A Possible Association Between Executive Dysfunction and Frailty in Patients With Neurocognitive Disorders

Neural correlates of frailty in cognitively healthy adults: A multimodal imaging study

OBJECTIVE

Frailty has emerged as prevalent condition in ageing. While frailty has been assessed through physical and functional criteria, recent studies have explored the link between cognitive decline and frailty, which remains complex and warrants further investigation. Our aims were to compare differences at the brain level between robust and frail older people without dementia and to explore possible associations between brain measures and cognitive performance assessed with neuropsychological tests.

METHODS

Using data from the "CAM-Cam" project that recruited a community dwelling population, we identified robust and frail participants based on the Rockwood Frailty index. Magnetic Resonance Imaging was performed to probe the interplay between physical frailty and cognitive health. The main aims were: (i) to identify differences in cognitive performance using the Cattell Culture Fair test and the Tip of the Tongue test and (ii) to assess voxel-wise group-related effects, using a general linear model design to investigate potential differences between our two study groups ("frail" and "robust").

RESULTS

Our findings revealed significantly smaller grey matter volume in frail individuals, primarily localized in cerebellar areas and in the right supramarginal gyrus. Diffusion magnetic resonance imaging scans showed diminished axial diffusivity values in frail participants, particularly in the corticospinal tract. Resting-state functional MRI showed increased functional connectivity values within the Default Mode Network (DMN) in frail individuals, relative to the robust group in parietal and cerebellar portions of the DMN. Moreover, we observed significant correlations between cognitive score and brain measures for our study groups.

CONCLUSIONS

The associations between cognitive test scores and anatomical and functional patterns in the brain highlight the complex interconnections between physical and cognitive aspects of frailty. This study brings novel insights into the early neurobiological markers associated with physical frailty in a cognitively healthy population.

Analysis of the Correlation between Frailty Index, Clinical Characteristics, Use of Anti-Epileptic Drug, and Prognosis in Elderly Patients with Epilepsy

BACKGROUND

Epilepsy is a common neurological disorder among the elderly, often leading to significant morbidity. Therefore, it is necessary to study the correlation between the frailty index, clinical characteristics of epilepsy, use of anti-epileptic drug, and the prognosis of elderly patients with epilepsy.

METHODS

This retrospective study included 106 elderly patients with epilepsy who were treated at the Affiliated Mindong Hospital, Fujian Medical University, China, between January 2018 and December 2022. Based on the severity of the prognosis, the seizures were classified into the major seizure group (tonic-clonic), minor seizure group (absence, myoclonus, clonus, tonic, atonic and partial seizures), and no seizure group. Furthermore, the relationship between the frailty index, clinical characteristics, use of epilepsy drugs, and the degree of epileptic seizures was assessed using the Logistic regression analysis.

RESULTS

Univariate analysis indicated that older age (p < 0.001), longer disease duration (p = 0.009), and the presence of comorbid conditions such as diabetes (p = 0.002) and coronary heart disease (p < 0.001) were all associated with seizure severity. Additionally, frailty was significantly related to seizure severity, with the non-frailty group having fewer major seizures compared to the pre-frailty and frailty groups (p < 0.001). Similarly, regular medication use (p < 0.001) and the number of drugs taken (p < 0.001) were significant factors, with irregular medication use and single-drug regimens being more common in patients with more severe seizures. Multivariate Logistic regression analysis indicated that a higher frailty index (p = 0.033), age over 70 years (p = 0.015), longer disease duration (p = 0.003), the presence of coronary heart disease (p < 0.001), and regular medication use (p = 0.022) were all significantly associated with more severe seizures.

CONCLUSION

Frailty index, age, disease duration, coronary heart disease, and regular medication are related to the prognosis of elderly patients with epilepsy. These findings highlight the significance of comprehensive management strategies to improve clinical outcomes in this group of patients.

