Different Cognitive Frailty Models and Health- and Cognitive-related Outcomes in Older Age: From Epidemiology to Prevention

Screening tools for subjective cognitive decline and mild cognitive impairment based on task-state prefrontal functional connectivity: a functional near-infrared spectroscopy study

BACKGROUND

Subjective cognitive decline (SCD) and mild cognitive impairment (MCI) carry the risk of progression to dementia, and accurate screening methods for these conditions are urgently needed. Studies have suggested the potential ability of functional near-infrared spectroscopy (fNIRS) to identify MCI and SCD. The present fNIRS study aimed to develop an early screening method for SCD and MCI based on activated prefrontal functional connectivity (FC) during the performance of cognitive scales and subject-wise cross-validation via machine learning.

METHODS

Activated prefrontal FC data measured by fNIRS were collected from 55 normal controls, 80 SCD patients, and 111 MCI patients. Differences in FC were analyzed among the groups, and FC strength and cognitive scale performance were extracted as features to build classification and predictive models through machine learning. Model performance was assessed based on accuracy, specificity, sensitivity, and area under the curve (AUC) with 95 % confidence interval (CI) values.

RESULTS

Statistical analysis revealed a trend toward more impaired prefrontal FC with declining cognitive function. Prediction models were built by combining features of prefrontal FC and cognitive scale performance and applying machine learning models, The models showed generally satisfactory abilities to differentiate among the three groups, especially those employing linear discriminant analysis, logistic regression, and support vector machine. Accuracies of 92.0 % for MCI vs. NC, 80.0 % for MCI vs. SCD, and 76.1 % for SCD vs. NC were achieved, and the highest AUC values were 97.0 % (95 % CI: 94.6 %-99.3 %) for MCI vs. NC, 87.0 % (95 % CI: 81.5 %-92.5 %) for MCI vs. SCD, and 79.2 % (95 % CI: 71.0 %-87.3 %) for SCD vs. NC.

CONCLUSION

The developed screening method based on fNIRS and machine learning has the potential to predict early-stage cognitive impairment based on prefrontal FC data collected during cognitive scale-induced activation.

Assessing Social Interaction and Loneliness and Their Association with Frailty among Older Adults with Subjective Cognitive Decline or Mild Cognitive Impairment: An Ecological Momentary Assessment Approach

BACKGROUND

Frail older adults are at greater risk of adverse health-related outcomes such as falls, disability, and mortality. Mild behavioral impairment (MBI), which is characterized by neurobehavioral symptoms in individuals without dementia, is a crucial factor in identifying at-risk groups and implementing early interventions for frail older adults. However, the specific role of social functioning, which encompasses social interaction and loneliness levels, in relation to frailty within this group remains unclear.

OBJECTIVE

This study investigated the association between frailty status, social interaction frequency, and loneliness levels among older adults with subjective cognitive decline (SCD) or mild cognitive impairment (MCI), while adjusting for MBI symptoms in two contexts: the presence and severity of MBI symptoms.

METHODS

Older adults with SCD or MCI were recruited from an outpatient clinic specializing in the early diagnosis and care management of dementia at a community health center, as well as from a community service center in Seoul, South Korea. Using an ecological momentary assessment approach, participants reported their daily social interaction frequency and loneliness level via a mobile application, four times daily for two weeks. Frailty status, the outcome variable, was assessed using the Korean version of the Frailty Phenotype Questionnaire. Additionally, MBI symptoms were assessed using the 34-item MBI-Checklist covering five domains. Multinomial logistic regression analyses were performed to investigate the association between frailty status (robust, pre-frail, and frail), the independent variables, adjusting for the presence or severity of MBI symptoms.

RESULTS

Among the 101 participants analyzed, 29.7% were classified as pre-frail, and12.8% as frail. Higher average daily social interaction scores were consistently associated with lower odds of frail compared to robust status. This was evident in the models adjusted for both the global presence (relative risk ratio [RRR]: 0.18, p =.02) and global severity (RRR: 0.20, p =.02) of MBI symptoms.

CONCLUSIONS

Frequent social interaction was inversely associated with frail status in older adults with SCD or MCI, even after adjusting for the presence and severity of MBI symptoms. These findings highlight the potential of social functioning as a modifiable factor for addressing frailty among older adults at risk of cognitive and functional decline. Future prospective studies using real-time measurements are needed to refine these findings and further investigate additional risk factors and functional outcomes in this group.

CLINICALTRIAL

Longitudinal bidirectional association between hand grip strength and cognitive function in Chinese older adults: Evidence from the China health and retirement longitudinal study

ObjectiveThis study examined the longitudinal reciprocal association between handgrip strength and cognitive function and the temporal sequence of changes in both factors in a national longitudinal cohort of Chinese older adults.MethodData were derived from 3 waves (2011 baseline and 2013, 2015 follow-up) of the China Health and Retirement Longitudinal Study (CHARLS). Participants were those with no memory-related disorders at baseline and follow-up, and those who had complete handgrip strength and cognitive data. Handgrip strength in at least 1 hand was measured in all 3 waves. The highest recorded value during the handgrip test was used as the outcome of the strength measurement. Mental intactness and episodic memory were used to assess the overall cognitive function at each wave of data collection. Cross-lagged panel models were used to examine the relationship between handgrip strength and cognition over time.ResultsA total of 2550 participants were included in the data analysis. Age of participants at baseline was 60-83 years, and 43.9% were female (n = 1120). The 5.7% of participants with weak muscle strength (n = 145), had slightly lower cognitive function than those in the normal group. Cross-lag panel analysis showed that baseline overall cognitive scores predicted subsequent handgrip strength. At the same time, handgrip strength at baseline predicted subsequent overall cognitive scores. The results remained robust after accounting for confounding factors.ConclusionThere was a longitudinal bidirectional correlation between handgrip strength and cognitive function in elderly Chinese individuals. Future studies should determine whether interventions to improve 1 (e.g., handgrip strength) might slow the development of the other (e.g., cognitive function).

The multiple mediating effects of social support and depressive symptoms on the relationship between frailty and cognitive function in older patients with heart failure: A cross-sectional study

AIMS

The aim of this study was to test the multiple mediating effects of social support and depression symptoms on the relationship between frailty and cognitive function in older patients with heart failure.

METHODS AND RESULTS

We used a convenience sampling method to recruit 444 older patients with heart failure who met the inclusion criteria from a university-affiliated general hospital. Multiple mediation analyses revealed that the relationship between frailty and cognitive function was influenced by social support (effect: -0.383, 95% CI [-0.774, -0.072]) and depressive symptoms (effect: -0.349, 95% CI [-0.710, -0.134]) both individually and in tandem (effect: -0.276, 95% CI [-0.591, - 0.106]).

CONCLUSION

Social support and depressive symptoms are multiple mediators of the relationship between frailty and cognitive function. Healthcare providers should implement interventions that focus on maximizing social return and minimizing depressive symptoms to mitigate the decline in cognitive function.

A systematic review of assessment tools for cognitive frailty: Use, psychometric properties, and clinical utility

BACKGROUND

The concept of 'cognitive frailty' (CF) was first developed by an international consensus group in 2013 and defined as evidence of both physical frailty and cognitive impairment without a clinical diagnosis of AD or another dementia. CF has been associated with adverse health outcomes and early identification is vital. Difficulty in the assessment of CF however is the lack of a diagnostic gold standard.

OBJECTIVES

This review aimed to identify assessment tools used to diagnose cognitive impairment in the diagnosis of cognitive frailty, their psychometric qualities and clinical utility.

RESEARCH DESIGN AND METHODS

Six databases were searched between 2013-2024. Studies were eligible if they reported a method of defining cognitive frailty, named the assessment tools, and stated cutoff values used to define cognitive impairment.

RESULTS

In the 116 included studies, large heterogeneity was found in the tools utilised, and cutoff scores applied, to diagnose cognitive impairment in the diagnosis of cognitive frailty. This review has demonstrated that diagnosis of CF relies predominantly on the use of three cognitive assessment tools (Mini Mental State Examination, Montreal Cognitive Assessment, Clinical Dementia Rating) from a total of 22 different tools identified in the literature. For assessment of physical frailty, 11 different tools were identified, with the Fried Frailty Index and FRAIL Scale predominantly utilised.

DISCUSSION AND IMPLICATIONS

The variation in the tools used to identify the diagnosis of CF means there is inconsistency in reporting, potentially impacting both the understanding of the prevalence, and the appropriate direction of intervention strategies.

Effect of Regular Exercise on Cognitive Frailty in the Elderly: A Systematic Review

OBJECTIVES

As one of the common senile syndromes characterized by the co-existence of physical frailty and cognitive impairment without dementia, the occurrence of cognitive frailty (CF) increases the risk of adverse health outcomes in older adults. However, its reversibility has attracted the interest of researchers in the search for effective interventions. A growing number of studies have been conducted to investigate the effect of regular physical exercise intervention on cognitive frailty in older adults with CF, but findings remain inconclusive. This study aimed to synthesize the pooled effect of current regular exercise intervention in community-dwelling older adults with cognitive frailty.

METHODS

Nine electronic databases (Cochrane Library, PubMed, EBSCOHost, Web of Science, Scopus, CNKI, Wanfang Database, VIP and SinoMed) were searched from their inception to 15 May, 2024. The Cochrane risk-of-bias tool (ROB 2) for RCTs was applied to assess the methodological quality. The mean difference or standardized mean difference with 95% CIs was calculated by using Stata 18.0.

RESULTS

Seventeen eligible studies involving a total of 2239 participants were included. The pooled results showed that older adults with CF in the intervention group had significant improvement in global cognitive function performance (MMSE scores: MD = 1.93 95% CI: 1.02 to 2.85, p < .0001, and MoCA scores: MD = 3.24, 95% CI: 1.57 to 4.91, p < .0001), executive function (time of TMT-B test: MD = -20.73, 95% CI: -33.96 to -7.50, p = .002), physical frailty state (Fried frailty phenotype scores: MD = -1.48, 95% CI: -2.37 to -0.58, p = .001, and EFS scores: MD = -0.81 points, 95% CI: -1.13 to -0.49, p < .0001), grip strength (SMD = 0.92, 95% CI: 0.15 to 1.07, p = .02), gait and balance (time of TUG: MD = -2.62, 95% CI: -4.12 to -1.11, p = .001), balance (BBS scores: MD = 8.56, 95% CI:- 3.37 to 13.75, p = .001) and quality of life (SMD = 0.75, 95% CI: 0.30 to 1.21, p = .001).

