review and critical appraisal

Background

Several prediction models for cognitive frailty (CF) in older adults have been developed. However, the existing models have varied in predictors and performances, and the methodological quality still needs to be determined.

Objectives

We aimed to summarize and critically appraise the reported multivariable prediction models in older adults with CF.

Methods

PubMed, Embase, Cochrane Library, Web of Science, Scopus, PsycINFO, CINAHL, China National Knowledge Infrastructure, and Wanfang Databases were searched from the inception to March 1, 2022. Included models were descriptively summarized and critically appraised by the Prediction Model Risk of Bias Assessment Tool (PROBAST).

Results

A total of 1,535 articles were screened, of which seven were included in the review, describing the development of eight models. Most models were developed in China (n = 4, 50.0%). The most common predictors were age (n = 8, 100%) and depression (n = 4, 50.0%). Seven models reported discrimination by the C-index or area under the receiver operating curve (AUC) ranging from 0.71 to 0.97, and four models reported the calibration using the Hosmer-Lemeshow test and calibration plot. All models were rated as high risk of bias. Two models were validated externally.

Conclusion

There are a few prediction models for CF. As a result of methodological shortcomings, incomplete presentation, and lack of external validation, the models' usefulness still needs to be determined. In the future, models with better prediction performance and methodological quality should be developed and validated externally.

Systematic review registration

www.crd.york.ac.uk/prospero, identifier CRD42022323591.

Baduanjin exercise modulates the hippocampal subregion structure in community-dwelling older adults with cognitive frailty

Background

Regular Baduanjin exercise intervention was proven to be beneficial in improving the cognitive ability and physical performance of older adults with different health conditions but was unclear to influence the structural plasticity of the hippocampus. This study aimed to explore the modulation of hippocampal subregions as a mechanism by which Baduanjin exercise improves cognitive frailty in older adults.

Methods

A total of 102 community-dwelling older adults with cognitive frailty were recruited and randomly allocated to the Baduanjin exercise training group and usual physical activity control group. The participants in the Baduanjin exercise training group participated in a 24-week Baduanjin exercise intervention program with an exercise frequency of 60 min per day, 3 days per week. Cognitive ability and physical frailty were assessed, and MRI scans were performed on all participants at baseline and after 24 weeks of intervention. The structural MRI data were processed with MRIConvert (version 2.0 Rev. 235) and FreeSurfer (version 6.0.0) software. Data analyses were performed using the independent sample t tests/Mann-Whitney U tests with the Bonferroni correction, mixed linear model, correlation, or mediation analysis by the SPSS 24.0 software (IBM Corp, Armonk, NY, United States).

Results

After 24 weeks of intervention, a statistically significant increase was found for the Montreal Cognitive Assessment (MoCA) scores (p = 0.002) with a large effect size (Cohen's d = 0.94) and the significant interaction effect (P _{goup × time} < 0.05), Memory Quotient (MQ) scores (p = 0.019) with a medium effect size (Cohen's d = 0.688) and the significant interaction effect (P _{goup × time} < 0.05), and other parameters of WMS-RC test including pictures (p = 0.042), recognition (p = 0.017), and association (p = 0.045) test with a medium effect size (Cohens' d = 0.592, 0.703, and 0.581) for the Baduanjin training group, while significant decrease for the Edmonton Frailty Scale (EFS) score (p = 0.022), with a medium effect size (Cohen's d = -0.659) and the significant interaction effect (P _{goup × time} < 0.05) for the Baduanjin training group. The differences in the left parasubiculum, Hippocampal Amygdala Transition Area (HATA), right Cornu Ammonis Subfield 1 (CA1) and presubiculum volumes from baseline to 24 weeks after intervention in the Baduanjin training group were significantly greater than those in the control group (p < 0.05/12). Further analysis showed that the changes in right CA1 volume were positively correlated with the changes in MoCA and MQ scores (r = 0.510, p = 0.015; r = 0.484, p = 0.022;), the changes in right presubiculum and left parasubiculum volumes were positively correlated with the changes in MQ (r = 0.435, p = 0.043) and picture test scores (r = 0.509, p = 0.016), respectively, and the changes in left parasubiculum and HATA volumes were negatively correlated with the changes in EFS scores (r = -0.534, p = 0.011; r = -0.575, p = 0.005) in the Baduanjin training group, even after adjusting for age, sex, years of education and marital status; furthermore, the volume changes in left parasubiculum and left HATA significantly mediated the Baduanjin exercise training-induced decrease in the EFS scores (β = 0.376, 95% CI 0.024 ~ 0.947; β = 0.484, 95% CI 0.091 ~ 0.995); the changes of left parasubiculum and right CA1 significantly mediated the Baduanjin exercise training-induced increase in the picture and MO scores (β = -0.83, 95% CI-1.95 ~ -0.002; β = -2.44, 95% CI-5.99 ~ -0.32).

Conclusion

A 24-week Baduanjin exercise intervention effectively improved cognitive ability and reduced physical frailty in community-dwelling older adults with cognitive frailty, and the mechanism might be associated with modulating the structural plasticity of the hippocampal subregion.

Effect of Whole-Body Vibration Training on Selected Intrinsic Risk Factors in Women Aged 60+ at Fall Risk: A Randomized Controlled Trial

The aim of the study was to determine whether Whole Body Vibration Training (WBVT) affects intrinsic risk factors for falls in women aged 60+ at fall risk.

DESIGN

Randomized controlled clinical trial. Blinding was applied to the persons in charge of evaluating the intervention's clinical results and statistical analysis.

METHODS

Forty-two women over 60 years old were randomly assigned to an experimental group (EG-12-week WBVT; n = 22) and a control group (CG-no additional physical activities; n = 20). Fear of falling was measured by the FES-I questionnaire, gait and dynamic balance using the Time-Up and Go test (TUG), aerobic endurance with the 6-Minute Walk Test (6MWT), and the functional strength of the lower body muscles with the 30-s Chair Stand Test (30SCST) at baseline and post-intervention. Additionally assayed were participants' blood concentrations of interleukin-6 (IL-6).

RESULTS

The 12-week WBVT improves gait and balance (TUG, p = 0.009), exercise tolerance (6MWT, p = 0.001), and functional strength (30SCST; p = 0.027) but does not reduce the intensity of fear of falling (FES-I, p = 0.655) and the IL-6 serum concentration (p = 0.377).

CONCLUSIONS

WBVT affects selected fall risk factors in women aged 60+ at fall risk.

