COGNITIVE FRAILTY AND INCIDENCE OF DEMENTIA IN OLDER PERSONS

2017 ◽  
pp. 1-7
Author(s):  
H. Shimada ◽  
H. Makizako ◽  
K. Tsutsumimoto ◽  
T. Doi ◽  
S. Lee ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Older Persons ◽  
Assessment Tool ◽  
Functional Decline ◽  
Word List ◽  
Community Dwelling ◽  
Future Research ◽  
Physical Frailty ◽  
Cognitive Frailty ◽  
Incidence Of Dementia

ACKGROUND: Cognitive frailty may be a preventive or therapeutic target for preventing dementia and functional decline with age. OBJECTIVES: To examine the relationship between physical and cognitive frailty and the incidence of dementia in community-living older persons. DESIGN: A prospective cohort study. Setting: General community in Japan. Participants: A total of 4072 persons aged ≥ 65 years. SETTING: A community in Japan. PARTICIPANTS: A total of 4072 community-dwelling older persons aged ≥ 65 years participated in the study. MEASUREMENTS: We characterized physical frailty as ≥ 3 of the following criteria: slow walking speed, muscle weakness, exhaustion, low physical activity, and weight loss. We used the National Center for Geriatrics and Gerontology-Functional Assessment Tool, which includes tests of word list memory, attention, and executive function, and processing speed to screen for cognitive frailty. The presence of ≥ 2 cognitive impairments, indicated by an age-adjusted score of at least 1.5 standard deviations below the reference threshold, was defined as cognitive frailty. The incidence of dementia was determined using data collected by the Japanese Health Insurance System over 24 months. RESULTS: The overall prevalence rates of physical frailty, cognitive impairment, and cognitive frailty (i.e., coexistence of frailty and cognitive impairment) were 5.1%, 5.5%, and 1.1%, respectively. During the follow-up period, 81 participants (2.0%) developed dementia. We found significant relationships between the incidence of dementia and cognitive impairment (hazard ratio (HR): 3.85, 95% confidence interval (95% CI): 2.09–7.10) and cognitive frailty (HR: 6.19, 95% CI: 2.7–13.99). However, the association between dementia and physical frailty did not reach significance (HR: 1.95, 95% CI: 0.97–3.91). CONCLUSIONS: Individuals with cognitive frailty had the highest risk of dementia. Future research should implement dementia prevention strategies among older persons with cognitive frailty.

scholarly journals Cognitive Frailty Predicts Incident Dementia among Community-Dwelling Older People

2018 ◽  
Vol 7 (9) ◽  
pp. 250 ◽  
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.

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

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.

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

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.

Increasing Life-Space Mobility in Community-Dwelling Older Persons With Cognitive Impairment Following Rehabilitation: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Phoebe Ullrich ◽  
Christian Werner ◽  
Martin Bongartz ◽  
Tobias Eckert ◽  
Bastian Abel ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Older Persons ◽  
Controlled Trial ◽  
Intervention Group ◽  
Community Dwelling ◽  
Control Group ◽  
Life Space ◽  
Home Based ◽  
Independent Life

Abstract Background Community-dwelling older persons with cognitive impairment (CI) following discharge from geriatric rehabilitation are at high risk of losing life-space mobility (LSM). Interventions to improve their LSM are, however, still lacking. The aim of this study was to evaluate the effects of a CI-specific, home-based physical training and activity promotion program on LSM. Methods Older persons with mild-to-moderate CI (Mini-Mental State Examination: 17–26 points) discharged home from rehabilitation were included in this double-blinded, randomized, placebo-controlled trial with a 12-week intervention period and 12-week follow-up period. The intervention group received a CI-specific, home-based strength, balance, and walking training supported by tailored motivational strategies. The control group received a placebo activity. LSM was evaluated by the Life-Space Assessment in Persons with Cognitive Impairment, including a composite score for LSM and 3 subscores for maximal, equipment-assisted, and independent life space. Mixed-model repeated-measures analyses were used. Results One hundred eighteen participants (82.3 ± 6.0 years) with CI (Mini-Mental State Examination: 23.3 ± 2.4) were randomized. After the intervention, the home-based training program resulted in a significant benefit in the Life-Space Assessment in Persons with Cognitive Impairment composite scores (b = 8.15; 95% confidence interval: 2.89–13.41; p = .003) and independent life-space subscores (b = 0.39; 95% confidence interval: 0.00–0.78; p = .048) in the intervention group (n = 63) compared to control group (n = 55). Other subscores and follow-up results were not significantly different. Conclusions The home-based training program improved LSM and independent life space significantly in this vulnerable population. Effects were not sustained over the follow-up. The program may represent a model for improved transition from rehabilitation to the community to prevent high risk of LSM restriction.