Strides towards healthy longevity: Harnessing the power of sports and elements of Kathak, an Indian classical dance form through social participation to combat cognitive frailty among older adults

Aging brings with it many health issues that can make life challenging. As much of the attention is given to non-communicable diseases, there are others which are slowly becoming a matter of great concern. One such issue is cognitive frailty, which is a high risk factor for dementia, falls, fractures and hospitalization. Though not yet declared a public health concern, it deserves early detection and prevention strategies. As it is reversible if treated on time, there is a need to look into its prevention and cure. Physical activity has proven to be very effective in the treatment of cognitive frailty. This scoping review thus aims to study the impact of physical activity through social participation on cognitive frailty. The authors recommend that focussing on one's muscular fitness through participation in sports and elements of Indian classical dance form like Kathak in groups/ communities can be a very effective way of combating cognitive frailty among older adults.

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.

Examining the relationship between CDAI and frailty and its manifestation in Parkinson's disease: a cross-sectional study

Background

Higher intake of antioxidants is associated with reduced risk of various chronic diseases. However, the relationship between composite dietary antioxidants and frailty has not been characterized, especially in neurodegenerative conditions like Parkinson's disease (PD) where frailty is highly prevalent. This study aimed to investigate the association between composite dietary antioxidant index (CDAI), a composite score reflecting antioxidant vitamin and mineral intakes, and frailty risk in the general United States (US) population and PD patients.

Methods

Data from 21,354 participants ≥40 years in the National Health and Nutrition Examination Survey (NHANES) 2003-2018 represented the general population sample, while 268 PD patients were analyzed separately. Frailty was defined using a validated index. Weighted logistic regression and restricted cubic splines (RCS) examined overall and nonlinear CDAI-frailty associations, adjusting for sociodemographics, lifestyle factors, and comorbidities.

Results

In the general population, each unit increase in CDAI was associated with a 3.7% lower likelihood of frailty after full adjustments. Vitamin A, C, E, selenium and carotenoids exhibited J-shaped relationships where frailty risk decreased below intake thresholds of 1093.04 μg, 161.53 mg, 13.66 mg, 109.99 μg, and 5057.50 μg, respectively. In contrast, the CDAI- frailty inverse association was weaker among PD patients and only vitamin C (threshold 52.45 mg) and zinc (9.35 mg) showed nonlinear links.

Conclusion

Higher dietary antioxidant intake was associated with lower frailty prevalence in the general US population, with vitamins A, C, E, selenium, and carotenoids exhibiting nonlinear J-shaped relationships. In contrast, these associations were weaker and less consistent among PD patients, with only vitamins C and zinc showing nonlinear correlations. These findings highlight population-specific differences in the role of dietary antioxidants in frailty and suggest the need for personalized nutritional strategies in PD frailty management.

Sex differences in frailty among older adults

By definition, aging is a natural, gradual and continuous process. On the other hand, frailty reflects the increase in vulnerability to stressors and shortens the time without disease (health span) while longevity refers to the length of life (lifespan). The average life expectancy has significantly increased during the last few decades. A longer lifespan has been accompanied by an increase in frailty and decreased independence in older adults, with major differences existing between men and women. For example, women tend to live longer than men but also experience higher rates of frailty and disability. Sex differences prevent optimization of lifestyle interventions and therapies to effectively prevent frailty. Sex differences in frailty and aging are rooted in a complex interplay between uncontrollable (genetic, epigenetic, physiological), and controllable factors (psychosocial and lifestyle factors). Thus, understanding the underlying causes of sex differences in frailty and aging is essential for developing personalized interventions to promote healthy aging and improve quality of life in older men and women. In this review, we have discussed the key contributors and knowledge gaps related to sex differences in aging and frailty.

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.

Health factors associated with cognitive frailty in older adults living in the community

Introduction

This study aims to investigate the health factors associated with cognitive frailty in frail and pre-frail older adults living in the community.

Methods

A total of 233 older adults meeting Fried's criteria for pre-frailty or frailty were included. Cognitive status was evaluated using the Short Portable Mental Status Questionnaire. Health factors encompassed nutritional status (evaluated using the Mini Nutritional Assessment tool, body mass index, and waist, arm, and leg circumferences), physical function (assessed with the Short Physical Performance Battery), quality of life (measured with the total index of the EuroQoL 5-Dimension 5-Level questionnaire - EQoL-Index -, and the Visual-Analogue Scale - QoL-VAS - for today's health state), as well as sleep, physical activity, and inactivity estimated through wrist-worn accelerometers. Multivariable logistic regression analyses were conducted to identify potential predictors of cognitive frailty, considering age as a confounding factor.