CONCLUSIONS

More than eight weeks of regular exercise interventions may improve global cognitive function and physical frailty status, but the effect on specific domains of cognitive or physical function needs further study to confirm.

Strides towards healthy longevity: Harnessing the power of sports and elements of Kathak, an Indian classical dance form through social participation to combat cognitive frailty among older adults

Aging brings with it many health issues that can make life challenging. As much of the attention is given to non-communicable diseases, there are others which are slowly becoming a matter of great concern. One such issue is cognitive frailty, which is a high risk factor for dementia, falls, fractures and hospitalization. Though not yet declared a public health concern, it deserves early detection and prevention strategies. As it is reversible if treated on time, there is a need to look into its prevention and cure. Physical activity has proven to be very effective in the treatment of cognitive frailty. This scoping review thus aims to study the impact of physical activity through social participation on cognitive frailty. The authors recommend that focussing on one's muscular fitness through participation in sports and elements of Indian classical dance form like Kathak in groups/ communities can be a very effective way of combating cognitive frailty among older adults.

Development and validation of a dynamic nomogram for predicting cognitive impairment risk in older adults with dentures: analysis from CHARLS and CLHLS data

BACKGROUND AND AIMS

Cognitive impairment is a common issue among older adults, with denture use identified as a potential, easily recognizable clinical risk factor. However, the link between denture wear and cognitive decline in older Chinese adults remains understudied. This study aimed to develop and validate a dynamic nomogram to predict the risk of cognitive impairment in community-dwelling older adults who wear dentures.

METHODS

We selected 2066 elderly people with dentures from CHARLS2018 data as the development and internal validation group and 3840 people from CLHLS2018 as the external validation group. Develop and treat the concentrated unbalanced data with the synthetic minority oversampling technique, select the best predictors with the LASSO regression ten-fold cross-validation method, analyze the influencing factors of cognitive impairment in the elderly with dentures using Logistic regression, and construct a nomogram. Subject operating characteristic curves, sensitivity, specificity, accuracy, precision, F1 score, calibration curve, and decision curve were used to evaluate the validity of the model in terms of identification, calibration, and clinical validity.

RESULTS

We identified five factors (age, residence, education, instrumental activities of daily living, and depression) to construct the nomogram. The area under the curve of the prediction model was 0.854 (95%CI 0.839-0.870) in the development set, 0.841 (95%CI 0.805-0.877) in the internal validation set, and 0.856 (95%CI 0.838-0.873) in the external validation set. Calibration curves indicated significant agreement between predicted and actual values, and decision curve analysis demonstrated valuable clinical application.

CONCLUSIONS

Five risk factors, including age, place of residence, education, instrumental activities of daily living, and depression level, were selected as the final nomogram to predict the risk of cognitive impairment in elderly denture wearers. The nomogram has acceptable discrimination and can be used by healthcare professionals and community health workers to plan preventive interventions for cognitive impairment among older denture-wearing populations.

Investigating Modifiable Factors Associated with Cognitive Decline: Insights from the UK Biobank

Objectives: Given the escalating global prevalence of age-related cognitive impairments, identifying modifiable factors is crucial for developing targeted interventions. Methods: After excluding participants with dementia and substantial missing data, 453,950 individuals from UK Biobank (UKB) were included. Cognitive decline was assessed across four cognitive domains. The top 10% exhibiting the greatest decline were categorized as the "Cognitively At-Risk Population". Eighty-three potential factors from three categories were analyzed. Univariate and multivariate Cox proportional hazards models were employed to assess the independent and joint effects of these factors on cognitive decline. Population Attributable Fractions (PAFs) were calculated to estimate the potential impact of eliminating each risk category. Results: Our findings revealed a significant impact of unfavorable medical and psychiatric histories on processing speed and visual episodic memory decline (Hazard Ratio (HR) = 1.34, 95% CI: 1.20-1.51, p = 6.06 × 10⁻7; HR = 1.50, 95% CI: 1.22-1.86, p = 1.62 × 10⁻4, respectively). Furthermore, PAF analysis indicated that physiological and biochemical markers were the most critical risk category for preventing processing speed decline (PAF = 7.03%), while social and behavioral factors exerted the greatest influence on preventing visual episodic memory decline (PAF = 9.68%). Higher education, socioeconomic status, and handgrip strength emerged as protective factors, whereas high body mass index (BMI), hypertension, and depression were detrimental. Conclusions: By identifying this high-risk group and quantifying the impact of modifiable factors, this study provides valuable insights for developing targeted interventions to delay cognitive decline and improve public health outcomes in middle-aged and older adults.

Epigenetic factors and inflammaging: FOXO3A as a potential biomarker of sarcopenia and upregulation of DNMT3A and SIRT3 in older adults

Background

Epigenetic factors influence inflammaging and geriatric disorders such as sarcopenia and frailty. It is necessary to develop a biomarker/panel of biomarkers for fast and easy diagnostics. Currently, hard-to-access equipment is required to diagnose sarcopenia. The development of a biomarker/panel of biomarkers will prevent many older adults from being excluded from the diagnostic process.

Methods

In this study, we analyzed selected gene expression profiles, namely, SIRT1, SIRT3, SIRT6, DNMT3A, FOXO1, FOXO3A, and ELAVL1, in whole blood. The study included 168 subjects divided into five groups: patients hospitalized at the Geriatrics Clinic and Polyclinic with sarcopenia, frailty syndrome, or without those disorders (geriatric control), and non-hospitalized healthy controls (HC) aged 25 to 30 years and over 50 years.

Results

We revealed a lower mRNA level of FOXO3A (p<0.001) in sarcopenic patients compared to the geriatric controls. Furthermore, we detected upregulation of DNMT3A (p=0.003) and SIRT3 (p=0.015) in HC over 50 years old compared to HC aged 25 to 30 years. Interestingly, we observed 2 cluster formations during the gene expression correlation analysis (SIRT1, SIRT3, DNMT3A, and FOXO1, ELAVL1). We also noted correlations of clinical parameters with mRNA levels in the sarcopenic patients group, such as vitamin D level with SIRT1 (r=0.64, p=0.010), creatine kinase with SIRT3 (r=-0.58, p=0.032) and DNMT3A (r=-0.59, p=0.026), creatinine with DNMT3A (r=0.57, p=0.026), erythrocyte sedimentation rate (ESR) with FOXO3A (r=0.69, p=0.004), and lactate dehydrogenase (LDH) with FOXO3A (r=-0.86, p=0.007). In the frailty syndrome group, we noted a correlation of appendicular skeletal muscle mass (ASMM) with ELAVL1 (r=0.59, p=0.026) mRNA level. In the geriatric controls, we observed a correlation of serum iron with FOXO3A mRNA level (r=-0.79, p=0.036).

Conclusions

Our study revealed FOXO3A as a potential biomarker of sarcopenia. Furthermore, we observed a high expression of epigenetic factors (DNMT3A and SIRT3) in older adults.

Lower Urinary Tract Symptoms and Fall Risk: An Important Problem in Older Women with Cognitive Frailty

INTRODUCTION AND HYPOTHESIS

The objective of our study is to investigate the presence of lower urinary tract symptoms (LUTS) and its correlation with the risk of falling in older women with cognitive frailty.

METHODS

The descriptive study was conducted on 102 female older adults, 60 women were classed as cognitively frail and 42 as healthy. Women were classified as having mild cognitive impairment based on the Clinical Dementia Rating Scale and as frail based on the Clinical Frailty Scale. The Bristol Female Lower Urinary Tract Symptoms questionnaire and Timed Up and Go test were applied to determine LUTS and fall risk respectively.

RESULTS

Cognitively frail women scored considerably higher for LUTS including quality of life, filling, incontinence, and voiding, than the healthy group (p < 0.001). Timed Up and Go test seconds were significantly longer in cognitively frail women (p < 0.001).

CONCLUSIONS

These data suggest the notion that cognitive frailty might increase the risk of LUTS and falls. Older women at high fall risk are more likely to have LUTS. Thus, health practitioners must recognize that embarrassment may prevent individuals from seeking urinary care. Even in the absence of patient complaints, older women with cognitive frailty should have a comprehensive fall history and LUTS testing. Implementing LUTS and fall-risk measures may avoid future falls and serious complications such as fractures.

Association of Cognitive Frailty With Subsequent All-Cause Mortality Among Middle-Aged and Older Adults in 17 Countries

OBJECTIVES

Cognitive frailty refers to the co-occurrence of cognitive impairment and frailty without concurrent Alzheimer's disease or dementia. Studies of cognitive frailty and mortality have been limited to single country or older people. However, frailty and cognitive decline may occur much earlier. We aimed to examine the association between different cognitive frailty status and subsequent all-cause mortality among middle-aged and older people in 17 countries.

METHODS

Participants aged 50 and over were drawn from six prospective cohorts of aging. We classified participants according to their cognitive impairment and frailty status into the following groups: none, only cognitive impairment, only frailty and cognitive frailty. Competing-risks regression models were used to evaluate the association of different cognitive frailty status at baseline with subsequent all-cause mortality.

RESULTS

The cognitive frailty group had a higher mortality risk compared to those without cognitive impairment and frailty groups. Meta-analysis results showed participants with cognitive frailty (pooled subhazard ratio [SHR] = 2.34, 95% confidence interval [CI]: 2.01-2.72, I2 = 68.0%) had a higher mortality risk compared with those with only cognitive impairment status (pooled SHR = 1.36, 95% CI: 1.25-1.48, I2 = 3.0%) or only frailty status (pooled SHR = 1.83, 95% CI: 1.72-1.95, I2 = 31.0%). The association between cognitive frailty and mortality were stronger among those who were aged 70 years and older, males, single and nonconsumers of alcohol.

CONCLUSIONS

Cognitive frailty, frailty or cognitive impairment alone, is associated with an increased risk of all-cause mortality in Asian, European and American countries. Physical and cognitive function screening should be conducted as early as possible in middle-aged and older people, and targeted intervention approaches should be developed to reduce the incidence of adverse health outcomes.