Exploring the Association between Multimorbidity and Cognitive Impairment in Older Adults Living in the Community: A Review of the Literature

2021 ◽  
pp. 108482232110304
Author(s):  
Grace F. Wittenberg ◽  
Michelle A. McKay ◽  
Melissa O’Connor
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Assessment Tool ◽  
Adult Population ◽  
Home Health ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Cognitive Screening ◽  
Review Of The Literature ◽  
Increased Risk

Two-thirds of older adults have multimorbidity (MM), or co-occurrence of two or more medical conditions. Mild cognitive impairment (CI) is found in almost 20% of older adults and can lead to further cognitive decline and increased mortality. Older adults with MM are the primary users of home health care services and are at high risk for CI development; however, there is no validated cognitive screening tool used to assess the level of CI in home health users. Given the prevalence of MM and CI in the home health setting, we conducted a review of the literature to understand this association. Due to the absence of literature on CI in home health users, the review focused on the association of MM and CI in community-dwelling older adults. Search terms included home health, older adults, cognitive impairment, and multimorbidity and were applied to the databases PubMed, CINAHL, and PsychInfo leading to eight studies eligible for review. Results show CI is associated with MM in older adults of increasing age, among minorities, and in older adults with lower levels of education. Heart disease was the most prevalent disease associated with increased CI. Sleep disorders, hypertension, arthritis, and hyperlipidemia were also significantly associated with increased CI. The presence of MM and CI was associated with increased risk for death among older adults. Further research and attention are needed regarding the use and development of a validated cognitive assessment tool for home health users to decrease adverse outcomes in the older adult population.

scholarly journals Intersectionality and Cognitive Impairment Risk in Older Persons With HIV: Age, Ethnicity, and LGBT Status

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 724-724
Author(s):  
Monica Rivera Mindt ◽  
Micah Savin ◽  
Angela Summers ◽  
Jordan Stiver ◽  
Alex Slaughter
Keyword(s):  
Working Memory ◽  
Cognitive Impairment ◽  
Executive Functioning ◽  
Hiv Infection ◽  
Older Persons ◽  
Neurocognitive Impairment ◽  
Future Research ◽  
Multiple Regressions ◽  
Persons Living With Hiv ◽  
Living With Hiv

Abstract The Latinx population is disproportionately affected by HIV-infection and older Latinx persons living with HIV (PLWH) are at greater risk for neurocognitive impairment (NCI). However, no studies have examined whether intersectionality (including Lesbian Gay Bisexual Transgender [LGBT] status) increases NCI risk. This study investigated whether LGBT status increases NCI risk in 126 PLWH (Ages 19-73 years; 74% Male; 66% Latinx, 34% NHW) who completed a comprehensive NC battery. Domain average T-scores were based on demographically-corrected norms. Multiple regressions revealed that after accounting for covariates (cocaine use, premorbid IQ) and other dimensions of intersectionality (age, ethnicity), LGBT status significantly contributed to NCI risk in attention/working memory (B=-4.50, p=.01) and executive functioning (trend-level; B=-3.67, p=.06). LGBT status, a key dimension of intersectionality, should be considered in NC assessment of PLWH. Future research is needed to identify factors (e.g., discrimination) that may confer increased NCI risk in this population.

Association between physical frailty and cognition in late-life depression

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.

scholarly journals Secondary prevention in cognitive frailty: the Treviso Dementia Registry

2016 ◽  
Vol 2 (2) ◽  
Author(s):  
Maurizio Gallucci
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Secondary Prevention ◽  
Action Plan ◽  
Health Conditions ◽  
Future Research ◽  
Cognitive Frailty ◽  
Preclinical Phase ◽  
Number Of Patients ◽  
Dementia Registry

Dementia is one of the most disabling health conditions for older people. Increasing attention is paid to the preclinical phase such as cognitive frailty and mild cognitive impairment, and to the prevention programs designed to reduce the number of patients in the future. The aims of this brief report are therefore: i) to illustrate an action plan currently active in Treviso and that is aimed at secondary prevention in cognitive frailty subjects on the Treviso Dementia (TREDEM) Registry; ii) to highlight the results achieved by the TREDEM Registry up to now and how these can be used in future research.

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