Abstract
Background: Frailty is a common syndrome among older adults and patients with several comorbidities. Grip strength (GS) is a representative parameter of frailty because it is a valid indicator of current and long-term physical conditions in the general population and patients with severe mental illnesses (SMIs). Physical and cognitive capacities of people with SMIs are usually impaired; however, their relationship with frailty or social functioning have not been studied to date. The current study aimed to determine if GS is a valid predictor of changes in cognitive performance and social functioning in patients with type-2 diabetes mellitus and SMIs. Methods: Assessments of social functioning, cognitive performance, and GS (measured with an electronic dynamometer) were conducted in 30 outpatients with type 2 diabetes mellitus, 35 with major depressive disorder, 42 with bipolar disorder, 30 with schizophrenia, and 28 healthy controls, twice during 1-year, follow-up period. Descriptive analyses were conducted using a one-way analysis of variance for continuous variables and the chi-squared test for categorical variables. Differences between groups for the motor, cognitive, and social variables at T1 and T2 were assessed using a one-way analysis of covariance, with sex and age as co-variates (p < 0.01). To test the predictive capacity of GS at baseline to explain the variance in cognitive performance and social functioning at T2, a linear regression analysis was performed (p < 0.05). Results: Predictive relationships were found among GS when implicated with clinical, cognitive, and social variables. These relationships explained changes in cognitive performance after one year of follow-up; the variability percentage was 67.7%, in patients with type-2 diabetes mellitus and 89.1% in patients with schizophrenia. Baseline GS along with other variables, also predicted changes in social functioning in major depressive disorder, bipolar disorder, and schizophrenia, with variability percentages of 67.3, 36, and 59%, respectively. Conclusion: GS combined with other variables significantly predicted changes in cognitive performance and social functioning in people with SMIs or type-2 diabetes mellitus. Interventions aimed to improve the overall physical conditions of patients who have poor GS could be a therapeutic option that confers positive effects on cognitive performance and social functioning.
Highlights
Physical fitness, cognitive ability, and social functioning are critical for living a healthy and happy life
Grip strength (GS) does influence cognitive and social changes since the physical condition in these patients is closely associated with the state of their disease. These findings suggest that people who are physically weaker or those whose physical abilities are diminished may be more vulnerable to a worsened pathology, that is, they may be in a state of physical and/or cognitive frailty
There are differences between the studied groups in terms of variability of results and the variables included in the regression models, with GS included at T1 to explain changes over time (T2)
Summary
Cognitive ability, and social functioning are critical for living a healthy and happy life. Connections between these three health components have been suggested, the causality and directionality of these relationships have not yet been fully elucidated (Firth et al, 2018a). These components are impaired in elderly patients and in those who, regardless of age, have chronic diseases such as type-2 diabetes mellitus (T2DM), major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia (SZ) (Guerra and Amaral, 2009; CataláLópez et al, 2013).
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