Evidence of Mediation by Depressive Symptoms in the Association Between Frailty and Cognitive Decline in Older Adults

Abstract Frailty and pre-frailty have been shown to predict cognitive decline in older adults; however, knowledge about mediating pathways in this association is lacking. This study aims to assess if depressive symptoms mediate the relationship between frailty and cognitive function. Frailty status, cognitive function scores, and depressive symptoms were measured in 4,672 community-dwelling US adults ≥65 and older from the Health and Retirement Study from 2006-2010. Fried’s frailty phenotype criteria (weakness, slowness, physical inactivity, low weight, and exhaustion) were used to categorize individuals as frail (3-5 criteria), pre-frail (1-2 criteria) and robust (0 criteria). Memory recall and global mental status (from 0-35) was used to determine cognitive function. The CES-D was used to assess depressive symptoms. A causal mediation analysis was performed to estimate the direct effect (DE), the direct effect (DE), and the indirect effect (IE). Both frailty (TE: β=-1.22; 95% CI: -1.75, -0.68) and pre-frailty (TE: β=-0.52; 95% CI: -0.86, -0.18) were found to be associated with lower cognitive scores, after adjusting for confounders. There was significant but small IE between frailty status and declining cognitive scores mediated by depressive symptoms [frailty: β=-0.09 (95% CI: -0.14, -0.03); pre-frailty: β = -0.03 (95% CI: -0.06, -0.01). Additionally, the DE was significant for frailty (β=-1.13; 95% CI: -1.67, -0.59) and pre-frailty (β=-0.49 95% CI: -0.82, -0.15). This study provides evidence that depressive symptoms may mediate the association between frailty and cognitive decline. The results suggest possible intervenable pathways for preventing or delaying cognitive decline.

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Relationship Between Frailty and Depression Among Community-Dwelling Older Adults: The Mediating and Moderating Role of Social Support

The Gerontologist ◽

10.1093/geront/gnaa072 ◽

2020 ◽

Vol 60 (8) ◽

pp. 1466-1475 ◽

Cited By ~ 1

Author(s):

Yaru Jin ◽

Huaxin Si ◽

Xiaoxia Qiao ◽

Xiaoyu Tian ◽

Xinyi Liu ◽

...

Keyword(s):

Social Support ◽

Older Adults ◽

Depressive Symptoms ◽

Rating Scale ◽

Depression Scale ◽

Community Dwelling ◽

Linear Regression Models ◽

Frailty Phenotype ◽

Community Dwelling Older Adults ◽

The Relationship

Abstract Background and Objectives Frailty is associated with depression in older adults and reduces their social support. However, the mechanism underlying such relationship remains unclear. We aim to examine whether social support acts as a mediator or moderator in the relationship between frailty and depression. Research Design and Methods This cross-sectional study was conducted among 1,779 community-dwelling older adults aged 60 and older. Frailty, social support, and depressive symptoms were measured by the Physical Frailty Phenotype, Social Support Rating Scale, and five-item Geriatric Depression Scale, respectively. Data were also collected on age, gender, years of schooling, monthly income, cognitive function, number of chronic diseases, physical function, and pain. Results Linear regression models showed that subjective support and support utilization, but not objective support, mediated and moderated the relationship between frailty and depressive symptoms. The Johnson–Neyman technique determined a threshold of 30 for subjective support, but not for support utilization, beyond which the detrimental effect of frailty on depressive symptoms was offset. Discussion and Implications Social support underlies the association of frailty with depression, and its protective role varies by type. Interventions on depression should address improving perceptions and utilization of social support among frail older adults rather than simply providing them with objective support.

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The Relationship between Subjective Cognitive Decline and Health Literacy in Healthy Community-Dwelling Older Adults

Healthcare ◽

10.3390/healthcare8040567 ◽

2020 ◽

Vol 8 (4) ◽

pp. 567

Author(s):

Akio Goda ◽

Shin Murata ◽

Hideki Nakano ◽

Koji Nonaka ◽

Hiroaki Iwase ◽

...

