Global Research On Cognitive Frailty: A Bibliometric and Visual Analysis of Papers Published During 2013 – 2021

Background: Cognitive frailty relates to various adverse health outcomes of older adults and is proposed as a new target of healthy ageing. This study aimed to analyze the status, hotspots, and emerging trends / frontiers of global research on cognitive frailty.Methods: Articles and reviews related to cognitive frailty of older people published from 2013 to 2021 were retrieved from the Web of Science Core Collection (WoSCC) database on 26 November 2021. CiteSpace 5.8.R3 was used to conduct the collaboration analysis, document co-citation analysis, and keyword co-occurrence analysis.Results: A total of 2,077 publications were included. There has been a rapid growth of publications on cognitive research since 2016. The United States, Italy, England, and Australia were the leading research centers of cognitive frailty; however, China has recently focused on this topic. The National Center for Geriatrics and Gerontology and Shimada H. were found to be the most prolific institution and author, respectively. Co-citation analysis identified 16 clusters, of which the largest was cognitive frailty. The most frequently occurred keyword was older adult, followed by cognitive impairment, frailty, risk, dementia, prevalence, mortality, health, and Alzheimer’s disease. Burst keyword detection revealed a rising interest in cognitive frailty models.Conclusions: By analyzing the publications over the past years, this study provides a comprehensive analysis of cognitive frailty research. A variety of visualized networks offer an in-depth understanding of the countries / regions, institutions, authors, hotspots, and research frontiers.

Serum Inflammatory Factors and Oxidative Stress Factors Are Associated With Increased Risk of Frailty and Cognitive Frailty in Patients With Cerebral Small Vessel Disease

Objective: To study the correlation between serum inflammatory factors, oxidative stress factors and frailty, and cognitive frailty in patients with cerebral small vessel disease (CSVD).Methods: A total of 281 patients with CSVD were selected from Tianjin Huanhu Hospital and Inner Mongolia People's Hospital from March 2019 to March 2021. CSVD was diagnosed by MRI. The FRAIL scale was used to evaluate the frailty of patients. Patients with CSVD with frailty and MMSE score <27 were considered to have cognitive frailty. Patients with non-cognitive frailty were included in the control group. The Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were used to evaluate the cognitive function of patients with CSVD. The serum interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α), matrix metalloproteinase 3 (MMP-3), superoxide dismutase (SOD), and malondialdehyde (MDA) of patients with CSVD were detected. The correlation between blood inflammatory factors and oxidative stress factors with the frailty and cognitive frailty patients of CSVD were analyzed. Univariate and multivariate logistic regression were used to analyze the correlation between cognitive frailty and CSVD.Results: Among the patients with CSVD selected in this study, female patients and older patients had a higher proportion of frailty (p < 0.001). In the Frail group, MoCA score and MMSE score were significantly lower than in the Pre-Frail and Robust groups, Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) scores were significantly higher than the Pre-Frail and Robust groups, and the differences were statistically significant (p < 0.05). Serum CRP, IL-6, TNF-α, MMP-3, and MDA levels in the Frail group were higher, but SOD levels were lower. The levels of serum CRP, IL-6, TNF-α, MMP-3, and MDA in patients with CSVD in the Cognitive Frailty group were significantly higher than those of the Control group, while the levels of SOD were significantly lower than those of the Control group, and the differences were significant (p < 0.001). The results of univariate and multivariate logistic regression analysis showed that CRP, TNF-α, MMP-3, and MDA levels were associated with cognitive frailty in patients with CSVD (p < 0.05).Conclusion: The increase of serum CRP, TNF-α, MMP-3, and MDA levels are significantly related to the increased risk of frailty and cognitive frailty in patients with CSVD.

Cognitive Frailty: An Update

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

“Neurocovid”: An Analysis of the Impact of Covid-19 on the Older Adults. Evolving Psychological and Neuropsychological Understanding

When SARS-CoV-2 began to spread, older adults experienced disproportionately greater adverse effects from the pandemic, including exacerbation of pre-existing physical and cognitive frailty conditions. More severe complications, higher mortality, and concerns about disruptions to their daily routines and access to care. Knowledge about the impact of COVID-19 on the brain is rapidly accumulating and this is reflected in the increasing use of the term “neurocovid”. Co-involvement of the central and peripheral nervous system had already been observed in SARS patients, but COVID-19 seems to invade it with greater affinity than other coronaviruses. This chapter provides an overview of the expanding understanding of the multiple ways in which COVID-19 affects the human brain, discuss the likelihood of long-term sequelae of neurocovid, and their implications for cognitive functions and behaviors in the elderly.

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

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.

Risk factors associated with cognitive frailty among community-dwelling older adults: A scoping review

Objectives This study aimed to explore the risk factors associated with cognitive frailty(CF) among community-dwelling older adults, and to provide the impact of CF on health-related outcomes. Methods PubMed, EMBASE, Cochrane, PsycINFO, CINAHL, RISS, DBpia, NDSL, and KoreaMed databases were searched to retrieve studies. Two reviewers independently screened titles, abstracts and articles. The inclusion criteria are peer-reviewed articles written in English or Korean for community-dwelling older adults with both physical frailty and cognitive impairment present at the same time. Results A total of 3,513 were searched, and the final 33 were extracted according to the inclusion criteria. Physical factors affecting CF were the number of chronic disease, cardiovascular disease, activity of daily living(ADL), making telephone calls and shopping during instrumental ADL, and a Mini Nutrition Assessment–Short Form score. Psychological factor was depressive symptoms. Significant behavioral factors included self-reported physical activity, low vitamin D, smoking, frequent insomnia, and sedentary lifestyle. In social factors, social participation such as volunteering was identified as a protective factor. Mortality, followed by dementia was health related outcomes on CF, including ADL dependence, poor quality of life, and hospitalization. However, the CF-related fall was inconsistent. Conclusion A wide variety of factors have been presented in studies related to CF. In order to understand CF and improve health-related outcomes, older adults in CF should be screened as high-risk group. When the risk factors and protective factors of CF managed, better health-related outcomes will lead to successful aging of community-dwelling older adults.