Effectiveness of interventions in older adults with cognitive frailty: a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

interventions targeting older adults with cognitive frailty have grown rapidly in recent years with inconsistent findings. However, there is no meta-analysis that has synthesised pooled estimates.

OBJECTIVE

to synthesise the pooled effect of current targeted interventions in older people with cognitive frailty.

METHODS

we conducted a systematic search in PubMed, Embase, Web of Science, the Cochrane Library, the JBI database and three Chinese databases (CNKI, Wan-Fang and VIP) for literature from the inception of the database until 8 March 2022. The mean difference or standardised mean difference with 95% CIs was calculated. The methodological quality was assessed by the Cochrane RoB 2.0. The certainty of evidence was assessed using the GRADE criteria.

RESULTS

thirteen randomised controlled trials with a total of 1,089 participants were included. The results of the meta-analysis showed that older adults with cognitive frailty in the intervention groups had significant improvement in frailty score [MD = -1.67, 95% CI (-2.39, -0.95), P < 0.00001, I2 = 97%], global cognitive function [MD = 3.38, 95% CI (1.90, 4.85), P < 0.00001, I2 = 93%], mobility [MD = -0.96, 95% CI (-1.27, -1.66), P < 0.00001, I2 = 0%], muscle strength [SMD = 0.75, 95% CI (0.09, 1.41), P = 0.03, I2 = 85%] and nutritional status [MNA:MD = 5.64, 95% CI (3.99, 7.29), P < 0.00001, I2 = 89%; ALB: MD = 3.23, 95% CI (0.76, 5.71), P = 0.01, I2 = 93%; PALB: MD = 54.52, 95% CI (25.26, 83.77), P = 0.0003, I2 = 96%; TRF: MD = 0.64, 95% CI (0.22, 1.06), P = 0.003, I2 = 97%]. The overall certainty of the evidence ranged from low to moderate.

CONCLUSIONS

interventions targeting older adults with cognitive frailty are effective in improving physical frailty, global cognitive function, physical function and nutritional status with low to moderate certainty. More research is still needed in the future to further enrich the evidence in these fields.

PROSPERO NUMBER

CRD42022318758.

Prevalence and possible factors of cognitive frailty in the elderly with hypertension and diabetes

BACKGROUND

Cognitive frailty is the coexistence of physical frailty and mild cognitive impairment. Research shows that cognitive frailty is related to an increased risk of hospitalization, mortality, disability, and dementia. Diabetes and hypertension are common risk factors for physical frailty and cognitive impairment. However, the factors influencing cognitive frailty in the elderly with hypertension and diabetes are still unclear. This study aimed to investigate the possible factors influencing cognitive frailty in the elderly with hypertension and diabetes.

METHODS

A cross-sectional study was conducted. We evaluated people over 60 years with hypertension and diabetes who underwent physical examination in Wuxi Xin'an Community Health Service Center. Frail scale, Montreal Cognitive Assessment-Basic and clinical dementia rating were used to assess cognitive frailty. We collected demographic characteristics, hypertension and diabetes-related laboratory indicators of the participants. We also used various scales to assess the overall health status of the elderly.

RESULTS

Approximately 20.8% of the participants were determined to have cognitive frailty in elderly adults with hypertension and diabetes. These participants were older, had a lower monthly income, and included a higher proportion of peasants. They also had a higher level of depression (p = 0.037), higher risk of falls (p = 0.000), higher risk of malnutrition (p = 0.002), poorer ability to perform activities of daily living (ADL) (p = 0.000), and less social support (p = 0.030). Multivariate regression analysis was used to further assess the factors for cognitive frailty. After adjusting for possible confounders, age and ADL score emerged as risk factors, whereas high monthly income decreased the risk of cognitive frailty.

CONCLUSION

Cognitive frailty is correlated with age, income, and ability to perform daily living activities in the elderly with diabetes and hypertension. Closer attention to the elderly who have low income and poor self-care ability may play an important role in the early prevention of cognitive frailty and even dementia.

Mediating role of homebound status between depressive symptoms and cognitive impairment among community-dwelling older adults in the USA: a cross-sectional analysis of a cohort study

OBJECTIVE

Depressive symptoms are known modifiable factors of cognitive impairment in older adults. However, the pathway through which depressive symptoms lead to cognitive impairment is not well understood. This study aimed to investigate whether homebound status (defined as usually unable to leave home unassisted) mediates the association between depressive symptoms and cognitive impairment in community-dwelling older adults in the USA.

DESIGN

A secondary analysis of cross-sectional data.

SETTINGS

Communities in the USA.

PARTICIPANTS

Community-dwelling older adults (N=7537) from the 2011 National Health and Aging Trends Study, a nationally representative survey of Medicare Beneficiaries in the USA.

MAIN OUTCOME MEASURES

Participants' cognitive impairment status was classified using a composite measure. Depressive symptoms were assessed using Patient Health Questionnaire-2. Homebound status was determined by the frequency, difficulty and needing help in getting outdoors. We used logistic regression and the Paramed command in STATA to analyse whether homebound mediated the association between depressive symptoms and cognitive impairment.

RESULTS

Participants were on average, 77.7 years old, female (58.3%) and non-Hispanic white (68.1%). About 26% of the participants were classified as having cognitive impairment, 16% reported depressive symptoms and 25% were homebound. Depressive symptoms (adjusted OR, 1.60; 95% CI 1.36 to 1.89) and homebound status (adjusted OR, 1.58; 95% CI 1.34 to 1.86) were independently associated with cognitive impairment. Homebound significantly mediated 12.5% of the total effect between depressive symptoms and cognitive impairment, with significant indirect effect (OR, 1.07; 95% CI 1.04 to 1.10), direct effect (OR, 1.61; 95% CI 1.36 to 1.91) and total effect (OR, 1.72; 95% CI 1.46 to 2.03).

CONCLUSIONS

This study supports a mediating role of homebound status in the relationship between depressive symptoms and cognitive impairment. Interventions to promote outdoor mobility should be studied for their ability to delay cognitive impairment for older adults with depressive symptoms.

Exercise interventions for older people with cognitive frailty-a scoping review

Background

As the global population ages, the issue of frailty in older people is gaining international attention. As one of the major subtypes of frailty, cognitive frailty is a heterogeneous clinical manifestation characterised by the co-existence of physical decline and cognitive impairment. The occurrence of cognitive frailty increases the risk of adverse health outcomes in older people, affecting their daily functioning and quality of life. However, cognitive frailty is a reversible state, and many interventions have been explored, with exercise interventions playing an important role in the non-pharmacological management of cognitive frailty. This study describes and summarises current exercise interventions for older people with cognitive frailty (including parameters such as mode, frequency and duration of exercise) and identifies the limitations of existing studies to inform future exercise interventions for older people with cognitive frailty.

