Frailty and Cognitive Function in Older Adults: A Systematic Review and Meta-Analysis of Cross-Sectional Studies

Predicting cognitive frailty in community-dwelling older adults: a machine learning approach based on multidomain risk factors

Cognitive frailty (CF), a clinical syndrome involving both physical frailty (PF) and impaired cognition (IC), is associated with adverse health outcomes in older adults. This study aimed to identify key predictors of CF and develop a machine learning-based model for CF risk assessment using data from 2404 community-dwelling older adults in the Korean Frailty and Aging Cohort Study (2016-2017). PF was evaluated using Fried frailty phenotype, while IC was assessed using Mini-Mental State Examination (MMSE). Participants exhibiting at least one frailty phenotype and MMSE score ≤ 24 were classified as having CF. A comprehensive analysis encompassing sociodemographic, clinical, and health status characteristics was conducted. A machine learning approach incorporating recursive feature elimination and bootstrapping was employed to develop the prediction model. Among the diverse CF-associated characteristics, the machine learning-based model identified six optimal features (key predictors): motor capacity, education level, physical function limitation, nutritional status, balance confidence, and activities of daily living. The model demonstrated robust predictive performance, achieving an area under the curve of 84.34%, with high sensitivity, specificity, and accuracy. These findings underscore the importance of comprehensive health assessments for early CF detection and demonstrate the potential of predictive modeling in facilitating personalized interventions for at-risk older adults.

The relationship between skeletal muscle mass and cognitive impairment in older adults: a longitudinal study based on CLHLS

Objective

To explore the relationship between skeletal muscle mass and cognitive impairment in older adults.

Methods

Based on the longitudinal survey data of the four phases of the China Older Adults Health Influencing Factors Longitudinal Survey Project from 2008 to 2018, this study used the Cox regression analysis method and the R4.3.3 software to construct a limiting cubic spline model to deeply explore the dose-response relationship between skeletal muscle mass and cognitive impairment in the older adults.

Results

In this study, 2,199 older adults (with ages ranging from 61 to 108 years, 51.7% of whom are female and 48.2% are male) were included and followed up for a decade, during which four rounds of data collection were carried out. The results showed that the proportion of new-onset cognitive impairment in men was 14.61%, while the proportion in women was 33.48%. After adjusting for confounding factors, Cox regression results showed that the larger the muscle mass group, the greater the protective effect on cognitive impairment. The results of RCS showed that the association between skeletal muscle mass and cognitive impairment in the older adults group (P overall trend <0.05, P nonlinear <0.05) showed a nonlinear increasing trend, and there were gender differences. ASMI < 7.2 kg/m2 in older men was a risk factor for cognitive impairment (HR>1); ASMI < 5.4 kg/m2 in older women was a risk factor for cognitive impairment (HR>1). This suggests that ASMI should be maintained at a high level in older men and women, respectively.

Conclusion

There is a link between skeletal muscle mass and cognitive impairment in older adults, and cognitive function can be improved through early intervention or by improving the level of skeletal muscle mass in older adults.

Effects of a multicomponent training and a detraining period on cognitive and functional performance of older adults at risk of frailty

AIMS

This study analyzes the effects of a 6-month multicomponent exercise program (MCT) followed by a 4-month detraining period on functional and cognitive status in pre-frail and frail older adults.

METHODS

A total of 108 pre-frail and frail adults aged 65 and older participated in the study. They were assigned by convenience to either a control group (CG) or an intervention group (IG). The IG underwent a 6-month MCT followed by a 4-month detraining period. Assessments included a DT test, the Timed Up and Go (TUG) test, the Mini-Mental State Examination (MMSE), and evaluations of basic and instrumental activities of daily living. Data were analyzed using repeated-measures ANOVA.

RESULTS

Significant group-by-time interactions were observed for the DT test (p < 0.05). The IG showed improved DT performance after the 6-month MCT (4.0, 95% CI: 2.2 to 5.7 s), followed by a decline after the detraining period (-1.1, 95% CI: -2.1 to -0.2 s). However, performance after detraining remained higher than at baseline (2.9, 95% CI: 1.0 to 4.6 s, p < 0.05). No statistically significant changes were observed in the CG. Additionally, no significant effects were found for MMSE scores or daily activity questionnaires.

CONCLUSION

MCT had beneficial effects on functional and cognitive performance in older adults, as assessed by the DT test. However, improvements in DT performance did not translate into better daily life activities. Although the 4-month detraining period negatively impacted DT performance, the results remained superior to baseline levels.

TRIAL REGISTRATION NUMBER

NCT03831841 and date of registration: 5th of November 2018.

The multiple mediating effects of social support and depressive symptoms on the relationship between frailty and cognitive function in older patients with heart failure: A cross-sectional study

AIMS

The aim of this study was to test the multiple mediating effects of social support and depression symptoms on the relationship between frailty and cognitive function in older patients with heart failure.

METHODS AND RESULTS

We used a convenience sampling method to recruit 444 older patients with heart failure who met the inclusion criteria from a university-affiliated general hospital. Multiple mediation analyses revealed that the relationship between frailty and cognitive function was influenced by social support (effect: -0.383, 95% CI [-0.774, -0.072]) and depressive symptoms (effect: -0.349, 95% CI [-0.710, -0.134]) both individually and in tandem (effect: -0.276, 95% CI [-0.591, - 0.106]).

CONCLUSION

Social support and depressive symptoms are multiple mediators of the relationship between frailty and cognitive function. Healthcare providers should implement interventions that focus on maximizing social return and minimizing depressive symptoms to mitigate the decline in cognitive function.

