Cognitive Frailty Research Articles

COGNITIVE FRAILTY: PREVALENCE, RISK FACTORS, AND THE RISK OF MORTALITY IN CHINESE MIDDLE-AGED AND OLDER ADULTS

Abstract To examine the age-specific prevalence, risk factors, and magnitude of the association between cognitive frailty and all-cause mortality in Chinese middle-aged and older adults. We used baseline (2011) and follow-up waves (2013, 2015, and 2018) data from the China Health and Retirement Longitudinal Study (CHARLS). The age group was categorized as middle-aged, old, and very old. Factors associated with cognitive frailty and the associations between cognitive frailty statuses and mortality were examined using multinomial logistic regression and Cox proportional hazards models, respectively. Totally 7947 participants were included in this study, and the overall prevalence of cognitive frailty was 12% (middle-aged, 11%; old, 10%; very old, 26%; P< 0.0001). Cognitive frailty was independently associated with rural residential status, long sleep duration, lack of social participation, depressive symptoms, and multimorbidity among all the age groups. Over the 7-year follow-up, participants with cognitive frailty were at a higher risk for all-cause mortality than the robust group (HR 1.70, 95%CI 1.12-2.57 for the middle-aged group, HR 1.70, 95%CI 1.02-2.84 for the old group, and HR 2.06, 95%CI 1.17-3.65 for the very old group). Pre-cognitive frailty was associated with a higher mortality risk in the middle-aged group only (HR 1.34, 95%CI 1.01-1.79). The prevalence of cognitive frailty in middle-aged adults was comparable with that in the old group. Cognitive frailty, a significant risk factor for mortality, was associated with multiple factors in middle-aged and older adults, calling for integrated cognitive frailty prevention strategies. Noticeably, pre-cognitive frailty in middle-aged people increases mortality risk and requires special attention.

SOCIAL PARTICIPATION AND DEPRESSIVE SYMPTOMS ON THE RELATIONSHIP BETWEEN COGNITIVE FRAILTY AND DISABILITY

Abstract To explore the multiple mediating effects of social participation and depressive symptoms on the relationship between cognitive frailty and functional disability. A total of 6122 participants from four waves of the China Health and Retirement Longitudinal Study (CHARLS) were included. Functional status was assessed by activities of daily living (ADL) and instrumental ADL (IADL). Analyses were restricted to middle-aged and older adults free of functional disability at baseline. Competing-risks regression and multiple mediation effects analysis adjusted for covariates were conducted. Cognitive frailty (hazard ratio [HR] 1.27, 95% confidence interval [CI] 1.09, 1.48), social participation (HR 0.87, 95%CI 0.79, 0.97), and depressive symptoms (HR 1.75, 95%CI 1.56, 1.95) were associated with the incidence of ADL disability. These factors were also found to predict the occurrence of IADL disability. Cognitive frailty was found to be associated with ADL disability, not only through the pathways of social participation (β = 0.009, 95% CI 0.001, 0.018) and depressive symptoms (β = 0.094, 95% CI 0.062, 0.131) separately, but also through social participation and depressive symptoms sequentially (β = 0.002, 95% CI 0.001, 0.003). Similar findings were also observed for the outcome of IADL disability. Cognitive frailty has been associated with functional disability, wherein social participation and depressive symptoms partially mediate the association. To prevent functional disability, it’s suggested to implement integrated and comprehensive intervention measures, including preventing and managing cognitive frailty, promoting social participation, and improving depressive symptoms.

