Reversible Cognitive Frailty, Dementia, and All-Cause Mortality. The Italian Longitudinal Study on Aging

Solfrizzi, Vincenzo; Scafato, Emanuele; Seripa, Davide; Lozupone, Madia; Imbimbo, Bruno P.; D'Amato, Angela; Tortelli, Rosanna; Schilardi, Andrea; Galluzzo, Lucia; Gandin, Claudia; Baldereschi, Marzia; Carlo, Antonio Di; Inzitari, Domenico; Daniele, Antonio; Sabbá, Carlo; Logroscino, Giancarlo; Panza, Francesco; Farchi, G; Capurso, Antonio; Lepore, Vito; Livrea, Paolo; Motta, Luciano; Carnazzo, G.; Motta, Massimo; Bentivegna, Prospera; Bonaiuto, S.; Cruciani, Guido; Postacchini, Demetrio; Amaducci, L.; Gandolfo, Carlo; Conti, Massimo; Canal, N.; Franceschi, M.; Scarlato, G.; Candelise, Livia; Scapini, Elio; Rengo, Franco; Abete, Pasquale; Cacciatore, Francesco; Enzi, Giuliano; Battistin, Leontino; Sergi, Giuseppe; Crepaldi, Gaetano; Maggi, Stefania; Minicuci, Nadia; Noale, Marianna; Grigoletto, Francesco; Perissinotto, Egle; Carbonin, Pierugo

doi:10.1016/j.jamda.2016.10.012

Cited by 149 publications

(143 citation statements)

References 46 publications

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“…This method was validated against an HRS substudy of Alzheimer disease and dementia that used an extended neuropsychological assessment as well as expert clinician adjudication to obtain gold standard diagnoses of normal cognition, CIND, and dementia. In the validation study, the 27-point scale classified individuals as normal cognition (scores, [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] and CIND (scores, 7-11). Scores lower than 7 indicated dementia, and these individuals were, therefore, excluded from the present study.…”

Section: Operationalization Of Physical Frailty and Cognitive Impairmentmentioning

confidence: 99%

Assessing Risk for Adverse Outcomes in Older Adults: The Need to Include Both Physical Frailty and Cognition

Aliberti

Cenzer

Smith

et al. 2018

J American Geriatrics Society

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BACKGROUND: Physical frailty is a powerful tool for identifying nondisabled individuals at high-risk of adverse outcomes. The extension to which cognitive impairment in those without dementia adds value to physical frailty in detecting high-risk individuals remains unclear. OBJECTIVES: To estimate the effects of combining physical frailty and cognitive impairment without dementia (CIND) on the risk of basic activities of daily living (ADL) dependence and death over eight years. DESIGN: Prospective cohort study. SETTING: The Health and Retirement Study (HRS). PARTICIPANTS: 7,338 community-dwelling people aged ≥65 years without dementia and ADL dependence at baseline (2006–2008). Follow-up assessments occurred every 2 years until 2014. MEASUREMENTS: The five components of the Cardiovascular Health Study defined physical frailty. A well-validated HRS method, including verbal recall, series of subtractions, and backward count task, assessed cognition. Primary outcomes were time to ADL dependence and death. Hazard models, considering death as competing risk, associated physical frailty and CIND with outcomes after adjusting for sociodemographics, comorbidities, depression and smoking status. RESULTS: The prevalence of physical frailty was 15%; CIND, 19%; and both deficits, 5%. In unadjusted and adjusted analyses, combining these factors identified older adults at an escalating risk for ADL dependence (no-deficit=14% [reference group]; only-CIND=26%, sub-hazard ratio [sHR]=1.5, 95% confidence interval [CI]=1.3–1.8; only-frail=33%, sHR=1.7, 95%CI 1.4–2.0; both-deficits=46%, sHR=2.0, 95%CI=1.6–2.6) and death (no-deficit=21%; only-CIND=41%, HR=1.6, 95%CI=1.4–1.9; only-frail=56%, HR=2.2, 95%CI=1.7–2.7; both-deficits=66%, HR=2.6, 95%CI=2.0–3.3) over eight-year follow-up. Adding the cognitive measure to models that already included physical frailty alone increased accuracy in identifying those at higher risk of ADL dependence (Harrell’s C 0.74 vs 0.71; P<0.001) and death (Harrell’s C 0.70 vs 0.67; P<0.001). CONCLUSION: Physical frailty and CIND are independent predictors of incident disability and death. Since together physical frailty and CIND identify vulnerable older adults better, risk assessment among older adults should include both physical and cognitive elements.