Update on Perioperative Delirium

A strong association between frailty and in-hospital delirium in nonsurgical patients has been shown. Physical and cognitive frailties have been associated with decline and dysfunction in the frontal cognitive domains. Risk factors for frailty are similar to risk factors for postoperative delirium (POD). Frailty can be screened and diagnosed by various tools and instruments. Different anesthetic techniques have been studied to decrease the incidence of POD. However, no anesthetic technique has been conclusively proven to decrease the risk of POD. Patients with dementia develop delirium more often, and delirium is associated with accelerated cognitive decline.

Motivation, barriers and preferences of lifestyle changes among older adults with frailty and mild cognitive impairments: A scoping review of qualitative analysis

Lifestyle intervention has proven effective in managing older adults' frailty and mild cognitive impairment issues. What remains unclear is how best to encourage lifestyle changes among older adults with frailty and Mild Cognitive Impairment (MCI). We conducted searches in electronic literature searches such as PubMed, Scopus, Cochrane Reviews, ProQuest, and grey resources to find articles published in English between January 2010 and October 2023. This review focused on research using a qualitative study design. We extracted data on publication year, location, the aim of the study, study population, involved intervention, barriers, motivations, and preferences reported in the articles. Out of 5226 retrieved, 253 articles were selected after the deletion of duplicates, title, abstract screening, and. We included fourteen articles for final analysis at the end of the review process. The two main themes generated from this review are intrinsic and extrinsic factors in motivations and barriers to lifestyle changes. The most reported motivators were the perceived benefits of lifestyle intervention and self-efficacy. Among the obstacles participants face are perceived adverse effects of intervention, lack of knowledge, existing impairment (physical or mental), and social support. Lifestyle change motivations and barriers among older adults mainly were intrinsic factors such as the perceived benefit of the intervention, self-efficacy, knowledge, familial commitment, and existing impairments. There is a need to empower older adults to overcome the barriers with support from healthcare professionals, the community, and the family.

A qualitative study on the impact and participation in the AGELESS multidomain intervention: Insights from older adults with cognitive frailty and their caregivers

BACKGROUND

Cognitive frailty (CF) is a major precursor to dementia, and multidomain interventions have the potential to delay, prevent or reverse its early onset. However, the successful translation and sustainability of such interventions in real-life settings remain uncertain. In this study, we aimed to explore the insights of older adults with CF and their caregivers regarding the impact and participation in the AGELESS multidomain intervention.

METHODS

This qualitative study was conducted following the completion of AGELESS multidomain intervention. Semi-structured interviews covering domains such as perceptions, benefits, barriers, facilitators, and program preferences were conducted among 17 older adults with CF and 10 caregivers following the completion of the intervention. The data obtained were transcribed verbatim and analyzed using thematic analysis. Each transcript was reviewed and coded to identify prevailing themes derived from the interview data.

RESULTS

The analysis revealed five distinct themes: (1) impact of the program, (2) facilitators enhancing participation, (3) barriers hindering participation, (4) suggestions for improving participation and (5) challenges to adopt digital platforms. Based on the findings, the AGELESS multidomain intervention had a positive impact on the participants and their caregivers. It was noted that they showed preference for in-person sessions over virtual ones. The study highlighted key factors critical for successful participation, including diversity and inclusivity. It emphasized incorporating a multi-component, group-based approach with social aspects. The intervention should be people-centered, dignified, affordable, and customized to meet the unique needs of each participant.

CONCLUSIONS

The AGELESS multidomain intervention was well received by older adults with CF and their caregivers who participated in this study. Moving forward, it is recommended that future initiatives focus on identifying opportunities to implement existing evidence-based programs on a larger scale for the prevention of dementia in older adults.

Structural dimensions of physical function and their associations with working memory in adults aged 60-74 years

The association between physical function and working memory in older adults is moderated by structural dimensions of physical function, but it is unclear which structural dimensions of physical function are associated with working memory in healthy older adults. The purpose of this study was to construct the structural dimensions of physical function and assess their associations with working memory in adults aged 60-74 years to provide potential targets for earlier identification and interventions of physical function and working memory decline in older adults. To this end, data from 664 to 589 eligible older adults were used for factor analysis and structural equation modeling, respectively. A constructed structural model of three factors of physical function had good reliability and validity. The structural dimensions of physical function in adults aged 60-74 years were mobility and dynamic balance, muscular strength and cardiorespiratory endurance. Physical function in older adults was closely associated with working memory, with mobility and dynamic balance-but not muscular strength and cardiorespiratory endurance- closely associated with working memory.

Cognitive frailty as a predictor of hospitalisation among older adults: a systematic review and meta-analysis

To examine whether cognitive frailty serves as a predictor of hospitalisation in older adults. PubMed, Web of Science, Embase, Scopus and Cochrane Library databases were systematically searched from inception to February 6, 2024. The reviewers independently selected studies, extracted data and evaluated the quality of studies. Stata 15.1 Software was used to perform the meta-analysis. A total of 13 articles were included in this study, including 34 230 participants. The results suggested that cognitive frailty was associated with hospitalisation in older adults (odds ratio (OR) = 1.79, 95% CI: 1.33-2.42, P < 0.001). The risk of hospitalisation for patients with cognitive frailty was 1.76 times higher than that for patients without cognitive frailty (relative risk = 1.76, 95% CI: 1.48-2.08, P < 0.001). According to different models of cognitive frailty, the results of subgroup analysis showed that the frail + cognitive impairment group had the highest risk of hospitalisation (OR = 2.22, 95% CI: 1.51-3.26, P < 0.001). Subgroup analysis based on study design showed that the incidence of hospitalisation was lowest in the cohort study group (OR = 1.51, 95% CI: 1.14-2.00, P = 0.004). This study suggested that cognitive frailty was an important predictor of hospitalisation in older adults. Future studies are needed to investigate the impact of cognitive frailty on hospitalisation in older adults, as this may help reduce hospitalisation rates and improve patients' quality of life.

Synergistic Effects of Omega-3 Fatty Acids and Physical Activity on Oxidative Stress Markers and Antioxidant Mechanisms in Aged Rats

BACKGROUND

Aging induces degenerative processes in the body, contributing to the onset of various age-associated diseases that affect the population. Inadequate dietary habits and low physical activity are major contributors to increased morbidity during aging. This study aimed to investigate the combined effects of omega-3 fatty acid supplementation and physical activity on the markers of oxidative stress and antioxidant defense mechanisms in aged male Wistar rats (23-24 months).

METHODS

The rats were randomly divided into four experimental groups: a sedentary control (placebo, no exercise), a trained (placebo and moderate-intensity graded aerobic exercise; Ex), and two trained groups supplemented with low (160 mg/kg of body weight; O1 + Ex) and high (320 mg/kg of body weight; O2 + Ex) doses of omega-3 fatty acids. The biochemical and functional parameters related to sarcopenia and the markers of oxidative stress were measured in blood and gastrocnemius muscle.

RESULTS

The results demonstrated dose-dependent, synergistic effects of omega-3 fatty acid supplementation and physical activity. The higher dose (320 mg/kg of body weight) improved plasma antioxidant capacity (TEAC, +21.01%, p < 0.01) and GPx activity (+78.05%, p < 0.05) while reducing CAT activity in erythrocytes (-19.92%, p < 0.05), likely as an adaptive stress response. Combined interventions also normalized cholesterol levels, improved the functional parameters of sarcopenia (stride length, +14.82%, p < 0.001), and enhanced antioxidant protection in aged rats.

CONCLUSIONS

These findings highlight the potential of combining omega-3 fatty acid supplementation and physical activity to counteract aging-related degenerative changes. Further research is needed to elucidate the underlying mechanisms and evaluate the long-term benefits of these strategies in aging populations.

Exploring the mediating roles of depression and cognitive function in the association between sarcopenia and frailty: A Cox survival analysis approach

BACKGROUND

Despite earlier research indicating a potential link between the development of sarcopenia and an elevated risk of frailty, the lack of comprehensive prospective data on the correlation between sarcopenia and frailty incidence leaves open the question of whether depression and cognitive function mediate this association.

OBJECTIVE

The principal aim of the current investigation was to evaluate the intricate interplay among sarcopenia, depression, and cognitive function collectively influence the risk of developing frailty.

METHODS

The participants included in this study were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS), which collectively encompassed a total of 3,108 participants. To examine the interrelationships among sarcopenia, depression, cognitive function, and the incidence of frailty, we employed Cox regression models along with structural equation modelling, while making necessary adjustments for baseline demographic characteristics and various lifestyle factors.

RESULTS

During a 4-year follow-up, we documented 753 frailty events. Compared to those with nonsarcopenia, those with possible sarcopenia and sarcopenia presented risk ratios for frailty events of 1.354 (95 % CI: 1.156, 1.586) and 1.514 (95 % CI: 1.203, 1.907), respectively. Stratified analyses by different statuses of sarcopenia further revealed that the significant effect of depression on frailty was present across all groups (nonsarcopenia, possible sarcopenia and sarcopenia), whereas the effect of cognitive function on frailty was limited to the non-sarcopenia and possible sarcopenia groups. Mediation analysis showed that sarcopenia was correlated not only with frailty through depression and cognitive function separately but also through a chain-mediated effect of depression and cognitive function together.

CONCLUSIONS

Sarcopenia is associated with frailty, depression and cognitive function playing partial, mediating roles. Frailty's susceptibility to depression and cognitive function differs based on sarcopenia status. Therefore, comprehensive interventions that include sarcopenia screening, interventions, improvements in depression, the promotion of mental health, and delays in cognitive decline will be more effective in preventing and delaying frailty. This effectiveness is particularly relevant for middle-aged and older adults who reside in China.

Risk Factors and Diagnostic Model Construction of Chronic Pain with Cognitive Impairment

Background

Cognitive impairment (CI) is frequently observed in patients with chronic pain (CP). CP progression increases the risk of dementia and accelerates Alzheimer's disease pathogenesis. However, risk diagnostic models and biomarkers for CP-related CI remain insufficient. Previous research has highlighted the relationships between several complete blood count parameters for CP or CI-related diseases, such as Alzheimer's disease, while the specific values of complete blood count parameters in CP-related CI patients remain unclear. This study aimed to explore the correlation between complete blood count parameters and CP-related CI to establish a risk diagnostic model for the early detection of CP-related CI.