EFFECT OF A HOME-BASED EXERCISE PROGRAM ON SUBSEQUENT FALLS IN OLDER ADULTS WITH COGNITIVE FRAILTY

Abstract Cognitive frailty is characterized by concurrent physical frailty and mild cognitive impairment. and increases the risk for falls. Whether exercise can reduce falls in older adults with cognitive frailty is unknown. We examined the effects of a home-based exercise intervention on subsequent falls among community-dwelling older adults with cognitive frailty and a history of falls. A secondary of a 12-month randomized controlled trial among older adults aged ≥70 years with a fall in the last 12 months. Participants were randomized to either 12 months of home-based exercise (EX; n=172) or usual care (UC; n=172). For this analysis, we only included participants who were classified as cognitively frail based on a Short Physical Performance Battery (SPPB) score ≤ 9/12 and a Montreal Cognitive Assessment score < 26/30. Our primary analysis examined the effect of EX on self-reported falls over 12 months. The secondary analysis examined whether higher exercise adherence, or dose, benefits physical frailty among the EX participants. At baseline, 192 participants were classified as cognitively frail (EX=93; UC=99). Falls rates were lower in EX participants vs. UC participants (IRR=0.65; p=0.042). At 12 months, in the EX group, SPPB score was significantly higher among participants with high adherence vs. those with low adherence (estimated mean difference: 1.22; p=0.004). Exercise is a promising strategy for reducing subsequent falls in older adults with cognitive frailty and a history of falls. Greater exercise adherence, or dose, may reduce physical frailty in this population at high risk for disability.

DEVELOP AND EXTERNALLY VALIDATE A RISK PREDICTION MODEL FOR SCREENING COGNITIVE FRAILTY IN OLDER ADULTS

Abstract Cognitive frailty, the combination of physical frailty and mild cognitive impairment, is a growing public health concern in aging populations. We aimed to develop and validate a risk prediction model for screening cognitive frailty in community-dwelling older adults without probable dementia (aged ≥ 65 years). We used Year 2011 data from National Health and Aging Trends Study (NHATS), with participants randomly divided into the training set (N=4,222) and internal validation set (N=2,111). We used Year 2015 data of NHATS as the external validation set (N=3,380). Cognitive frailty was assessed with the Fried phenotypic criteria and cognitive performance in three domains (memory, orientation and executive function). Independent risk factors were screened by multivariate logistic regression analysis. Model performance was assessed by discrimination (area under the curve [AUC]) and calibration (Hosmer-Lemeshow test). The final model included 13 key predictors (age, gender, education, smoke, walking for exercise, vigorous activity, self-rated health, depressive symptoms, balance impairments, arthritis, hospitalization, activities of daily living, and instrumental activities of daily living score). The model showed good discrimination with an AUC of 0.92 (95% CI: 0.90-0.93) for the training set, 0.92 (95% CI: 0.89-0.95) for the internal validation set, and 0.88 (95% CI: 0.85-0.91) for the external validation set. The Hosmer-Lemeshow test yielded P values of 0.10, 0.92, and 0.85 for the three sets, respectively, suggesting good calibration. Our risk prediction model has the potential to screen older adults at risk for cognitive frailty, enabling early interventions to prevent or delay cognitive decline and physical disability.

FRAILTY AND COGNITIVE IMPAIRMENT: RESULTS FROM A DIVERSE SAMPLE OF OLDER PERSONS RECEIVING HEMODIALYSIS

Abstract Persons who are receiving hemodialysis are at high risk for frailty and cognitive impairment. However, little is known about the overlap of these conditions in a diverse older hemodialysis population. Our goal is to examine frailty and cognition in a diverse sample of older adults receiving hemodialysis. Data was collected as part of a cross-sectional observational study examining mentation, mood, and mobility. Frailty was identified using the Study of Osteoporotic Fractures Index and cognition was assessed with the Montreal Cognitive Assessment (MoCA) (cut off score ≤ 26). Blind MoCAs were administered (cut off score ≤ 22) when appropriate. 35 participants (mean age = 73.9 ± 10.7) enrolled. 60% were males and 20% were Spanish-speaking. 20% identified as Asian, 23% as Black, and 23% as Hispanic/ Latino. Of note, four blind MoCAs in Spanish were administered. 83% had abnormal MoCA scores. 86% were frail or pre-frail. The majority of the sample (69%) had concurrent cognitive impairment and frailty or pre-frailty. In this diverse sample of older adults receiving hemodialysis, we found that both frailty and cognitive impairment are extremely common, with a large portion of the sample exhibiting both. This suggests that interventions targeting cognitive impairment or frailty should account for the frequent overlap of both conditions, particularly among historically underserved populations.