Methods

Using a scoping review approach, Chinese and English literature published in PubMed, Web of Science, Cochrane Library, Embase, China Knowledge Network, Wanfang Database, China Biomedical Literature Database (SinoMed) and Vipshop from April 2013, when the definition of cognitive frailty first appeared, to August 2021 was searched to select studies related to exercise interventions for this group, extract information from the included literature, and summarise and report the findings.

Results

Nine RCT trial studies and one quasi-experiment study were included, for a total of 10 articles. The exercise modalities involved walking, brisk walking, Otago exercise, resistance exercise, balance training, flexibility training and Baduanjin, etc.; the intensity of exercise was based on individualised guidance and graded exercise intensity; the frequency of exercise was mostly 3–4 times/week; the duration of exercise was mostly 30–60 min/time; compared to the control group, the included studies showed statistically significant improvements in cognitive function, frailty status, and depression with the exercise intervention.

Conclusion

There is a paucity of evidence on exercise interventions for older people with cognitive frailty. The evidence provided in this study suggests that exercise interventions may be beneficial for older people with cognitive frailty. However, the existing studies suffer from small sample sizes, short intervention periods, inadequate monitoring of the entire exercise process, and non-uniformity in the assessment of exercise effects. More randomized controlled trials should be conducted in the future to explore the most effective, low-cost and simple interventions to meet the needs of the older people with cognitive frailty.

The effects of interventions to enhance cognitive and physical functions in older people with cognitive frailty: a systematic review and meta-analysis

Introduction

Cognitive frailty is the co-existence of mild cognitive impairment and physical frailty that increases the risk of adverse health outcomes. The existing systematic reviews on cognitive frailty in the literature have focused only on identifying associated factors and adverse outcomes, and their relationship with frailty and cognition. This study aimed to examine the effects of interventions on cognitive functions, frailty, and physical functions and provide an overview of intervention components used in older people with cognitive frailty.

Methods

This is a systematic review and meta-analysis. Medline, PubMed, CINAHL, Embase, PsycINFO, and Cochrane were searched for publishing during 2013–2021. Studies were selected based on the following eligibility criteria: 1) older people (age ≥ 60 years), 2) cognitive frailty, 3) outcomes on frailty or cognition or physical function, and 4) randomized controlled trial with any type of intervention. The Physiotherapy Evidence Database (PEDro) scale was used to rate the quality of the included studies. The review protocol was registered with PROSPERO (CRD42021251321).

Results

Two thousand five hundred six studies were identified, 9 were eligible, and 8 were included in the meta-analysis. The standardized mean difference (Hedges G) between groups of cognitive functions was 0.95, frailty status was 0, physical function in walking was -1.67, and the physical function in core strength assessment was 3.39. Physical activity appeared as an essential component in all interventions for older people with cognitive frailty.

Discussion

All interventions include physical activity as one of the components. Other components include cognitive training, nutrition education, behavioural intervention, mind–body intervention, psychosocial support, and virtual reality. The interventions are effective to promote cognitive and physical functions, but not physical frailty.

Supplementary Information

The online version contains supplementary material available at 10.1186/s11556-022-00299-9.

A Meta-Analysis to Detect Efficacy of Physical Activity Interventions to Enhance Effects Related to the Fragility among Older Adults

Background

The role of physical activity is well-known to intercept the condition of fragility and decrease its outcomes. This study aimed to determine the efficacious physical activity intervention measure which enhances the outcomes associated to fragility in the older adults. Material and Methods. We searched MEDLINE, Cochrane Central Register of Controlled, and EMBASE for the published studies in the duration June 2000 to February 2020 which were further shortlisted as per the inclusion and exclusion criteria of the study. The elder population considered from the selected studies was considered in an age of 65 years or more who were pre-fragile or fragile. Here, we included the clinical as well as randomized control trials.

Results

After extracting the data, we measured the risk ratio for aerobic intervention for physical intervention group as 0.55 [95% confidence interval (C.I) as 0.29, 1.03], mobility/rehabilitation interventions were nonsignificant for both groups with reported risk ratio as 1.13 (95% C.I as 0.96, 1.33), muscular strength randomized control trails as a significant integrated outcome estimate over the mobility measure, where the risk ratio was obtained as 1.17 (95% C.I 1.00, 1.35), for the randomized control trials of the mixed interventions showed a significant integrated outcome over the measures of mobility with obtained risk difference 0.03 (95% C.I -0.03, 0.09) and significant effects for daily life activities for intervention group with odds ratio 0.98 (95% C.I was 0.68, 1.41).

Conclusion

From the conducted systematic review and meta-analysis, we determined a low to medium authentication that different physical activities interventions are considered to be advantageous for the pre-fragile as well as the fragile elderly people. The studies are required to be more comprehensive and clear about defining the fragility so as to assure the determination and performing of such interventions into a clinical execution.

Self-reported difficulty in walking 400 meters: the “red flag” for probable sarcopenia

Background

Sarcopenia is associated with adverse outcomes in older people. Several tools are recommended to assess muscle mass, muscle strength and physical performance, but are not always available in daily practice.

Objective

The aim of the present study is to evaluate if there is a correlation between the personal perception of physical performance (assessed through a question on personal functional status) and the effective presence of sarcopenia (according to the EWGSOP2 definition) using data from the Longevity Check-up 7 + project.

Design

Cross-sectional study.

Setting

The Longevity Check-up 7 + project is an ongoing study started in June 2015 and conducted in unconventional settings (i.e., exhibitions, malls, and health promotion campaigns).

Subjects

Candidate participants are eligible for enrollment if they are at least 18 years of age and provide written informed consent. For the present study subjects 65 years age old and older have been considered (n = 2901).

Methods

According to the most recent EWGSOP2 consensus definition, subjects were defined to be affected by probable sarcopenia when handgrip strength was less than 27 kg in male and less than 16 kg in female, respectively. Furthermore, a single question assessed the perceived health status regarding own physical performance: “Do you have any difficulty in walking 400 m?”.

Results

Using the EWGSOP2 algorithm, 529 (18,9%) participants were identified as affected by probable sarcopenia with a significant higher prevalence among subjects with self-reported difficulty in walking 400 m compared to participant without any difficulty (33.6% versus 13.1%, respectively; p < 0.001). Relative to participants without self-reported difficulty, those subjects with self-reported difficulty in walking 400 m showed a significantly higher risk of sarcopenia (odds ratio [OR]: 3.34; 95% confidence interval [CI]: 2.75–4.07).

