Predicting Non-elective hospital readmission or Death using a Composite Assessment of Cognitive Impairment and Frailty in Elderly Inpatients With Cardiovascular Diseases

Abstract Background: No prior studies have assessed the role of cognitive impairment and physical frailty in elderly inpatients with cardiovascular disease (CVD). We aimed to assess the utility of a combination developed using the mini-mental state examination (MMSE) + clock drawing test (CDT) and the Fried phenotype for predicting non-elective hospital readmission or death within 6-month in elderly inpatients with CVD. Methods : A single center prospective cohort was conducted between September 2018 and February 2019. Inpatients aged 65 years or older were recruited. All enrolled patients received a comprehensive geriatric assessment during hospitalization. The Kaplan-Meier curves were used to estimate the cumulative incidence of events. The multivariate Cox regression model was used to analyze the association between frailty and cognitive status and the non-elective hospital readmission or death. Results : A total of 542 patients were included; and a total of 113 patients (20.9%) died or were readmitted at 6-month. Overall 20% screened positive for cognitive impairment, including 8% were cognitive impairment combined with physical frailty, which were more older, more common in women and non-married group, had a lower education and a higher risk of malnutrition. Frail participants with normal (hazard ratio [HR]:1.73, 95% confidence intervals [CI]:1.06-2.82, P=0.028) and impaired cognition (HR:2.50, 95% CI:1.27-4.91, P=0.008) had a higher risk of non-elective hospital readmission or death than robust patients, after adjustment for age, sex, education level, marital status, the presence of diabetes mellitus, heart failure, and previous stroke. Conclusions : The presence of physical frailty and cognitive frailty were powerful predictors of non-elective hospital readmission or death in elderly inpatients with CVD, and taking cognitive impairment into account in the frailty model may allow better prediction of adverse outcomes of frailty in the short time. Trial registration: ChiCTR1800017204; date of registration: 07/18/2018.

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Predicting Non-elective hospital readmission or Death using a Composite Assessment of Cognitive and Physical Frailty in Elderly inpatients with Cardiovascular Disease

10.21203/rs.2.20842/v3 ◽

2020 ◽

Author(s):

Simin Yao ◽

Peipei Zheng ◽

Yaodan Liang ◽

Yuhao Wan ◽

Ning Sun ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cognitive Impairment ◽

Sex Education ◽

Hospital Readmission ◽

Education Level ◽

Cox Proportional Hazards ◽

Physical Frailty ◽

Discriminative Ability ◽

Frailty Phenotype ◽

Elderly Inpatients

Abstract Background: We aimed to assess the utility of the combination of the mini-mental state examination (MMSE) + clock drawing test (CDT) and the Fried phenotype for predicting non-elective hospital readmission or death within six months in elderly inpatients with cardiovascular disease (CVD).Methods: A single-center prospective cohort was conducted from September 2018 to February 2019. Inpatients ≥65 years old were recruited. Predictive validity was tested using a Cox proportional hazards regression model analysis, and the discriminative ability was evaluated by the receiver operating characteristic (ROC) curve. Results: A total of 542 patients were included. Overall, 12% (64/542) screened positive for cognitive impairment, 16% (86/542) were physically frail and 8% (44/542) had cognitive impairment combined with physical frailty, showing an older age (P<0.001) and a lower education level (P<0.001) than physically frail patients. A total of 113 patients (20.9%) died or were readmitted at six months. Frail participants with a normal (hazard ratio [HR]: 1.73, 95% confidence interval [CI]: 1.06-2.82, P=0.028) or impaired cognition (HR: 2.50, 95% CI: 1.27-4.91, P=0.008) had a higher risk of non-elective hospital readmission or death than robust patients after adjusting for the age, sex, education level, marital status, the presence of diabetes mellitus, heart failure, and history of stroke. The area under the ROC curve (AUC) showed that the discriminative ability in relation to six months readmission and death for the MMSE + CDT + Fried phenotype was 0.65 (95% CI: 0.60-0.71), and the AUC for men was 0.71 (95% CI: 0.63-0.78), while that for women was 0.60 (95% CI: 0.51-0.69).Conclusions: Accounting for cognitive impairment in the frailty phenotype may allow for the better prediction of non-elective hospital readmission or death in elderly inpatients with CVD in the short term.Trial registration: ChiCTR1800017204; date of registration: 07/18/2018.