EXAMINING FRAILTY SUBDOMAINS (PHYSICAL, PSYCHOLOGICAL, COGNITIVE, SOCIAL) IN COMMUNITY-LIVING ADULTS 45–85

Abstract Frailty prevalence estimates vary considerably (4.0% to 59.1% in one review). Understanding these differences and what drives frailty among individuals could lead to more focused interventions. Breaking frailty into subdomains and exploring their relationships is one approach to this. A 127-item overall Frailty Index (FI) based on data collected on Canadian Longitudinal Study on Aging (CLSA) Comprehensive Cohort participants (n = 30,097 community-living adults aged 45-85 at baseline) was used to create physical, psychological, cognitive, and social subdomain-specific FIs. Each FI was divided into quintiles with the highest 20% (Q5) considered the frailest. We assessed subdomain FI quintile concordance (Goodman and Kruskal’s gamma), described the joint distribution of those most frail (Q5), and estimated the association between sex and age with Q5 subdomain FIs membership (logistic regression). The concordance among FI subdomain quartiles was low. The highest gammas (0.25-0.36) were between the physical/psychological and psychological/cognition subdomains. Concordance was generally higher in females who had higher odds of Q5 membership for overall (1.5), physical (1.7), psychological (1.6) and social frailty (1.1), and lower odds for cognitive frailty (0.7). The odds of Q5 membership increased with age for overall frailty and all subdomains except psychological frailty, which decreased with age. Our results suggest low concordance among frailty subdomains and the relationship between Q5 membership with sex and age differed by subdomain. These data may help to better target frailty interventions, but longitudinal data are needed to explore both the time course and interrelationships across subdomains.

A Scoping Review of the Effects of Ambient Air Quality on Cognitive Frailty

Environmental and public health research has given considerable attention to the impact of air quality on brain health, with systematic reviews being widespread. No literature review has been conducted for cognitive frailty—a multidimensional syndrome combining physical frailty and cognitive impairment and their apparent co-dependence, linked to increased vulnerability and adverse health outcomes, including dementia. Instead, cognitive decline and frailty are implicitly explored through research on air quality and comorbid cognitive and physical decline in elderly populations. A scoping review was conducted to explore the need for a systematic review. Combining the Arksey and O’Malley, and PRISMA-ScR checklist, a scoping review of SCOPUS using ‘cogniti*’ + ‘resilience’ + ‘air quality’ or ‘cogniti*’ + ‘ageing’ + ‘air quality’ resulted in n = 2503 articles, screened and reduced using inclusion and exclusion criteria, to n = 16 articles. Air quality appears to be a critical risk factor for cognitive decline, even at air quality levels below WHO targets. Moderate long-term ambient air pollution appears linked to increased risk of cognitive frailty, suggesting earlier and more active interventions to protect older people. There are varied effects on cognition across the life course, with both emotional and functional impacts. Effects may be more detrimental to elderly people with existing conditions, including economic and health inequalities. Generalisation of results is limited due to the absence of a dose–response, variations in methods, controlling for comorbid effects, and variance across studies. No literature review has been performed for cognitive frailty, largely due to the fact that it is not presently treated as an explicit outcome. The findings support the need for more research and a more extensive summary of the literature but suggest that there is worsening cognitive function over the life course as a result of increased PM2.5 concentrations. Furthermore, air quality appears to be a critical risk factor even at levels below World Health Organisation targets.

The functional trajectories of older women having surgery for gynaeoncology cancer: A single site prospective observational study

IntroductionPopulation aging longevity and advances in robotic surgery suggest that increasing numbers of older women having gynaeoncological surgery is likely. Postoperative morbidity and mortality are more common in older than younger women with the age-associated characteristics of multimorbidity and frailty being generally predictive of worse outcome. Priorities that inform treatment decisions change during the life course: older patients often place greater' value on quality-of-life-years gained than on life expectancy following cancer treatments. However, data on post-operative cognition, frailty, or functional independence is sparse and not routinely collected. This study aimed to describe the clinical characteristics and trajectory of functional change of older women in the 12 months following gynaeoncological surgery and to explore the associations between them. Materials and MethodsThe prospective observational cohort study recruited consecutive women aged 65 or over scheduled for major gynaeoncologic surgery between July 2017 and April 2019. Baseline data on cancer stage, multimorbidity, and geriatric syndromes including cognition, frailty, and functional abilities were collected using standardised tools. Delirium and post-operative morbidity were recorded. Post hospital assessments were collected at 3-, 6-, and 12-months. ResultsOverall, of 103 eligible participants assessed pre-operatively, most (77, 70%) remained independent in personal care at all assessments from discharge to 12 months. Functional trajectories varied widely over the 12 months but overall there was no significant decline or improvement for the 85 survivors. Eleven experienced a clinically significant decline in function at six months. This was associated with baseline low mood (P < 0.05), albeit with small numbers (6 of 11). Cognitive impairment and frailty were associated with lower baseline function but not with subsequent functional decline. DiscussionThere was no clear clinical profile to identify the minority of older adults who experienced a clinically significant decline six months after surgery and for most, the decline was transient. This may be helpful in enabling informed patient consent. Assessment for geriatric syndromes and frailty may improve individual care but our findings do not indicate criteria for segmenting the patient population for selective attention. Future work should focus on causal pathways to potentially avoidable decline in those patients where this is not determined by the cancer itself.

