Cognitive frailty as a predictor of adverse outcomes among older adults: A systematic review and meta‐analysis

Abstract

Objective A systematic review and meta‐analysis basing on the prospective cohort studies were conducted to explore the risk of all‐cause mortality and dementia in cognitively frail older adults compared to robust older adults and to determine whether it was a predictor of adverse outcomes. Methods Pubmed, Web of Science, The Cochrane Library, EMBASE, and CINAHL databases were searched to retrieve studies on adverse outcomes of cognitive frailty. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Stata 15.0 Software was used to perform the meta‐analysis. The all‐cause mortality and dementia were observed to be the primary outcomes, while the other data were considered as the secondary outcome. Results A total of 14 studies were included in qualitative analysis and 12 studies were included in the meta‐analysis, with low risk of bias and moderate to good methodological quality. The results showed that cognitive frailty in older people had a higher risk of all‐cause mortality [HR = 1.93, 95%CI (1.67, 2.23), p < .001] and dementia [HR = 3.66, 95%CI (2.86, 4.70) as compared with robust. The subgroup analysis showed that the assessment tools were the main source of heterogeneity. Conclusion In older adults living in communities, the cognitive frailty was found to be a significant predictor of all‐cause mortality and dementia. Nonetheless, cognitive frailty was found to be a better predictor of all‐cause mortality and dementia than just frailty.

Aging metrics incorporating cognitive and physical function capture mortality risk: results from three prospective cohort studies

“…For instance, the AUC of CI-PF and FI for mortality prediction in CHARLS were 0.563 and 0.573, respectively, which were relatively higher than that of the MCR measurement (i.e., 0.507). Recent meta-analyses revealed that vulnerable persons defined by CI-PF or FI in older persons have a higher risk of all-cause mortality [40, 41]. Our study extends the findings of these previous studies.…”

“…During the 1999-2002 cycle, NHANES used the Digit Symbol Substitution Test (DSST) to assess cognitive function, with higher scores indicating better cognitive function (range: 0-133). According to the literature [23], a person was classified as having cognitive impairment if the summary score was below the median DSST score (i.e., 40).…”

Prevalence and Risk Factors for Cognitive Frailty in Aging Hypertensive Patients in China

“…CF is a type of frailty in patients who do not have dementia but have physical frailty (PF) and mild cognitive impairment (MCI) [4]. Researchers have found that, compared with the consideration of frailty and cognitive impairment, the consideration of CF can improve the prediction of disability, falls, dysfunction and death in the aging population [5][6][7][8][9]. CF is reversible, so it may become a target for the prevention of disability [10].…”

Items analysis of the Frailty Index (FI-35): Insight in the contribution of each item to the level of frailty

“…Prefrailty is a risk factor for cognitive dysfunction, and cognition tends to decline as frailty increases [ 24 – 27 ]. A meta-analysis from Bu [ 28 ] summarized that cognitive frailty was found to be a predictor of dementia in older adults living in communities. In our work, the abilities of memory, expression and solving problems were representative of cognitive impairment.…”