Relationships between physical frailty and cognitive decline over 8 years: A longitudinal study among community-dwelling older Chinese immigrants

OBJECTIVES

To examine patterns of physical frailty changes, their sociocultural correlates, and associations with initial cognitive functioning and cognitive decline over an eight-year observation period among community-dwelling older Chinese immigrants.

DESIGN

An 8-year follow-up longitudinal study.

SETTING AND PARTICIPANTS

2,835 community-dwelling adults aged 60 and above living in Chicago, who self-identified as Chinese, with a mean age of 72.5 years at baseline.

MEASUREMENTS

Frailty was assessed using five indicators across the five waves, and patterns of change were identified through repeated measures latent class analysis (RMLCA). Cognitive functioning was assessed using the Chinese Mini-Mental State Examination (C-MMSE). The associations between frailty patterns and cognitive change trajectories were evaluated using latent growth curve modeling (LGCM), adjusted for sociodemographic, health, and immigration covariates.

RESULTS

Four distinct frailty patterns were identified: least frail (53%), decreased frailty (21%), increased frailty (15%), and constantly frail (11%), with differential sociodemographic and immigration profiles. Compared to the least frail class, respondents in the increased frailty class (intercept: B = -0.108, p < .05; slope: B = -0.073, p < .001) and the constantly frail class (intercept: B = -0.150, p < .01; slope: B = -0.043, p < .001) showed poorer initial cognitive functioning and faster rates of cognitive decline after controlling for covariates. No significant differences in cognitive outcomes were observed between the least frail and the decreased frailty classes. Compared to Cantonese speakers, Mandarin speakers experienced a slower rate of cognitive decline (B = 0.033, p < .001).

CONCLUSIONS

These findings demonstrate that physical frailty is associated with cognitive decline, particularly among older Chinese immigrants who remain constantly frail or experience increasing frailty over time. Clinical interventions should prioritize addressing both physical frailty and cognitive decline, with special attention to vulnerable subgroups within this population.

Association between cognitive reserve proxies and frailty phenotype: data from UK Biobank

A potential protective role of cognitive reserve proxies against frailty has been suggested in older adults. We explored the cross-sectional association between cognitive reserve indicators and frailty phenotype. Data were obtained from the UK Biobank. We included 31,975 dementia-free participants aged ≥ 60 years (50.7% females, 2.2% frail) who completed a web-based cognitive assessment (fluid intelligence, working memory, visuospatial attention and processing speed, and executive functioning). Frailty was defined according to the Fried's phenotype (unintentional weight loss, exhaustion, low physical activity, slowness, and weakness). Participants meeting three or more criteria were classified as frail. Cognitive performance was compared between nonfrail and frail groups, and regression models were employed to analyze the associations between cognitive reserve proxies (education, skill level of occupation, social support, and multiple deprivation index (MDI)) and the likelihood of frailty. Frail and nonfrail groups significantly differed on cognitive function, with frail individuals demonstrating poorer performance on all cognitive functions (all p < .05) except fluid intelligence. Regression analysis showed that, after adjusting for age and sex, a lower educational level (odds ratio (OR) .797, 95% confidence interval (CI) .673-.944, p = .009), having maintained occupations with low cognitive requirements (OR .790, 95% CI .668-.936, p = .006), having less social support (OR .755, 95% CI .631-.903, p = .002), and living in a region with a high rate of multiple deprivation (OR 1.025, 95% CI 1.019-1.031, p < .001), significantly increased the probability of experiencing frailty. Our findings support the relationship between declined cognitive functions and frailty emphasizing the importance of implementing public health measures to enhance cognitive reserve.

Effects of comprehensive intervention models on cognitive frailty in community-dwelling older adults: A 12-month follow-up study

BACKGROUND

Cognitive frailty (CF) is of concern because of its high prevalence in older population and its close association with adverse health outcomes. However, interventions against CF in China are relatively simple. Therefore, the purpose of this study was to analyse the effects of comprehensive interventions on CF in community-dwelling older adults.

METHODS

225 participants, including 108 individuals with reversible CF (RCF) and 117 individuals with potentially RCF (PRCF) were recruited and divided into intervention and control groups. Participants in RCF Intervention Group underwent primary intervention, and participants in PRCF Intervention Group underwent secondary intervention. CF reversal rate and MoCA score were recorded.

RESULTS

Primary intervention and secondary intervention could well reversed CF. Additionally, MoCA scores changed significantly.

CONCLUSIONS

Adhering to regular comprehensive interventions can effectively reverse CF for community-dwelling older adults. Additionally, RCF maybe is an effective target for reversing CF via early intervention.

Joint Physical-Psychosocial Frailty and Risks of All-Cause and Cause-Specific Premature Mortality

BACKGROUND

The importance of integrating physical and psychosocial factors in assessing frailty -health outcomes has been increasingly acknowledged, while the related evidence is lacking. We sought to investigate the associations of joint physical-psychosocial frailty with risk of premature mortality and evaluate the relative importance of individual physical and psychosocial factors.

DESIGN

A total of 381,295 participants with no history of cancer or cardiovascular disease (CVD) were recruited from the UK Biobank cohort. The physical-psychosocial frailty was evaluated based on seven indicators including weight loss, exhaustion, physical activity, walking pace, grip strength, social isolation, and loneliness. The outcomes were premature mortality from all causes, cancer, CVD, and other causes. Cox proportional hazards models were used to assess the associations between the physical-psychosocial frailty and premature mortality.