Effect of Baduanjin exercise on executive function in older adults with cognitive frailty: A randomized controlled trial

Objective To investigate the effectiveness of Baduanjin exercise on executive function in community-dwelling older adults with cognitive frailty. Design Randomized controlled trial. Setting Community residential centers. Subjects 120 eligible older adults. Interventions Baduanjin training group received supervised Baduanjin training, 60 min sessions three times per week for 24 weeks. The control group did not receive any exercise intervention. Main measures Primary outcome was executive function, assessed using Clock Drawing Test. Secondary outcomes included the subcomponents of executive function (working memory, inhibitory control and cognitive flexibility), attention and cognitive frailty (global cognitive function, physical frailty) assessed using Verbal Fluency Test, Trail Making Test-A/B, Stroop Test, Montreal Cognitive Assessment and Edmonton Frailty Scale, respectively, at baseline and 24 weeks after intervention. Results After the 24-week intervention, the scores of Clock Drawing Test and Verbal Fluency Test, the Trail Making Test-B time and the Card correct numbers of Stroop Test in Baduanjin training group showed significant improvement compared with control group (all P < 0.05) with small to moderate effect sizes and the significant interaction effect of group by time in the Clock Drawing Test and Trail Making Test-B test (P = 0.003 and P = 0.043); cognitive frailty variables, including Montreal Cognitive Assessment and Edmonton Frail Scale scores, also showed significant improvement (P = 0.002 and P = 0.004) with a moderate effect sizes and a significant interaction effect (P < 0.001, P = 0.013). No adverse events were reported. Conclusion Regular Baduanjin training may be an effective and safe intervention to improve cognitive frailty and executive function in community-dwelling older adults with cognitive frailty. Trial registration Chinese Clinical Trial Registry, ChiCTR2100050857. Data of registration: 8/5/2020, https://www.chictr.org.cn/showproj.html?proj = 133037.

The vaccination of the aged in post COVID-19 era

As human grow older, immune-senescence, inflammaging, decline in physical and cognitive functions, frailty, various comorbidities and related polypharmacy make us vulnerable to infectious diseases, which in turn accelerates aging vice versa. Immunization for the aged against vaccine-preventable diseases is being emphasized more and more. However, in reality, the effective immune response is hindered for the similar reasons, so strategies to overcome this are being taken. The goal of elderly vaccination is to reduce the severity, mortality, and burden of disease. This review introduces 2023 adult immunization guidelines of the Korean Society of Infectious Diseases including influenza, pneumococcus, varicella zoster and coronavirus disease 2019 (COVID-19), and recently licensed respiratory syncytial virus vaccination. Clinicians are required to play a role in helping client’s decisions by providing and discussing scientific information about the benefits and risks of vaccination based on an understanding of the their medico-social condition in this post-COVID-19 era.

The Relationship Between Inner Retinal Thickness, Cognition, and Frailty in Community‐dwelling Older Adults: findings from a 6‐year follow‐up study

