Cognitive Frailty and Its Association with All-Cause Mortality Among Community-Dwelling Older Adults in Taiwan: Results from I-Lan Longitudinal Aging Study

Liu, Li Kuo; Chen, Chia-Hung; Lee, Wei Ju; Wu, Yi Hui; Hwang, An Chun; Lin, Ming Hsien; Shimada, Hiroyuki; Peng, Li Ning; Loh, Ching‐Hui; Arai, Hidenori; Chen, Liang Kung

doi:10.1089/rej.2017.2038

Cited by 56 publications

(56 citation statements)

References 41 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%

“…21,22 Previous studies have suggested there may be a cumulative impact of frailty and CIND in predicting poor outcomes in older adults, although these studies have had limitations, such as nonrepresentative samples or limited follow-up times. [10][11][12][13]23 Furthermore, the extent to which CIND adds prognostic value to physical frailty in identifying nondisabled individuals who are at increased risk for adverse outcomes remains unclear. In addition, studies that investigated the interactions between CIND and physical frailty are extremely limited.…”

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confidence: 99%

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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%

mentioning

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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show abstract

“…Based on these findings, we developed a new operational definition of cognitive frailty as follows: physical frailty; presence of slow walking speed or muscle weakness; cognitive impairment [ 18 ]; and signs of impairment in word list memory, attention, executive function, or processing speed in the National Center for Geriatrics and Gerontology-Functional Assessment Tool (NCGG-FAT) [ 19 , 20 ]. This new definition has less stringent criteria than those we previously reported in order to improve its suitability as a primary screening tool [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Cognitive Frailty Predicts Incident Dementia among Community-Dwelling Older People

Shimada

Doi

Lee

et al. 2018

JCM

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Cognitive frailty, defined as the presence of both frailty and cognitive impairment, is a risk factor for adverse events in older adults. However, prevalence rates of cognitive frailty are low (1.1–2.5%), so primary screening is unsuitable in community settings. The aim of the study was to examine whether a new definition of cognitive frailty, which was developed for primary screening, is useful to predict incident dementia in community-dwelling older adults. A total of 4570 older adults participated in the study (2326 women; average age, 71.9 ± 5.5 years). We defined physical frailty as the presence of ≥1 of the following symptoms: slow walking speed and muscle weakness. Cognitive impairment was defined as ≥1 symptom of cognitive impairment, indicated by an age- and education-adjusted score that was ≥1.5 standard deviations below the reference threshold in word list memory, attention, executive function, and processing speed tests. Cognitive frailty was defined as comorbid physical frailty and cognitive impairment. The incidence of dementia was determined using data collected by the Japanese Health Insurance System over 36 months. The prevalence rates of physical frailty, cognitive impairment, and cognitive frailty were 17.5%, 15.3%, and 9.8%, respectively. Cognitive impairment (hazard ratio [HR]: 2.06, 95% confidence interval [95% CI]: 1.41–3.02) and cognitive frailty (HR: 3.43, 95% CI: 2.37–4.97) were found to be significant risk factors for dementia. However, the association between dementia and physical frailty was not significant (HR: 1.13, 95% CI: 0.76–1.69). Individuals with comorbid physical frailty and cognitive impairment could have a higher risk of dementia than healthy older adults or older adults with either physical frailty or cognitive impairment alone.

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“…Thrombo-embolic and/or reduction of cardiac output appear to be the main mechanisms involved in the determination of cognitive impairment in elderly patients with CVD, which involves common diseases such as CAD, hypertension, DM and HF [23,24]. Cognitive impairment is a risk factor for adverse events in patients with CVD [10]. The most widely used tool for evaluating cognitive impairment is the MMSE [25].…”

Section: Discussionmentioning

confidence: 99%

“…A significant association between frailty and a poor prognosis has been described in patients with CVD [6,7]. Age-associated cognitive decline and impairment have also been shown to be associated with an increased mortality [10,11]. However, most previous reports only evaluated the relationship between physical frailty or cognitive impairment and CVD.…”

Section: Introductionmentioning

confidence: 99%

Predicting Non-elective hospital readmission or Death using a Composite Assessment of Cognitive and Physical Frailty in Elderly inpatients with Cardiovascular Disease

Yao

Zheng

Liang

et al. 2020

Preprint

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Background: We aimed to assess the utility of the combination of the mini-mental state examination (MMSE) + clock drawing test (CDT) and the Fried phenotype for predicting non-elective hospital readmission or death within six months in elderly inpatients with cardiovascular disease (CVD).Methods: A single-center prospective cohort was conducted from September 2018 to February 2019. Inpatients ≥65 years old were recruited. Predictive validity was tested using a Cox proportional hazards regression model analysis, and the discriminative ability was evaluated by the receiver operating characteristic (ROC) curve. Results: A total of 542 patients were included. Overall, 12% (64/542) screened positive for cognitive impairment, 16% (86/542) were physically frail and 8% (44/542) had cognitive impairment combined with physical frailty, showing an older age (P<0.001) and a lower education level (P<0.001) than physically frail patients. A total of 113 patients (20.9%) died or were readmitted at six months. Frail participants with a normal (hazard ratio [HR]: 1.73, 95% confidence interval [CI]: 1.06-2.82, P=0.028) or impaired cognition (HR: 2.50, 95% CI: 1.27-4.91, P=0.008) had a higher risk of non-elective hospital readmission or death than robust patients after adjusting for the age, sex, education level, marital status, the presence of diabetes mellitus, heart failure, and history of stroke. The area under the ROC curve (AUC) showed that the discriminative ability in relation to six months readmission and death for the MMSE + CDT + Fried phenotype was 0.65 (95% CI: 0.60-0.71), and the AUC for men was 0.71 (95% CI: 0.63-0.78), while that for women was 0.60 (95% CI: 0.51-0.69).Conclusions: Accounting for cognitive impairment in the frailty phenotype may allow for the better prediction of non-elective hospital readmission or death in elderly inpatients with CVD in the short term.Trial registration: ChiCTR1800017204; date of registration: 07/18/2018.

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Cognitive Frailty and Its Association with All-Cause Mortality Among Community-Dwelling Older Adults in Taiwan: Results from I-Lan Longitudinal Aging Study

Abstract: The prevalence of cognitive frailty was 13.3% in Taiwan and was predictive for all-cause mortality. Further study is needed to explore the pathophysiology and reversibility of cognitive frailty.

Cited by 56 publications

References 41 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

Cognitive Frailty Predicts Incident Dementia among Community-Dwelling Older People

Predicting Non-elective hospital readmission or Death using a Composite Assessment of Cognitive and Physical Frailty in Elderly inpatients with Cardiovascular Disease

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