Methods

This cross-sectional study was conducted at West China Hospital, Sichuan University. The Montreal Cognitive Assessment (MoCA) was used to classify patients into either the CP with CI group or the CP without CI group. Univariate analysis and multivariate logistic regression analysis were used to screen the related factors of CP-related CI for constructing a risk diagnostic model, and the model was evaluated using receiver operating characteristic (ROC) curve analysis.

Results

The study ultimately included 163 eligible patients. Based on analysis, age (OR, 1.037 [95% CI, 1.007-1.070]; P=0.018), duration of pain (OR, 2.546 [95% CI, 1.099-6.129]; P=0.032), VAS score (OR, 1.724 [95% CI, 0.819-3.672]; P=0.153), LMR (OR, 0.091 [95% CI, 0.024-0.275]; P<0.001), absolute neutrophil value (OR, 0.306 [95% CI, 0.115-0.767]; P=0.014), and lymphocyte percentage (OR, 6.551 [95% CI, 2.143-25.039]; P=0.002) were identified as critical factors of CP-related CI. The diagnostic model was evaluated by the ROC curve, demonstrating good diagnostic value with an area under the curve (AUC) of 0.803, a sensitivity of 0.603 and a specificity of 0.871.

Conclusion

The risk diagnostic model developed in this study for CP-related CI has significant value and enables clinicians to customize interventions based on each patient's needs.

The mitochondrial function of peripheral blood cells in cognitive frailty patients

Background

Cognitive frailty (CF), characterized by the coexistence of physical frailty and cognitive impairment, is linked to increased morbidity and mortality in older adults. While CF has been linked to multiple physiological and lifestyle factors, the underlying biological mechanisms remain poorly understood. This study investigated the risk factors for CF and explored the relationship between mitochondrial function and CF in hospitalized patients.

Methods

A total of 279 hospitalized individuals were recruited from December 2020 to August 2022, conducted comprehensive clinical assessments, and collected peripheral blood samples. CF was evaluated using the Physical Frailty Phenotype and Montreal Cognitive Assessment scales. Nutritional status was assessed with the Mini Nutritional Assessment, and depression was measured using the Geriatric Depression Scale. DNA was obtained from the peripheral blood and interrogated for mitochondrial DNA copy number (mtDNAcn). Peripheral blood mononuclear cells isolated from peripheral blood were examined for respiratory function and reactive oxygen species (ROS) levels. Additionally, plasma samples were analyzed for inflammatory markers and Carnitine Palmitoyltransferase II (CPT2).

Results

Among the participants, 90 were classified as CF and 46 as non-CF. Logistic regression analysis revealed that increased age (OR 1.156, 95% CI 1.064-1.255), lower educational attainment (OR 0.115, 95% CI 0.024-0.550), malnutrition (OR 0.713, 95% CI 0.522-0.973), and higher depression scores (OR 1.345, 95% CI 1.065-1.699) were significantly associated with CF. The independent t tests and Mann-Whitney U tests showed the CF group exhibited impaired mitochondrial function, characterized by reduced mtDNAcn and respiratory activity, coupled with elevated ROS, interleukin-6, and CPT2 levels compared with the non-CF group. After adjusted for age, sex, and BMI, compared with non-CF group, the OR values for the CF group of mtDNAcn and ROS were 0.234 (95% CI = 0.065-0.849) (p = 0.027) and 1.203 (95% CI = 1.075-1.347) (p = 0.001), respectively. The Sensitive analysis showed that the area under curve values for mtDNAcn and ROS were 0.653 and 0.925.

Conclusion

Age, lower educational attainment, malnutrition, and depression are significant risk factors for CF. Moreover, mitochondrial dysfunction, characterized by decreased mtDNAcn, impaired respiratory function and increased ROS levels appears to be a critical phenotype of CF.

Association between frailty and adverse outcomes in patients undergoing maintenance hemodialysis: a systematic review and meta-analysis

OBJECTIVES

The aim of this study was to determine the strength of the association between frailty and adverse outcomes in patients undergoing maintenance hemodialysis.

DESIGN

A systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Patients aged ≥18 years who were undergoing maintenance hemodialysis.

METHODS

PubMed, Web of Science, Embase, the Cochrane Library, Scopus, the China Knowledge Resource Integrated Database, the Wanfang Database and the Weipu Database were searched from inception until 11 April 2024. The reviewers independently selected the studies, extracted the data and evaluated the quality of the studies. Stata 15.1 software was used to perform the meta-analysis.

RESULTS

A total of 36 articles were included in this study, including 56,867 patients. The primary outcome events in this study were mortality, hospitalization, and vascular access events. The secondary outcomes were depression, cognitive impairment, falls, fracture, sleep disturbances, and quality of life. This study suggested that frailty was associated with mortality in patients undergoing maintenance hemodialysis [hazard ratio (HR), 1.97; 95% CI, 1.62-2.40]. Frailty increased the risk of mortality in patients [odds ratio (OR), 2.33; 95% CI, 1.47-3.68]. In addition, we found that frailty was significantly associated with hospitalization in patients undergoing maintenance hemodialysis (OR, 2.47; 95% CI, 1.52-4.03). Patients who were undergoing maintenance hemodialysis and who were frail had a greater risk of hospitalization [RR, 1.47; 95% CI, 1.05-2.08] and emergency visits (RR, 2.28; 95% CI, 1.78-2.92). The results of this study also suggested that frailty was associated with a greater risk of vascular access events (HR, 1.72; 95% CI, 1.50-1.97). Finally, frailty increased the risk of depression (OR, 4.31; 95% CI, 1.83-10.18), falls and fractures, and reduced quality of life.

CONCLUSIONS

The findings of this study suggested that frailty was an important predictor of adverse outcomes in patients undergoing maintenance hemodialysis. In the future, medical staff should regularly evaluate signs of weakness, formulate individual diagnosis and treatment plans, adjust dialysis plans according to the patient's condition, and reduce the occurrence of adverse events.

REGISTRATION

The study protocol was registered on PROSPERO (https://www.crd.york.ac.uk/PROSPERO/, number: CRD42023486239).

Transition of Physical, Psychological, and Cognitive Frailty and Its' Associated Determinants in Malaysian Older Adults: A 5-Year Follow-up Study

Frailty, a multifaceted syndrome, affects approximately 26% of older adults globally, yet there are limited data on the prevalence and longitudinal impact of frailty subtypes. Therefore, in this study, we aim to determine the prevalence of physical, psychological, and cognitive frailty, transitions between subtypes, and associated health determinants among Malaysian community-dwelling older adults. This study is part of the longitudinal aging study in Malaysia (LRGS Ageless and TUA). We assessed 815 older adults in 2014, with successful follow-up of 402 participants (mean age: 67.08 ± 5.38 years) after 5 years. Frailty subtypes were assessed at baseline, and transitions were evaluated at the 5-year mark. At baseline, the prevalence of older adults categorized as robust, physical frailty, cognitive frailty, and psychological frailty was 26.7%, 36.3%, 12.1%, and 16.7%, respectively, with 8.1% exhibiting concurrent psychological and cognitive frailty. Follow-up results showed that 22.9% remained robust, 46.8% experienced no change, 24.9% deteriorated (adversed), and 5.5% improved (reversed). Logistic regression analysis identified living alone (p < 0.001), increased body fat percentage (p < 0.05), increased waist circumference (p < 0.05), reduced fat-free mass (p < 0.05), decreased lower limb flexibility (p < 0.05), and declined cardiorespiratory fitness (p < 0.05) as significant predictors of frailty deterioration. Higher Mini Mental State Examination (MMSE) scores and improved Timed Up and Go and Chair Stand test results (p < 0.05) were significantly associated with the reversal of frailty subtypes (p < 0.05). Younger older adults (p < 0.001), males (p < 0.05), those with lower WHO Disability Scale scores (p < 0.05), and higher MMSE scores (p < 0.05) were significantly less likely to develop frailty subtypes. Intervention strategies that focus on combined physical, cognitive, and psychosocial functions are crucial for both reversing and preventing the progression of frailty subtypes in older adults.

Prevalence and influencing factors of cognitive frailty among Chinese older adults: A systematic review and meta-analysis

AIMS

Cognitive frailty refers to the coexistence of physical frailty and cognitive impairment in older adults, without a concurrent diagnosis of Alzheimer's disease or other dementias. This review aims to evaluate the prevalence of CF subtypes and identify influencing factors among Chinese older adults.

METHODS

The following databases were searched: PubMed/Medline, Embase, Cochrane Library, WOS, PsycINFO and CNKI et al (1 January 2001 to 20 October 2022). The risk of bias was assessed using the Agency for Healthcare Research and Quality Evidence-based Practice Center Methods Guide. Stata 17.0 software was used to pool the prevalence of cognitive frailty, and the pooled odds ratio and 95% CI of the influencing factors were calculated.

RESULTS

The meta-analysis (56 studies and 80,320 participants) revealed the following prevalence rates: CF (18.9%), reversible CF (19.5%), potentially reversible CF (17.5%), CF in community-dwelling older adults (14.3%), CF in nursing homes (22.7%) and CF in older inpatients (25.2%). Influential factors identified included age, gender, education, nutrition, depression, exercise, sleep and comorbidity.

CONCLUSIONS

The prevalence of CF among Chinese older adults is notably high, and it probably underestimates the prevalence of reversible cognitive frailty. It is crucial to encourage adherence to healthy behaviours, as it can effectively reduce and delay the onset of cognitive frailty.

The effectiveness of multicomponent exercise in older adults with cognitive frailty: a systematic review and meta-analysis

BACKGROUND

Cognitive frailty, intimately tied to adverse outcomes such as falls, early mortality, and hospitalization, represents a dynamic, reversible process. Multicomponent exercise has emerged as one of the most potent means of mitigating cognitive frailty.

AIMS

This research seeks to quantitively amalgamate the effects of multicomponent exercise on various domains: cognitive function, frailty status, and other health-related outcomes in cognitively frail older adults.