Keyword(s):

Older Adults ◽

Health Literacy ◽

Cognitive Function ◽

Cognitive Decline ◽

Depression Scale ◽

Community Dwelling ◽

Subjective Cognitive Decline ◽

Healthy Community ◽

Community Dwelling Older Adults ◽

The Relationship

Few studies have examined the effects of health literacy on people at risk of developing dementia; its effects on the pathogenesis of subjective cognitive decline (SCD) are particularly unclear. This study aimed to clarify the relationship between health literacy and SCD in a population of healthy community-dwelling older adults. SCD status was assessed using the Cognitive Function domain of the Kihon Checklist (KCL-CF). Health literacy, in turn, was evaluated using the Communicative and Critical Health Literacy (CCHL) scale. Global cognitive function and depressive symptoms were evaluated using the Mini-Mental State Examination (MMSE) and a five-item version of the Geriatric Depression Scale (GDS-5), respectively. Participants who were suspected of having SCD were significantly older than their non-SCD peers, and scored significantly worse on the CCHL, MMSE, and GDS-5. In addition, SCD status was found to be associated with CCHL and GDS-5 scores, as well as age, according to a logistic regression analysis. These findings suggest that low health literacy is linked to SCD morbidity in healthy community-dwelling older adults and should prove useful in the planning of dementia prevention and intervention programs for this population.

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PHYSICAL ACTIVITY MEDIATES THE EFFECTS OF DEPRESSIVE SYMPTOMS ON THE COGNITIVE FUNCTION OF OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.1388 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S378-S379

Author(s):

Yit Mui Khoo ◽

Hisako Matsuo

Keyword(s):

Physical Activity ◽

Older Adults ◽

Depressive Symptoms ◽

Cognitive Function ◽

Cognitive Decline ◽

Mediation Analysis ◽

Vigorous Physical Activity ◽

Chronically Ill ◽

Hierarchical Regression ◽

The Relationship

Abstract Evidence suggests that depressive symptoms among older adults were associated with cognitive impairment and affect cognitive decline over time, while physical activity was associated with lower risk of cognitive decline or have positive effect on cognitive function. The purpose of this study is to examine whether physical activity could mediate the effects of depressive symptoms on the cognitive function of older adults. Data from the 2014 Health and Retirement Survey (HRS) of older adults ≥ 60 years (N=9,753) were used. Hierarchical regression was conducted to examine the relationship between depressive symptoms, physical activity, and cognitive function. Mediation analysis was used to examine whether physical activity could mediate the effects of depressive symptoms on cognitive function. Regression results indicated that increased depressive symptoms was associated with poorer cognitive function, while increased moderate and mild physical activity were associated with better cognitive function. Mediation analysis indicated that the direct effect of depressive symptoms on cognitive function was significant. The indirect effect of depressive symptoms on cognitive function mediated by moderate and mild physical activity were also significant. Findings suggest that physical activity could potentially improve the cognitive function of older adults who have depressive symptoms. Moderate and mild physical activity could benefit older adults with depressive symptoms and reduce the risk of cognitive decline. Frail, disabled or chronically ill older adults are less likely to participate in vigorous physical activity, but they could benefit from moderate or mild physical activity and have better cognitive health.

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Prospective Associations of Physical Frailty With Future Falls and Fear of Falling: A 48-Month Cohort Study

Physical Therapy ◽

10.1093/ptj/pzab059 ◽

2021 ◽

Author(s):

K Makino ◽

S Lee ◽

S Bae ◽

I Chiba ◽

K Harada ◽

...