KEY RESULTS

During a median follow-up period of 12.7 years, we recorded 20,328 premature deaths. Each additional increment in the physical-psychosocial frailty index was associated with a 26% (HR 1.26, 95% CI 1.24-1.28), 10% (HR 1.10, 95% CI 1.08-1.12), 30% (HR 1.30, 95% CI 1.26-1.33), and 44% (HR 1.44, 95% CI 1.41-1.47) higher risk of all-cause, cancer, cardiovascular, and other-cause premature mortality, respectively. Compared with participants with the physical-psychosocial frailty index of 0, those with the index ≥ 4 had a 2.67 (95% CI 2.49-2.87)-fold higher risk of all-cause premature mortality. Slow walking pace and social isolation were the top two strongest predictors for all-cause premature mortality. In addition, we found that lower body mass index (BMI), age, smoking status, and dietary quality modified the associations of physical-psychosocial frailty with all-cause premature mortality (P-interaction < 0.05).

CONCLUSIONS

In this cohort study of UK Biobank participants, joint physical-psychosocial frailty is significantly associated with risks of all-cause and cause-specific premature mortality, highlighting the importance to jointly assess physical and psychosocial factors in determining aging-related health.

Associations between frailty and cognitive impairment in Parkinson´s disease: a cross-sectional study

BACKGROUND

The presence of frailty is common in people with Parkinson's disease, as is cognitive dysfunction. Previous research on frailty has focused on the physical aspects of the pathology.

AIMS

To analyze the relationship between frailty and cognitive impairment in patients with Parkinson's disease and to know which disease characteristics are associated with frailty.

METHODS

An observational, correlational and cross-sectional study was conducted. Participants were recruited from a Home Rehabilitation Service and two Parkinson's Associations. An individualized assessment was carried out by means of a structured interview. Frailty was assessed with the Fried scale and cognitive function with the Mini Mental State Examination and the Parkinson's Disease Cognitive Rating Scale.

RESULTS

90 patients were recruited, 60% men, with a mean age of 73.50 (6.71) years. Frailty was associated with age and disease severity (p < 0.05). Frail patients presented worse cognitive performance relative to pre-frail and robust patients. A negative correlation (coefficient - 0.503) was observed between frailty and measures of patients' cognitive function (p < 0.05).

DISCUSSION

The coexistence of frailty and cognitive impairment should be assessed, as PD patients with both conditions are more vulnerable and have a higher chance of experiencing adverse effects.

CONCLUSION

Frail patients with Parkinson's disease present an impairment of cognitive functions dependent on cortical and subcortical regions, being these regions more preserved in the case of robust. The development of programs for early detection of frailty and cognitive function in these patients is necessary to implement strategic intervention plans focused on reversing frailty and cognitive impairment. PROTOCOL REGISTRATION NUMBER: http://www.

CLINICALTRIALS

gov ID: NCT05388526.

Predicting grip strength-related frailty in middle-aged and older Chinese adults using interpretable machine learning models: a prospective cohort study

Introduction

Frailty is an emerging global health burden, and there is no consensus on the precise prediction of frailty. We aimed to explore the association between grip strength and frailty and interpret the optimal machine learning (ML) model using the SHapley Additive exPlanation (SHAP) to predict the risk of frailty.

Methods

Data for the study were extracted from the China Health and Retirement Longitudinal Study (CHARLS) database. Socio-demographic, medical history, anthropometric, psychological, and sleep parameters were analyzed in this study. We used the least absolute shrinkage and selection operator (LASSO) regression to filter the model for the best predictor variables and constructed six ML models for predicting frailty. The feature performance of six ML models was compared based on the area under the receiver operating characteristic curve (AUROC) and the light gradient boosting machine (LightGBM) model was selected as the best predictive frailty model. We used SHAP to interpret the LightGBM model and to reveal the decision-making process by which the model predicts frailty.

Results

A total of 10,834 eligible participants were included in the study. Using the lowest quartile of grip strength as a reference, grip strength was negatively associated with the risk of frailty when grip strength was >29.00 kg for males or >19.00 kg for females (p < 0.001). The LightGBM model predicted frailty with optimal performance with an AUROC of 0.768 (95% CI 0.741 ~ 0.795). The SHAP summary plot showed that all features predicted frailty in order of importance, with cognitive function being considered the most important predictive feature. The poorer the cognitive function, nighttime sleep duration, body mass index (BMI), and grip strength, the higher the risk of frailty in middle-aged and older adults. The SHAP individual force plot clearly shows that the LightGBM model predicts frailty in the individual decision-making process.

Conclusion

The grip strength-related LightGBM prediction model based on SHAP has high accuracy and robustness in predicting the risk of frailty. Increasing grip strength, cognitive function, nighttime sleep duration, and BMI reduce the risk of frailty and may provide strategies for individualized management of frailty.

The mitochondrial function of peripheral blood cells in cognitive frailty patients

Background

Cognitive frailty (CF), characterized by the coexistence of physical frailty and cognitive impairment, is linked to increased morbidity and mortality in older adults. While CF has been linked to multiple physiological and lifestyle factors, the underlying biological mechanisms remain poorly understood. This study investigated the risk factors for CF and explored the relationship between mitochondrial function and CF in hospitalized patients.

Methods

A total of 279 hospitalized individuals were recruited from December 2020 to August 2022, conducted comprehensive clinical assessments, and collected peripheral blood samples. CF was evaluated using the Physical Frailty Phenotype and Montreal Cognitive Assessment scales. Nutritional status was assessed with the Mini Nutritional Assessment, and depression was measured using the Geriatric Depression Scale. DNA was obtained from the peripheral blood and interrogated for mitochondrial DNA copy number (mtDNAcn). Peripheral blood mononuclear cells isolated from peripheral blood were examined for respiratory function and reactive oxygen species (ROS) levels. Additionally, plasma samples were analyzed for inflammatory markers and Carnitine Palmitoyltransferase II (CPT2).