Results

Cognitive frail participants exhibited advanced age, heightened self-reported exhaustion, diminished overall physical performance, reduced leg perimeter, decreased engagement in moderate-to-vigorous physical activity, and higher levels of inactivity (all p<0.05). However, after adjusting for age, only QoL-VAS emerged as a cognitive frailty risk factor (Odds ratio: 1.024), while the EQoL-Index, calf perimeter, and levels of moderate-to-vigorous physical activity were identified as protective factors (Odds ratios: 0.025, 0.929, and 0.973, respectively).

Discussion

This study highlights the complex relationship between non-modifiable factors such as age, and modifiable factors including quality of life, nutritional status, and physical activity in the development of cognitive frailty among older adults with a frailty phenotype living in the community.

Frailty after COVID-19: The wave after?

The COVID-19 pandemic poses an ongoing public health challenge, with a focus on older adults. Given the large number of older persons who have recovered from COVID-19 and reports of long-lasting sequelae, there is reasonable concern that the COVID-19 pandemic may lead to a long-term deterioration in the health of older adults, i.e., a potential "wave of frailty." Therefore, it is critical to better understand the circumstances surrounding the development of frailty as a result of COVID-19, as well as the underlying mechanisms and factors contributing to this development. We conducted a narrative review of the most relevant articles published on the association between COVID-19 and frailty through January 2023. Although few studies to date have addressed the effects of COVID-19 on the onset and progression of frailty, the available data suggest that there is indeed an increase in frailty in the elderly as a result of COVID-19. Regarding the underlying mechanisms, a multicausal genesis can be assumed, involving both direct viral effects and indirect effects, particularly from the imposed lockdowns with devastating consequences for the elderly: decreased physical activity, altered diet, sarcopenia, fatigue, social isolation, neurological problems, inflammation, and cardiovascular morbidity are among the possible mediators. Since the COVID-19 pandemic is leading to an increase in frailty in the elderly, there is an urgent need to raise awareness of this still little-known problem of potentially great public health importance and to find appropriate prevention and treatment measures.

Parkinson's Disease, SARS-CoV-2, and Frailty: Is There a Vicious Cycle Related to Hypovitaminosis D?

The literature has long established the association between aging and frailty, with emerging evidence pointing to a relationship between frailty and SARS-CoV-2 contagion. The possible neurological consequences of SARS-CoV-2 infection, associated with physical and cognitive frailty, could lead to a worsening of Parkinson's disease (PD) in infected patients or-more rarely-to an increase in the Parkinsonian symptomatology. A possible link between those clinical pictures could be identified in vitamin D deficiency, while the whole process would appear to be associated with alterations in the microbiota-intestine-brain axis that fall within the α-Synuclein Origin site and Connectome (SOC) model, and allow for the identification of a body-first PD and a brain-first PD. The model of care for this condition must consider intrinsic and extrinsic variables so that care by a multidisciplinary team can be successfully predicted. A multidimensional screening protocol specifically designed to identify people at risk or in the early stages of the disease should begin with the investigation of indices of frailty and microbiota-intestine-brain axis alterations, with a new focus on cases of hypovitaminosis D.

Number of ideas in spontaneous speech predicts cognitive impairment and frailty in community-dwelling older adults nine years later

OBJECTIVE

To investigate the associations between linguistic parameters in spontaneous speech at baseline and cognitive impairment and frailty nine years later.

METHODS

A prospective analysis was carried out on data of the Frailty in Brazilian Older People Study (FIBRA) Study, a population-based study on frailty. From a probabilistic sample of 384 individuals aged 65 and older at baseline (2008-2009), 124 aged 73 years and older at follow-up were selected, as they had scored above the cutoff values of cognitive screening for dementia adjusted by years of schooling at baseline and had answered to the question What is healthy aging and had no frailty at baseline. Verbal responses were submitted to content analysis and had its ideas and words counted. Number of ideas corresponded to the frequency of meaning categories and number of words to all identified significant textual elements in the text constituted by the sample answers to that question.