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Predicting Non-elective hospital readmission or Death using a Composite Assessment of Cognitive and Physical Frailty in Elderly inpatients with Cardiovascular Disease

10.21203/rs.2.20842/v2 ◽

2020 ◽

Author(s):

Simin Yao ◽

Peipei Zheng ◽

Yaodan Liang ◽

Yuhao Wan ◽

Ning Sun ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cognitive Impairment ◽

Sex Education ◽

Roc Curve ◽

Hospital Readmission ◽

Education Level ◽

Physical Frailty ◽

Discriminative Ability ◽

Frailty Phenotype ◽

Elderly Inpatients

Abstract Background: We aimed to assess the utility of the combination of the mini-mental state examination (MMSE) + clock drawing test (CDT) and the Fried phenotype for predicting non-elective hospital readmission or death within six months in elderly inpatients with cardiovascular disease (CVD). Methods : A single-center prospective cohort was conducted from September 2018 to February 2019. Inpatients ≥65 years old were recruited. Predictive validity was tested using a Cox proportional hazards regression model analysis, and the discriminative ability was evaluated by the receiver operating characteristic (ROC) curve. Results : A total of 542 patients were included. Overall, 12% (64/542) screened positive for cognitive impairment, 16% (86/542) were physically frail and 8% (44/542) had cognitive impairment combined with physical frailty, showing an older age (P<0.001) and a lower education level (P<0.001) than physically frail patients. A total of 113 patients (20.9%) died or were readmitted at six months. Frail participants with a normal (hazard ratio [HR]: 1.73, 95% confidence interval [CI]: 1.06-2.82, P=0.028) or impaired cognition (HR: 2.50, 95% CI: 1.27-4.91, P=0.008) had a higher risk of non-elective hospital readmission or death than robust patients after adjusting for the age, sex, education level, marital status, the presence of diabetes mellitus, heart failure, and history of stroke. The area under the ROC curve (AUC) showed that the discriminative ability in relation to six months readmission and death for the MMSE + CDT + Fried phenotype was 0.65 (95% CI: 0.60-0.71), and the AUC for men was 0.71 (95% CI: 0.63-0.78), while that for women was 0.60 (95% CI: 0.51-0.69). Conclusions : Accounting for cognitive impairment in the frailty phenotype may allow for the better prediction of non-elective hospital readmission or death in elderly inpatients with CVD in the short term. Trial registration: ChiCTR1800017204; date of registration: 07/18/2018.

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Predicting non-elective hospital readmission or death using a composite assessment of cognitive impairment and frailty in elderly inpatients with cardiovascular diseases

European Heart Journal ◽

10.1093/ehjci/ehaa946.3227 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Yao ◽