Results

Among the participants, 90 were classified as CF and 46 as non-CF. Logistic regression analysis revealed that increased age (OR 1.156, 95% CI 1.064-1.255), lower educational attainment (OR 0.115, 95% CI 0.024-0.550), malnutrition (OR 0.713, 95% CI 0.522-0.973), and higher depression scores (OR 1.345, 95% CI 1.065-1.699) were significantly associated with CF. The independent t tests and Mann-Whitney U tests showed the CF group exhibited impaired mitochondrial function, characterized by reduced mtDNAcn and respiratory activity, coupled with elevated ROS, interleukin-6, and CPT2 levels compared with the non-CF group. After adjusted for age, sex, and BMI, compared with non-CF group, the OR values for the CF group of mtDNAcn and ROS were 0.234 (95% CI = 0.065-0.849) (p = 0.027) and 1.203 (95% CI = 1.075-1.347) (p = 0.001), respectively. The Sensitive analysis showed that the area under curve values for mtDNAcn and ROS were 0.653 and 0.925.

Conclusion

Age, lower educational attainment, malnutrition, and depression are significant risk factors for CF. Moreover, mitochondrial dysfunction, characterized by decreased mtDNAcn, impaired respiratory function and increased ROS levels appears to be a critical phenotype of CF.

Mid-upper arm circumference as a screening tool for identifying physical frailty in community-dwelling older adults: The Korean Frailty and Aging Cohort Study

AIMS

Frailty in older adults is influenced by various factors, such as poor nutritional status. Mid-upper arm circumference (MUAC) is a validated, simple, and non-invasive tool for assessing nutritional status. Despite its potential, no study has explored the association between MUAC and physical frailty in older adults. This study aims to investigate this association and assess whether MUAC can be used as a screening tool in community and primary clinical practice.

METHODS

A cross-sectional study was conducted with 1178 participants aged 71.8 to 86.7 years from the 2019 Korean Frailty and Aging Cohort Study (KFACS). Physical frailty was defined using the Fried frailty phenotype criteria. MUAC was measured as the average circumference of both upper arms without compressing the subcutaneous tissue. Odds ratios (ORs) and 95% confidence intervals (CIs) for physical frailty, stratified by sex, were estimated using multiple logistic regression analysis after adjustments.

RESULTS

MUAC was lower in physically frail men compared with non-frail men (28.0 ± 2.9 vs. 29.4 ± 2.6 cm, P < 0.001). MUAC was negatively correlated with the Frailty Index (r = -0.155, P < 0.001). Multiple logistic regression analysis revealed that MUAC was an independent factor for physical frailty in men (OR  0.986, 95% CI  0.973-1.000, P = 0.049). The optimal MUAC cutoff for identifying physical frailty in men was 28.2 cm (sensitivity 60.7%, specificity 71.4%, AUC  0.672, 95% CI 0.595-0.749, P < 0.001). No significant results were found for women.

CONCLUSION

Low MUAC is significantly associated with physical frailty in older men, suggesting the potential for MUAC to be utilized as a screening tool for physical frailty in community and primary clinical settings. Geriatr Gerontol Int 2024; 24: 1292-1299.

Prevalence and influencing factors of cognitive frailty among Chinese older adults: A systematic review and meta-analysis

AIMS

Cognitive frailty refers to the coexistence of physical frailty and cognitive impairment in older adults, without a concurrent diagnosis of Alzheimer's disease or other dementias. This review aims to evaluate the prevalence of CF subtypes and identify influencing factors among Chinese older adults.

METHODS

The following databases were searched: PubMed/Medline, Embase, Cochrane Library, WOS, PsycINFO and CNKI et al (1 January 2001 to 20 October 2022). The risk of bias was assessed using the Agency for Healthcare Research and Quality Evidence-based Practice Center Methods Guide. Stata 17.0 software was used to pool the prevalence of cognitive frailty, and the pooled odds ratio and 95% CI of the influencing factors were calculated.

RESULTS

The meta-analysis (56 studies and 80,320 participants) revealed the following prevalence rates: CF (18.9%), reversible CF (19.5%), potentially reversible CF (17.5%), CF in community-dwelling older adults (14.3%), CF in nursing homes (22.7%) and CF in older inpatients (25.2%). Influential factors identified included age, gender, education, nutrition, depression, exercise, sleep and comorbidity.

CONCLUSIONS

The prevalence of CF among Chinese older adults is notably high, and it probably underestimates the prevalence of reversible cognitive frailty. It is crucial to encourage adherence to healthy behaviours, as it can effectively reduce and delay the onset of cognitive frailty.

Association Between Cognitive Function and Emotion, Sleep, Frailty, and Nutrition in Hospitalized Patients

BACKGROUND

With the rapid increase in China's aging population, cognitive impairment in the elderly has become a significant public health issue.

AIMS

In this study we performed a cross-sectional analysis to comprehensively investigate the relationship between cognitive function and emotion, sleep, frailty, nutrition, and clinical variables in hospitalized geriatric patients according to age group and sex. We determined the most important risk factors for cognitive impairment.

METHOD

A total of 1121 inpatients were recruited from the Department of Gerontology at the Fifth Affiliated Hospital of Sun Yat-sen University, China, from August 2023 to April 2024. Cognitive assessment was performed using the Mini-Mental State Examination scale and Montreal Cognitive Assessment. The sleep quality was evaluated based on the Pittsburgh Sleep Quality Index, and anxiety and depression were evaluated based on the Hamilton Anxiety Scale and Hamilton Depression Scale.

