Incidence and Predictors of Cognitive Frailty Among Older Adults: A Community-based Longitudinal Study

(1) Background: Cognitive frailty (CF) is the simultaneous presence of physical frailty and cognitive impairment with an increased risk of dementia. Considering that the risk factors of CF are mostly elucidated from cross-sectional studies, we conducted a community-based longitudinal study to determine the incidence and the predictors of CF among Malaysian older adults.; (2) Methods: Out of 490 older adults participating in the Malaysian Towards Useful Aging (TUA) study, 282 were successfully followed-up at five-years for an analysis of the CF incidence. CF was defined as a comorbid physical frailty (>1 Fried criteria) and mild cognitive impairment (Petersen criteria). A comprehensive interview-based questionnaire was administered for sociodemographic information, cognitive function, physical function, dietary intake, psychosocial, and biochemical indices. Univariate analyses were performed for each variable, followed by a regression analysis to identify the predictors of CF that accounted for confounding effects between the studied factors; (3) Results: The incidence rate of CF was 7.1 per 100 person-years. Advancing age (OR=1.12, 95% CI:1.04-1.21, p < 0.05), depression (OR=1.20, 95% CI:1.05-1.37, p < 0.05), decreased processing speed, assessed by a lower digit symbol score (OR=0.67, 95%CI:0.0.56-0.80, p < 0.05), decreased functional mobility measured using Timed-Up-and-Go (TUG) (OR=1.23, 95% CI:1.04-1.46, p < 0.05), low vitamin D intake (OR:0.36, 95% CI:0.14-0.93, p < 0.05) and physical frailty (OR=2.16, 95% CI:1.02-4.58, p < 0.05) were predictors for CF incidence; and (4) Conclusions: Our study results could be used as an initial reference for future studies to formulate effective preventive management and intervention strategies to decelerate CF development among older adults.

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Cognitive Frailty And Risk Of Functional Disability In Older Japanese Adults: A 4-Year Prospective Study

Innovation in Aging ◽

10.1093/geroni/igab046.2989 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 820-821

Author(s):

Sanmei Chen ◽

Takanori Honda ◽

Tao Chen ◽

Hiro Kishimoto ◽

Shuzo Kumagai ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Functional Disability ◽

Community Dwelling ◽

Cardiovascular Health Study ◽

Minor Trauma ◽

Physical Frailty ◽

Term Care ◽

Cognitive Frailty ◽

Increased Risk

Abstract Background Cognitive frailty is a newly proposed clinical entity, referring to concurrent cognitive impairment and physical frailty in the absence of dementia. The clinical significance of cognitive frailty remains poorly understood. We aimed to investigate the association between cognitive frailty and functional disability in older adults. Methods A total of 1,644 non-demented older adults aged ≥65 years (mean age: 73 ± 6 years; men: 41.8%) and without functional disability at baseline were followed-up for 4 years. Cognitive frailty was defined as the presence of both physical frailty (based on the modified Cardiovascular Health Study criteria) and cognitive impairment (Mini-Mental State Examination score of <24 points). Functional disability was identified using the database of Japan’s Long-term Care Insurance System. Association between cognitive frailty and functional disability was assessed by using the Cox proportional hazard models. Results During the follow-up, 152 participants were identified as being functionally disabled. There was a significant interaction between physical frailty and cognitive impairment on the development of functional disability (P <0.1). Compared with being robust both physically and cognitively, the hazard ratio (95% confidence interval) of functional disability was 8.40 (4.05-17.42) for cognitively frailty, after adjustment for age, sex, education, living alone, smoking, drinking, number of comorbidities (hypertension, stroke, chronic heart disease, diabetes, chronic kidney disease, poor hearing, poor vision, osteoarthritis or rheumatism, minor trauma fracture, or cancer). Conclusion Cognitive frailty was associated with an increased risk of functional disability in community-dwelling older adults. Cognitive frailty could be an underrecognized risk factor for functional disability.

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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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Association Between Body Mass Index, Its Change And Cognitive Impairment Among Chinese Older Adults: A Community-Based, 9-Year Prospective Cohort Study

10.21203/rs.3.rs-417270/v1 ◽

2021 ◽

Author(s):

Shanshan Wu ◽

Xiaozhen Lv ◽

Jie Shen ◽

Hui Chen ◽

Yuan Ma ◽

...