AbstractBackgroundThinning of the inner retinal thickness, including ganglion cell‐inner plexiform layer (GC‐IPL) and retinal nerve fiber layer (RNFL), has been related to cognitive decline. However, the relationship between GC‐IPL/RNFL thickness, physical frailty, and cognitive frailty remains unclear. Therefore, this longitudinal study aims to investigate the association of these retinal markers with cognition, frailty, and cognitive frailty.MethodThis is a 7‐year cohort study including 221 community‐dwelling elders in the ongoing Taiwan Initiate for Geriatric Epidemiological Research (TIGER) between 2015 and 2017 and received biennial assessments for cognition and physical frailty three consecutive times. The global and domain‐specific (memory, attention, executive function, and language) cognition were assessed using the Taiwanese version of the Montreal Cognitive Assessment and a series of neuropsychological tests. Physical frailty was assessed by modified Fried frailty phenotypes. The generalized linear mixed model was used to analyze the association between GC‐IPL/RNFL thickness and global/domain‐specific cognitive frailty adjusted for age, sex, years of education, apolipoprotein E ε4 status carriers, cigarette smoking status, presence of depressive symptoms, hypertension or diabetes mellitus, years of follow‐up, and practice effect.ResultThe performance of global cognition decreased as the mean GC‐IPL thickness of bilateral eyes deviated from the sample mean (76.6 µm) (quadratic GC‐IPL: β = ‐0.4×10−2; 95% confidence interval: ‐0.7×10−2 to ‐0.2×10−2). Similar associations were also found for logical memory with RNFL/GC‐IPL thickness. No significant association was observed between RNFL/GC‐IPL thickness and physical frailty. An increased odds of impaired logical memory‐physical frailty was found for GC‐IPL (quadratic GC‐IPL: adjusted odds ratio = 1.005; 95% confidence interval: 1.001 to 1.005), but no significant association was found between cognitive frailty and RNFL thickness.ConclusionChange in the GC‐IPL thickness was associated with impaired cognition and poor logical memory‐frailty performance. The inner retinal thickness may serve as a biomarker for cognition or cognitive frailty in non‐demented elders.

Association between oral health and cognitive frailty in community‐dwelling older adults

AbstractBackgroundCognitive frailty indicates the presence of both physical frailty and mild cognitive impairment (MCI) and has been associated with an increased risk of adverse health outcomes (e.g., mortality). Poor oral health has been related to cognitive impairment and physical frailty, respectively. However, the association between oral health and cognitive frailty remains unclear. This study aimed to explore the association between oral health and cognitive frailty in community‐dwelling older adults.MethodThis 10‐year cohort study (2011‐2021) is a part of an ongoing prospective cohort study. At baseline (2011‐2013), 605 non‐demented community‐dwelling older adults (aged 65+) with four biennial follow‐ups. Cognitive frailty was defined as the coexistence of MCI and physical frailty. Extended definitions of cognitive frailty were also assessed and defined as the coexistence of impaired cognitive domains and physical frailty. Oral health variables included tooth defects, dentition, and periodontal status. The generalized linear mixed model was used to explore the longitudinal association between oral health and cognitive frailty, adjusting for age, sex, lifestyle, comorbidity, and so on.ResultThe mean age of the study participants was 72.7 at baseline, and 53.4% were female. We found that tooth defect was associated with worsening of impaired memory‐frailty [adjusted odds ratio (aOR) = 1.13; 95% confidence interval (CI) = 1.03‐1.24] and impaired verbal fluency‐frailty (aOR = 1.07; 95% CI = 1.00‐1.11) over time; Dentition was associated with worsening of impaired executive function‐frailty (aOR = 1.10; 95% CI = 1.02‐1.18) over time; Periodontal status was associated with worsening of impaired memory‐frailty (aOR = 1.07; 95% CI = 1.02‐1.13) and verbal fluency‐frailty (aOR = 1.05; 95% CI = 1.00‐1.11) over time. No significant associations were found for traditional cognitive frailty and impaired attention‐frailty.ConclusionCognitive frailty is associated with oral health after adjusting for covariates. Inspection of oral health is helpful to predict the risk of cognitive impairment at an early stage. Further research on this topic is warranted to validate our findings.

P46: Subjective cognitive decline and frailty status: results from the Compostela Ageing Study.