RESULTS

Sex and age differences existed with respect to cognition, emotion, and sleep quality. After full adjustment, age, education level, working status, hemoglobin level, activities of daily living, Hamilton Depression Scale, and Pittsburgh Sleep Quality Index scores were significantly and independently associated with cognitive impairment.

DISCUSSION

Geriatric patients with a better mood, sleep and nutrition status, higher education level, and more social engagement performance had superior cognitive function. Interventions, such as valuing education, improving sleep, relaxing emotions, preventing anemia, and adjusting lifestyle, may help prevent the development of cognitive deficits. Elderly and female patients required special attention.

CONCLUSIONS

Various factors were shown to contribute to maintenance of cognitive function.

Association between frailty index and cognitive dysfunction in older adults: insights from the 2011-2014 NHANES data

Background

As the population ages, the occurrence of cognitive decline and dementia is continuously increasing. Frailty is a prevalent problem among older adults. Epidemiologic studies have shown a comorbidity between frailty and cognitive impairment. However, their relationship remains unclear. The frailty index is an important indicator for measuring frailty. This study aims to investigate the relationship between frailty index and cognitive dysfunction in older adults aged 60 years and older in the United States from the 2011-2014 National Health and Nutrition Examination Survey (NHANES).

Methods

Community-dwelling older adults aged 60 years or older from 2011 to 2014 were extracted from the NHANES database. The frailty index was calculated using the formula: frailty index = total number of deficits present/total number of deficits measured. The Animal Fluency (AF), the Digit Symbol Substitution Test (DSST), the Consortium to Establish a Registry for Alzheimer's disease Delayed Recall (CERAD-DR), and Word Learning (CERAD-WL) were used to evaluate cognitive dysfunction. Firstly, weighted logistic regression analysis was used to explore the relationship between frailty index and cognitive dysfunction. Secondly, the influence of covariates on the frailty index was evaluated by subgroup analysis and interaction. Finally, the non-linear relationship is discussed by using the restricted cubic spline regression model.

Results

Our study included a total of 2,574 patients, weighted logistic regression analysis, after adjusting for all covariates, showed that the frailty index was associated with every test score. The interaction showed that covariates had no significant effect on this association in AF. The association between the frailty index and AF in the restricted cubic spline regression model is non-linear. As the frailty index increased, the risk of AF reduction increased, suggesting a higher risk of cognitive dysfunction.

Conclusion

In general, a high frailty index appears to be associated with an increased risk of cognitive dysfunction in the elderly. Consequently, protecting against cognitive decline necessitates making geriatric frailty prevention and treatment top priorities.

The Association between Physical Frailty and Cognitive Performance in Older Adults Aged 60 to 96 Years: Data from the "Good Aging in Skåne" (GÅS) Swedish Population Study

BACKGROUND

The association between physical frailty and performance in different cognitive domains in the absence of cognitive disorders is poorly understood. Hence, we aimed to explore the associations between frailty levels based on the Fried Physical Frailty Phenotype and performance of different cognitive domains. We also aimed to examine the associations between cognitive function and each criterion in the Fried Frailty Scale using the same cognitive domains in a non-dementia population aged 60-96 years.

METHODS

This cross-sectional study included 4,329 participants aged 60-96 years, drawn from the "Good Aging in Skåne" population study. Frailty indices included handgrip strength, physical endurance, body mass index (BMI), physical activity, and walking speed. Cognitive function was assessed across eight domains: episodic memory, processing speed, semantic memory, verbal fluency, working memory, attention, executive function, and visual perception. We constructed adjusted multiple linear regression models for each cognitive domain, with the frailty levels as the independent variable. Likewise, we constructed linear regression models with each cognitive domain as the dependent variable and frailty criteria as independent variables.

RESULTS

Physical frailty was associated with poor performance in episodic memory, processing speed, semantic memory, verbal fluency, working memory, attention, and executive functions (p<0.001 for all associations). Weaker hand grip strength was independently associated with poorer performance in all cognitive domains (p < 0.015).

CONCLUSION

Higher levels of frailty were associated with poorer performance in all cognitive domains except visual perception. Describing frailty by considering cognitive functioning may provide a better understanding of frailty.

Neuropsychological Deficits in Disordered Screen Use Behaviours: A Systematic Review and Meta-analysis

Over the last few decades, excessive and disordered screen use has become more prevalent, prompting investigations into its associated consequences. The extent to which disordered screen use behaviours impact neuropsychological functioning has been reportedly mixed and at times inconsistent. This review sought to synthesise the literature and estimate the magnitude of overall cognitive impairment across a wide range of disordered screen use behaviours. We also sought to determine the cognitive domains most impacted, and whether the observed impairments were moderated by the classification of screen-related behaviours (i.e., Internet or gaming) or the format of cognitive test administration (i.e., paper-and-pencil or computerised). A systematic search of databases (Embase, PsycINFO, MEDLINE) identified 43 cross-sectional articles that assessed neuropsychological performance in disordered screen use populations, 34 of which were included in the meta-analysis. A random-effects meta-analysis revealed significant small/medium (g = .38) cognitive deficits for individuals with disordered screen use behaviours relative to controls. The most affected cognitive domain with a significant medium effect size (g = .50) was attention and focus followed by a significant reduction in executive functioning (g = .31). The classification of disordered screen use behaviours into Internet or gaming categories or the format of cognitive testing did not moderate these deficits. Additionally, excluding disordered social media use in an exploratory analysis had little effect on the observed outcomes. This study highlights a number of methodological considerations that may have contributed to disparate findings and shows that disordered screen use can significantly impact cognitive performance. Recommendations for future research are also discussed. Data for this study can be found at https://osf.io/upeha/ .