Keyword(s):

Older Adults ◽

Body Mass Index ◽

Weight Loss ◽

Cohort Study ◽

Cognitive Impairment ◽

Prospective Cohort ◽

Community Based ◽

Chinese Older Adults ◽

Large Weight Loss ◽

Increased Risk

Abstract Objective To examine the association of baseline body mass index (BMI) and BMI change with cognitive impairment among older adults in China. Methods The study included data from the Chinese Longitudinal Healthy Longevity Study, a national community-based prospective cohort study from 2002-2018. Baseline BMI and BMI change measurements were available for 12,027 adults aged older than 65 years. Cognitive impairment was defined as Chinese version of the Mini Mental State Examination score less than 18. Multivariable Cox proportional hazard model was used.Results Among 12027 participants (mean age was 81.23 years old and 47.48% were male), the proportion of underweight, normal, overweight and obese at baseline was 33.87%, 51.39%, 11.39% and 3.34%, respectively. During an average of 5.9 years’ follow-up, 3086 participants (4.35 per 100 person-years) with incident cognitive impairment were identified. Compared with normal weight group, adjusted hazard ratio (AHR) for cognitive impairment was 0.86 (95% CI 0.75-0.99) among overweight group, whereas corresponding AHR was 1.02 (95% CI 0.94-1.10) in underweight and 1.01 (95% CI 0.80-1.28) in obese. Large weight loss (<-10%) was significantly associated with an increased risk of cognitive impairment (AHR, 1.42, 95% CI 1.29-1.56), compared to stable weight status group (-5%~5%). In the restricted cubic spline models, BMI change showed a L-shaped association with cognitive impairment. Conclusions BMI-defined overweight is associated with a reduced risk of cognitive impairment among Chinese older adults, while large weight loss is associated with increased risk. More attention should be paid to older adults with significant weight loss.

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Cognitive Frailty and Its Long-Term Effect on Depression in an Older Population in Korea

Innovation in Aging ◽

10.1093/geroni/igab046.1708 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 442-442

Author(s):

Yoonjung Ji ◽

TaeWha Lee ◽

Eunkyung Kim

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Group Analysis ◽

Secondary Analysis ◽

Epidemiological Studies ◽

Physical Frailty ◽

Older Population ◽

Cognitive Frailty ◽

The Relationship

Abstract Cognitive frailty is a condition where physical frailty and mild cognitive impairment (MCI) co-exist without dementia. It occurs in 1.8%-8.9% of the general older population, and older people with depression have a higher risk of frailty. However, the relationship between cognitive frailty and depression is still unclear. This study aimed to determine the relationship between cognitive frailty and depression of older adults by time using comparative group analysis. A secondary analysis was conducted using the Korean Longitudinal Study of Aging (KLoSA) dataset from 2010 to 2018. A sample was 981 older adults who were 65 years old and without dementia over residing in the community. Cognitive frailty was defined as having a mini-mental state examination score of 18-23 and 3 or more of the Fried frailty indexes. Generalized Estimating Equation model and chi-square test were employed. Of the 981 subjects, the cognitive frailty(CF) was 28.5%, followed by robust (37.7%), physical frailty (PF, 29.4%), mild cognitive impairment (MCI, 4.4%) at baseline. The group differences on depression measured by the Center for Epidemiological Studies Depression (CESD) were statistically significant in the PF (F=4.70, p<.001) and the CF (F=4.95, p<.001) group compared to the robust group. The time difference effect (F=.09, p=.05) and a group-by-time interaction effect were observed (p<.001). This study confirmed that cognitive frailty is strongly associated with depression. Effective approaches to managing psychological wellbeing, including dementia, are essential for older adults with cognitive frailty.

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Heterogeneous Influence of Frailty Phenotypes in Age-Related Hearing Loss and Tinnitus in Chinese Older Adults: An Explorative Study

Frontiers in Psychology ◽

10.3389/fpsyg.2020.617610 ◽

2021 ◽

Vol 11 ◽

Author(s):

Qingwei Ruan ◽

Jie Chen ◽

Ruxin Zhang ◽

Weibin Zhang ◽

Jian Ruan ◽

...