METHODS

Our methodology entailed a comprehensive review of literature in databases including PubMed, EMbase, CINAHL, Cochrane Library, Web of Science, Wanfang, Sinomed, VIP, and CNKI from the inception of these databases to December 10, 2023. For our statistical analysis, we utilized RevMan 5.3, Stata 17.0 and R 4.3.2 software. Adherence was maintained to the PRISMA checklist, with the study being registered with PROSPERO (CRD42024499808).

RESULTS

Our review encapsulated a total of 2,222 participants and 11 trials. The findings intimate that multicomponent exercise enhances cognitive function [MD = 2.52, p = 0.03]), grip strength[SMD = 0.39, p = 0.008] and lower limb muscle strength[MD = 4.30, p < 0.001], while alleviating frailty[MD = -2.21, p < 0.001] and depression [MD = -1.20, p = 0.001]. However, cogent evidence is still lacking to endorse the positive effects of multicomponent exercises on both ADL(p = 0.19) and quality of life(p = 0.16). Subgroup analyses revealed beneficial effects on cognitive frailty for multicomponent exercise whose type of exercise consisted of aerobic, the duration of which exceeded 120 min per week, and whose form of exercise was group exercise.

CONCLUSION

Multicomponent exercises offer significant improvements in cognitive function, muscle strength, and have the added benefit of reducing frailty and depression in older adults. However, these exercises do not appear to influence activities of daily living and quality of life positively.

Risk factors analysis of cognitive frailty among geriatric adults in nursing homes based on logistic regression and decision tree modeling

Objective

To investigate the risk factors associated with cognitive frailty among older adults in nursing homes using logistic regression and decision tree modeling, and to compare the predictive performance of these methods.

Methods

A cross-sectional study was conducted involving 697 participants aged 60 and older residing in eight nursing homes in Sichuan province, China. Participants were recruited using convenience sampling. Data were collected through questionnaires administered to the older adults. Logistic regression and decision tree modeling were employed to construct models predicting cognitive frailty.

Results

Logistic regression analysis identified age, education degree, exercise, intellectual activities, number of chronic diseases, nutritional status, sleep quality, and depression as significant predictors of cognitive frailty (all p < 0.05). The final decision tree model consisted of three layers and 17 nodes. Six factors were identified as significant predictors: sleep quality, number of chronic diseases, depression, education level, nutrition, and exercise. Receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) for the logistic regression model was 0.735 (95% CI: 0.701-0.767) with a sensitivity of 0.58 and specificity of 0.75. The AUC for the decision tree model was 0.746 (95% CI: 0.712-0.778) with a sensitivity of 0.68 and specificity of 0.70.

Conclusion

Age, education level, exercise, intellectual activities, sleep quality, number of chronic diseases, nutritional status, and depression are significant risk factors for cognitive frailty in older adults residing in nursing homes. Both logistic regression and decision tree models demonstrated comparable predictive performance, with each offering distinct advantages. The combined use of these methods can enhance predictive accuracy and provide valuable insights for clinical practice and policy development.

Effects of activities participation on frailty of older adults in China

Objective

Frailty represents a significant health challenge among older adults, necessitating effective interventions to enhance their overall wellbeing. This study aims to investigate the impact of various types of activity participation on frailty in older adults and to elucidate their intrinsic associations, thereby providing a basis for targeted interventions.

Methods

This study constructed a classification of activities based on the framework proposed by the WHO regarding functional ability in healthy aging, innovatively dividing activities into five categories: physical activity, social activity, economic activity, information activity and sleep activity. Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS 2020), the research employed multiple linear regression and mediation analysis to explore the effects of these activities on the frailty status of older adults and their underlying mechanisms. Furthermore, propensity score matching was conducted to robustly test the regression results.

Results

The study found that physical activity (β = -0.006, p < 0.01), social activity (β = -0.007, p < 0.01), economic activity (β = -0.017, p < 0.01), information activity (β = -0.040, p < 0.01) and sleep activity (β = -0.044, p < 0.01) all had significant positive effects on the frailty status of older adults. Additionally, sleep activity mediated the relationship between physical activity and frailty status, accounting for 4.819%. Social activity mediated the relationship between information activity and frailty status, accounting for 7.692%.

Conclusion

Older adults should enhance their participation in various activities to alleviate frailty. This can be further improved through the following three aspects: engaging in moderate physical exercise, fostering and promoting awareness of volunteer services, and popularizing the use of information technology.

Frailty and Behavioral and Psychological Symptoms of Dementia: A Single Center Study

Background: During the time-course of cognitive decline, Behavioral and Psychological Symptoms of Dementia (BPSD) may arise, negatively impacting the outcomes. Methods: The aim of this single center, longitudinal study was to evaluate the correlation between frailty and BPSD in a population of older patients with dementia. BPSD were classified into three clusters: "mood/apathy" (depression, apathy, sleep disturbances, appetite disturbances), "psychosis" (delusions, hallucinations, and anxiety), and "hyperactivity" (agitation, elation, motor aberrant behavior, irritability, disinhibition). Using the Clinical Frailty Scale (CFS), patients were categorized as "severely frail", "mild/moderately frail" and "robust" (CFS ≥ 7, 4-6, and ≤ 3, respectively). Results: In total, 209 patients (mean age 83.24 ± 4.98 years) with a clinical diagnosis of dementia were enrolled. BPSD were prevalent among the severely frail patients. A positive correlation at regression analysis was found between frailty and "hyperactivity" cluster at baseline and follow-up visits (p < 0.001, p = 0.022, p = 0.028, respectively), and was confirmed at the network analysis. Loss of independence in IADL was correlated to hyperactivity and psychosis symptoms (p < 0.001 and p = 0.013, respectively). Conclusions: Scarce literature is available regarding the correlation between frailty and BPSD, which in our study is significant, especially for symptoms in the hyperactivity cluster. Frailty assessment may help identify patients at the highest risk for developing BPDS who might benefit from targeted intervention in the earliest phases of the disease.

Understanding exogenous factors and biological mechanisms for cognitive frailty: A multidisciplinary scoping review

Cognitive frailty (CF) is the conjunction of cognitive impairment without dementia and physical frailty. While predictors of each element are well-researched, mechanisms of their co-occurrence have not been integrated, particularly in terms of relationships between social, psychological, and biological factors. This interdisciplinary scoping review set out to categorise a heterogenous multidisciplinary literature to identify potential pathways and mechanisms of CF, and research gaps. Studies were included if they used the definition of CF OR focused on conjunction of cognitive impairment and frailty (by any measure), AND excluded studies on specific disease populations, interventions, epidemiology or prediction of mortality. Searches used Web of Science, PubMed and Science Direct. Search terms included "cognitive frailty" OR (("cognitive decline" OR "cognitive impairment") AND (frail*)), with terms to elicit mechanisms, predictors, causes, pathways and risk factors. To ensure inclusion of animal and cell models, keywords such as "behavioural" or "cognitive decline" or "senescence", were added. 206 papers were included. Descriptive analysis provided high-level categorisation of determinants from social and environmental through psychological to biological. Patterns distinguishing CF from Alzheimer's disease were identified and social and psychological moderators and mediators of underlying biological and physiological changes and of trajectories of CF development were suggested as foci for further research.

Transcranial photobiomodulation increases cognition and serum BDNF levels in adults over 50 years: A randomized, double-blind, placebo-controlled trial

BACKGROUND

There is a significant lack of therapeutic options for mild cognitive impairment (MCI), which is rapidly becoming a global epidemic due to aging. Transcranial photobiomodulation (t-PBM) involves delivering near-infrared light (NIR) to the scalp, targeting cortical areas of the brain. NIR t-PBM has recently emerged as a potential therapy for various neurodegenerative conditions, including memory issues.

AIMS

This study aimed to evaluate cognition scores (primary outcome), depression, anxiety, resilience scores, neuroplasticity, and neurodegeneration biomarkers (secondary outcomes) in individuals with MCI undergoing t-PBM therapy or receiving a placebo.

MATERIALS AND METHODS

A total of 93 older adult individuals with MCI were randomly assigned to either a t-PBM (n = 47) or Placebo (n = 46) group. Clinical assessments were conducted at baseline, 60 days post-treatment, and a 150-day follow-up. We also measured serum levels of brain-derived neurotrophic factor (BDNF), a neuroplasticity biomarker, as well as neuron-specific enolase (NSE) and calcium-binding protein B (S100B), which are neurodegeneration biomarkers. Intervention effects were analyzed using repeated measures (RM) two-way ANOVA followed by Tukey post hoc test. Fischer's exact test and Generalized Estimating Equations (GEE) were also applied.

RESULTS

Of the 93 older adults individuals invited to participate, 76 (t-PBM: 40, placebo: 36) completed the study. The t-PBM significantly improved cognition as measured by the Montreal Cognitive Assessment (MoCA) compared to placebo (p = 0.0301). The delta values for MoCA scores were 3.20 in the t-PBM group and 1.97 in the placebo group. This effect persisted until the three-month follow-up, accompanied by increased BDNF levels in the t-PBM group but not in the placebo group (p = 0.0046). The delta values for BDNF were 821.94 in the t-PBM group and 359.41 in the placebo group. t-PBM did not alter depression, anxiety, resilience scores, nor the levels of NSE and S100B in individuals with MCI.

CONCLUSION

The t-PBM increases cognitive function and BDNF levels in adults with MCI. Its application as an adjunctive treatment may play a crucial role in preventing neurodegenerative diseases.

Preoperative frailty tendency predicts delirium occurrence in older people undergoing spinal surgery

BACKGROUND

This prospective cohort study focused on the predictive value of frailty or pre-frailty assessed by Edmonton Frailty Scale (EFS) for postoperative delirium in spinal surgery patients.

METHODS

The primary outcome measurement was postoperative delirium (POD) evaluated by Confusion Assessment Method at day 1, day 2, and day 3 after the surgery. Secondary outcomes included severity and duration of POD, severe postoperative pain measured by Faces Pain Scale-Revised. Patients scheduled for elective spinal surgery were enrolled and assessed for frailty by EFS before surgery. Demographic data, preoperative, intraoperative, and postoperative information were collected.