Changes in cognitive function after a 12-week POWER rehabilitation in older adults with schizophrenia and frailty

BACKGROUND

The effectiveness of isolated resistance training (RT) on cognitive function among older adults with schizophrenia is insufficiently investigated. This study investigated the effectiveness of 12-weeks POWER rehabilitation, a novel RT regimen, on cognitive function among older patients with schizophrenia and frailty.

METHODS

Thirty-two older adults with schizophrenia and frailty were enrolled and randomized to receive either a 12-week, twice weekly POWER rehabilitation, or without add-on training. Cognitive functioning was assessed using mini-mental state examination (MMSE), digit symbol substitution test, color trail task (CTT), and digit span task (DST). Physical performance was assessed by walking speed and hand grip strength. The generalized estimating equations was used to compare pre- and post-training outcome measure between groups.

RESULTS

Between-group analysis revealed significant improvement in CTT1 and hand grip strength in the intervention group compared to the controls. Subgroup analyses showed CTT1 performance significantly improved after 12 weeks of POWER rehabilitation in the intervention group (time, p < .001), independent of age, educational level, global cognition, depressive symptoms, and psychotropic medication use. Increased hand grip strength was significantly associated with improved performance in MMSE, CTT1, and DST forward at study endpoint.

CONCLUSION

A 12-week POWER rehabilitation for older patients with schizophrenia and frailty is safe and feasible, and may benefit physical and some domains of cognitive functioning.

Physical frailty intensifies the positive association of oral frailty with poor global cognitive function and executive function among older adults especially for females: a cross-sectional study

BACKGROUND

Oral frailty is reported to increase the risk of new onset of mild cognitive impairment. Whereas, the association of oral frailty with cognition among older adults in both physical frail and non-physical frail status has not been sufficiently explored, and whether there are sex differences in the association is unclear. This study investigated the association of oral frailty and physical frailty with global cognitive function and executive function among older adults, as well as the sex differences in such association.

METHODS

This cross-sectional study included 307 participants aged ≥ 60 years old from communities between June 2023 and August 2023, in Nanjing, China. Global cognitive function and executive function were assessed by using the Montreal Cognitive Assessment (MoCA) and Trail Making Tests A (TMT-A), respectively. Oral frailty was identified by the combination of natural tooth, Oral Frailty Index-8 (OFI-8), and oral diadochokinesis. Physical frailty was measured by using Fried phenotype model which contained 5 criteria: unintentional weight loss, weakness, exhaustion, slowness, and low physical activity. Multiple linear regression analyses for overall participants and stratified by sex and presence or absence of physical frailty were performed, respectively, to examine the association between oral frailty and cognitive functions.

RESULTS

The median age of participants was 70 years old. The study included 158 (51.5%) females, 53 (17.3%) individuals with physical frailty, and 65 (21.2%) participants with oral frailty. After adjustment, the association between oral frailty and global cognitive function was observed in the physical frailty group (B = -2.67, 95% Confidence Interval [CI]: -5.27 to -0.07, p = 0.045) and the females with physical frailty (B = -4, 95% CI: -7.41 to -0.58, p = 0.024). Oral frailty was associated with executive function in overall participants (B = 0.12, 95% CI: 0.01 to 0.22, p = 0.037), physical frailty group (B = 23.68, 95% CI: 1.37 to 45.99, p = 0.038). In the adjusted models, oral frailty was significantly associated with executive function in all females (B = 0.21, 95% CI: 0.05 to 0.36, p = 0.009), in females without physical frailty (B = 0.19, 95% CI: 0.02 to 0.36, p = 0.027), and in females with physical frailty (B = 48.69, 95% CI: 7.17 to 90.21, p = 0.024).

CONCLUSIONS

Physical frailty intensifies the positive association of oral frailty with poor global cognitive function and executive function among older adults, particularly among females. It is ponderable to consider sex differences and facilitate the management of physical frailty when it comes to promoting cognitive health based on the perspective of oral health among older adults.

The clinical utility of three frailty measures in identifying HIV-associated neurocognitive disorders

OBJECTIVE

Frailty measures vary widely and the optimal measure for predicting HIV-associated neurocognitive disorders (HAND) is unclear.

DESIGN

A study was conducted to examine the clinical utility of three widely used frailty measures in identifying HIV-associated neurocognitive disorders.

METHODS

The study involved 284 people with HIV (PWH) at least 50 years enrolled at UC San Diego's HIV Neurobehavioral Research Program. Frailty measurements included the Fried Phenotype, the Rockwood Frailty Index, and the Veterans Aging Cohort Study (VACS) Index. HAND was diagnosed according to Frascati criteria. ANOVAs examined differences in frailty severity across HAND conditions. ROC analyses evaluated sensitivity and specificity of each measure to detect symptomatic HAND [mild neurocognitive disorder (MND) and HIV-associated dementia (HAD)] from no HAND.

RESULTS

Across all frailty measures, frailty was found to be higher in HAD compared with no HAND. For Fried and Rockwood (not VACS), frailty was significantly more severe in MND vs. no HAND and in HAD vs. ANI (asymptomatic neurocognitive impairment). For discriminating symptomatic HAND from no HAND, Fried was 37% sensitive and 92% specific, Rockwood was 85% sensitive and 43% specific, and VACS was 58% sensitive and 65% specific.

CONCLUSION

These findings demonstrate that Fried and Rockwood outperform VACS in predicting HAND. However, ROC analyses suggest none of the indices had adequate predictive validity in detecting HAND. The results indicate that the combined use of the Rockwood and Fried indices may be an appropriate alternative.

