Cognitive Function, Sarcopenia, and Inflammation Are Strongly Associated with Frailty: A Framingham Cohort Study

Mehta, Manaav; Louissaint, Jeremy; Parikh, Neal S; Long, Michelle T.; Tapper, Elliot B.

doi:10.1016/j.amjmed.2021.07.012

Cited by 25 publications

(20 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although we previously illustrated the impact of HE on frailty ( 6 ), it was unclear whether its impact was a product of advanced disease or whether it identified an independent role of cognitive dysfunction in the pathogenesis of the frailty phenotype. In a recent study evaluating the association between the ANT and the Liver Frailty Index among participants of the Framingham Heart Study who lacked cirrhosis, we found that ANT performance, in addition to systemic inflammation and sarcopenia, was associated with frailty ( 20 ). Taken together, these data show that cognitive dysfunction is robustly associated with frailty across representative population samples in patients with and without cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Animal Naming Test Is Associated With Poor Patient-Reported Outcomes and Frailty in People With and Without Cirrhosis: A Prospective Cohort Study

Tapper

Kenney

Nikirk

et al. 2022

Clin Transl Gastroenterol

Self Cite

View full text Add to dashboard Cite

INTRODUCTION: Cognitive dysfunction is a major driver of care complexity, poor patient-reported outcomes, and frailty for people with cirrhosis. The performance and clinical associations of the animal naming test (ANT) in the general population are unknown. We evaluated ANT performance in a representative sample of older Americans with and without chronic liver disease (CLD). METHODS: We analyzed 6,661 subjects enrolled in the 2010–2016 Health and Retirement Survey, a representative cohort of >30,000 US adults. Average age of participants was 75 years. We evaluated 3 subject subgroups: (i) without CLD, (ii) noncirrhosis CLD, and (iii) cirrhosis. We determined the association between the ANT (overall) and S-ANT1 <10 (adjusted for age and education) and health status, basic and instrumental activities of daily living, healthcare utilization (care hours received and hospitalizations), and frailty measures (hand grip and walk speed). RESULTS: Overall, 8.2% of the sample had noncirrhotic CLD and 1.3% had cirrhosis. CLD or cirrhosis was not independently associated with ANT. Poor ANT performance was associated with poor health status and frailty overall. An S-ANT <10 was associated with fair-poor self-reported health (odds ratio [OR] 1.37; 95% confidence interval [CI]: 1.20–1.56), care hours received (incidence rate ratio [IRR] 2.39; 95% CI: 1.79–3.19), and hospitalizations (IRR 1.14; 95% CI: 1.03–1.26). S-ANT <10 was also associated with activities of daily living disability (OR 1.31; 95% CI: 1.13–1.51), instrumental activities of daily living disability (OR 1.85; 95% CI: 1.59–2.14), weaker hand grip (IRR 0.94; 95% CI: 0.92–0.96), and time to walk 2.5 m (IRR 1.23; 95% CI: 1.17–1.29). DISCUSSION: ANT performance is not specific to CLD/cirrhosis but is associated with patient-reported outcomes and frailty in a nationally representative sample of elderly subjects with and without CLD.

show abstract

Section: Discussionmentioning

confidence: 99%

Animal Naming Test Is Associated With Poor Patient-Reported Outcomes and Frailty in People With and Without Cirrhosis: A Prospective Cohort Study

Tapper

Kenney

Nikirk

et al. 2022

Clin Transl Gastroenterol

Self Cite

View full text Add to dashboard Cite

show abstract

“…[ 17 , 24 ] It is also strongly correlated with handgrip strength, gait speed, 6‐minute walk distances, and is predictive of short‐term and long‐term survival. [ 17 , 19 , 26 ] In patients with cirrhosis, serum creatinine is not an adequate kidney biomarker, largely due to the overestimation of the glomerular filtration rate in the presence of sarcopenia. [ 39 ] On the other hand, the serum levels of CysC show good performance in the early diagnosis of renal dysfunction in patients with cirrhosis, regardless of muscle mass and gender.…”

Section: Discussionmentioning

confidence: 99%

“…A binary logistic regression analysis was performed to establish the factors independently associated with sarcopenia. Because our hypothesis stipulates evaluating the creatinine‐CysC ratio as an objective predictor of sarcopenia, [ 26 ] we decided to prespecify the inclusion of the ratio in the model, as a clinically relevant variable, independent of the interpretation of the unadjusted analysis. The association is presented as odds ratio (OR) and 95% confidence intervals (CIs).…”