Keyword(s):

Older Adults ◽

Cohort Study ◽

Fear Of Falling ◽

Community Dwelling ◽

Cardiovascular Health Study ◽

Physical Frailty ◽

Frailty Status ◽

Community Dwelling Older Adults ◽

The Relationship

Abstract Objective The present study aimed to examine the prospective associations of physical frailty with future falls and fear of falling (FOF) among community-dwelling older adults. Methods A prospective cohort study with a 48-month follow-up was conducted in a Japanese community. Participants were 2469 community-dwelling older adults aged 65 years or older who completed baseline and follow-up assessments at intervals of 48±2 months. Primary outcomes were recent falls (defined as at least one fall within the past year) and FOF (determined by response to “Are you afraid of falling?”) at follow-up survey. Physical frailty, operationalized by the frailty phenotype (slowness, weakness, exhaustion, weight loss, and low activity) based on the criteria of the Japanese version of the Cardiovascular Health Study (J-CHS), was also assessed as a predictor of future falls and FOF. Results Multivariate logistic regression showed that pre-frailty or frailty increase the risk of not only future falls (OR: 1.57; 95%CI = 1.20-2.05) but also FOF (OR: 1.33; 95%CI = 1.05-1.69). In addition, the relationship between baseline frailty status and future falls remained significant after adjusting for baseline FOF (OR: 1.55; 95%CI = 1.19-2.02), and the relationship between baseline frailty status and future FOF also remained significant after adjusting for baseline falls (OR: 1.32; 95%CI = 1.04-1.68). Conclusions Frailty status may predict future falls and FOF among community-dwelling older adults. Strategies to prevent frailty may be beneficial to prevent not only future falls but also future FOF in a community setting. Impact Falls and FOF have a close relationship but a different clinical meaning. Older adults with physical frailty may require monitoring as high-risk not only for falls but also for FOF.

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Abstract 22: Visit-to-Visit Variability in Blood Pressure is Related to Late-Life Cognitive Decline

Circulation ◽

10.1161/circ.131.suppl_1.22 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Bo Qin ◽

Anthony J Viera ◽

Linda S Adair ◽

Brenda L Plassman ◽

Lloyd J Edwards ◽

...

Keyword(s):

Blood Pressure ◽

Older Adults ◽

Cognitive Function ◽

Cognitive Decline ◽

Verbal Memory ◽

Repeated Measures ◽

Community Dwelling ◽

Cognitive Testing ◽

Cognitive Test ◽

Nutrition Survey

Introduction: Recent studies suggest higher visit-to-visit variability of blood pressure (BP) is associated with worse cognitive function, but evidence based on longitudinal cognitive testing has not been reported. Hypothesis: We assessed the hypothesis that higher visit-to-visit variability in BP, but not mean BP, would be associated with faster decline in cognitive function among community-dwelling older adults. Methods: This prospective cohort study comprised 1213 adults who had two or more waves of BP measurements as part of the China Health and Nutrition Survey from 1991, up to their first cognitive tests, and completed a cognitive screening test at two or more waves in 1997, 2000 or 2004. Mean (SD) age at first cognitive test was 64 (6) y. Outcomes were repeated measures of global cognitive scores (baseline mean ± SD: 19 ± 6 points), standardized composite cognitive and verbal memory scores (standardized units [SU]). Visit-to visit BP variability was expressed as the standard deviation [SD] or as the variation independent of mean (SD/mean^x, with x derived from curve fitting) in BP measures obtained at a mean interval of 3.6 years. Multivariable-adjusted linear mixed-effects models were used to determine the association of changes in cognitive scores with visit-to visit BP variability. Results: Higher visit-to-visit variability in systolic BP, but not mean systolic BP, was associated with a faster decline of cognitive function (adjusted mean difference [95% CI] for high vs. low tertile of SD in variability (Figure): global score -0.23 points/y [-0.41 to -0.04], composite scores -0.029 SU/y [-0.056 to -0.002] and verbal memory -0.044 SU/y [-0.075 to -0.012]). Higher visit-to-visit variability in diastolic BP was associated with a faster decline of global cognitive function only among adults 55-64 years, independent of mean diastolic BP. Conclusion: Higher long-term BP visit-to-visit variability predicted a faster rate of cognitive decline among older adults.