Interaction between plant-based dietary pattern and frailty on cognitive decline: a longitudinal analysis of the Chinese Longitudinal Healthy Longevity Survey cohort

OBJECTIVES

Frailty is a risk factor for faster cognitive decline, while plant-based dietary patterns are associated with decreased risk of cognitive decline. We aimed to explore their interaction with cognitive function among older adults.

METHODS

We used data from the Chinese Longitudinal Healthy Longevity Survey between 2008 and 2018. Frailty was evaluated based on the frailty index (FI), and the plant-based diet index (PDI) was calculated using food frequency questionnaire at baseline. Repeated measures of the Mini-Mental State Examination (MMSE) were utilised to assess cognitive function. We used linear mixed models to estimate regression coefficients (β) and 95% confidence intervals (CI).

RESULTS

We included 7,166 participants with a median follow-up of 5.8 years. Participants in pre-frail (β = -0.18, 95% CI: -0.24, -0.13) and frail (β = -0.39, 95% CI: -0.48, -0.30) groups experienced an accelerated decline in MMSE score compared with the robust group. The PDI modified the above association, with corresponding associations with frailty being much more pronounced among participants with a lower PDI (frail vs. robust β = -0.44, 95% CI: -0.56, -0.32), compared with those with a higher PDI (frail vs. robust β = -0.27, 95% CI: -0.40, -0.13). In addition, A combination of frailty and a low PDI was strongly associated with a faster decline in MMSE score (β = -0.52, 95% CI: -0.63, -0.41).

CONCLUSION

Adherence to plant-based dietary patterns attenuates the association between frailty and cognitive decline. If the observed association is causal, promoting plant-based dietary patterns may be a strategy to reduce the effects of frailty on neurological health.

Dynamics, association, and temporal sequence of cognitive function and frailty: a longitudinal study among Chinese community-dwelling older adults

BACKGROUND

Little is known about the association of longitudinal dynamics between cognitive function and frailty in Chinese older adults. The temporal sequences between cognitive function and frailty remains unclear. Our study investigates this directionality association using longitudinal data.

METHODS

Latent growth and multivariate latent growth models were employed to examine dynamics of cognition and frailty and their association among 2824 older adults in China. Cross-lagged panel analyses were used to assess the temporal sequences between frailty and cognition. The relation between cognitive domains and frailty was also examined using aforementioned methods.

RESULTS

Cognitive function was negatively associated with frailty status. Higher initial level of cognition indicated lower baseline level (β=-0.175, P < 0.001) and change rate (β=-0.041, P = 0.002) of frailty. We observed a reciprocal association between frailty and cognitive function rather than a unidirectional causal relationship. The initial cognitive performance for all components were negatively associated with baseline (β ranged between - 0.098 to -0.023) and change rate (β ranged between - 0.007 to -0.024) of frail status. No consistent associations between change rate of cognitive components and either initial level or change rate of frailty were detected.

CONCLUSIONS

Our study detected a reciprocal association between cognition and frailty rather than a unidirectional causal relationship. Our results also revealed different connections between cognitive performance and frailty across diverse cognitive domains.

Exploring the relationship between frailty and executive dysfunction: the role of frontal white matter hyperintensities

Introduction

Frailty is a geriatric syndrome frequently associated with executive dysfunction and white matter hyperintensities (WMH). But the relation between executive dysfunction and brain changes is poorly understood in frail subjects. Our hypothesis is that frontal-WMH mediates the association between frailty and executive dysfunction.

Methods

A convenience sample of 113 subjects older than 65 years without dementia was studied with neuropsychological test, a structured clinical interview, physical examination and brain MRI. They were classified as robust or pre-frail and frail using the frailty phenotype score (0-5). The frontal WMH (F-WMH) were manually graduated (0-6) using the "Age-Related White Matter Changes score" from FLAIR sequences at a 3 Tesla brain MRI. A mediation analysis was done for testing whether F-WMH could act as a link factor between frailty phenotype score and executive dysfunction.

Results

The group's mean age was 74 ± 6 years, subjects with higher frailty score had more depressive symptoms and worse performance in executive function tests. A regression analysis that explained 52% of the variability in executive functions, revealed a significant direct effect of frailty score (Standardized βcoeff [95% CI] -0.201, [-0.319, -0.049], and F-WMH (-0.152[-0.269, -0.009]) on executive functions, while the F-WMH showed a small partial mediation effect between frailty and executive functions (-0.0395, [-0.09, -0.004]).

Discussion

Frontal matter hyperintensities had a small mediation effect on the association between frailty and executive dysfunction, suggesting that other neuropathological and neurofunctional changes might also be associated with executive dysfunction in frail subjects.

Relationship Between Chronic Pain Types (Nociceptive and Neuropathic-Like Symptoms) and Frailty in Community-Dwelling Japanese Older Adults: A Cross-Sectional Study

Purpose

Chronic pain may accelerate the development of frailty in older adults through a variety of mechanisms. There are no published investigations of the influence of neuropathic-like symptoms on physical frailty. We investigated the association between chronic pain types (nociceptive and neuropathic-like symptoms) and frailty in community-dwelling Japanese older adults.

Participants and Methods

This was a population-based cross-sectional study conducted in 2017 in the city of Itoshima, Japan of 917 participants aged 65-75 years, not in need of long-term care, who had completed the physical function tests and questionnaires administered at measurement sessions held at community centers at three sites over a 1- to 2-month period. Their chronic pain types were classified as no-chronic pain, nociceptive pain, and neuropathic-like symptoms according to their painDETECT scores. Frailty phenotypes were defined by the following five components: unintentional weight loss, low grip strength, exhaustion, slow gait speed, and low physical activity. A logistic regression model was used to compute the odds ratios (ORs) and 95% confidence interval (CIs) for frailty status outcomes.