Section: Methodsmentioning

confidence: 99%

“…[ 3 , 12 , 13 , 14 ] In addition, in different settings such as critically ill patients, [ 15 , 16 , 17 ] colon cancer, [ 18 ] aging population, [ 19 , 20 ] CKD, [ 21 ] diabetes [ 22 , 23 ] and transplantation, [ 24 , 25 ] the creatinine/CysC ratio has proven to be a reliable and reproducible parameter with an adequate diagnostic capacity to predict the presence of sarcopenia. [ 26 ] However, the evidence in patients with cirrhosis is scarce. [ 27 , 28 ] In this setting, our objective was to evaluate the factors associated with the presence of sarcopenia (particularly including the creatinine/CysC ratio), and to build a score capable of predicting its presence in patients awaiting LT, as well as to evaluate the capacity of such score as a predictor of mortality.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Sarcopenia HIBA score predicts sarcopenia and mortality in patients on the liver transplant waiting list

et al. 2022

View full text Add to dashboard Cite

Sarcopenia is a prevalent condition that predicts prognosis in patients awaiting liver transplantation (LT). The gold standard for the diagnosis of sarcopenia is the assessment of the muscular area at L3 with computed tomography (CT) scan (skeletal muscle index [SMI]), but the routine use of CT scan is limited in clinical practice. Thus, we designed a single-center observational study aimed to evaluate the clinical factors associated with the presence of sarcopenia by SMI, and to build a score capable of predicting or excluding the presence of sarcopenia in patients on the LT waiting list (WL). Binary logistic regression analysis was performed to establish the factors independently associated with sarcopenia, and the Sarcopenia Hospital Italiano de Buenos Aires (HIBA) score was built from the resulting model after internal validation analysis by bootstrapping and correction for optimism. The predictive capability of mortality on the WL was evaluated with competing risk regression analysis. A total of 215 patients with cirrhosis on the LT WL were included. The independent factors associated with the presence of sarcopenia were male sex (odds ratio[OR]: 6.09, p < 0.001), body mass index (OR: 0.74, p < 0.001), Child Pugh (OR:1.44, p < 0.001), and the ratio creatinine/Cystatin C (OR: 0.03, p = 0.007).The Sarcopenia HIBA score constructed with these variables showed an area under the curve of 0.862. During follow-up, 77 (36%) patients underwent LT, 46 (21%) died, and 92 (43%) remained alive. After adjusting for Model for End-Stage Liver Disease-Sodium, Sarcopenia HIBA score was an independent predictor of WL mortality (subhazard ratio: 1.19; 95% confidence interval 1.01-1.40; p = 0.042). Sarcopenia HIBA score is an easy-to-use, objective, and reliable diagnostic and predictive tool that can be useful to improve the prognostic evaluation and allow identifying a group of patients with a higher risk of death while awaiting LT.

show abstract

“…The relation between frailty and inflammation in patients without kidney disease is well reported 79,80 . The data in the dialysis population are relatively scarce.…”

Section: Frailty and Inflammationmentioning

confidence: 99%

From MIA to FIFA: The vicious matrix of frailty, inflammation, fluid overload and atherosclerosis in peritoneal dialysis

Chan¹,

Fung²,

Szeto

et al. 2023

Nephrology

View full text Add to dashboard Cite

Cardiovascular disease (CVD) is a major cause of mortality and morbidity in peritoneal dialysis (PD) patients. Two decades ago, the common co-existence of malnutrition and systemic inflammation PD patients with atherosclerosis and CVD led to the proposed terminology of 'malnutrition-inflammation-atherosclerosis (MIA) syndrome'. Although the importance of malnutrition is well accepted, frailty represents a more comprehensive assessment of the physical and functional capability of the patient and encompasses the contributions of sarcopenia (a key component of malnutrition), obesity, cardiopulmonary as well as neuropsychiatric impairment.In recent years, it is also increasingly recognized that fluid overload is not only the consequence but also play an important role in the pathogenesis of CVD. Moreover, fluid overload is closely linked with the systemic inflammatory status, presumably by gut oedema, gastrointestinal epithelial barrier dysfunction and leakage of bacterial fragments to the systemic circulation. There are now a wealth of published evidence to show intricate relations between frailty, inflammation, fluid overload and atherosclerotic disease in patients with chronic kidney disease (CKD) and those on PD, a phenomenon that we propose the term 'FIFA complex'. In this system, frailty and atherosclerotic disease may be regarded as two patientoriented outcomes, while inflammation and fluid overload are two inter-connected pathogenic processes. However, there remain limited data on how the treatment of one component affect the others. It is also important to define how treatment of fluid overload affect the systemic inflammatory status and to develop effective anti-inflammatory strategies that could alleviate atherosclerotic disease and frailty.

show abstract

Cognitive Function, Sarcopenia, and Inflammation Are Strongly Associated with Frailty: A Framingham Cohort Study

Cited by 25 publications

References 35 publications

Animal Naming Test Is Associated With Poor Patient-Reported Outcomes and Frailty in People With and Without Cirrhosis: A Prospective Cohort Study

Animal Naming Test Is Associated With Poor Patient-Reported Outcomes and Frailty in People With and Without Cirrhosis: A Prospective Cohort Study

Sarcopenia HIBA score predicts sarcopenia and mortality in patients on the liver transplant waiting list

From MIA to FIFA: The vicious matrix of frailty, inflammation, fluid overload and atherosclerosis in peritoneal dialysis

Contact Info

Product

Resources

About