RESULTS

231 out of 325 patients were enrolled and analyzed in this study at last. The cohort with 36.8% being frail and 28.5% being vulnerable. Postoperative delirium was detected in 41 in 231 patients. Multivariate logistic regression analysis revealed that vulnerable to frailty (OR = 4.681, 95% CI: 1.199 to 18.271, P = 0.026), after adjusted duration of surgery more than 3 h, using flumazenil at the end of surgery, using butorphanol only in postoperative patient-controlled intravenous analgesia, moderate-to-severe pain at day 1 and 2, is a strong predictor of postoperative delirium. Frailty was associated with longer duration (frailty vs. fit, P = 0.364) and stronger severity of postoperative delirium in the first two days (P < 0.001). High EFS score was independent risk factor of severe postoperative pain (Frailty vs. Fit: OR = 5.007, 95% CI: 1.903 to 13.174, P = 0.001; Vulnerable vs. Fit: OR = 2.525, 95% CI: 1.008 to 6.329, P = 0.048). In stratified tests, Sufentanil regimen in intravenous PCA significantly increase the proportion of POD in vulnerable group (P = 0.030), instead of frailty group (P = 0.872) or fit group (P = 0.928).

CONCLUSIONS

Frailty can increase the risk, severity, duration of delirium and severe postoperative pain in the first 3 days after surgery of patients.

TRIAL REGISTRATION

The protocol of this study has been approved by the Ethic Committee of Shanghai Changzheng Hospital (Approval file number: 2022SL044) and informed consent was obtained from all the patients. The trial was retrospectively registered at chictr.org.cn (ChiCTR2300073306) on 6th July 2023.

Gender differentials in cognitive frailty among older adults in India: a multivariate decomposition approach

There has been an increasing focus on the interplay between physical frailty and cognitive impairment, as both conditions pose significant risks for life-threatening health complications and are receiving considerable attention in global geriatric health initiatives. A recent consensus introduces "cognitive frailty," denoting the co-existence of physical frailty and cognitive impairment without dementia. This study aims to ascertain the prevalence of cognitive frailty and investigate the factors contributing to gender differentials of cognitive frailty among older adults in India. This study has used the data from the nationally representative survey Longitudinal Ageing Study in India 2017-18. This study included a sample of 13,946 males and 14,989 females aged 60 and above. Descriptive and bivariate analyses were conducted. A proportion test was employed to assess gender disparities and determine the statistical significance of risk factors. Furthermore, multivariate decomposition analysis was performed to identify the extent to which various covariates contribute to explaining the gender differences observed in cognitive frailty. The overall prevalence of cognitive frailty was 4.4%. There was a significant gender difference in cognitive frailty among older adults in India (Difference: 4.3%; p-value < 0.001] with 2.1% (95% CI: 1.8-2.3) older males and 6.4% (95% CI: 6.0-6.8) older females suffering from cognitive frailty. The considerable gender gap in cognitive frailty would be reduced if women had similar levels of education (37% reduction) than men. Results highlight that increasing age, being a woman (AOR: 1.61; 95% CI: 1.33-1.95), out-of-wedlock, less education and non-working status (AOR:2.19; 95% CI: 1.71-2.80) were significantly associated with cognitive frailty. Poor nutritional status, and depression are also prone among the cognitively frail participants. Gender sensitive interventions improving education access for women are crucial. Developing countries like India urgently require a multidimensional approach to ensure appropriate and comprehensive healthcare for the elderly population.

Neurophysiological markers of early cognitive decline in older adults: a mini-review of electroencephalography studies for precursors of dementia

The early detection of cognitive decline in older adults is crucial for preventing dementia. This mini-review focuses on electroencephalography (EEG) markers of early dementia-related precursors, including subjective cognitive decline, subjective memory complaints, and cognitive frailty. We present recent findings from EEG analyses identifying high dementia risk in older adults, with an emphasis on conditions that precede mild cognitive impairment. We also cover event-related potentials, quantitative EEG markers, microstate analysis, and functional connectivity approaches. Moreover, we discuss the potential of these neurophysiological markers for the early detection of cognitive decline as well as their correlations with related biomarkers. The integration of EEG data with advanced artificial intelligence technologies also shows promise for predicting the trajectory of cognitive decline in neurodegenerative disorders. Although challenges remain in its standardization and clinical application, EEG-based approaches offer non-invasive, cost-effective methods for identifying individuals at risk of dementia, which may enable earlier interventions and personalized treatment strategies.

Change of leisure activity participation and associations with cognitive frailty in older adults: A population-based longitudinal study

OBJECTIVES

To examine changes in leisure activity participation and their associations with cognitive frailty among older adults.

METHODS

The study utilized data from the Chinese Longitudinal Healthy Longevity Survey covering 2008-2018. Three distinct intervals represented short-term (2008-2011), medium-term (2008-2014) and long-term (2008-2018) changes in leisure activity participation, and the change patterns of levels of leisure activities based on the tertile were described. Restricted cubic splines (RCS) were used to determine the inflection point of the absolute value of leisure activity participation over two time points. Group-based trajectory modeling identified trajectories of leisure activity participation among participants from 2008 to 2018. Logistic regression analysis examined how changes in leisure activity participation impacted cognitive frailty.

RESULTS

Five patterns of change in leisure activity participation were identified, including the persistently low group, the declining (medium-low, high-low, high-medium) group, persistently medium, rising (low-medium, low-high, medium-high), and persistently high levels of activity. A lower risk of cognitive frailty was found among three groups of persistently medium, rising, and persistently high levels of activity across three distinct intervals and among the declining group over the short-term and long-term intervals but not in the medium-term interval than among the persistently low group, respectively. RCS analysis showed that the inflection point of the association between absolute changes in leisure activity and cognitive frailty was -2.11 (short-term), -0.9 (medium-term), and -3.94 (long-term). Leisure activity trajectories were categorized into persistently low, persistently moderate, and persistently high groups, and both the persistently moderate and persistently high groups exhibited a lower risk of cognitive frailty compared to the persistently low group.

CONCLUSION

Persistently moderate to high levels and increasing levels of leisure activities can reduce the risk of cognitive frailty in the short, medium, and long term, and even the declining in leisure activity participation less than the threshold could protect against cognitive frailty, particularly in the short and long term.

The Effect of Balance-Based Interventions on Cognitive Functions of the Healthy and MCI Elderly: A Systematic Review and Meta-analysis

Background

Aging is an inseparable part of life, accompanied by mild to severe cognitive disorders. This study aimed to investigate the influence of balance-based interventions on cognitive function in older adults, encompassing both healthy individuals and those with mild cognitive impairment (MCI).

Methods

A systematic review was conducted by searching multiple databases up to April 2023, and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist was followed for reporting. Sixteen studies, comprising 1148 participants aged 43 to 89 years, were analyzed. Balance exercises were administered 1 to 3 times per week, lasting 30 to 60 minutes per session. Methodological quality was assessed using the Downs and Black checklist. A meta-analysis was conducted for executive functions (Stroop Test) and complex attention (Trail-Making Test, TMT A&B), while other outcomes underwent qualitative analysis.

Results

Qualitative analysis revealed positive effects on specific executive functions and complex attention aspects. However, the meta-analysis did not show significant differences in scores between balance training and control groups, which included healthy adults receiving nonbalance interventions or no intervention.

Conclusion

Limited research and methodological constraints hinder conclusive findings on balance-based interventions for older adults' cognitive functions. Yet, these interventions show the potential to enhance executive function and complex attention, emphasizing the need for further research in disability and rehabilitation.

Prevalence of and factors associated with cognitive frailty in elderly patients with chronic obstructive pulmonary disease: A cross-sectional study

The status of cognitive frailty in elderly patients with chronic obstructive pulmonary disease (COPD) and its influencing factors in China remains unclear. This study aimed to investigate the prevalence of and factors associated with cognitive frailty in elderly patients with COPD. This cross-sectional study enrolled elderly patients with stable COPD between May and November 2022 from the Respiratory Department of the First Affiliated Hospital of Zhengzhou University and the Fifth Affiliated Hospital of Zhengzhou University. Convenience sampling method was adopted. Frailty Phenotype scale, Montreal Cognitive Assessment scale, Geriatric Depression Scale, and Clinical Dementia Rating scale were used to assess the prevalence of cognitive frailty in elderly patients with COPD. Multivariable logistic regression analysis was used to explore the associated factors. A total of 406 valid questionnaires were collected, and 173 patients (35.6%) had cognitive frailty. Binary logistic regression analysis showed that sex (odds ratio [OR] = 0.009; 95%CI: 0.001-0.770; P = .038), depression (OR = 17.780; 95%CI: 1.092-289.478; P = .043), modified Medical Research Council grade 1-3 (OR = 28.394-4095.683; 95%CI: 1.086-4,592,652.211; P < .05), global initiative for chronic obstructive lung disease grade 2 and 3 (OR = 32.508-282.072; 95%CI: 1.101-12,516.874; P < .05), and frequencies of acute exacerbations of COPD and hospitalizations within 1 year of 2 times (OR = 21.907; 95%CI: 4.587-104.622; P < .001) were independently associated with cognitive frailty. The prevalence of cognitive frailty in elderly patients with stable COPD was high. Female, depression, modified Medical Research Council grade, global initiative for chronic obstructive lung disease grade, and frequencies of acute exacerbations of COPD and hospitalizations within 1 year might be the factors independently associated with cognitive frailty, educational level might be a protective associated factor for cognitive frailty.

Analysis of the potential profile and influencing factors for oral frailty in olderly patients with dental implants

OBJECTIVE

To investigate the current state of oral frailty in oldely patients with require dental implants, analyze influencing factors in the characteristics of oral frailty across different patient categories, and provide a reference for clinical staff to identify high-risk groups and develop proactive management strategies.

METHODS

Between January 2024 and March 2024, 654 patients with dental implants were selected using convenience sampling from six secondary and tertiary stomatological hospitals in Jiangsu and Zhejiang provinces. Data were collected via a general information questionnaire and the Oral Frailty Index-8. The latent profiles of oral frailty were examined, and univariate and Logistic regression analyses were conducted to determine the impact of various factors on these profiles.