Conclusions

A single “Red Flag” question such as “Do you have any difficulty in walking 400 m?” should be considered as a recommended method for screening probable sarcopenia risk.

Multi-Concept Frailty Predicts the Late-Life Occurrence of Cognitive Decline or Dementia: An Updated Systematic Review and Meta-Analysis of Longitudinal Studies

Background

Frailty is a multidimensional syndrome that increases an individual’s vulnerability for developing adverse health outcomes, which include dementia. It might serve as a promising target for dementia prevention. However, there are currently no studies summarizing the association between multi-concept frailty and the risk of cognitive disorders. This study aims to summarize the evidence of associations between multi-concept frailty and cognitive disorders based on longitudinal studies.

Methods

Scopus, The Cochrane Library, PsycINFO, CINAHL, PubMed, and EMBASE databases were searched from inception to January 2, 2022. Longitudinal studies, which explored the association of frailty with incident risk of cognitive decline or dementia, were included. The multivariable-adjusted effect estimates were pooled by random-effects models. The evidence credibility was depicted according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method.

Results

A total of 30 longitudinal studies were included. Four types of frailty concepts were involved, including physical, cognitive, social, and biopsychosocial frailty. The meta-analysis comprised 20 studies of 252,571 older adults (mean age: 64.1–80.4 years), among whom 7,388 participants developed cognitive decline or dementia. Physical frailty was associated with higher risk of developing cognitive disorders [pooled relative risk (pRR) = 1.52, 95% confidence interval (CI): 1.28–1.80, I2 = 21.2%, pRR = 1.62 for cognitive decline, 95% CI: 1.07–2.45, I2 = 40.2%, pRR = 1.37 for all-cause dementia (ACD), 95% CI: 1.13–1.66, I2 = 0.0%]. Cognitive frailty (pRR = 2.90, 95% CI: 1.28–6.55, I2 = 78.1%) and pre-frailty (pRR = 4.24, 95% CI: 2.74–6.56, I2 = 30.2%) were linked to higher risk of ACD. Biopsychosocial frailty could predict a 41% (pRR = 1.41, 95% CI: 1.17–1.71) elevated risk of cognitive decline or dementia [pRR = 1.53 (95% CI: 1.19–1.96) for ACD and 1.11 (95% CI: 1.05–1.17) for Alzheimer’s disease (AD)]. In the systematic review, social frailty was associated with a 53% higher risk of AD. Preventing frailty could avoid a maximum of 9.9% cognitive disorders globally. The overall evidence strength is rated as low-to-moderate. Inconsistency and imprecision are major sources of bias.

Conclusion

Frailty in late life is a promising risk factor for cognitive disorders. Frail elderly should be monitored for their cognitive dynamics and initiate early prevention of dementia.

Systematic Review Registration

www.ClinicalTrials.gov, identifier CRD4202127 3434.

Effects of Remotely Supervised Physical Activity on Health Profile in Frail Older Adults: A Randomized Controlled Trial Protocol

Background

Frailty is considered a major public health challenge of the 21st century, characterized by the decline of multiform body functions. Physical activity may be the most effective intervention to delay frailty. This study aims to verify the effect of remotely supervised physical activity on health profile in community-dwelling frail older adults.

Design

This is a multicenter, three-blind, two-arm, and cohort randomized controlled study.

Methods

The intelligent exercise rehabilitation management system (IERMS) is an integrated digital platform that involves evaluation, guidance, monitoring, and feedback. A total of 120 participants aged ≥ 65 years and diagnosed as frailty on the FRAIL scale will be recruited and randomly divided into two groups. Group 1 will receive a 12-week IERMS-based intervention, and Group 2 will receive the usual care. Data will be collected at baseline, 12 and 24 weeks. The primary outcome is the physical function, and secondary outcomes include gait parameters, psychology, and cognition measurements. Analyses will be performed using DSS statistics, version 25. P < 0.05 will be considered statistically significant.

Conclusion

We believe that intervention plays a positive role in delaying the frailty. If our program is effective, we will provide a viable means to promote healthy aging in primary healthcare.

Trial registration number

ChiCTR2100052286; Pre-results.

Cognitive Frailty: An Update

This review article provides an update of the empirical research on cognitive fragility conducted in the last four years. The studies retrieved were classified in four different categories. The first category includes articles relating cognitive frailty to cognitive reserve and which continue to highlight the importance of educational level. The second category includes recent research on cognitive fragility biomarkers, involving neuroimaging, metabolism and, in a novel way, microbiota. The third category includes research on how cognitive frailty is related to motor development and physical functioning, exploring e.g. the use of technology to study motor markers of cognitive frailty. Finally, in the fourth category, research clarifying the difference between reversible frailty and potentially reversible cognitive frailty has led to new interventions aimed at reducing cognitive frailty and preventing negative health outcomes. Interventions based on physical activity and multicomponent interventions are particularly emphasized. In addition, recent research explores the long-term effects of dual interventions in older adults living in nursing homes. In summary, research on cognitive frailty has increased in recent years, and applied aspects have gained importance.

Association between Cognitive Frailty and Adverse Outcomes among Older Adults: A Meta-Analysis

OBJECTIVES

This systematic review and meta-analysis aimed to pool the effect size of the association between cognitive frailty and adverse outcomes (e.g., falls, disability, and hospitalization) among older adults.

DESIGN

Systematic review and meta-analysis.

METHODS

PubMed, ScienceDirect, and Embase were searched from their respective inceptions to June 1, 2022. We extracted prospective cohort studies that reported the association between cognitive frailty and adverse outcomes. Random or fixed-effects models based on heterogeneity were used to pool the effect sizes of independent associations of cognitive frailty, frailty only, and cognitive impairment only with each adverse outcome.

RESULTS

Fifteen studies involving 49,122 older adults were included in the meta-analysis. Older adults with cognitive frailty had higher odds ratios (OR) for falls (1.82, 95% confidence interval [CI]: 1.29-2.58), disability (3.17, 95%CI: 2.24-4.48), and hospitalization (1.78, 95%CI: 1.48-2.14) compared with those without frailty and cognitive impairment. Older adults with frailty only demonstrated a high risk for falls (pooled OR 1.76, 95%CI: 1.25-2.48), disability (pooled OR 1.82, 95%CI: 1.43-2.33), and hospitalization (pooled OR 1.64, 95% CI: 1.45-1.85). The influence of cognitive impairment only on adverse outcomes was lower compared with cognitive frailty or frailty. Subgroup analyses showed that those with cognitive frailty (defined by the frailty phenotype plus Mini-Mental State Examination) were at greater risk for developing adverse outcomes.