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Abstract P411: Longitudinal Association Between Frailty and Arterial Stiffness in Community-dwelling Older Adults: The Atherosclerosis Risk in Communities Study

Circulation ◽

10.1161/circ.141.suppl_1.p411 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Alvin G Thomas ◽

Anna Kucharska-Newton ◽

Jingkai Wei ◽

Priya Palta ◽

Sheila Burgard ◽

...

Keyword(s):

Older Adults ◽

Community Dwelling ◽

Frailty Phenotype ◽

Cross Sectional ◽

Arterial Stiffening ◽

Atherosclerosis Risk In Communities ◽

Loss To Follow Up ◽

Frailty Status ◽

Longitudinal Association ◽

Aortic Stiffening

Introduction: Frailty is predictive of cardiovascular disease and is suggested to co-occur with arterial stiffening, the hallmark of vascular aging. However, the temporal relationship is uncertain. Using the ARIC study, we examine the association of baseline frailty with cross-sectional and 5-year change in carotid-femoral pulse wave velocity (cfPWV) in older adults. Methods: Participants at visit 5 (2011-2013) were classified as frail (≥3 criteria), prefrail (1-2 criteria), or robust using the Fried frailty phenotype criteria (unintentional weight loss, exhaustion, grip strength, slow walking speed, and low physical activity). We measured cfPWV at visits 5 and 6/7 (2016-2019). We used linear regression with inverse-probability of attrition weights to estimate the association between frailty and 5-year change in cfPWV while accounting for loss-to-follow-up among survivors. Models were adjusted for age, sex, race-center, mean arterial pressure, height, heart rate, smoking, and time between visits. Results: Of 5,096 participants at visit 5 (58% female, 21% black, mean age 75 [SD 5.1] years), 296 (6%) were frail and 2403 (47%) prefrail. In adjusted analyses at visit 5, frail participants had 30 cm/s (95% CI: -9, 69; p=0.1) higher cfPWV and prefrail participants had 12 cm/s (95% CI: -5, 30; p=0.2) higher cfPWV than those classified as robust (Table 1). In longitudinal analyses adjusted for attrition, we observed a 3 cm/s (95% CI: -11, 19; p=0.6) and 6 cm/s (95% CI: 0, 12; p=0.05) greater annualized increase in cfPWV over ~5 years among frail and prefrail participants, respectively, relative to the rate of arterial stiffening among robust participants (26 cm/s per year). Conclusions: Compared to robust older adults, greater aortic stiffness was observed among frail community-dwelling adults. Changes in aortic stiffening over the course of 5 years were not materially influenced by frailty status at baseline. Frail older adults may present with greater arterial aging and its associated hemodynamic effects on target organs.

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Engagement in Lifestyle Activities is Associated with Increased Alzheimer’s Disease-Associated Cortical Thickness and Cognitive Performance in Older Adults

Journal of Clinical Medicine ◽

10.3390/jcm9051424 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1424 ◽

Cited By ~ 1

Author(s):