Objective:The relationship between objective cognitive performance and physical frailty has been explored in the recent literature and cognitive frailty has emerged as a strong field of study in psychogerontology. However, less is known about the relationship between subjective cognitive status and physical frailty. The aim of this communication is to present the relationships found between subjective cognitive decline and physical frailty in the third wave of the Compostela Aging Study, the first in which frailty status has been studied.Methods:Cognitive and neuropsychological, functional, and affective assessment was conducted with persons over 50 years of age with subjective memory complaints in the health area of Santiago de Compostela. 149 participants who completed the third wave of the study and who did not present dementia or other serious pathologies were selected. Mild Cognitive Impairment (MCI) was diagnosed according to the current criteria in a special meeting of the research team. In the participants without MCI, the intensity and severity of their complaints were assessed according to the Subjective Cognitive Decline (SCD) criteria. Physical frailty was assessed following the frailty phenotype as described by Fried et al.Results:Only 4 participants (2.7%) presented physical frailty (3, 4 or 5 criteria in the frailty phenotype). Of those presenting physical pre-frailty (1 or 2 criteria), 36 were MCI (23.8%), 33 SCD (21.9%) and 36 controls. Finally, 40 participants (26.5%) presented no frailty criteria (8 with MCI, 13 with SCD and 19 controls). Participants with SCD and pre-frailty were of intermediate age and they had more years of education than the group with MCI and pre-frailty, although these differences were not significant. They have significantly more symptoms of depression (GDS) and worse mental health status (GHQ-12) than participants without frailty and pre-frailty controls, and more symptoms of anxiety (GAD-7) than participants without frailty.Conclusion:The relationship between subjective memory complaints and frailty could help to establish groups at special risk of cognitive impairment in phases prior to objective cognitive decline, being these groups particularly optimal targets for preventive intervention. However, a detailed characterization of these subgroups is still required.

Association Between Internet Accessibility and Health Literacy among Community‐Dwelling Older Adults with Cognitive Frailty (CF) from Lower Socioeconomic Status (LES) group: A Cross‐sectional Study

AbstractBackgroundThe objective of this study was to determine the association between internet accessibility, health literacy and sociodemographic factors among older adults with cognitive frailty (CF) from lower socioeconomic status (LES) group.MethodThis study was a part of the AGELESS trial’s screening phase, which was conducted from October 2021 till March 2022 for developing telehealth multi‐domain intervention. The data included were sociodemographic variables, internet access and health literacy index. About 282 community‐dwelling older people aged 60 years (mean age 68.65 ± 6.52) from lower socioeconomic status (LES) participated in this study. Purposive sampling was utilized to identify cognitive frailty using Fried’s Criteria and Clinical Dementia Rating (CDR) while health literacy was measured using Health Literacy Questionnaire HLS‐M‐18 (Health Literacy Index). Linear regression was performed to analyse the sociodemographic factors influencing health literacy.ResultIn this study, we found that more participants who accessed to Internet compared to Internet non‐users, 68.1% and 31.9%, respectively. They significantly consisted of females (54.1%), married (56.8%), obtained secondary education level (61.1%) and still working (69.7%) (p&lt;0.05). The majority of them (75.1%) utilised digital technology devices in their daily life for example smartphones (70%), computers or laptops (4.4%), followed by tablets (3.7%) which their primary functions were for family interaction and update online news, 67.8% and 31.3% respectively. In addition, Internet users among older adults with cognitive frailty from the LES group had a 3‐fold better health literacy than internet non‐users (OR 3.248, 95% CI: 1.059 – 5.436, p&lt;0.05). Those who were married and higher education level were also the main factors influencing their health literacy in this target population (OR 2.314, 95% CI: 0.241 – 4.386, p&lt;0.05; OR 0.494, 95% CI: 0.219 – 0.768, p&lt;0.05).ConclusionOur findings imply that Internet users among older people with CF from the LES group adopted the Internet mainly for family connection and update online news. Future research should emphasize the understanding of Internet adoption as a non‐pharmalogical intervention for cognitive frailty such as telehealth or mobile health (mHealth) using specific mechanisms for instance qualitative or mixed method design.

Clinical Manifestations.

