Characterisation of Physical Frailty and Associated Physical and Functional Impairments in Mild Cognitive Impairment

Abstract

ObjectiveTo characterize the physical frailty phenotype and its associated physical and functional impairments in mild cognitive impairment (MCI).MethodParticipants with MCI (N = 119), normal low cognition (NLC, N = 138), and normal high cognition (NHC, N = 1,681) in the Singapore Longitudinal Ageing Studies (SLAS-2) were compared on the prevalence of physical frailty, low lean body mass, weakness, slow gait, exhaustion and low physical activity, and POMA balance and gait impairment and fall risk.ResultsThere were significantly higher prevalence of frailty in MCI (18.5%), than in NLC (8.0%) and NHC (3.9%), and pre-frailty in MCI (54.6%), NLC (52.9%) than in NHC (48.0%). Age, sex, and ethnicity-adjusted OR (95% CI) of association with MCI (versus NHC) for frailty were 4.65 (2.40–9.04) and for pre-frailty, 1.67 (1.07–2.61). Similar significantly elevated prevalence and adjusted ORs of association with MCI were observed for frailty-associated physical and functional impairments. Further adjustment for education, marital status, living status, comorbidities, and GDS significantly reduced the OR estimates. However, the OR estimates remained elevated for frailty: 3.86 (1.83–8.17), low body mass: 1.70 (1.08–2.67), slow gait: 1.84 (1.17–2.89), impaired gait: 4.17 (1.98–8.81), and elevated fall risk 3.42 (1.22–9.53).ConclusionTwo-thirds of MCI were physically frail or pre-frail, most uniquely due to low lean muscle mass, slow gait speed, or balance and gait impairment. The close associations of frailty and physical and functional impairment with MCI have important implications for improving diagnostic acuity of MCI and targetting interventions among cognitively frail individuals to prevent dementia and disability.

Utility of Functional Metrics Assessed During Acute Care on Hospital Outcomes: A Systematic Review

“…Gender, age, cognition level, and existing comorbidities are significant predictors or confounders of physical function and hospital outcomes so ideally all studies would adjust for these variables . Gender and age were frequently reported among the eligible studies.…”

Examining Frailty Phenotype Dimensions in the Oldest Old

“…Fourth, the slight association of sociodemographic variables with the two dimensions suggested that this approach of frailty showed very little association with sociodemographic aspects not corroborating previous studies (Bieniek et al, 2016;Nyunt et al, 2017;Papachristou et al, 2017;Lewis et al, 2018), which should be the subject of further research, considering these two dimensions of the frailty phenotype and across different age groups. This study analyzed only the oldest old people with very low variability in education level and health condition, as referred to in the Limitations section.…”

“…Regarding the frailty phenotype, participants were considered "frail" if they fulfilled three or more criteria, "pre-frail" if they fulfilled one or two, and "robust" if none of the criteria was fulfilled. The metrics were slightly changed following the procedures used in similar studies with very old individuals (e.g., Gonzalez-Pichardo et al, 2013;Nyunt et al, 2017). In particular:…”

Development of a model on factors affecting instrumental activities of daily living in people with mild cognitive impairment – a Delphi study

“…Literature suggests additional personal factors that might influence IADL performance in MCI [3], however with inconsistent findings. Age was found to be associated with impaired IADL performance in MCI [44,46], as well as depression [44,47], frailty [36], physical activity [48] and comorbidities [44,49]. In contrast, Mariani and colleagues revealed that IADL performance was more strongly related with cognitive function than physical comorbidities [33].…”

“…Moreover, studies using clinical assessments of balance, e.g. POMA, revealed an association between IADL performance and balance in people with MCI [36].…”