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Section: Operationalization Of Physical Frailty and Cognitive Impairmentmentioning

confidence: 99%

Assessing Risk for Adverse Outcomes in Older Adults: The Need to Include Both Physical Frailty and Cognition

Aliberti

Cenzer

Smith

et al. 2018

J American Geriatrics Society

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“…However, precisely how physical frailty or pre-frailty causes cognitive decline is not known (Kelaiditi et al, 2014; Panza et al, 2015; Ruan et al, 2015). It has been shown that cognitive frailty not only predicts dementia but also all-cause mortality among the elderly in both short- and long-term observations (Solfrizzi et al, 2017). …”

Section: Aging Is In the Mind—how To Change The Mind?mentioning

confidence: 99%

Is It Time to Begin a Public Campaign Concerning Frailty and Pre-frailty? A Review Article

Sacha

Soboń

et al. 2017

Front. Physiol.

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Frailty is a state that encompasses losses in physical, psychological or social domains. Therefore, frail people demonstrate a reduced potential to manage external stressors and to respond to life incidents. Consequently, such persons are prone to various adverse consequences such as falls, cognitive decline, infections, hospitalization, disability, institutionalization, and death. Pre-frailty is a condition predisposing and usually preceding the frailty state. Early detection of frailty (i.e., pre-frailty) may present an opportunity to introduce effective management to improve outcomes. Exercise training appears to be the basis of such management in addition to periodic monitoring of food intake and body weight. However, various nutritional supplements and other probable interventions, such as treatment with vitamin D or androgen, require further investigation. Notably, many societies are not conscious of frailty as a health problem. In fact, people generally do not realize that they can change this unfavorable trajectory to senility. As populations age, it is reasonable to begin treating frailty similarly to other population-affecting disorders (e.g., obesity, diabetes or cardiovascular diseases) and implement appropriate preventative measures. Social campaigns should inform societies about age-related frailty and pre-frailty and suggest appropriate lifestyles to avoid or delay these conditions. In this article, we review current information concerning therapeutic interventions in frailty and pre-frailty and discuss whether a greater public awareness of such conditions and some preventative and therapeutic measures may decrease their prevalence.

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“…Frail older adults with cognitive impairment who have a fivefold increase (HR, 5.12) in mortality risk, a twelvefold increase (OR, 12.2) in functional disability, and lower quality of life compared to individuals with isolated frailty or cognitive impairment (Feng et al, 2017). The relationship between physical frailty and cognitive impairment with evidence of an interrelated neuropathology (Buchman et al, 2014; Lista and Sorrentino, 2010) may provide a means to identify individuals with cognitive impairment caused by non-neurodegenerative conditions that might be reversible (Buchman and Bennett, 2013; Kelaiditi et al, 2013; Solfrizzi et al, 2017). Although frailty and cognitive impairment have been shown to be related, both constructs have long been studied separately (Kelaiditi et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

“…Although, some research has been conducted on the association between physical function and cognitive impairment there is still no comprehensive list or understanding of the underlying mechanisms for cognitive frailty. Identification of emerging biomarkers from studies of sarcopenia, physical frailty, and cognitive impairment will help distinguish between changes related to normal aging, irreversible pathological process, and specific neurological diseases that may be reversible and establish a reliable research criteria for a novel clinical construct (Blazer et al, 2015; Solfrizzi et al, 2017). …”

Section: Introductionmentioning

confidence: 99%

Shared biological pathways for frailty and cognitive impairment: A systematic review

Sargent

Nalls

Starkweather

et al. 2018

Ageing Research Reviews

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Reversible Cognitive Frailty, Dementia, and All-Cause Mortality. The Italian Longitudinal Study on Aging

Cited by 149 publications

References 46 publications

Assessing Risk for Adverse Outcomes in Older Adults: The Need to Include Both Physical Frailty and Cognition

Assessing Risk for Adverse Outcomes in Older Adults: The Need to Include Both Physical Frailty and Cognition

Is It Time to Begin a Public Campaign Concerning Frailty and Pre-frailty? A Review Article

Shared biological pathways for frailty and cognitive impairment: A systematic review

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