CONCLUSION

Our findings indicate that cognitive frailty is an independent risk factor for adverse outcomes (e.g., falls, disability, and hospitalization). Early screening and comprehensive intervention may improve cognitive frailty and reduce the risk for adverse outcomes among older adults.

Cognitive impairment in candidates for allogeneic hematopoietic stem cell transplantation

Hematopoietic cell transplant (HCT) is an increasingly common and curative treatment strategy to improve survival among individuals with malignant and nonmalignant diseases, with over one million HCTs having been performed worldwide. Neurocognitive dysfunction is a common and untoward consequence of HCT for many recipients, although few studies have examined the profile of neurocognitive impairments in HCT or their association with clinical features, such as frailty, or the incidence of pre-HCT neurocognitive impairments across all ages, which may influence post-HCT neurocognitive impairments. We examined the pattern and correlates of pre-transplant neurocognitive dysfunction in a prospective sample of adults undergoing HCT. Neurocognition was assessed using the Montreal Cognitive Assessment Battery. Frailty was assessed using the Short Physical Performance Battery. Linear regression analysis was used to examine the associations between neurocognitive performance and frailty. Neurocognitive screening profiles were also examined by partitioning MoCA into domain scores, including Executive Function and Memory. We also examined the associations between neurocognition, frailty, and clinical outcomes, including length of transplant hospitalization and survival. One hundred and ten adults were evaluated across a wide age range (range: 19-75; mean age = 54.7 [SD = 14.1]). Neurocognitive performance tended to fall below published normative levels (mean MoCA = 25.5 [SD = 4.1]), with 17% of participants demonstrating impaired performance compared with medical normative data (MoCA ≤ 22) and 34% exhibiting impaired performance relative to healthy samples (MoCA ≤ 25). Mild impairments (MoCA ≤ 25) were common across age ranges, including middle-aged patients (23% for age < 50; 35% for age 50-60, 41% for age ≥ 60), particularly for items assessing Executive Function. Greater levels of frailty associated with lower neurocognitive screening scores (r = -0.29, P < 0.01) and Executive Functioning (r = -0.24, P < 0.01), whereas greater age was associated with poorer Memory performance only (r = -0.33, P < 0.01). Greater levels of frailty prior to transplant associated with longer length of stay (β = 0.10, P = 0.046), but were not associated with survival. Neurocognitive impairments are common among adults undergoing HCT and the pattern of performance varies by age. Pre-transplant frailty is associated with neurocognitive functioning and may portend worse post-transplant early clinical outcomes.

An update on cognitive frailty: Its definition, impact, associated factors and underlying mechanisms, and interventions

Since the concept and operational definition of "cognitive frailty" (simultaneous presence of physical frailty and cognitive impairment without concurrent dementia) were proposed by the International Academy of Nutrition and Aging and the International Association of Gerontology and Geriatrics, cognitive frailty has been widely investigated. This review is intended to address the operational definition of cognitive frailty, its consequences, contributing factors and underlying mechanisms, as well as interventions for cognitive frailty. Although the definitions and assessments of cognitive frailty vary among researchers, older adults with both physical frailty and cognitive impairment are shown to be at higher risk of adverse health outcomes, including death, disability, hospitalization and incident dementia, than those with either condition alone. While the underlying mechanisms of cognitive frailty are still unclear, factors shown to be associated with cognitive frailty include sociodemographic factors, social status, nutritional status, geriatric syndrome, physical and cognitive activities, functional status, comorbidities, medication use, gut-derived metabolites and structural changes in the brain. Accumulating evidence indicates the need for comprehensive geriatric assessment that helps identify the possible causes of cognitive frailty and develop a multimodal individualized intervention to prevent adverse health outcomes for older adults with cognitive frailty. Further studies are required to clarify the mechanisms through which physical frailty and cognitive impairment interact to accelerate adverse health outcomes, particularly cognitive outcomes. In addition, for older adults with cognitive frailty, an effective flow diagram from primary screening through comprehensive assessment to multidimensional intervention needs to be developed for future implementation in both clinical and community settings. Geriatr Gerontol Int 2021; ••: ••-••.

Multi-domain interventions for the prevention of dementia and cognitive decline

BACKGROUND

Dementia is a worldwide concern. Its global prevalence is increasing. Currently, no effective medical treatment exists to cure or to delay the onset of cognitive decline or dementia. Up to 40% of dementia is attributable to potentially modifiable risk factors, which has led to the notion that targeting these risk factors might reduce the incidence of cognitive decline and dementia. Since sporadic dementia is a multifactorial condition, thought to derive from multiple causes and risk factors, multi-domain interventions may be more effective for the prevention of dementia than those targeting single risk factors.

OBJECTIVES

To assess the effects of multi-domain interventions for the prevention of cognitive decline and dementia in older adults, including both unselected populations and populations at increased risk of cognitive decline and dementia.

SEARCH METHODS

We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), CINAHL (EBSCOhost), Web of Science Core Collection (ISI Web of Science), LILACS (BIREME), and ClinicalTrials.gov on 28 April 2021. We also reviewed citations of reference lists of included studies, landmark papers, and review papers to identify additional studies and assessed their suitability for inclusion in the review.

SELECTION CRITERIA

We defined a multi-domain intervention as an intervention with more than one component, pharmacological or non-pharmacological, but not consisting only of two or more drugs with the same therapeutic target. We included randomised controlled trials (RCTs) evaluating the effect of such an intervention on cognitive functioning and/or incident dementia. We accepted as control conditions any sham intervention or usual care, but not single-domain interventions intended to reduce dementia risk. We required studies to have a minimum of 400 participants and an intervention and follow-up duration of at least 12 months.

DATA COLLECTION AND ANALYSIS

We initially screened search results using a 'crowdsourcing' method in which members of Cochrane's citizen science platform identify RCTs. We screened the identified citations against inclusion criteria by two review authors working independently. At least two review authors also independently extracted data, assessed the risk of bias and applied the GRADE approach to assess the certainty of evidence. We defined high-certainty reviews as trials with a low risk of bias across all domains other than blinding of participants and personnel involved in administering the intervention (because lifestyle interventions are difficult to blind). Critical outcomes were incident dementia, incident mild cognitive impairment (MCI), cognitive decline measured with any validated measure, and mortality. Important outcomes included adverse events (e.g. cardiovascular events), quality of life, and activities of daily living (ADL).  Where appropriate, we synthesised data in random-effects meta-analyses. We expressed treatment effects as risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs).