RESULTS

Multivariate logistic regression analyses, controlling for the effects of age, sex, and education, showed that individuals with a high number of ideas at baseline had lower chance of having cognitive impairment (OR = 0.39; 95% CI 0.22 - 0.69) and frailty (OR 0.66; 95% CI 0.44 - 0.99) nine years later than those with low number of ideas.

CONCLUSIONS

Higher number of ideas, but not number of words, in spontaneous speech seems to be associated to a more positive prognosis in mental and physical health nine years later. Linguistic markers may be used to predict cognitive impairment and frailty in older individuals.

Frailty and cognitive impairment in Parkinson’s disease: a systematic review

BACKGROUND

Frailty can lead to increased vulnerability in older people and patients with Parkinson's disease (pwPD) and worsen their health conditions. These patients can also develop cognitive function impairment. The objective is to analyze whether there is a relationship between frailty and cognitive impairment in pwPD, and to find out which instruments to use for its evaluation.

METHODS

Publications were searched in PubMed, Medline, Web of Science, Cinalh, Cochrane Library, Embase, Phycinfo, and Scopus. The results were measured with the instruments that are used to assess frailty and cognitive impairment, and analyze their relationship.

RESULTS

Two hundred seventy-one articles were identified, of which 12 met the inclusion criteria. All studies assessed frailty and cognitive function in pwPD. Five studies analyzed the relationship between frailty and cognitive impairment. The most used instruments were the Fried scale followed by the Clinical Frailty Scale (CFS) for frailty. Cognitive impairment was mostly evaluated with the Mini-Mental State Examination and the Montreal Cognitive Assessment. The prevalence data ranged from 20.2 to 51.5% with the Fried scale and from 35.6 to 83.9% with the CFS. Cognitive impairment was present in 15 to 45.2% of the pwPD.

CONCLUSION

Analysis of the included studies shows a relationship between frailty and cognitive impairment in pwPD. There was significant variability in the application of the scales used, which influences the prevalence data. More observational and experimental studies are needed to provide more evidence on this association and to determine which is the optimal tool to identify frailty in pwPD using multidimensional scales.

Cognitive impairment in candidates for allogeneic hematopoietic stem cell transplantation

Hematopoietic cell transplant (HCT) is an increasingly common and curative treatment strategy to improve survival among individuals with malignant and nonmalignant diseases, with over one million HCTs having been performed worldwide. Neurocognitive dysfunction is a common and untoward consequence of HCT for many recipients, although few studies have examined the profile of neurocognitive impairments in HCT or their association with clinical features, such as frailty, or the incidence of pre-HCT neurocognitive impairments across all ages, which may influence post-HCT neurocognitive impairments. We examined the pattern and correlates of pre-transplant neurocognitive dysfunction in a prospective sample of adults undergoing HCT. Neurocognition was assessed using the Montreal Cognitive Assessment Battery. Frailty was assessed using the Short Physical Performance Battery. Linear regression analysis was used to examine the associations between neurocognitive performance and frailty. Neurocognitive screening profiles were also examined by partitioning MoCA into domain scores, including Executive Function and Memory. We also examined the associations between neurocognition, frailty, and clinical outcomes, including length of transplant hospitalization and survival. One hundred and ten adults were evaluated across a wide age range (range: 19-75; mean age = 54.7 [SD = 14.1]). Neurocognitive performance tended to fall below published normative levels (mean MoCA = 25.5 [SD = 4.1]), with 17% of participants demonstrating impaired performance compared with medical normative data (MoCA ≤ 22) and 34% exhibiting impaired performance relative to healthy samples (MoCA ≤ 25). Mild impairments (MoCA ≤ 25) were common across age ranges, including middle-aged patients (23% for age < 50; 35% for age 50-60, 41% for age ≥ 60), particularly for items assessing Executive Function. Greater levels of frailty associated with lower neurocognitive screening scores (r = -0.29, P < 0.01) and Executive Functioning (r = -0.24, P < 0.01), whereas greater age was associated with poorer Memory performance only (r = -0.33, P < 0.01). Greater levels of frailty prior to transplant associated with longer length of stay (β = 0.10, P = 0.046), but were not associated with survival. Neurocognitive impairments are common among adults undergoing HCT and the pattern of performance varies by age. Pre-transplant frailty is associated with neurocognitive functioning and may portend worse post-transplant early clinical outcomes.

