A Longitudinal Study on the Association of Interrelated Factors Among Frailty Dimensions, Cognitive Domains, Cognitive Frailty, and All-Cause Mortality

Abstract

Background: Cognitive frailty integrating impaired cognitive domains and frailty dimensions has not been explored. Objective: This study aimed to explore 1) associations among frailty dimensions and cognitive domains over time and 2) the extended definitions of cognitive frailty for predicting all-cause mortality. Methods: This four-year cohort study recruited 521 older adults at baseline (2011–2013). We utilized 1) generalized linear mixed models exploring associations of frailty dimensions (physical dimension: modified from Fried et al.; psychosocial dimension: integrating self-rated health, mood, and social relationship and support; global frailty: combining physical and psychosocial frailty) with cognition (global and domain-specific) over time and 2) time-dependent Cox proportional hazard models assessing associations between extended definitions of cognitive frailty (cognitive domains-frailty dimensions) and all-cause mortality. Results: At baseline, the prevalence was 3.0%for physical frailty and 37.6%for psychosocial frailty. Greater physical frailty was associated with poor global cognition (adjusted odds ratio = 1.43–3.29, β: –1.07), logical memory (β: –0.14 to –0.10), and executive function (β: –0.51 to –0.12). Greater psychosocial frailty was associated with poor global cognition (β: –0.44) and attention (β: –0.15 to –0.13). Three newly proposed definitions of cognitive frailty, “mild cognitive impairment (MCI)-psychosocial frailty,” “MCI-global frailty,” and “impaired verbal fluency-global frailty,” outperformed traditional cognitive frailty for predicting all-cause mortality (adjusted hazard ratio = 3.49, 6.83, 3.29 versus 4.87; AIC = 224.3, 221.8, 226.1 versus 228.1). Conclusion: Notably, extended definitions of cognitive frailty proposed by this study better predict all-cause mortality in older adults than the traditional definition of cognitive frailty, highlighting the importance of psychosocial frailty to reduce mortality in older adults.

Cognitive impairment in people with physical frailty using the phenotype model: A systematic review and meta analysis

“…Results extracted from MoCA in Chen et al 36 . showed the same pattern, where frail people scored 26.2 ± 2.4, prefrail 26.8 ± 2.3 and robust 27.1 ± 2.0, indicating that MoCA scores decrease with increasing frailty.…”

“…55 However, according to the Cochrane Handbook, the use of standardized mean difference is a well-established and accepted part of meta-analyses. 22 We considered conversion of global MoCA scores to MMSE scores 56 from Chen et al 36 but opted not to due to the risk of introducing more heterogeneity in the analysis.…”

“…well as a lower MMSE score in prefrail than in robust people with a mean difference of −0.68 (95% CI −0.94, −0.43), see Figure2.Results extracted from MoCA in Chen et al36 showed the same pattern, where frail people scored 26.2 � 2.4, prefrail 26.8 � 2.3 and robust 27.1 � 2.0, indicating that MoCA scores decrease with increasing frailty. This study was not included in the main meta-F I G U R E 1 PRISMA flow chart for the inclusion process T A B L E 3 a Selection bias, selective reporting, lack of representativeness in selection.…”

Multi-Concept Frailty Predicts the Late-Life Occurrence of Cognitive Decline or Dementia: An Updated Systematic Review and Meta-Analysis of Longitudinal Studies

“…After scanning the titles and abstracts, 79 articles were considered as potentially eligible. After reviewing the bibliography and full-texts, 30 studies met the eligibility criteria, and 20 studies reporting risk estimates were included in the meta-analysis ( Buchman et al, 2007 ; Avila-Funes et al, 2009 , 2012 ; Boyle et al, 2010 ; Gray et al, 2013 ; Solfrizzi et al, 2013 , 2017a , 2017b , 2019 ; Montero-Odasso et al, 2016 ; Feng et al, 2017 ; Rogers et al, 2017 ; Trebbastoni et al, 2017 ; Chen et al, 2018 ; Shimada et al, 2018a , b ; Li et al, 2020 ; Sugimoto et al, 2020 ; Bai et al, 2021 ; Ward et al, 2021 ) cognitive domains ( Boyle et al, 2010 ; Bunce et al, 2019 ; Magnuson et al, 2019 ; Thibeau et al, 2019 ; Gale et al, 2020 ; Paolillo et al, 2020 ; Chen et al, 2021 ; Williams et al, 2021 ), two literature investigated the association between social frailty and cognition ( Tsutsumimoto et al, 2019 ; Huang et al, 2021 ), and one literature investigated the correlation between cognition and frailty status transitions ( Liu et al, 2021 ). The detailed characteristics of studies included in the systematic review and meta-analysis are summarized in Table 1 (for more details see Supplementary Table 1 ).…”

Covid-19 frailty impacts and implications

“…46,54 Moreover, intense tailored regimens that can simultaneously counter frailty as well as COVID exposure and severity are strongly indicated, regardless of viral status, especially if they target those with multiple comorbid health conditions, those with diabetes, sarcopenia, impaired cognition, and depression, among other age associated negative health correlates. In addition provision of the following may warrant attention: Source: [2,7,10,11,30,46,47,58,[62][63][64] In addition to the above practical ideas, more evidence based ideas and attention to the upstream factors that induce both frailty, as well as COVID-19 may prove insightful. 47,65,66…”