H Wang ◽

J Yang ◽

N Sun

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

High Risk ◽

Hospital Readmission ◽

Adverse Outcomes ◽

Public Institution ◽

Funding Source ◽

Physical Frailty ◽

Kaplan Meier ◽

Elderly Inpatients

Abstract Background Cardiovascular disease (CVD) and related complications are significant healthcare problems in the growing elderly population. Metabolic factors are the predominant risk factors for CVD, sedentary behaviour and physical inactivity are major modifiable risk factors for CVD. Age-associated cognitive decline and impairment are associated with an increased mortality. Cognitive and physical components of frailty have pathophysiologic rationale as risk factors for CVD. There is a clinical need to identify more practical screens that can assist us to definite cognitive impairment and physical frailty, then to determine which patients with CVD are at high risk of adverse outcomes, early management of these high-risk patients can reduce readmission rates, healthcare spending, and improve quality of care. Purpose We aimed to assess the utility of a combination developed using the mini-mental state examination + clock drawing test and the Fried phenotype for predicting non-elective hospital readmission or death within 6-month in elderly inpatients with CVD. Methods A single center prospective cohort was conducted between September 2018 and February 2019. Inpatients aged 65 years or older were recruited. All enrolled patients received a comprehensive geriatric assessment during hospitalization. The Kaplan-Meier curves were used to estimate the cumulative incidence of events. The multivariate Cox regression model was used to analyze the association between frailty and cognitive status and the non-elective hospital readmission or death. Results A total of 542 patients were included; and a total of 113 patients (20.9%) died or were readmitted at 6-month. Overall 20% screened positive for cognitive impairment, including 8% were cognitive impairment combined with physical frailty, which were more older, more common in women and non-married group, had a lower education and a higher risk of malnutrition. Frail participants with normal (hazard ratio [HR]: 1.73, 95% confidence intervals [CI]: 1.06–2.82, P=0.028) and impaired cognition (HR: 2.50, 95% CI: 1.27–4.91, P=0.008) had a higher risk of non-elective hospital readmission or death than robust patients, after adjustment for age, sex, education level, marital status, the presence of diabetes mellitus, heart failure, and previous stroke. Conclusions The presence of physical frailty and cognitive frailty were powerful predictors of non-elective hospital readmission or death in elderly inpatients with CVD, and taking cognitive impairment into account in the frailty model may allow better prediction of adverse outcomes of frailty in the short time. Kaplan-Meier survival curves Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Beijing Municipal Science & Technology Commission, Chinese Academy of Medical Sciences

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NEUROPSYCHOLOGICAL PROFILE OF “COGNITIVE FRAILTY” SUBJECTS IN MAPT STUDY

Journal of Prevention of Alzheimer's Disease ◽

10.14283/jpad.2016.94 ◽

2016 ◽

pp. 1-9

Author(s):

J. Delrieu ◽

S. Andrieu ◽

M. Pahor ◽

C. Cantet ◽

M. Cesari ◽

...

Keyword(s):

Cognitive Impairment ◽

Alzheimer Disease ◽

Cognitive Status ◽

Physical Frailty ◽

Clinical Dementia Rating ◽

Frailty Phenotype ◽

Cognitive Frailty ◽

Clinical Criteria ◽

Neuropsychological Profile ◽

Set Up

Objectives: An international group proposed the existence of “cognitive frailty”, a condition defined by simultaneous presence of physical frailty and cognitive impairment in the absence of dementia. The objective was to compare the neuropsychological profiles in subgroups of elders differentiated across their physical frailty (Fried phenotype) and cognitive status (Clinical Dementia Rating score) to characterize the “cognitive frailty” entity. Method: We studied baseline characteristics of 1,617 subjects enrolled in Multidomain Alzheimer Disease Preventive Trial (MAPT). Included subjects were aged 70 years or older and presented at least 1 of the 3 following clinical criteria: (1) Memory complaint spontaneously reported to a general practitioner, (2) limitation in one instrumental activity of daily living, (3) slow gait speed. Subjects with dementia were not included in the trial. Results: “Cognitive frailty individuals” significantly differed from “individuals with cognitive impairment and without physical frailty”, scoring worse at executive, and attention tests. They presented subcortico-frontal cognitive pattern different of Alzheimer Disease. Cognitive performance of subjects with 3 criteria or more of the frailty phenotype are cognitively more impaired than subjects with only one. Discusion: The characterization of “cognitive frailty” must be done in frail subjects to set up specific preventive clinical trials for this population.

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PHYSICAL FRAILTY, COGNITIVE FRAILTY, AND THE RISK OF DEMENTIA IN THE GAIT AND BRAIN STUDY

Innovation in Aging ◽

10.1093/geroni/igz038.1466 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S396-S397

Author(s):

Manuel Montero-Odasso ◽

Yanina S Adamson ◽

Susan Muir-Hunter ◽

Tim Doherty ◽

Alvaro Casas-Herrero ◽

...