Results

The prevalence of pre-frailty was 51.9%, and that of frailty was 5.1%. In multinomial logistic regression analyses, compared to the no-chronic pain group, the OR for the presence of pre-frailty among the participants with nociceptive pain was 1.54 (95% CI: 1.04-2.30, p=0.03), and the OR for the presence of frailty among the participants with neuropathic-like symptoms was 4.37 (95% CI: 1.10-17.37, p=0.04). The neuropathic sensory symptoms of burning, tingling/prickling, and numbness were each associated with frailty, but not with the risk of pre-frailty.

Conclusion

Neuropathic-like symptoms were significantly associated with the presence of frailty in community-dwelling Japanese older adults. Chronic pain types might have different effects on frailty status.

The role of vitamin D in the link between physical frailty and cognitive function: A mediation analysis in community-dwelling Chinese older adults

Background

Physical frailty and cognitive aging have important influences on poor clinical outcomes in older adults. Many studies have investigated the association between frailty and cognitive function, but whether vitamin D mediates the association between frailty and cognitive function is unclear. We explored the mediating role of vitamin D on the cross-sectional association between physical frailty and cognitive function using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS).

Methods

We analyzed data from 1944 subjects aged 60 years and older from the 2011 CLHLS cohort. Frailty status was identified by the Osteoporotic Fracture Study (SOF) index. The Chinese version of the Mini-Mental State Examination (MMSE) was used to assess cognitive function. Linear regression models were used to examine the association between frailty, vitamin D, and cognition, adjusted for a range of covariates. Mediation analyses tested the indirect effects of vitamin D on physical frailty and cognitive function.

Result

Physical frailty was negatively associated with vitamin D levels and scores on the MMSE, and vitamin D levels were positively associated with scores on the MMSE. Linear regression analysis showed that physical frailty and serum vitamin D concentration were significant predictors of cognitive function. Importantly, mediation analysis showed that serum vitamin D concentration significantly mediated the relationship between physical frailty and cognitive function.

Conclusion

The association between physical frailty and cognitive function appears to be mediated by vitamin D. Future studies should explore whether serum vitamin D concentrations may mediate the association between physical frailty and cognitive decline and whether this mediating role is moderated by other factors.

Cognitive Frailty is Associated With Elevated Proinflammatory Markers and a Higher Risk of Mortality

BACKGROUND

Cognitive impairment and physical frailty are common among older adults and associated with a higher likelihood of adverse health outcomes. These two conditions frequently coexist in the same individual as cognitive frailty, yet few studies have examined the impact of such comorbidity on clinical outcomes or underlying biological mechanisms.

METHODS

A total of 1,340 older adults (age ≥60 years old) from the Bambui Cohort Study of Ageing, with a total follow-up of 10 years, were included in this study. Frailty was defined by the accumulation of deficit framework and cognitive impairment based on scores on the MMSE less than 22. In addition, serum IL-6 levels were measured by cytometric bead array assay.

RESULTS

Individuals classified with cognitive frailty had significantly higher serum IL-6 levels compared to the robust, cognitively unimpaired group. Those with cognitive frailty (aOR = 1.97 [1.18-3.27] and prefrailty and cognitive impairment (aOR = 1.83 [1.24-2.69]) had the highest mortality risk over 10 years of follow-up. Higher IL-6 levels were also independently associated with a higher mortality rate (aOR = 1.37 [1.23-1.54]).

CONCLUSION

Our study shows that cognitive Frailty indicates a vulnerability state and of increasing mortality risk. Our findings also suggested that proinflammatory abnormalities can be viewed as a central phenomenon underlying common age-related problems (e.g., cognitive impairment and Frailty) and outcomes (e.g., mortality).

Executive function and attentional bias as serial mediators in the relationship between frailty and depressive symptoms among older inpatients: A cross-sectional study

AIMS AND OBJECTIVES

To examine the serial mediating effect of executive function and attentional bias in the relationship between frailty and depressive symptoms.

BACKGROUND

Although the role of frailty in predicting depression has been well documented, the underlying mechanisms remain unclear.

DESIGN

A cross-sectional study was conducted with 667 older inpatients aged 60-90 years in the internal medicine wards of a hospital in China.

METHODS

Attentional bias, frailty and depressive symptoms were assessed using the Attention to Positive and Negative Information Scale, the Physical Frailty Phenotype and the 5-item Geriatric Depression Scale. Executive function was measured using 3 tests, including digital backward, category Verbal Fluency Test and Trail Making Test. The study followed the STROBE guideline.

RESULTS

The latent profile analysis (LPA) identified four patterns of attentional bias, namely "no positive bias & no negative bias" (class 1, 9.3%), "minor positive bias & no negative bias" (class 2, 48.0%), "major positive bias & minor negative bias" (class 3, 25.6%) and "major positive bias & no negative bias" (class 4, 17.1%). Regression analysis found that frailty was associated with depressive symptoms. Frailty was also negatively associated with executive function, which was a protective factor for attentional bias class 1, 2 and 3 with reference to class 4. Attentional bias class 1 and 2 but not class 3 was associated with depressive symptoms with reference to class 4. The joint significance test confirmed executive function and attentional bias as serial mediators linking frailty to depressive symptoms.

DISCUSSION

Unlike robust older adults who have the age-related positivity effect, frail older adults have attentional bias deficits due to executive dysfunction, and consequently experience clinically relevant depressive symptoms.

RELEVANCE TO CLINICAL PRACTICE

Healthcare providers should take executive function training and attentional bias regulation into consideration to reduce the detrimental effects of frailty on emotional well-being.