Oral function, nutritional status and physical status in Japanese independent older adults

OBJECTIVES

To clarify the associations among oral status, nutritional status and physical status in Japanese independent older adults.

BACKGROUND

It is important to focus on factors affecting physical status associated with life dysfunction, long-term care and mortality. However, there are very few reports of the associations among oral status, nutritional status and physical status.

MATERIALS AND METHODS

Patients who visited the Preventive Dentistry Clinic at Okayama University Hospital from November 2017 to January 2019 participated in this cross-sectional study. Number of teeth, periodontal condition and oral function were recorded. Bacteria counts in tongue dorsum, oral wettability, tongue pressure, tongue and lip movement function [oral diadochokinesis (ODK)], masticatory ability, bite force and swallowing function were measured. Nutritional status was assessed by the Mini Nutritional Assessment. Physical frailty status and Elderly Status Assessment Set were also evaluated. These variables were analysed by structural equation modelling (SEM).

RESULTS

Data from 203 patients were analysed (63 males and 140 females). Patients ranged in age from 60 to 93 years. The final model of the path diagram was completed by SEM. ODK was positively associated with nutritional status, and nutritional status was negatively associated with frailty. Age was associated with ODK, nutritional status and frailty.

CONCLUSION

Based on the associations among age, ODK, nutritional status and frailty, maintaining tongue movement function may contribute to good nutritional status and physical status in Japanese independent older adults.

Investigating Neuroimaging Correlates of Early Frailty in Patients With Behavioral Variant Frontotemporal Dementia: A MRI and FDG-PET Study

Frailty is a dynamic clinical condition characterized by the reduction of interconnections among different psychobiological domains, which leads to a homeostatic vulnerability. The association between physical frailty and cognitive dysfunctions is a possible predictor of poor prognosis in patients with neurodegenerative disorders. However, this construct has not been fully analyzed by a multidimensional neuropsychogeriatric assessment matched with multimodal neuroimaging methods in patients with behavioral variant frontotemporal dementia (bvFTD). We have investigated cognitive dysfunctions and frailty status, assessed by both a neuropsychological evaluation and the Multidimensional Prognostic Index (MPI), in a sample of 18 bvFTD patients and compared to matched healthy controls. Gray matter (GM) volume (as assessed by voxel-based morphometry) and metabolism (on 18fluorodeoxyglucose positron emission tomography) were first separately compared between groups, then voxelwise compared and correlated to each other within patients. Linear regression of the MPI was performed on those voxels presenting a significant correlation between altered GM volume and metabolism. The neuropsychological assessment reflected the diagnoses and the functional-anatomical alterations documented by neuroimaging analyses. In particular, the majority of patients presented significant executive dysfunction and mood changes in terms of apathy, depression, and anxiety. In the overall MPI score, the patients fell in the lower range (indicating an early frailty status). On imaging, they exhibited a bilateral decrease of GM density and hypometabolism involving the frontal pole, the anterior opercular region, and the anterior cingulate cortex. Greater atrophy than hypometabolism was observed in the bilateral orbitofrontal cortex, the triangular part of the inferior frontal gyrus, and the ventral striatum, whereas the contrary was detected in the bilateral dorsal anterior cingulate cortex and pre-supplementary motor area. MPI scores significantly correlated only with the co-occurrence of a decrease of GM density and hypometabolism in the right anterior insular cortex, but not with the separate pathological phenomena. Our results show a correlation between a specific pattern of co-occurring GM atrophy and hypometabolism with early frailty in bvFTD patients. These aspects, combined with executive dysfunction and mood changes, may lead to an increased risk of poor prognosis, highlighting a potentially critical and precocious role of the insula in the pathogenesis of frailty.