Keyword(s):

Cognitive Impairment ◽

Cognitive Status ◽

Physical Frailty ◽

Frailty Phenotype ◽

Cognitive Frailty ◽

Gait Performance ◽

Incident Dementia ◽

Risk Of Progression ◽

The Relationship ◽

Brain Study

Abstract Cognitive-frailty has been proposed as a distinctive entity which preludes dementia. We examined the relationship between physical frailty, cognitive status, and gait performance as predictors of cognitive decline and incident dementia. Using a cohort study of 252 community older adults free of dementia at baseline, we found that participants with frailty had a higher prevalence of cognitive impairment (77%) compared to those without (54%, p=0.02) but the risk of progression to dementia was not significant. Adding cognitive impairment to the frailty phenotype (cognitive-frailty) predicted further cognitive impairment and progression to dementia. However, when the slow gait component of frailty was combined with baseline cognitive impairment, it showed the highest risk of progression to dementia (HR: 35.9; 95%CI: 4.0–319.2; p= 0.001). Frailty and Cognitive impairment are common and co-exist in the same individuals. However, slowing gait seems to be the frailty component driving the association with future dementia.

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The Importance of Engaging in Physical Activity in Older Adulthood for Transitions Between Cognitive Status Categories and Death: A Coordinated Analysis of 14 Longitudinal Studies

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa268 ◽

2020 ◽

Author(s):

Tomiko Yoneda ◽

Nathan A Lewis ◽

Jamie E Knight ◽

Jonathan Rush ◽

Rebecca Vendittelli ◽

...

Keyword(s):

Physical Activity ◽

Cognitive Impairment ◽

Longitudinal Studies ◽

Sex Education ◽

Cognitive Status ◽

Extensive Literature ◽

Multinomial Regression ◽

Older Adulthood ◽

Modifiable Factors ◽

The Impact

Abstract Background Given increasing incidence of cognitive impairment and dementia, further understanding of modifiable factors contributing to increased healthspan is crucial. Extensive literature provides evidence that physical activity (PA) delays the onset of cognitive impairment; however, it is unclear whether engaging in PA in older adulthood is sufficient to influence progression through cognitive status categories. Method Applying a coordinated analysis approach, this project independently analyzed 14 longitudinal studies (NTotal = 52 039; mean baseline age across studies = 69.9–81.73) from North America and Europe using multistate survival models to estimate the impact of engaging in PA on cognitive status transitions (nonimpaired, mildly impaired, severely impaired) and death. Multinomial regression models were fit to estimate life expectancy (LE) based on American PA recommendations. Meta-analyses provided the pooled effect sizes for the role of PA on each transition and estimated LEs. Results Controlling for baseline age, sex, education, and chronic conditions, analyses revealed that more PA is significantly associated with decreased risk of transitioning from nonimpaired to mildly impaired cognitive functioning and death, as well as substantially longer LE. Results also provided evidence for a protective effect of PA after onset of cognitive impairment (eg, decreased risk of transitioning from mild-to-severe cognitive impairment; increased likelihood of transitioning backward from severe-to-mild cognitive impairment), though between-study heterogeneity suggests a less robust association. Conclusions These results yield evidence for the importance of engaging in PA in older adulthood for cognitive health, and a rationale for motivating older adults to engage consistently in PA.

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Midlife Plasma Aβ and Late-Life Risk of Cognitive Impairment: The Atherosclerosis Risk in Communities Study

Innovation in Aging ◽

10.1093/geroni/igaa057.810 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 251-252

Author(s):

Kevin Sullivan ◽

Chad Blackshear ◽

A Richey Sharrett ◽

Rebecca Gottesman ◽

David Knopman ◽

...

Keyword(s):