RESULTS

In this cross-sectional study, 605 valid questionnaires were returned, yielding an effective rate of 92.58%. The mean oral frailty score was 6.64 ± 1.21, with the sample comprising 223 males and 382 females, averaging 72.54 ± 6.33 years old. Oral frailty was categorized into three latent profiles: high (20.50%), moderate (53.72%), and low (25.78%) frailty groups. Factor analysis indicated that age, gender, education level, family income, number of implants, and dyslipidemia significantly predicted the classification of these profiles (P < 0.05).

CONCLUSION

Oral frailty in oldely patients with dental implants exhibits heterogeneity and is influenced by age, sex, education level, family income, number of implants, and dyslipidemia. Clinical staff should recognize the characteristics of different patient categories and implement proactive measures for those at high risk of oral frailty to enhance their quality of life.

Cognitive frailty in relation to vitamin B12 and 25-hydroxyvitamin D in an elderly population: a cross-sectional study from NHANES

Background

Nutritional support has been identified as a potential intervention for cognitive frailty; however, the association between 25-hydroxyvitamin D [25-(OH)D], vitamin B12, and cognitive frailty remains ambiguous.

Methods

This study utilized data from two cycles (2011-2012, 2013-2014) of the National Health and Nutrition Examination Survey (NHANES) to investigate this relationship. The researchers constructed a 41-item frailty index encompassing diverse aspects of physical functioning, psychological evaluation, and medical conditions, and evaluated each participant individually. The study utilized Spearman's rank correlation coefficient and univariate ordered logistic regression to assess the relationships between variables and cognitive frailty. Recursive feature elimination and cross-validation methods were employed to identify the most influential variables for building and optimizing multivariate ordered logistic regression models. Subgroup analyses and interaction tests were further conducted to validate the identified correlations.

Results

The findings of this study confirm a negative linear correlation between 25-(OH)D levels and cognitive frailty in older adults. Specifically, a one-unit increase in 25-(OH)D levels was associated with a 12% reduction in the risk of cognitive frailty. The result was further supported by subgroup analyses and interaction tests.

Conclusion

The existence of a negatively correlated linear association between 25-(OH)D levels and cognitive frailty in older adults is plausible, but further rigorously designed longitudinal studies are necessary to validate this relationship.

Cognitive, Neuropsychological and Biological Effects of Oxygen-Ozone Therapy on Frailty: A Study Protocol for a 5-Week, Randomized, Placebo-Controlled Trial

Cognitive frailty (CF) is a heterogeneous syndrome that is becoming one of the most serious health problems as the world's population age is increasing. Elucidating its biological mechanisms as well as prevention and treatments is becoming increasingly significant, particularly in view of the associated health costs. We presented the study protocol of a research project funded by the Italian Ministry of Health (grant number RF-2016-02363298) aiming to investigate the cognitive and neuropsychological effects of a 5-week treatment with therapy based on the regenerative properties of ozone (O3) in a cohort of subjects stratified according to CF scores. We also studied the potential effects of O3 on blood-based biomarkers indicative of specific biological systems that may be altered in CF. Seventy-five older persons were recruited and randomly assigned to receive the active treatment (150 cc of oxygen-O2-O3 mixture at the concentration of 30 µg of O3 per cc of O2), O2, or the placebo (air) for 5 weeks. The main endpoints were the change in the scores of clinical scales from baseline (T0) to weeks 3 (T3), 9 (T9), and 15 (T15) after treatment and the change in biomarker levels resulting from transcriptomics, proteomics, and metabolomic patterns at the same times. The positive results from this study could have important clinical implications.

Adverse childhood experiences and cognitive function in later life: the sequential mediating roles of education level and adult loneliness

Background

This study assesses the impact of adverse childhood experiences (ACEs) on the cognitive function of older adults. Furthermore, it examines the potential underlying mechanism involving education level and the subjective "feeling of loneliness" (FOL).

Methods

Analyzing a population-based cohort sample from the China Health and Retirement Longitudinal Study database, 8,365 subjects aged 45 or older were interviewed in 2018. Ten ACEs indicators were measured using life history questionnaires assessed at 2014. FOL was assessed using a single item from 10-item Center for Epidemiological Studies Depression Scale (CESD-10). Cognitive function was assessed using a structured questionnaire comprising four dimensions: memory, orientation, computation, and visuospatial abilities.

Results

In the fully adjusted model, which accounted for age, gender, marital status, smoke, drink, rural residence, and education levels of both mothers and fathers, the linear regression analysis indicated that ACEs were inversely associated the lower education level (B = -0.058, 95% CI = -0.090, -0.026, p < 0.001), and ACEs were found to be linked to an elevated risk of FOL (B = 0.072, 95% CI = 0.056, 0.089, p < 0.001). In addition, ACEs was not significantly associated with cognitive function (B = -0.047, 95% CI = -0.108, 0.015, p = 0.136), but FOL was significantly associated with cognitive function (B = -0.483, 95% CI = -0.561, -0.404, p < 0.001). Mediation analysis revealed that education level and FOL sequentially and partially mediated the association between ACEs and the total cognitive score, with a proportion mediated of 52.58%.

Limitations

The evaluation of ACEs exposure was based on binary response options. This method limited our ability to explore various dimensions of adversity, such as ages of occurrence, severity, frequency, duration, and the extent of psychological effects at the time. Furthermore, the assessment of loneliness relied on a single item from the CESD-10, introducing a potential source of measurement error.

Conclusion

Our study unveils a substantial association between ACEs and education level, as well as with FOL and cognitive function in the older adults. Moreover, education level and FOL serve as sequential mediating factors in the relationship between ACEs and cognitive function.

Expanding the Neurological Phenotype of Anderson-Fabry Disease: Proof of Concept for an Extrapyramidal Neurodegenerative Pattern and Comparison with Monogenic Vascular Parkinsonism

Anderson-Fabry disease (AFD) is a genetic sphingolipidosis involving virtually the entire body. Among its manifestation, the involvement of the central and peripheral nervous system is frequent. In recent decades, it has become evident that, besides cerebrovascular damage, a pure neuronal phenotype of AFD exists in the central nervous system, which is supported by clinical, pathological, and neuroimaging data. This neurodegenerative phenotype is often clinically characterized by an extrapyramidal component similar to the one seen in prodromal Parkinson's disease (PD). We analyzed the biological, clinical pathological, and neuroimaging data supporting this phenotype recently proposed in the literature. Moreover, we compared the neurodegenerative PD phenotype of AFD with a classical monogenic vascular disease responsible for vascular parkinsonism and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). A substantial difference in the clinical and neuroimaging features of neurodegenerative and vascular parkinsonism phenotypes emerged, with AFD being potentially responsible for both forms of the extrapyramidal involvement, and CADASIL mainly associated with the vascular subtype. The available studies share some limitations regarding both patients' information and neurological and genetic investigations. Further studies are needed to clarify the potential association between AFD and extrapyramidal manifestations.

Prevalence of cognitive frailty and its associated factors in a population of Iranian older adults

BACKGROUND

In recent years cognitive frailty has emerged as an important predictor of adverse health outcomes in older adults. Herein, we aimed to investigate the prevalence and associated factors of cognitive frailty in a population of community-dwelling older adults in Iran.

METHOD

This cross-sectional study was conducted as part of the second cycle of the Amirkola Health and Aging Project (AHAP). Physical frailty and cognitive impairment were evaluated using the FRAIL questionnaire and the mini-mental state examination (MMSE) respectively. Cognitive frailty was defined as co-existence of frailty and cognitive impairment without presence of dementia. Depression and disability were assessed using the Persian version of geriatric depression scale (GDS) and instrumental activities of daily living (IADL) questionnaire.

RESULTS

Overall 1775 individuals (47.1% female) with mean age of 69.7 ± 7.3 years were included in the final analysis. The prevalence of cognitive frailty was 12.0%. The prevalence of cognitive frailty among males and females was 4.3% and 20.7%, respectively. After adjusting for all possible confounders through binary logistic regression analysis, factors such as older age (OR 1.06, CI 1.03-1.09), female gender (OR 2.25, CI 1.42-3.57), illiteracy (OR 3.84, CI 2.03-8.29), more comorbidities (OR 1.21, CI 1.12-1.31), depression (OR 2.01, CI 1.40-2.86), and greater IADL disability (OR 1.68, CI 1.44-3.96), were independently and significantly associated with cognitive frailty.

CONCLUSION

In this population of Iranian older adults, prevalence of cognitive frailty was consistent with its estimated mean global prevalence. Age, gender, illiteracy, comorbidities, depression and IADL disability were associated with cognitive frailty. Further research is required to develop screening tools and prevention strategies.

Cardiovascular risk factors among older persons with cognitive frailty in middle income country

BACKGROUND

Cognitive frailty, characterized by the coexistence of cognitive impairment and physical frailty, represents a multifaceted challenge in the aging population. The role of cardiovascular risk factors in this complex interplay is not yet fully understood.

AIM

To investigate the relationships between cardiovascular risk factors and older persons with cognitive frailty by pooling data from two cohorts of studies in Malaysia.

METHODS

A comprehensive approach was employed, with a total of 512 community-dwelling older persons aged 60 years and above, involving two cohorts of older persons from previous studies. Datasets related to cardiovascular risks, namely sociodemographic factors, and cardiovascular risk factors, including hypertension, diabetes, hypercholesterolemia, anthropometric characteristics and biochemical profiles, were pooled for analysis. Cognitive frailty was defined based on the Clinical Dementia Rating scale and Fried frailty score. Cardiovascular risk was determined using Framingham risk score. Statistical analyses were conducted using SPSS version 21.

RESULTS

Of the study participants, 46.3% exhibited cognitive frailty. Cardiovascular risk factors including hypertension (OR:1.60; 95%CI: 1.12-2.30), low fat-free mass (OR:0.96; 95%CI: 0.94-0.98), high percentage body fat (OR:1.04; 95%CI: 1.02-1.06), high waist circumference (OR:1.02; 95%CI: 1.01-1.04), high fasting blood glucose (OR:1.64; 95%CI: 1.11-2.43), high Framingham risk score (OR:1.65; 95%CI: 1.17-2.31), together with sociodemographic factors, i.e., being single (OR 3.38; 95%CI: 2.26-5.05) and low household income (OR 2.18; 95%CI: 1.44-3.30) were found to be associated with cognitive frailty.