Cognitive frailty (CF) has been defined as the simultaneous presence of physical frailty (PF) and subjective or objective cognitive impairment, with current definitions differentiating, respectively, between reversible and potentially reversible CF. The former is indicated by subjective cognitive decline (SCD) and the latter by Mild Cognitive Impairment (MCI). Although CF is an emerging topic in the study of cognitive ageing, its relationship with cognitive reserve (CR) proxies have not been established. The prevalence of CF and the characterization of the sample in terms of its level of CR was studied in the second cohort of the Compostela Ageing Study (CompAS). 150 participants of the second follow-up of this cohort who completed the PF assessment were studied. The frailty phenotype was used to operationalize the level of PF of the participants. Weakness was measured by 3 measurements of the grip strength (GS) in the dominant hand. Slow gait speed was measured through a timed-up and go (TUG) task. Low physical activity was measured with the Spanish version of the Minnesota Physical Activity Questionnaire (VREM). MCI and SCD were diagnosed using the current criteria. The level of CR was established using the scores of the Cognitive Reserve Index questionnaire (CRIq). Bivariate correlations were made between CRIq subscales scores and the results in GS, TUG and VREM. A higher percentage of high CR was observed in participants without frailty, and a higher percentage of participants with medium level of CR showed pre-frailty (c2 = 27,96 p<.05). Significant moderate correlations were obtained between GS and CRI-q working activity (r = .47), and between TUG and CRI-q leisure time (r = -.35). As expected for a risk factor for dementia, there were significant relationships between CF and several domains of CR. Future longitudinal analysis should analyze the capacity of the CR to attenuate or delay the onset of cognitive frailty.

Cognitive frailty in the elderly: a concept analysis

Abstract Frailty is a recession of age-related reserves caused by a variety of causes and is becoming the most important clinical syndrome that affects the health of the elderly. In the elderly, frailty and cognitive dysfunction often exist, and some people have proposed cognitive frailty. Cognitive frailty is an elderly syndrome that increases the risk of dementia, in the same time, and can independently predict the adverse health outcomes of the patient and affect the quality of the patient’s survival. This paper, under the guidance of Walker and Avant method, provides theoretical basis for early recognition and intervention of cognitive weakness in the elderly.

Baseline characteristics and study progress of the CITA GO‐ON Study. A FINGER‐like Multidomain Intervention to Prevent Cognitive Decline in Spain

AbstractBackgroundThe FINGER study demonstrated the efficacy of a non‐pharmacological multidomain intervention to prevent cognitive decline in at‐risk older adults. After a successful pilot feasibility study, in Q3 2021 we launched the CITA GO‐ON study, inspired by FINGER methodology to demonstrate the efficacy of a risk factor and lifestyles multimodal intervention to prevent cognitive decline in southern Europe. Here we describe the baseline characteristics of participants recruited in the study.MethodThe CITA GO‐ON study (ClinicalTrials.gov, NCT04840030) is a two‐year randomized, controlled trial. The primary aim is to reduce the risk of decline in cognitive functioning in the Neuropsychology Test Battery after two years by a multi‐modal intervention on risk factors and protective life‐styles as compared to standard health care. Inclusion criteria are: 60‐85 years old; CAIDE dementia risk score ≥ 6; cognitive frailty; no dementia. The multidomain intervention includes optimized control of cardiovascular risk factors; correction of polypharmacy; cognitive training; physical exercise program; socioemotional intervention; and promotion of adherence to the Mediterranean diet.ResultsTo date, 1964 individuals completed pre‐screening using self‐administered online survey in REDCap (Research Electronic Capture) and 874 (44.5%) fulfilled criteria for an in‐person screening visit. Screening was successful in 477 of participants. Mean (SD) age is 66.24 (4.99), 13.26 (4.43) years of education, MMSE 28.27 (1.78), CAIDE score 7.48 (1.36), and 235 (49%) are men. Based on CAIDE components, at baseline, 287 (60%) showed high systolic blood pressure, 165 (35%) low physical activity, 122 (26%) high BMI, and 101 (21%) with high cholesterol. Regarding cognitive frailty, 144 (31%) presented low performance on brief cognitive testing (Memory Alteration Test ≤ 40 and/or Fototest ≤ 35), 186 (39%) presented memory complaints (Cognitive Change Index ≥ 20), and 147 (30%) showed both criteria. Currently, 191 have been randomly assigned to the control and 192 to the Intervention groups. So far, adherence to intervention activities is high, ranging from 73% to 97%, depending on the modality.ConclusionCITA GO‐ON Study recruitment strategy includes participants with high risk of dementia based on modifiable factors and in situation of cognitive fragility, with might increase the probability of obtaining positive efficacy results.

