Abstract
To examine how various combinations of cognitive impairment (overall performance and specific domains) and pre-frailty predict risks of adverse outcomes; and to determine whether cognitive frailty may be defined as the combination of cognitive impairment and the presence of pre-frailty. Community-based cohort study. Chinese men and women (n = 3,491) aged 65+ without dementia, Parkinson's disease and/or frailty at baseline. Frailty was characterized using the Cardiovascular Health Study criteria. Overall cognitive impairment was defined by a Cantonese Mini-Mental Status Examination (CMMSE) total score (<21/24/27, depending on participants' educational levels); delayed recall impairment by a CMMSE delayed recall score (<3); and language and praxis impairment by a CMMSE language and praxis score (<9). Adverse outcomes included poor quality of life, physical limitation, increased cumulative hospital stay, and mortality. Compared to those who were robust and cognitively intact at baseline, those who were robust but cognitively impaired were more likely to develop pre-frailty/frailty after 4 years (P < 0.01). Compared to participants who were robust and cognitively intact at baseline, those who were pre-frail and with overall cognitive impairment had lower grip strength (P < 0.05), lower gait speed (P < 0.01), poorer lower limb strength (P < 0.01), and poorer delayed recall at year 4 [OR, 1.6; 95% confidence interval (CI), 1.2-2.3]. They were also associated with increased risks of poor quality of life (OR, 1.5; 95% CI, 1.1-2.2) and incident physical limitation at year 4 (OR, 1.8; 95% CI, 1.3-2.5), increased cumulative hospital stay at year 7 (OR, 1.5; 95% CI, 1.1-2.1), and mortality over an average of 12 years (OR, 1.5; 95% CI, 1.0-2.1) after adjustment for covariates. There was no significant difference in risks of adverse outcomes between participants who were pre-frail, with/without cognitive impairment at baseline. Similar results were obtained with delayed recall and language and praxis impairments. Robust and cognitively impaired participants had higher risks of becoming pre-frail/frail over 4 years compared with those with normal cognition. Cognitive impairment characterized by the CMMSE overall score or its individual domain score improved the predictive power of pre-frailty for poor quality of life, incident physical limitation, increased cumulative hospital stay, and mortality. Our findings support to the concept that cognitive frailty may be defined as the occurrence of both cognitive impairment and pre-frailty, not necessarily progressing to dementia.
Highlights
Frailty represents a state of decline in functional reserves, which increases the risk of adverse health outcomes such as morbidity, disability, and institutionalization, after a stressor event [1]
An international consensus group organized by the International Academy on Nutrition and Aging (IANA) and the International Association of Gerontology and Geriatrics (IAGG) proposed the definition as a clinical condition characterized by the simultaneous presence of both physical frailty and Mild Cognitive Impairment (MCI) (Clinical Dementia Rating = 0.5) [17]
Chinese men and women who were free of dementia and/or Parkinson’s disease and who were non-frail at baseline, we examined how various combinations of cognitive impairment and pre-frailty predict risks of adverse outcomes, and to determine whether cognitive frailty may be defined as the combination of cognitive impairment and the presence of pre-frailty
Summary
Frailty represents a state of decline in functional reserves, which increases the risk of adverse health outcomes such as morbidity, disability, and institutionalization, after a stressor event [1]. A popular approach to the assessment of frailty as proposed by Fried et al [1] (i.e., the phenotype approach) encompasses the assessment of five criteria-based primarily on physical attributes and capabilities including poor grip strength, slow walking speed, low levels of physical activity, exhaustion, and unintentional weight loss, whereas an individual is considered to be frail if they present with three or more of five criteria. There is no universal consensus regarding the entity of cognitive frailty and its definition, there is general consensus of the importance of recognizing cognitive impairment, as differentiated from screening for dementia [21]
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