CONCLUSION

Cardiovascular-risk specific risk factors and sociodemographic factors were associated with risk of cognitive frailty, a prodromal stage of dementia. Early identification and management of cardiovascular risk factors, particularly among specific group of the population might mitigate the risk of cognitive frailty, hence preventing dementia.

Study of electronic biofeedback combined with nursing intervention in the treatment of vascular cognitive impairment-no dementia

OBJECTIVE

To investigate the effects of electronic biofeedback combined with nursing intervention and conventional drug treatment on cognitive function in patients with vascular cognitive impairment-no dementia (VCIND).

METHODS

A total of 102 patients with VCIND treated in the Department of Neurology from January 2021 to May 2022 were enrolled and divided into the routine treatment group and biofeedback group according to different treatment methods. The routine treatment group was given conventional drug therapy and nursing intervention; for the biofeedback group, electronic biofeedback therapy was added, based on the routine treatment group. The Montreal Cognitive Assessment, (MoCA), Alzheimer's Disease Assessment Scale-Cognitive Subscale, (ADAS-cog), and Hamilton Depression Scale (HAMD) were checked before treatment, 2 weeks after treatment, and 3 months after treatment.

RESULTS

At 3 months of treatment, the scores of the MoCA and ADAS-cog scales in the biofeedback group were better than those in the routine treatment group, while no difference was detected in the HAMD scores before and after treatment and between the two groups.

CONCLUSION

Electronic biofeedback therapy for VCIND can significantly improve the MoCA score, reduce the ADAS-cog score and improve the cognitive level of patients and can be used as a complementary treatment for VCIND.

The relationship between oral frailty and oral dysbiosis among hospitalized patients aged older than 50 years

OBJECTIVE

This study aimed to clarify the relationship between oral frailty and oral dysbiosis among hospitalized patients aged ≥ 50 years.

METHODS

A prospective observational study was conducted. Number of teeth, masticatory ability, articulatory oral motor skill, tongue pressure, swallowing pressure, and choking were used to assess oral frailty. Saliva samples were collected from the oral cavity for bacterial culture.

RESULTS

A total 103 in patients enrolled and 53.4% suffered from oral frailty. Oral frailty was found to have a 3.07-fold correlation with the presence of Enterobacterales in the oral cavity (p = 0.037), especially in poor articulatory oral motor skill, which showed at greater risk of Enterobacterales isolated from the oral cavity by 5.58-fold (p = 0.01).

CONCLUSION

Half of hospitalized patients was found to have oral frailty that was related to more Enterobacterales in the oral cavity. This evidence suggests that the enhancement of articulatory oral motor skills may serve as a potential strategy for mitigating the presence of Enterobacterales within the oral cavity.

Mediator Role of Frailty and Biological Deficits in Dementia Prognosis-Retrospective Cohort Study

Background and Objectives: Dementia is increasing worldwide. This study aimed to examine the impact of comorbidity burden and frailty on dementia prognosis in patients with dementia. Materials and Methods: This retrospective cohort study was conducted with 47 patients with dementia who were followed for up to two years. The Modified Charlson Comorbidity Index (MCCI), Mini-Mental State Examination (MMSE-E), and Edmonton Fragility Scale were used besides laboratory and clinical findings. Results: The mean age of the 47 patients was 78.77 ± 12.44 years. During the follow-up period, MMSE-E scores were observed to improve in 50% of the patients. Initial MMSE-E scores were found to be lowest in men and patients with coronary artery disease or depression, while final MMSE-E scores were observed to be lowest in patients with depression and low vitamin B12 or vitamin D levels. The rates of decrease in MMSE-E scores in non-, moderately and severely frail patients were 21.4%, 55.6%, and 70.6%, respectively. There was a moderate negative correlation between MMSE-E scores and both comorbidity burden and frailty scores. The mediation analysis revealed that frailty was a complete mediator, and that comorbidity burden led to an increase in frailty and a decrease in MMSE-E scores. During the follow-up period, patients with moderate frailty, hypertension, diabetes mellitus, alcohol and tobacco use, low B12 levels, or hypothyroidism showed an increased risk of decrease in cognitive functions. Conclusions: There was a significant association between dementia prognosis and both frailty and biological deficits. We recommend the adoption of a syndemic approach in the follow-up of dementia, as we believe that the prevention of frailty and associated biological deficits will contribute to slowing dementia's clinical course.

Associations of cognitive impairment and functional limitation with all-cause mortality risk in older adults: A population-based study from the National Health and Nutrition Examination Survey

Cognitive impairment and functional limitation are commonly observed in older adults. They have a complex correlation, and both are risk factors for mortality. This prospective cohort study aimed to explore the independent and joint impact of cognitive impairment and functional limitations on all-cause mortality in older adults. A total of 3,759 participants aged ≥ 60 years who had available information on mortality data, cognitive function, physical function, and covariates were enrolled. Cox proportional hazards regression models were employed to assess the independent and joint impacts of cognitive impairment and functional limitation on all-cause mortality. Smoothing curve fitting was used to show the nonlinear relationship between the Digit Symbol Coding (DSC) score and all-cause mortality. An interaction between cognitive impairment and functional limitation was identified when examining their associations with all-cause mortality. Cognitive impairment and functional limitation independently correlated with all-cause mortality risk even after adjusting for covariates and performing mutual adjustments (HR for cognitive impairment: 1.34, 95% CI 1.15-1.56; HR for functional limitation: 1.50, 95% CI 1.32-1.70). When the DSC score was > 18, as the score increased, the risk of death significantly decreased (HR 0.99, 95% CI 0.98-0.99). Participants with both cognitive impairment and functional limitation had the highest hazard ratio for all-cause mortality (HR 1.98, 95%CI 1.63-2.40). In summary, cognitive impairment and functional limitation independently correlated with increased all-cause mortality risk. A higher DSC score was a protective factor reducing the premature mortality risk. Older adults with cognitive impairment and functional limitation demonstrated the highest all-cause mortality risk.

The Impact of Frailty Components and Preoperative Mechanical Cardiac Support Changes with Time after Heart Transplantation

BACKGROUND

Frailty has been proven to be associated with mortality after orthotopic heart transplantation (OHT). The aim of our study was to determine the impact of frailty on mortality in the current era using pretransplant mechanical cardiac support (MCS).

METHODS

We retrospectively calculated the frailty scores of 471 patients undergoing OHT in a single institution between January 2012 and August 2022. The outcome was all-cause mortality.

RESULTS

The median survival time was 1987 days (IQR: 1487 days) for all patients. In total, 266 (56.5%) patients were categorized as nonfrail, 179 (38.0%) as prefrail, and 26 (5.5%) as frail. The survival rates were 0.73, 0.54, and 0.28 for nonfrail, prefrail, and frail patients, respectively. The frailty score was associated with mortality [HR: 1.34 (95% CI: 1.22-1.47, p < 0.001)]. Among the components of the frailty score, age above 50 years, creatinine ≥ 3.0 mg/dL or prior dialysis, and hospitalization before OHT were independently associated with mortality. Continuous-flow left ventricular assist devices (CF-LVAD) were associated with an increased risk for all-cause mortality [AHR: 1.80 (95% CI: 1.01-3.24, p = 0.047)].

CONCLUSIONS

The components of the frailty score were not equally associated with mortality. Frailty and pretransplant MCS should be included in the risk estimation.

Effectiveness of Partially Hydrolyzed Guar Gum on Cognitive Function and Sleep Efficiency in Healthy Elderly Subjects in a Randomized, Double-Blind, Placebo-Controlled, and Parallel-Group Study

The consumption of functional foods in a daily diet is a promising approach for the maintenance of cognitive health. The present study examines the effects of water-soluble prebiotic dietary-fiber, partially hydrolyzed guar gum (PHGG), on cognitive function and mental health in healthy elderly individuals. Participants consumed either 5 g/day of PHGG or a placebo daily for 12 weeks in this randomized, double-blind, placebo-controlled, and parallel-group study. An assessment of cognitive functions, sleep quality, and subjective mood evaluations was performed at baseline and after 8 and 12 weeks of either PHGG or placebo intake. The visual memory scores in cognitive function tests and sleepiness on rising scores related to sleep quality were significantly improved in the PHGG group compared to the placebo group. No significant differences were observed in mood parameters between the groups. Vigor-activity scores were significantly improved, while the scores for Confusion-Bewilderment decreased significantly in the PHGG group when compared to the baseline. In summary, supplementation with PHGG was effective in improving cognitive functions, particularly visual memory, as well as enhancing sleep quality and vitality in healthy elderly individuals (UMIN000049070).

Gut Bacteria Provide Genetic and Molecular Reporter Systems to Identify Specific Diseases

With genetic information gained from next-generation sequencing (NGS) and genome-wide association studies (GWAS), it is now possible to select for genes that encode reporter molecules that may be used to detect abnormalities such as alcohol-related liver disease (ARLD), cancer, cognitive impairment, multiple sclerosis (MS), diabesity, and ischemic stroke (IS). This, however, requires a thorough understanding of the gut-brain axis (GBA), the effect diets have on the selection of gut microbiota, conditions that influence the expression of microbial genes, and human physiology. Bacterial metabolites such as short-chain fatty acids (SCFAs) play a major role in gut homeostasis, maintain intestinal epithelial cells (IECs), and regulate the immune system, neurological, and endocrine functions. Changes in butyrate levels may serve as an early warning of colon cancer. Other cancer-reporting molecules are colibactin, a genotoxin produced by polyketide synthetase-positive Escherichia coli strains, and spermine oxidase (SMO). Increased butyrate levels are also associated with inflammation and impaired cognition. Dysbiosis may lead to increased production of oxidized low-density lipoproteins (OX-LDLs), known to restrict blood vessels and cause hypertension. Sudden changes in SCFA levels may also serve as a warning of IS. Early signs of ARLD may be detected by an increase in regenerating islet-derived 3 gamma (REG3G), which is associated with changes in the secretion of mucin-2 (Muc2). Pro-inflammatory molecules such as cytokines, interferons, and TNF may serve as early reporters of MS. Other examples of microbial enzymes and metabolites that may be used as reporters in the early detection of life-threatening diseases are reviewed.