Keyword(s):

Older Adults ◽

Hearing Loss ◽

Cognitive Impairment ◽

Cognitive Decline ◽

Community Dwelling ◽

Lower Probability ◽

Physical Frailty ◽

Frailty Phenotype ◽

Cognitive Frailty ◽

Age Related

BackgroundFried physical frailty, with mobility frailty and non-motor frailty phenotypes, is a heterogeneous syndrome. The coexistence of the two phenotypes and cognitive impairment is referred to as cognitive frailty (CF). It remains unknown whether frailty phenotype has a different association with hearing loss (HL) and tinnitus.MethodsOf the 5,328 community-dwelling older adults, 429 participants aged ≥58 years were enrolled in the study. The participants were divided into robust, mobility, and non-mobility frailty, mobility and non-mobility CF (subdivided into reversible and potentially reversible CF, RCF, and PRCF), and cognitive decline [subdivided into mild cognitive impairment (MCI) and pre-MCI] groups. The severity and presentations of HL and/or tinnitus were used as dependent variables in the multivariate logistic or nominal regression analyses with forward elimination adjusted for frailty phenotype stratifications and other covariates.ResultsPatients with physical frailty (mobility frailty) or who are robust were found to have lower probability of developing severe HL and tinnitus, and presented HL and/or tinnitus than those with only cognitive decline, or CF. Patients with RCF and non-mobility RCF had higher probability with less HL and tinnitus, and the presentation of HL and/or tinnitus than those with PRCF and mobility RCF. Other confounders, age, cognitive and social function, cardiovascular disease, depression, and body mass index, independently mediated the severity of HL and tinnitus, and presented HL and/or tinnitus.ConclusionFrailty phenotypes have divergent association with HL and tinnitus. Further research is required to understand the differential mechanisms and the personalized intervention of HL and tinnitus.Clinical Trial RegistrationClinicalTrials.gov identifier, NCT2017K020.

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Cognitive frailty in relation to adverse health outcomes independent of multimorbidity in Chinese older adults

Innovation in Aging ◽

10.1093/geroni/igaa057.3342 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 908-909

Author(s):

Zuyun Liu ◽

Chen Chen ◽

Juyoung Park ◽

Chenkai Wu ◽

Qian-Li Xue ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Health Outcomes ◽

Healthy Aging ◽

Physical Frailty ◽

International Consensus ◽

Cognitive Frailty ◽

Chinese Older Adults ◽

Adverse Health ◽

Adverse Health Outcomes

Abstract Cognitive frailty was proposed in 2013 by an (I.A.N.A./I.A.G.G.) international consensus group; however, little is known about its status and associations with adverse health outcomes in China. The objectives of this study were to evaluate: 1) the associations of cognitive frailty with various health outcomes including disability, hospitalization, and death; 2) whether the associations differed by multimorbidity in Chinese older adults. We included 5113 Chinese older adults (aged 60+ years) who had baseline (2011 wave) cognition and physical frailty assessments and follow-up for 4 years from the China Health and Retirement Longitudinal Study. We found that about 16.0% had cognitive impairment; 6.7% had physical frailty; and 1.6% met criteria for cognitive frailty (having both cognitive impairment and physical frailty). Both cognitive impairment (odds ratios (ORs) range: 1.41 to 2.11) and physical frailty (ORs range: 1.51 to 2.43) were independently associated with basic activities of daily living (BADL), instrumental ADL (IADL), mobility disability, hospitalization, and death among participants without that corresponding outcome at baseline, even after accounting for covariates. Relative to participants who had normal cognition and were nonfrail, those with cognitive frailty had the highest risk for IADL disability (OR=3.40, 95% CI, 1.23–9.40) and death (OR=3.89, 95% CI, 2.25–6.47). We did not find significant interaction effects between cognitive frailty and multimorbidity (P for interactions>0.05). Overall, cognitive frailty was associated with disability and death, independent of multimorbidity. This highlights the importance of assessing cognitive frailty in the community to promote primary and secondary preventions for healthy aging.

