Abstract
Physical frailty together with cognitive impairment (Cog), known as cognitive frailty, is emerging as a strong and independent predictor of cognitive decline over time. We examined whether remote physical activity (PA) monitoring could be used to identify those with cognitive frailty. A validated algorithm was used to quantify PA behaviors, PA patterns, and nocturnal sleep using accelerometer data collected by a chest-worn sensor for 48-h. Participants (N = 163, 75 ± 10 years, 79% female) were classified into four groups based on presence or absence of physical frailty and Cog: PR-Cog-, PR+Cog-, PR-Cog+, and PR+Cog+. Presence of physical frailty (PR-) was defined as underperformance in any of the five frailty phenotype criteria based on Fried criteria. Presence of Cog (Cog-) was defined as a Mini-Mental State Examination (MMSE) score of less than 27. A decision tree classifier was used to identify the PR-Cog- individuals. In a univariate model, sleep (time-in-bed, total sleep time, percentage of sleeping on prone, supine, or sides), PA behavior (sedentary and light activities), and PA pattern (percentage of walk and step counts) were significant metrics for identifying PR-Cog- (p < 0.050). The decision tree classifier reached an area under the curve of 0.75 to identify PR-Cog-. Results support remote patient monitoring using wearables to determine cognitive frailty.
Highlights
Cognitive impairment and physical frailty are known as two independent geriatric risk factors for adverse clinical outcomes including hospitalization, disability, loss of independence, dementia, morbidity, and mortality [1,2], as well as future cognitive decline [3,4,5]
Based on physical frailty and cognitive function assessments, we identified four groups of participants as follows: PR+cognitive impairment (Cog)- (n = 41), PR+Cog- (n = 4), PR-Cog+ (n = 89), and PR-Cog- (n = 29) (Figure 1A)
We demonstrated the feasibility of using a single chest-worn sensor to monitor sleep, physical activity, and postural activities in an older community-living population
Summary
Cognitive impairment and physical frailty are known as two independent geriatric risk factors for adverse clinical outcomes including hospitalization, disability, loss of independence, dementia, morbidity, and mortality [1,2], as well as future cognitive decline [3,4,5]. There is growing awareness and evidence that physically frail older adults are prone to cognitive impairment and vice versa. Studies have shown that the coexistence of these two geriatric conditions (cognitive frailty) creates a vicious cycle of declines in older adults’ quality of life [6,7,8]. To emphasize the importance of screening for cognitive frailty, the International Consensus Group on “Cognitive Frailty”, organized by The International Academy on Nutrition And Aging (I.A.N.A) and the International Association. Common approaches for assessing cognitive frailty are based on assessing cognition [10,11]
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