MAIN RESULTS

We included nine RCTs (18.452 participants) in this review. Two studies reported incident dementia as an outcome; all nine studies reported a measure for cognitive functioning. Assessment of cognitive functioning was very heterogeneous across studies, ranging from complete neuropsychological assessments to short screening tests such as the mini-mental state examination (MMSE). The duration of the interventions varied from 12 months to 10 years. We compared multi-domain interventions against usual care or a sham intervention. Positive MDs and RRs <1 favour multi-domain interventions over control interventions. For incident dementia, there was no evidence of a difference between the multi-domain intervention group and the control group (RR 0.94, 95% CI 0.76 to 1.18; 2 studies; 7256 participants; high-certainty evidence). There was a small difference in composite Z-score for cognitive function measured with a neuropsychological test battery (NTB) (MD 0.03, 95% CI 0.01 to 0.06; 3 studies; 4617 participants; high-certainty evidence) and with the Montreal Cognitive Assessment (MoCA) scale (MD 0.76 point, 95% CI 0.05 to 1.46; 2 studies; 1554 participants), but the certainty of evidence for the MoCA was very low (due to serious risk of bias, inconsistency and indirectness) and there was no evidence of an effect on the MMSE (MD 0.02 point, 95% CI -0.06 to 0.09; 6 studies; 8697participants; moderate-certainty evidence). There was no evidence of an effect on mortality (RR 0.93, 95% CI 0.84 to 1.04; 4 studies; 11,487 participants; high-certainty evidence). There was high-certainty evidence for an interaction of the multi-domain intervention with ApoE4 status on the outcome of cognitive function measured with an NTB (carriers MD 0.14, 95% CI 0.04 to 0.25, noncarriers MD 0.04, 95% CI -0.02 to 0.10, P for interaction 0.09). There was no clear evidence for an interaction with baseline cognitive status (defined by MMSE-score) on cognitive function measured with an NTB (low baseline MMSE group MD 0.06, 95% CI 0.01 to 0.11, high baseline MMSE group MD 0.01, 95% CI -0.01 to 0.04, P for interaction 0.12), nor was there clear evidence for an effect in participants with a Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) score > 6 points (MD 0.07, 95%CI -0.00 to 0.15).

AUTHORS' CONCLUSIONS

We found no evidence that multi-domain interventions can prevent incident dementia based on two trials. There was a small improvement in cognitive function assessed by a NTB in the group of participants receiving a multi-domain intervention, although this effect was strongest in trials offering cognitive training within the multi-domain intervention, making it difficult to rule out a potential learning effect. Interventions were diverse in terms of their components and intensity.

Feasibility and Effects of Virtual Reality Motor-Cognitive Training in Community-Dwelling Older People With Cognitive Frailty: Pilot Randomized Controlled Trial

BACKGROUND

Cognitive frailty refers to the coexistence of physical frailty and cognitive impairment, and is associated with many adverse health outcomes. Although cognitive frailty is prevalent in older people, motor-cognitive training is effective at enhancing cognitive and physical function. We proposed a virtual reality (VR) simultaneous motor-cognitive training program, which allowed older people to perform daily activities in a virtual space mimicking real environments.

OBJECTIVE

We aimed to (1) explore the feasibility of offering VR simultaneous motor-cognitive training to older people with cognitive frailty and (2) compare its effects with an existing motor-cognitive training program in the community on the cognitive function and physical function of older people with cognitive frailty.

METHODS

A two-arm (1:1), assessor-blinded, parallel design, randomized controlled trial was employed. The eligibility criteria for participants were: (1) aged ≥60 years, (2) community dwelling, and (3) with cognitive frailty. Those in the intervention group received cognitive training (ie, cognitive games) and motor training (ie, cycling on an ergometer) simultaneously on a VR platform, mimicking the daily living activities of older people. Those in the control group received cognitive training (ie, cognitive games) on tablet computers and motor training (ie, cycling on the ergometer) sequentially on a non-VR platform. Both groups received a 30-minute session twice a week for 8 weeks. Feasibility was measured by adherence, adverse outcomes, and successful learning. The outcomes were cognitive function, physical frailty level, and walking speed.

RESULTS

Seventeen participants were recruited and randomized to either the control group (n=8) or intervention group (n=9). At baseline, the median age was 74.0 years (IQR 9.5) and the median Montreal Cognitive Assessment score was 20.0 (IQR 4.0). No significant between-group differences were found in baseline characteristics except in the number of chronic illnesses (P=.04). At postintervention, the intervention group (Z=-2.67, P=.01) showed a significantly larger improvement in cognitive function than the control group (Z=-1.19, P=.24). The reduction in physical frailty in the intervention group (Z=-1.73, P=.08) was similar to that in the control group (Z=-1.89, P=.06). Improvement in walking speed based on the Timed Up-and-Go test was moderate in the intervention group (Z=-0.16, P=.11) and greater in the control group (Z=-2.52, P=.01). The recruitment rate was acceptable (17/33, 52%). Both groups had a 100% attendance rate. The intervention group had a higher completion rate than the control group. Training was terminated for one participant (1/9, 11%) due to minimal VR sickness (Virtual Reality Sickness Questionnaire score=18.3/100). Two participants (2/8, 25%) in the control group withdrew due to moderate leg pain. No injuries were observed in either group.

CONCLUSIONS

This study provides preliminary evidence that the VR simultaneous motor-cognitive training is effective at enhancing the cognitive function of older people with cognitive frailty. The effect size on frailty was close to reaching a level of significance and was similar to that observed in the control group. VR training is feasible and safe for older people with cognitive frailty.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04467216; https://clinicaltrials.gov/ct2/show/NCT04467216.

Causal effects of physical activity and sedentary behaviour on health deficits accumulation in older adults

BACKGROUND

Increasing physical activity (PA) and reducing sedentary behaviour (SB) have been associated with healthy ageing, but their effects when adjusted for reverse causation and selection bias remain unclear.

METHODS

A deficits accumulation (DA) index based on the number and severity of 51 health deficits (0-100%) was calculated at baseline and three biannual follow-up visits, in a representative cohort of 3 228 community-dwelling older adults in Spain. Average differences in DA index by previous recreational PA, household PA, mentally-active SB and passive SB were estimated using marginal structural models with inverse probability of exposure and censoring weights.