Cognitive Impairment ◽

Standard Deviation ◽

Sex Education ◽

Lower Risk ◽

Late Life ◽

Cognitive Status ◽

Cognitive Outcomes ◽

Effective Population ◽

Standard Deviation Increase ◽

Cerebral Amyloidosis

Abstract Plasma-based biomarkers of amyloid beta (Aβ), a neuropathological hallmark of Alzheimer’s disease, show promise in predicting cognitive impairment and mapping onto cerebral amyloidosis, but little is known about how midlife plasma Aβ associates with late-life cognitive outcomes. Midlife plasma variants Aβ42 and Aβ40 were measured using a fluorimetric bead-based immunoassay in a subsample of visit 3 ARIC participants (1993-95; n=2585, mean age=59.4±5.2, 57% female, 23% African American). We investigated the relationship between midlife plasma Aβ and late-life mild cognitive impairment (MCI; n=923) and dementia (n=628) diagnosed from 2011-19. Multinomial logistic regressions estimated relative risk ratios (RRR) of MCI, dementia, and death vs normal cognitive status as a function of:(1) Aβ42:Aβ40 ratio, (2) Aβ42 and Aβ40 included as separate terms, and (3) Protected Aβ group (participants with Aβ42≥46 pg/ml and Aβ40 <233 pg/ml). Adjusters included age, sex, education, site-race, and APOE4. Every doubling of midlife plasma Aβ42:Aβ40 up to a threshold of 0.20 was associated with 41% lower risk of developing MCI/dementia in comparison to cognitively normal (RRR=0.59 [95% CI:0.42, 0.82]), with no association for ratio values ≥0.20. Every standard deviation increase in plasma Aβ42 was associated with 17% lower risk of dementia (RRR=0.83 [0.70, 0.99]), whereas every standard deviation increase in plasma Aβ40 was associated with 16% higher risk of MCI (RRR=1.16 [1.02, 1.31]). The protected midlife plasma Aβ group had 86% lower risk of late-life dementia vs all others (RRR=0.14 [0.04, 0.47]). Early measurement of plasma Aβ may prove an accessible and effective population screener for future cognitive impairment.

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Association between physical frailty and cognition in late-life depression

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.037 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S84-S84

Author(s):

M. Arts ◽

R. Collard ◽

H. Comijs ◽

M. Zuidersma ◽

S. de Rooij ◽

...

Keyword(s):

Cognitive Impairment ◽

Cognitive Functioning ◽

Processing Speed ◽

Verbal Memory ◽

Late Life ◽

Interference Control ◽

Late Life Depression ◽

Physical Frailty ◽

Cognitive Frailty ◽

Frailty Criteria

IntroductionCognitive frailty has recently been defined as the co-occurrence of physical frailty and cognitive impairment. Late-life depression is associated with both physical frailty and cognitive impairment, especially processing speed and executive functioning.Aim and objectivesIn this study, we investigated the association between physical frailty and cognitive functioning in depressed older persons.MethodsIn a total of 378 patients (> 60 years) with depression according to DSM-IV criteria and a MMSE score of 24 points or higher, the physical frailty phenotype as well as its individual criteria (weight loss, weakness, exhaustion, slowness, low activity) was studied. Cognitive functioning was examined in 4 domains: verbal memory, working memory, interference control, and processing speed.ResultsOf the 378 depressed patients (range 60–90 years; 66.1% women), 61 were classified as robust (no frailty criteria present), 214 as prefrail (1 or 2 frailty criteria present), and 103 as frail (> 3 criteria). Linear regression analyses, adjusted for confounders, showed that the severity of physical frailty was associated with poorer verbal memory, slower processing speed, and decreased working memory, but not with changes in interference control.ConclusionIn late-life depression, physical frailty is associated with poorer cognitive functioning, although not consistently for executive functioning. Future studies should examine whether cognitive impairment in the presence of physical frailty belongs to cognitive frailty and is indeed an important concept to identify a specific subgroup of depressed older patients, who need multimodal treatment strategies integrating physical, cognitive, and psychological functioning.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Living alone with dementia: lack of awareness adds to functional and cognitive vulnerabilities

International Psychogeriatrics ◽

10.1017/s1041610209991529 ◽

2010 ◽

Vol 22 (5) ◽

pp. 778-784 ◽

Cited By ~ 31

Author(s):

Susan W. Lehmann ◽

Betty S. Black ◽

Andrew Shore ◽

Judith Kasper ◽

Peter V. Rabins

Keyword(s):

