Abstract
Physical frailty is closely associated with cognitive impairment. We aim to investigate the neuropsychological profiles of prefrail and non-frail dementia-free community-dwelling older adults using a comprehensive neuropsychological evaluation, and to examine the association between specific frailty criteria and clinical and neuropsychological scores. Participants completed a comprehensive standardized neuropsychological evaluation (covering cognitive domains such as memory, executive functions, language and attention), and frailty assessment. Frailty was assessed according to biological criteria: unintentional weight loss, exhaustion, low physical activity, slowness, and weakness. The sample comprised 60 dementia-free community-dwelling adults, aged 65 years or older (range 65–89 years; 60.0% women). Forty-two participants were classified as robust (no frailty criteria present), and 18 as prefrail (1 or 2 frailty criteria present). We explored neurocognitive differences between the groups and examined the association between specific criteria of frailty phenotype and clinical and neuropsychological outcomes with bivariate tests and multivariate models. Prefrail participants showed poorer cognitive performance than non-frail participants in both memory and non-memory cognitive domains. However, delayed episodic memory was the only cognitive subdomain that remained significant after controlling for age, gender, and educational level. Gait speed was significantly associated with general cognitive performance, immediate memory, and processing speed, while grip strength was associated with visual episodic memory and visuoconstructive abilities. Both gait speed and grip strength were negatively associated with depressive scores. Our results suggest that prefrailty is associated with cognitive dysfunction. The fact that specific cognitive domains may be susceptible to subclinical states of physical frailty may have important clinical implications. Indeed, early detection of specific cognitive dysfunctions may allow opportunities for reversibility.
Highlights
Frailty is a common clinical syndrome in older adults due to age-related cumulative decline in multiple physiological systems, associated with negative health outcomes, including deterioration of daily living activities, disability, institutionalization, morbidity, and mortality [1]
No significant differences were observed between groups in overall cognitive performance assessed by the Mini-Mental State Examination (MMSE) (U = 345.5, z = −0.542, p = 0.588), bivariate tests indicated that prefrail participants showed worse scores in Benton Visual Retention Test, both in immediate (U = 216.5, z = −2.537, p = 0.011, r = −0.33) and delayed (U = 167.5, z = −3.297, p = 0.001, r = −0.43) applications, poor scores on the Luria-NDA immediate memory subscale (U = 226.0, z = −2.453, p = 0.014, r = −0.32), and worse scores in part B of Trail Making Test (U = 183.0, z = −2.646, p = 0.008, r = −0.34), compared to non-frail participants
Multivariate regression models revealed that delayed episodic memory was the only cognitive subdomain that remained significantly associated with frail status after controlling for age, gender and educational level
Summary
Frailty is a common clinical syndrome in older adults due to age-related cumulative decline in multiple physiological systems, associated with negative health outcomes, including deterioration of daily living activities, disability, institutionalization, morbidity, and mortality [1]. The rates of change of frailty and cognition over time are strongly correlated and associated with the same brain pathologies, such as the presence of macroinfarcts, Alzheimer’s disease pathology, and nigral neuronal loss [28]. Consideration of both factors is required for the identification of vulnerable older adults at risk of adverse health outcomes [20, 26]. Frailty and cognitive disorders, which are increasingly prevalent with advancing age, are being recognized as major healthcare priorities
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