Seongryu Bae ◽

Sangyoon Lee ◽

Kenji Harada ◽

Keitaro Makino ◽

Ippei Chiba ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Older Adults ◽

Cognitive Function ◽

Direct Effect ◽

Cortical Thickness ◽

Social Activities ◽

Direct Path ◽

Cognitive Activities ◽

Lifestyle Activities ◽

The Relationship

The aim of this study was to examine the association between lifestyle activities, including physical, cognitive, and social activities, and Alzheimer’s disease (AD) signature cortical thickness, as well as to examine the mediating role of AD signature cortical thickness in lifestyle activities and cognitive function in community-dwelling healthy older adults. Participants were 1026 older adults who met the study inclusion criteria. The physical, cognitive, and social activities of daily life were assessed using a self-reporting questionnaire. AD signature cortical thickness was determined using FreeSurfer software. Cognitive function was evaluated using the National Center for Geriatrics and Gerontology-Functional Assessment Tool. Path analysis (based on structural equation modeling (SEM)) of cognitive activities indicated that the direct path from cognitive activities to cognitive function was significant (p < 0.001), as was the direct path from AD signature cortical thickness to cognitive function (p < 0.001). Physical (p < 0.05) or social activities (p < 0.05) had a direct effect on cognitive function. However, AD signature cortical thickness did not mediate the relationship between physical or social activities and cognitive function. Our findings suggest that higher levels of cognitive activities later in life have a significant and positive direct effect on cognitive function. Additionally, AD signature cortical thickness significantly mediates the relationship between cognitive activities and cognitive function.

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P2-591: TAU TANGLE DENSITY MODIFIES THE RELATIONSHIP BETWEEN HOSPITALIZATION AND COGNITIVE DECLINE IN COMMUNITY-DWELLING OLDER ADULTS

Alzheimer s & Dementia ◽

10.1016/j.jalz.2018.06.1286 ◽

2006 ◽

Vol 14 (7S_Part_17) ◽

pp. P964-P964

Author(s):

Bryan D. James ◽

Robert S. Wilson ◽

Patricia A. Boyle ◽

Raj C. Shah ◽

Melissa Lamar ◽

...

Keyword(s):

Older Adults ◽

Cognitive Decline ◽

Community Dwelling ◽

Community Dwelling Older Adults ◽

The Relationship

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The association between motor capacity and mobility performance: frailty as a moderator

European Review of Aging and Physical Activity ◽

10.1186/s11556-019-0223-4 ◽

2019 ◽

Vol 16 (1) ◽

Cited By ~ 4

Author(s):

Carl-Philipp Jansen ◽

Nima Toosizadeh ◽

M. Jane Mohler ◽

Bijan Najafi ◽

Christopher Wendel ◽

...

Keyword(s):

Older Adults ◽

Frailty Index ◽

Community Dwelling ◽

Daily Routine ◽

Cross Sectional ◽

Mobility Performance ◽

Frailty Status ◽

Walking Performance ◽

And Performance ◽

The Relationship

Abstract Background In older adults, the linkage between laboratory-assessed ‘motor capacity’ and ‘mobility performance’ during daily routine is controversial. Understanding factors moderating this relationship could help developing more valid assessment as well as intervention approaches. We investigated whether the association between capacity and performance becomes evident with transition into frailty, that is, whether frailty status moderates their association. Methods We conducted a cross-sectional analysis of the observational Arizona Frailty Cohort Study (ClinicalTrials.gov identifier: NCT01880229) in a community-dwelling cohort in Tucson, Arizona. Participants were N = 112 older adults aged 65 years or older who were categorized as non-frail (n = 40), pre-frail (n = 53) or frail (n = 19) based on the Fried frailty index. Motor capacity was quantified as normal (NWS) and fast walking speed (FWS). Mobility performance was quantified as 1) cumulated physical activity (PA) time and 2) everyday walking performance (average steps per walking bout; maximal number of steps in one walking bout), measured by a motion sensor over a 48 h period. Hierarchical linear regression analyses were performed to evaluate moderation effects. Results Unlike in non-frail persons, the relationship between motor capacity and mobility performance was evident in pre-frail and frail persons, confirming our hypothesis. A moderating effect of frailty status was found for 1) the relationship between both NWS and FWS and maximal number of steps in one bout and 2) NWS and the average steps per bout. No moderation was found for the association between NWS and FWS with cumulated PA. Conclusion In pre-frail and frail persons, motor capacity is associated with everyday walking performance, indicating that functional capacity seems to better represent mobility performance in this impaired population. The limited relationship found in non-frail persons suggests that other factors account for their mobility performance. Our findings may help to inform tailored assessment approaches and interventions taking into consideration a person’s frailty status.

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