How to perform a general population‐based recruitment strategy for a multidomain intervention trial for dementia prevention—the CITA GO‐ON trial experience

AbstractBackgroundFINGER trial has demonstrated the potential for dementia prevention by targeting different lifestyle domains in older adults. It highlighted the importance of selecting the correct window of opportunity for preventive actions by including participants at high risk of dementia. This approach is being tested worldwide to support future public health interventions, where the selection of the appropriate target population is crucial. Here we share our approach and results in recruiting older adults with increased dementia risk and cognitive frailty from the general population for the CITA Go‐On trial.MethodCITA GO‐ON is a single‐center randomized controlled trial in which non‐demented‐adults between 60‐80y will be allocated to receive standard care or a risk factor control and lifestyle‐based multidomain intervention. It replicates FINGER trial inclusion criteria, but the recruitment strategy is based on the community level in Gipuzkoa (Spain) instead of a previous health registry. Together with press and social media releases, mailing, and small group talks, the main recruitment strategy has been coordinated with local governments. Interested people fulfill an online form that allows identifying those who meet the pre‐established requirements (CAIDE dementia risk score ≥6) prior to attending an individualized face‐to‐face cognitive screening visit (evaluation of exclusion criteria and brief cognitive testing).ResultBy December 2022, we have reached and informed about the trial more 24000 people including all citizens older than 60 in three small municipalities in collaboration with the local town halls. Of these, 1919 completed the pre‐screening questionnaire using REDCap, 868 were screened and 450 recruited (mean age: 68,57 (6,58), 50,87% female, and mean CAIDE: 7,49 (1,39)). In person calculated (mean (sd): 6,98 (1,70)) and self‐reported (mean (sd): 7,23 (1,77)) CAIDE score is similar (p = 0,062) in our experience. Table 1 resumes age, sex, CAIDE and MMSE of the interested sample. Recruitment period is still opened.ConclusionCITA GO‐ON recruitment is a multi‐disciplinary population oriented efficient strategy to identify adults at high risk of dementia understanding and willing to participate in a multi‐modal intervention prevention trial. It allows to select candidates from the whole population, and not only those linked to specialized health care systems or registries.

Clinical Manifestations.

Apathy is defined as the lack of motivation and has been found to be associated with incident dementia in western populations (Dalen, 2018). Little is known about the impact of apathy in Asians. Apathy is a prevalent behavioural symptom of pre dementia and current literature shows that apathy increases the risk of dementia (Bock, 2020). Apathy is also linked to an increased risk of frailty(Ayers, 2018) and found to impair executive function and processing speed(Lohner, 2017). We aim to evaluate the association of apathy with cognitive function, frailty and lifestyle factors in a pre-dementia community population in Singapore. We recruited 534 participants from the community who completed a detailed neuropsychological assessment. Apathy was measured using the mild behavioural impairment checklist (MBI-C). To test for the association of apathy with the different variables, we performed a multiple generalized linear model controlling for covariates age, sex and education. The study population included 186 participants with subjective cognitive decline and 348 mild cognitive impairment participants from Dementia Research Centre (Singapore). Mean age of the cohort was 62.55, SD = 9.55, mean education years was 13.97, SD = 3.45 and majority were women (57.1%). The prevalence of apathy among our cohort was 23.5%. Compared to participants without apathy, those with apathy had poorer cognitive scores in processing speed (test of coding) (β = -4.60, p<0.001), executive function (colour trails 2) (β = 9.71, p = 0.020), episodic memory on the RAVLT Delayed (β = -0.738, p = 0.026), RCFT Delayed (β = -1.941, p = 0.009) and FCSRT delayed (β = -0.616, p = 0.030). Participants with apathy were also more frail (β = 0.316, p<0.001) on the Fried Phenotype frailty assessment test and had poorer quality of life (β = -12.49, p<0.001), had lower levels of physical activity (β = 0.163, p = 0.017), and had poorer sleep (β = 2.25, p<0.001). Apathy is associated with worse cognitive performance, higher frailty, lower physical performance and poorer sleep in an Asian pre-dementia community cohort. Screening for apathy and appropriate early intervention could reduce incidence of dementia and frailty.

Intervention of muscle-building and antifrailty exercise combined with Baduanjin for frailty of different functional levels: study protocol for a randomised controlled trial

IntroductionFrailty has been currently considered as a multidimensional concept, including physical, cognitive and social frailty. Frailty has also been associated with a range of adverse events, which might increase the...