RESULTS

Compared with participants with previous recreational PA of 10-19.9 metabolic equivalent hours/week (MET-hours/week), average differences in DA index (95% confidence intervals) were 0.19 (-1.09, 1.48), 0.69 (-0.23, 1.61), -0.66 (-1.34, 0.02), -0.87 (-1.59, -0.13) and -0.55 (-1.37, 0.28) for 0, 0.1-9.9, 20-29.9, 30-39.9 and ≥40 MET-hours/week, respectively (P for trend = 0.006). Household PA showed no effect on subsequent DA after adjusting for reverse causation. Women, but not men, who spent 7-14.9, 15-20.9 and ≥21 h/week on mentally active SB had DA decreases of 0.09 (-1.00, 1.19), 1.08 (-0.28, 2.45) and 2.17 (0.58, 3.75), respectively, compared with 1-6.9 h/week (P for trend = 0.005); whereas women who spent 3-3.9, 4-4.9 and ≥5 h/day on passive SB showed DA increases of 0.41 (-0.52, 1.35), 1.35 (0.13, 2.57) and 2.13 (0.78, 3.47), respectively, compared with 2-2.9 h/day (P for trend = 0.001).

CONCLUSIONS

The proposed methodology allows estimation of the causal effects of PA and SB on ageing, by simulating a random assignment in which all subjects have the same probability of exposure.

Effectiveness of physical activity interventions in older adults with frailty or prefrailty: a systematic review and meta-analysis

Background:

Methods:

Results:

Interpretation:

PROSPERO registration:

Frailty and HIV: Moving from Characterization to Intervention

PURPOSE OF REVIEW

While the characteristics associated with frailty in people with HIV (PWH) have been well described, little is known regarding interventions to slow or reverse frailty. Here we review interventions to prevent or treat frailty in the general population and in people with HIV (PWH).

RECENT FINDINGS

Frailty interventions have primarily relied on nonpharmacologic interventions (e.g., exercise and nutrition). Although few have addressed frailty, many of these therapies have shown benefit on components of frailty including gait speed, strength, and low activity among PWH. When nonpharmacologic interventions are insufficient, pharmacologic interventions may be necessary. Many interventions have been tested in preclinical models, but few have been tested or shown benefit among older adults with or without HIV. Ultimately, pharmacologic and nonpharmacologic interventions have the potential to improve vulnerability that underlies frailty in PWH, though clinical data is currently sparse.

Motoric cognitive risk syndrome, physio-cognitive decline syndrome, cognitive frailty and reversibility with dual-task exercise

INTRODUCTION

Cognitive frailty (CF) is associated with dementia and disability. It was initially proposed in 2013 by the International Institute of Nutrition and Aging and the International Geriatrics Association. Over the years, there have been many emerging definitions e.g., Motoric Cognitive Risk Syndrome (MCR), Physio-cognitive Decline Syndrome (PCDS), reversible CF and potentially reversible CF.

OBJECTIVE

Our objective was to determine the demographics including physical, functional, and psychosocial factors for the four CF definitions amongst community-dwelling older adults. In addition, the effect of dual-task exercise on the reversibility of different definitions of CF was also studied.

METHODS

Participants were community-dwelling older adults aged ≥60 years recruited between August 2017 and December 2019. Older adults screened to be frail, prefrail or have cognitive impairment were invited to participate in dual-task exercise program called HAPPY (Healthy Ageing Promotion Program for You). Improvement in cognition, frailty, and physical performance after a 3-month dual-task exercise intervention program was compared with controls.

RESULTS

The prevalence of CF depending on definition ranged from 8.8% to 28.7% with minimal overlap. The cognitive scores were significantly lower in all the groups predominantly affecting non-memory domains except for reversible CF. Frailty was three to seven times more prevalent in CF. MCR group had higher prevalence of functional limitation, pain and depression. All four groups had significant increase in global cognition scores especially in the attention domain where the control group declined, and reduction in the prevalence of frailty post intervention. MCR and reversible CF were significantly associated with increased odds of cognitive improvement after 3 months of intervention compared with control.

CONCLUSION

CF is a novel concept and regardless of the definitions, is a target for reversing frailty, functional limitation and cognitive impairment through dual-task exercise. Long-term prospective studies are needed to evaluate the effectiveness of dual-task interventions in delaying the conversion to dementia and reduction of disability.

Nutritional domains in frailty tools: Working towards an operational definition of nutritional frailty

Different methods have been proposed for the assessment of the nutritional status in frailty phenotypes. In the present narrative review article, we have summarized the number and specifications of nutritional items in existing frailty tools, in order to develop a possible means of assessment and operational definition of the nutritional frailty phenotype. In six different databases until December 2019, we searched for original articles regarding frailty tools (i.e., scales, indexes, scores, questionnaires, instruments, evaluations, screening, indicators), analyzing each tool regarding nutritional items. We identified 160 articles describing 71 frailty tools. Among the selected frailty tools, 54 were community-based (70 %), 17 hospital-based (22 %), 4 validated in long-term care institutions for older adults (LTCIOA) (5.1 %) and 2 validated in both community- and hospital-based settings, including LTCIOA (2.5 %). Fifty-two of these tools (73 %) included at least one nutritional item. Twenty-two (42 %) reported two or more nutritional items. The items were grouped in the following categories: A) anthropometric measurements, B) laboratory measurements, and C) other nutritional-related measurements. Anthropometric measurements stood out compared to all other items. Nutritional items are included in the majority of frailty tools, strengthening the concept that they may have a direct implication on an increased risk of adverse health-related outcomes in frail subjects. This supports the development of the concept of nutritional frailty as an independent frailty phenotype. Subsequent steps will be to assess the contribution of each nutritional item to a possible operational definition of nutritional frailty and define the items that may best identify this new frailty phenotype.

CCCDTD5: Reducing the risk of later-life dementia. Evidence informing the Fifth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD-5)

The Fifth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD-5) was a year-long process to synthesize the best available evidence on several topics. Our group undertook evaluation of risk reduction, in eight domains: nutrition; physical activity; hearing; sleep; cognitive training and stimulation; social engagement and education; frailty; and medications. Here we describe the rationale for the undertaking and summarize the background evidence-this is also tabulated in the Appendix. We further comment specifically on the relationship between age and dementia, and offer some suggestions for how reducing the risk of dementia in the seventh decade and beyond might be considered if we are to improve prospects for prevention in the near term. We draw to attention that a well-specified model of success in dementia prevention need not equate to the elimination of cognitive impairment in late life.