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Cognitive Frailty Predicts Incident Dementia among Community-Dwelling Older People

Journal of Clinical Medicine ◽

10.3390/jcm7090250 ◽

2018 ◽

Vol 7 (9) ◽

pp. 250 ◽

Cited By ~ 21

Author(s):

Hiroyuki Shimada ◽

Takehiko Doi ◽

Sangyoon Lee ◽

Hyuma Makizako ◽

Liang-Kung Chen ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Significant Risk ◽

Word List ◽

Community Dwelling ◽

Prevalence Rates ◽

Physical Frailty ◽

Cognitive Frailty ◽

Primary Screening ◽

Incident Dementia

Cognitive frailty, defined as the presence of both frailty and cognitive impairment, is a risk factor for adverse events in older adults. However, prevalence rates of cognitive frailty are low (1.1–2.5%), so primary screening is unsuitable in community settings. The aim of the study was to examine whether a new definition of cognitive frailty, which was developed for primary screening, is useful to predict incident dementia in community-dwelling older adults. A total of 4570 older adults participated in the study (2326 women; average age, 71.9 ± 5.5 years). We defined physical frailty as the presence of ≥1 of the following symptoms: slow walking speed and muscle weakness. Cognitive impairment was defined as ≥1 symptom of cognitive impairment, indicated by an age- and education-adjusted score that was ≥1.5 standard deviations below the reference threshold in word list memory, attention, executive function, and processing speed tests. Cognitive frailty was defined as comorbid physical frailty and cognitive impairment. The incidence of dementia was determined using data collected by the Japanese Health Insurance System over 36 months. The prevalence rates of physical frailty, cognitive impairment, and cognitive frailty were 17.5%, 15.3%, and 9.8%, respectively. Cognitive impairment (hazard ratio [HR]: 2.06, 95% confidence interval [95% CI]: 1.41–3.02) and cognitive frailty (HR: 3.43, 95% CI: 2.37–4.97) were found to be significant risk factors for dementia. However, the association between dementia and physical frailty was not significant (HR: 1.13, 95% CI: 0.76–1.69). Individuals with comorbid physical frailty and cognitive impairment could have a higher risk of dementia than healthy older adults or older adults with either physical frailty or cognitive impairment alone.

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Cognitive function and amyloid marker in frail older adults: The COGFRAIL Cohort Study

Journal of Frailty & Aging ◽

10.14283/jfa.2020.57 ◽

2020 ◽

pp. 1-8

Author(s):

S. Sourdet ◽

G. Soriano ◽

J. Delrieu ◽

Z. Steinmeyer ◽

S. Guyonnet ◽

...

Keyword(s):

Older Adults ◽

Body Composition ◽

Cognitive Impairment ◽

Amyloid Β ◽

Amyloid Pet ◽

Physical Frailty ◽

Cognitive Frailty ◽

Frail Older Adults ◽

Amyloid Pathology ◽

Cerebral Amyloid

Background: Frailty and cognitive impairment are common manifestations of the ageing process and are closely related. But the mechanisms linking aging, physical frailty, and cognitive disorders, are complex and remain unclear. Objectives: We aim to explore the role of cerebral amyloid pathology, but also a range of nutritional, physical, biological or brain-aging marker in the development of cognitive frailty. Method: COGFRAIL study is a monocentric prospective study of frail older patients with an objective cognitive impairment (Clinical Dementia Rating Scale global score at 0.5 or 1). Three-hundred-and-twenty-one patients are followed up every 6 months, for 2 years. Clinical assessment at baseline and during follow-up included frailty, physical, mood, sensory, nutritional, and cognitive assessment (with a set of neuropsychological tests). Cerebral amyloid pathology is measured by amyloid Positron Emission Tomography (PET) or amyloid-β-1-42 level in cerebrospinal fluid. Brain magnetic resonance imaging, measurement of body composition using Dual X Ray Absorptiometry and blood sampling are performed. The main outcome of the study is to assess the prevalence of positive cerebral amyloid status according to amyloid PET or amyloid-β-1-42 level CSF. Secondary outcomes included biological, nutritional, MRI imaging, cognitive, clinical, physical and body composition markers to better understand the mechanisms of cognitive frailty. Perspective: COGFRAIL study will give the opportunity to better understand the link between Gerosciences, frailty, cognitive impairment, and Alzheimer’s disease, and to better characterize the physical and cognitive trajectories of frail older adults according to their amyloid status. Understanding the relationship between physical frailty and cognitive impairment is a prerequisite for the development of new interventions that could prevent and treat both conditions.

