Brain structural alterations and clinical features of cognitive frailty in Japanese community-dwelling older adults: the Arao study (JPSC-AD)

Abstract

Cognitive frailty (CF) is a clinical condition defined by the presence of both mild cognitive impairment (MCI) and physical frailty (PF). Elderly with CF are at greater risk of dementia than those with MCI or PF alone, but there are few known clinical or neuroimaging features to reliably distinguish CF from PF or MCI. We therefore conducted a population-based cross-sectional study of community elderly combining physical, cognitive, neuropsychiatric, and multisequence magnetic resonance imaging (MRI) evaluations. The MRI evaluation parameters included white matter (WM) lesion volumes, perivascular and deep subcortical WM lesion grades, lacunar infarct prevalence, microbleed number, and regional medial temporal lobe (MTL) volumes. Participants were divided into 4 groups according to the presence or absence of MCI and PF—(1) no MCI, PF (n = 27); (2) no PF, MCI (n = 119); (3) CF (MCI + PF) (n = 21), (4) normal controls (n = 716). Unique features of CF included shorter one-leg standing time; severe depressive symptoms; and MRI signs of significantly more WM lesions, lacunar infarcts, small-vessel disease lesions, microbleeds, and reduced MTL volumes. These unique deficits suggest that interventions for CF prevention and treatment should focus on motor skills, depressive symptoms, and vascular disease risk factor control.

Potential Imaging Biomarkers of Cognitive Frailty

“…A brain MRI study in Japanese community-dwelling older adults showed more lacunar infarction and CMB with a severe WMH degree in the CF group. (30) In this study, the CF group had medial temporal lobe atrophy (MTA) compared with that of the normal controls, but there was no difference in the degree of MTA between the CF and MCI groups without physical frailty. (30) An Australian memory clinic cohort study (31) examined both WMH and MTA and found that there was a significant difference in WMH severity but no difference in MTA between patients with frailty, defined as a frailty index > 0.25, and participants without frailty.…”

“…There have been many studies related to depressive symptoms in CVSD, (45) but only a few studies on neuroimaging findings and depressive symptoms have been conducted in CF. (30) As depressed mood itself, vulnerability to stress, and other psychological factors can affect CF, longitudinal studies that comprehensively evaluate these factors and frailty should be conducted. Immunological blood biomarkers have been explored for both frailty and CF.…”

Understanding exogenous factors and biological mechanisms for cognitive frailty: a multidisciplinary scoping review

“…Das, 2022; Ge et al, 2020; Kelaiditi et al, 2013; Ma et al, 2017; Sargent et al, 2018; Vatanabe et al, 2022; Zhang et al, 2021), with some indicating higher prevalence of depression in participants with CF versus PF or CI alone (e.g. Ge et al, 2020; Kwan et al, 2019; Yoshiura et al, 2022). Zhang et al’s (2021) meta-analysis suggested that only papers using the Geriatric Depression scale (GDS), EQ-5D, and GHQ12 found a clear increased risk of CF in the context of depression.…”

Gesture imitation performance in community‐dwelling older people: assessment of a gesture imitation task in the screening and diagnosis of mild cognitive impairment and dementia

“…Neuropsychiatrists diagnosed MCI or dementia in participants, according to the JPSC‐AD diagnostic procedure 22 based on the results of questionnaires, neurological and neuropsychological assessments, and brain MRI 23,24 . MCI was diagnosed according to Petersen's criteria, 25 dementia according to the DSM‐III‐R (Revised Edition), and dementia subtypes according to standard criteria 22 .…”

“…Neuropsychiatrists diagnosed MCI or dementia in participants, according to the JPSC-AD diagnostic procedure 22 based on the results of questionnaires, neurological and neuropsychological assessments, and brain MRI. 23,24 MCI was diagnosed according to Petersen's criteria, 25 dementia according to the DSM-III-R (Revised Edition), and dementia subtypes according to standard criteria. 22 The National Institute of Neurological and Communicative Disorders and Stroke and Alzheimer's Disease and Related Disorders Association criteria (NINCDS-ADRDA) 26 were used for diagnosing ADD, National Institute of Neurological Disorders and Stroke-Association International pour la Recherche et l'Enseignement en Neurosciences criteria (NINDS-AIREN) 27 for vascular dementia, and Third Consensus Report of the Dementia with Lewy Bodies (DLB) Consortium 28 for DLB.…”