Trimethylamine N-Oxide, a Gut Microbiota-Dependent Metabolite, is Associated with Frailty in Older Adults with Cardiovascular Disease

Objective

Our study aimed to explore the association between trimethylamine N-oxide and frailty in older adults with cardiovascular disease.

Patients and Methods

This cross-sectional study analyzed a total of 451 people aged 65 years or older who underwent comprehensive geriatric assessments. Frailty status was determined using a frailty index constructed with 48 variables according to the cumulative deficits model. Physical frailty and cognitive frailty were also assessed in detail. Fasting plasma TMAO was measured by mass spectrometry.

Results

The proportion of frail subjects was 29.9% (135/451). Plasma TMAO levels were significantly higher in frail patients than in nonfrail individuals (4.04 [2.84–7.01] vs 3.21 [2.13–5.03] µM; p<0.001). Elevated plasma TMAO levels were independently associated with the likelihood of frailty (OR 2.12, 95% CI 1.01–4.38, p=0.046). Dose–response analysis revealed a linear association between the TMAO concentration and the OR for frailty. A 2-unit increase in TMAO was independently correlated with physical frailty (OR 1.23, 95% CI 1.08–1.41, p for trend 0.002) and cognitive frailty (OR 1.21, 95% CI 1.01–1.45, p for trend 0.04).

Conclusion

Elevated circulating TMAO levels are independently associated with frailty among older adults with cardiovascular disease.

The prevalence of cognitive frailty and pre-frailty among older people in Bangkok metropolitan area: a multicenter study of hospital-based outpatient clinics

Objectives:

To identify the prevalence of, and factors associated with, cognitive frailty and prefrailty, and to investigate correlation between frailty tools.

Methods:

One hundred and ninety five older adults were recruited from the medical outpatient clinics of 3 tertiary hospitals in Bangkok metropolitan region. The data collected were demographic information, lifestyle factors, functional status, mood assessment, and cognitive and frailty assessments. The frailty tools used were Frailty Phenotype and FRAIL scale.

Results:

The prevalence of pre-frailty, frailty, mild cognitive impairment (MCI), cognitive pre-frailty and cognitive frailty was 57.4%, 15.9%, 26.2%, 14.4% and 6.7%, respectively. A multivariate analysis showed that age ≥70 years (OR 5.34; 95% CI 2.06-12.63), and education at primary school or under (OR 4.18; 95% CI 1.61-10.82) were associated with cognitive frailty and cognitive pre-frailty. The correlation between physical frailty rated by the Modified Fried Frailty Phenotype and the FRAIL scale was good (Kappa coefficient = 0.741).

Conclusions:

The prevalence of cognitive frailty is not uncommon which requires screening and interventions. Age and a low educational level were related to cognitive frailty/prefrailty. The FRAIL scale yielded a high correlation with Frailty phenotypes, implying its benefit in routine clinical use in primary care practice, where there is limited time and resources.

Precision prevention of Alzheimer's and other dementias: Anticipating future needs in the control of risk factors and implementation of disease-modifying therapies

Empirical evidence suggests that a fair proportion of dementia cases are preventable, that some preventive actions can be taken immediately, and others may soon be implemented. Primary prevention may target cognitively normal persons with modifiable risk factors through lifestyle and multiple domain interventions (including general cardiovascular health). While the effect on individuals may be modest, it might have a large societal impact by decreasing overall dementia incidence by up to 35%. Secondary prevention will target cognitively normal persons at high risk of dementia due to Alzheimer's disease pathology with future anti-amyloid, anti-tau, or other drugs. This approach is likely to have major benefits to both individuals and society. Memory clinics will need structural and functional changes to adapt to novel technologies and increased patients' demands, and brand-new services may need to be developed with specific skills on risk profiling, risk communication, and personalized risk reduction plans.

Dietary Factors Associated with Frailty in Old Adults: A Review of Nutritional Interventions to Prevent Frailty Development

Frailty syndrome is a medical condition that is characterised by a functional decline, usually from 65 years old on, and creates the need for assistance to perform daily living activities. As the population ages, the need for specialised geriatric care will increase immensely, and consequently, the need for specialised services for the care of these people will increase accordingly. From a nutritional point of view, to control or balance the nutritional status of residents will be essential in order to prevent sarcopenia and, consequently, frailty development. In this line, previous studies have highlighted the association among low energy intake, inadequate intake of protein and vitamin D, and an increased risk of frailty development. However, there is a lack of intervention studies on frail patients, especially in the realm of quality clinical trials. The few studies performed to date seem to indicate that there is a protective role of protein supplementation against frailty syndrome. In this regard, it is tempting to suggest daily 30 g protein supplements to prevent frailty. However, it is well established that excess protein can also be harmful; therefore, specific individual characteristics should be considered before prescribing these supplements. On the other hand, the relevance of other nutritional interventions, such as vitamin D, omega-3, and medium-chain triglycerides, is much more scarce in the literature. Therefore, we encourage the development of new clinical trials to carry out effective therapies to prevent frailty development.

Cognitive Frailty and Its Association with Nutrition and Depression in Community-Dwelling Older People

BACKGROUND

Cognitive frailty is a condition where physical frailty and mild cognitive impairment (MCI) co-exist. It is associated with increased risk of dementia and dependency. Previous studies reported that malnutrition and depression are associated with physical frailty and MCI; however, their relationships with cognitive frailty remained to be explored. The aims of this study were to examine the association of nutrition and depression with cognitive frailty, in comparison to having physical frailty or MCI alone.

METHODS

This study employed a cross-sectional design. Data collection was conducted in the community settings on the older people without dementia. Dependent variables were cognitive frailty, physical frailty, and MCI. The independent variables were depression and nutrition. Multi-nominal regression was employed to examine the relationships between the dependent and independent variables. The associations were adjusted by four known co-variates, including age, gender, education and APOE ε4 carrier status.

RESULTS

A total of 185 participants were recruited from four community centres and one elderly hostel and completed the data collection. Approximately 44.9% of the older people with physical frailty and 82.5% of elderly with MCI belonged to cognitive frailty. Multi-nominal regression models showed that depression is positively associated with cognitive frailty and with physical frailty, but not associated with solely MCI. Nutrition is negatively associated with cognitive frailty, but not associated with physical frailty or MCI alone.

CONCLUSION

Cognitive frailty is associated with malnutrition and depression. Therapeutic interventions managing depression and malnutrition may focus the older people with cognitive frailty to improve efficacy and cost-effectiveness.