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Frailty, with or without Cognitive Impairment, is a Strong Predictor of Recurrent Falls in a US Population-Representative Sample of Older Adults

The Journals of Gerontology Series A ◽

10.1093/gerona/glab083 ◽

2021 ◽

Author(s):

Mei-Ling Ge ◽

Eleanor M Simonsick ◽

Bi-Rong Dong ◽

Judith D Kasper ◽

Qian-Li Xue

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Strong Predictor ◽

Word Recall ◽

Physical Frailty ◽

Frailty Phenotype ◽

Clock Drawing Test ◽

Recurrent Falls ◽

Health Aging ◽

Marginal Means

Abstract Background Physical frailty and cognitive impairment have been separately associated with falls. The purpose of the study is to examine the associations of physical frailty and cognitive impairment separately and jointly with incident recurrent falls among older adults. Methods The analysis included 6000 older adults in community or non-nursing home residential care settings who were ≥65 years and participated in the National Health Aging Trends Study (NHATS). Frailty was assessed using the physical frailty phenotype; cognitive impairment was defined by bottom quintile of clock drawing test or immediate and delayed 10-word recall, or self/proxy-report of diagnosis of dementia, or AD8 score≥ 2. The marginal means/rates models were used to analyze the associations of frailty (by the physical frailty phenotype) and cognitive impairment with recurrent falls over 6 years follow-up (2012-2017). Results Of the 6000 older adults, 1,787 (29.8%) had cognitive impairment only, 334 (5.6%) had frailty only, 615 (10.3%) had both, and 3,264 (54.4%) had neither. After adjusting for age, sex, race, education, living alone, obesity, disease burden, and mobility disability, those with frailty (with or without cognitive impairment) at baseline had higher rates of recurrent falls than those without cognitive impairment and frailty (frailty only: Rate ratio (RR)=1.31, 95% confidence interval (CI)=1.18-1.44; both: RR=1.28, 95% CI=1.17-1.40). The association was marginally significant for those with cognitive impairment only (RR=1.07, 95% CI=1.00-1.13). Conclusions Frailty and cognitive impairment were independently associated with recurrent falls in non-institutionalized older adults. There was a lack of synergistic effect between frailty and cognitive impairment.

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Association of self-perceived income sufficiency with cognitive impairment among older adults: a population-based study in India

BMC Psychiatry ◽

10.1186/s12888-021-03257-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

T. Muhammad ◽

Shobhit Srivastava ◽

T. V. Sekher

Keyword(s):

Risk Factors ◽

Older Adults ◽

Cognitive Impairment ◽

Activities Of Daily Living ◽

Psychological Health ◽

Daily Living ◽

Basic Needs ◽

Well Being ◽

Asset Ownership ◽

Increased Risk

Abstract Background Greater cognitive performance has been shown to be associated with better mental and physical health and lower mortality. The present study contributes to the existing literature on the linkages of self-perceived income sufficiency and cognitive impairment. Study also provides additional insights on other socioeconomic and health-related variables that are associated with cognitive impairment in older ages. Methods Data for this study is derived from the 'Building Knowledge Base on Population Ageing in India'. The final sample size for the analysis after removing missing cases was 9176 older adults. Descriptive along with bivariate analyses were presented to show the plausible associations of cognitive impairment with potential risk factors using the chi-square test. Also, binary logistic regression analysis was performed to provide the relationship between cognitive impairment and risk factors. The software used was STATA 14. Results About 43% of older adults reported that they had no source of income and 7.2% had income but not sufficient to fulfil their basic needs. Older adults with income but partially sufficient to fulfil their basic needs had 39% significantly higher likelihood to suffer from cognitive impairment than older adults who had sufficient income [OR: 1.39; OR: 1.21–1.59]. Likelihood of cognitive impairment was low among older adults with asset ownership than older adults with no asset ownership [OR: 0.83; CI: 0.72–0.95]. Again, older adults who work by compulsion (73.3%) or felt mental or physical stress due to work (57.6%) had highest percentage of cognitive impairment. Moreover, older adults with poor self-rated health, low instrumental activities of daily living, low activities of daily living, low subjective well-being and low psychological health were at increased risk for cognitive impairment. Conclusion The study highlights the pressing need for care and support and especially financial incentives in the old age to preserve cognitive health. Further, while planning geriatric health care for older adults in India, priority must be given to financially backward, with no asset ownership, with poor health status, older-older, widowed, and illiterate older individuals, as they are more vulnerable to cognitive impairment.

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