Cognitive Impairment ◽

Functional Impairment ◽

Cognitive Abilities ◽

Primary Care Physicians ◽

Psychiatric Symptoms ◽

Cognitive Status ◽

Adverse Outcomes ◽

Living Alone ◽

Cognitive Vulnerabilities ◽

Functional Factors

ABSTRACTBackground: Approximately 25% of individuals with dementia live alone, yet little is known about the cognitive and functional factors that impact detection of impairment.Methods: Subjects with dementia (n = 349) from a community study of dementia management were administered the Mini-mental State Examination (MMSE) and were asked to rate their cognitive status. Each participant's knowledgeable informant (KI) was interviewed to provide information about the subject's mental health and levels of cognitive and functional impairment. Subjects with dementia living alone (n = 97, 27.8%) were compared to subjects living with others (n = 252, 72.2%) regarding functional impairment, psychiatric symptoms, cognitive functioning, and dementia recognition.Results: While subjects with dementia living alone had significantly fewer ADL impairments (p < 0.0001) and less cognitive impairment (p < 0.0001) than subjects with dementia who were living with others, nearly half of subjects living alone had two or more IADL impairments. Both knowledgeable informants (p < 0.001) and primary care physicians (p < 0.009) were less likely to detect dementia in subjects living alone, while 77.3% of subjects with dementia living alone rated their cognitive abilities as “good” or “a little worse”. Subjects with dementia living alone and those living with others had similar rates of psychosis (p = 0.2792) and depressive symptoms (p = 0.2076).Conclusions: Lack of awareness of cognitive impairment by individuals with dementia living alone as well as their knowledgeable informants and physicians, combined with frequent functional impairment and psychiatric symptoms, heightens risk for adverse outcomes. These findings underscore the need for increased targeted screening for dementia and functional impairment among older persons living alone.

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Deviations in Hippocampal Subregion in Older Adults With Cognitive Frailty

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2020.615852 ◽

2021 ◽

Vol 12 ◽

Author(s):

Mingyue Wan ◽

Yu Ye ◽

Huiying Lin ◽

Ying Xu ◽

Shengxiang Liang ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Molecular Layer ◽

Chinese Version ◽

Healthy Controls ◽

Physical Frailty ◽

Cognitive Frailty ◽

Significant Volume ◽

The Right ◽

Volume Decrease

BackgroundCognitive frailty is a particular state of cognitive vulnerability toward dementia with neuropathological hallmarks. The hippocampus is a complex, heterogeneous structure closely relates to the cognitive impairment in elderly which is composed of 12 subregions. Atrophy of these subregions has been implicated in a variety of neurodegenerative diseases. The aim of this study was to explore the changes in hippocampal subregions in older adults with cognitive frailty and the relationship between subregions and cognitive impairment as well as physical frailty.MethodsTwenty-six older adults with cognitive frailty and 26 matched healthy controls were included in this study. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCA) scale (Fuzhou version) and Wechsler Memory Scale-Revised Chinese version (WMS-RC), while physical frailty was tested with the Chinese version of the Edmonton Frailty Scale (EFS) and grip strength. The volume of the hippocampal subregions was measured with structural brain magnetic resonance imaging. Partial correlation analysis was carried out between the volumes of hippocampal subregions and MoCA scores, Wechsler’s Memory Quotient and physical frailty indexes.ResultsA significant volume decrease was found in six hippocampal subregions, including the bilateral presubiculum, the left parasubiculum, molecular layer of the hippocampus proper (molecular layer of the HP), and hippocampal amygdala transition area (HATA), and the right cornu ammonis subfield 1 (CA1) area, in older adults with cognitive frailty, while the proportion of brain parenchyma and total number of white matter fibers were lower than those in the healthy controls. Positive correlations were found between Wechsler’s Memory Quotient and the size of the left molecular layer of the HP and HATA and the right presubiculum. The sizes of the left presubiculum, molecular of the layer HP, and HATA and right CA1 and presubiculum were found to be positively correlated with MoCA score. The sizes of the left parasubiculum, molecular layer of the HP and HATA were found to be negatively correlated with the physical frailty index.ConclusionSignificant volume decrease occurs in hippocampal subregions of older adults with cognitive frailty, and these changes are correlated with cognitive impairment and physical frailty. Therefore, the atrophy of hippocampal subregions could participate in the pathological progression of cognitive frailty.

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