Different Cognitive Frailty Models and Health- and Cognitive-related Outcomes in Older Age: From Epidemiology to Prevention

Abstract

Frailty, a critical intermediate status of the aging process that is at increased risk for negative health-related events, includes physical, cognitive, and psychosocial domains or phenotypes. Cognitive frailty is a condition recently defined by operationalized criteria describing coexisting physical frailty and mild cognitive impairment (MCI), with two proposed subtypes: potentially reversible cognitive frailty (physical frailty/MCI) and reversible cognitive frailty (physical frailty/pre-MCI subjective cognitive decline). In the present article, we reviewed the framework for the definition, different models, and the current epidemiology of cognitive frailty, also describing neurobiological mechanisms, and exploring the possible prevention of the cognitive frailty progression. Several studies suggested a relevant heterogeneity with prevalence estimates ranging 1.0–22.0% (10.7–22.0% in clinical-based settings and 1.0–4.4% in population-based settings). Cross-sectional and longitudinal population-based studies showed that different cognitive frailty models may be associated with increased risk of functional disability, worsened quality of life, hospitalization, mortality, incidence of dementia, vascular dementia, and neurocognitive disorders. The operationalization of clinical constructs based on cognitive impairment related to physical causes (physical frailty, motor function decline, or other physical factors) appears to be interesting for dementia secondary prevention given the increased risk for progression to dementia of these clinical entities. Multidomain interventions have the potential to be effective in preventing cognitive frailty. In the near future, we need to establish more reliable clinical and research criteria, using different operational definitions for frailty and cognitive impairment, and useful clinical, biological, and imaging markers to implement intervention programs targeted to improve frailty, so preventing also late-life cognitive disorders.

Bidirectional relationship between caregiver burden and neuropsychiatric symptoms in patients with Alzheimer's disease: A narrative review

“…On the other hand, as defined in the models of cognitive frailty, reversible cognitive and functional damages that can be caused by a number of factors associated with aging, including vascular diseases, sarcopenia, increased inflammation, metabolic and hormonal changes, and psychosocial factors may accelerate progression of dementia . Interventions, such as drug treatment for chronic diseases, physical activity, fall prevention, and nutritional support, which target physical, nutritional, cognitive, and psychological domains, may delay the progression and secondary occurrence of cognitive frailty‐related adverse outcomes . Therefore, it is important for caregivers to start supporting their patients for a secondary prevention (lifestyle) of cognitive and functional impairment, which may increase caregiver burden, as well as deal with cognitive and noncognitive symptoms of dementia .…”

“…[21][22][23] Interventions, such as drug treatment for chronic diseases, physical activity, fall prevention, and nutritional support, which target physical, nutritional, cognitive, and psychological domains, may delay the progression and secondary occurrence of cognitive frailty-related adverse outcomes. 24 Therefore, it is important for caregivers to start supporting their patients for a secondary prevention (lifestyle) of cognitive and functional impairment, which may increase caregiver burden, as well as deal with cognitive and noncognitive symptoms of dementia. 21,24 Another problem is that caregivers often have to serve their caregiving role for many years due to the fact that AD last on for longer periods of time as the average 8 years, and it has a progression despite of the treatment.…”

“…24 Therefore, it is important for caregivers to start supporting their patients for a secondary prevention (lifestyle) of cognitive and functional impairment, which may increase caregiver burden, as well as deal with cognitive and noncognitive symptoms of dementia. 21,24 Another problem is that caregivers often have to serve their caregiving role for many years due to the fact that AD last on for longer periods of time as the average 8 years, and it has a progression despite of the treatment. 7,17,25 As a result of these factors, during the performing all these tasks for patients with AD, the caregivers often describe the experience as "enduring stress and frustration.…”

Gut microbiota, cognitive frailty and dementia in older individuals: a systematic review

“…3 Interestingly, most of these factors have been associated with alterations in the composition of the gut microbiota, that is, the ensemble of bacteria, fungi, viruses, protozoa and archaea symbiotically living in the distal human gastrointestinal tract 24…”

Crosstalk Between the Gut Microbiome and Bioactive Lipids: Therapeutic Targets in Cognitive Frailty

“…Epidemiological evidence estimates that the prevalence of cognitive frailty ranges from 1 to 22% (11-22% in clinical settings and 1-4% in community settings), varying according to the conceptual definition used to categorize it (e.g., the Fried phenotype or the deficit accumulation model) (4). As the "Baby Boomer" generation passes the age of 65, the incidence of people living with cognitive frailty is expected to increase in the coming years (4)(5)(6). This projected growth is expected to have a significant impact on multiple social structures, including on the individual, caregivers, families, and clinical settings, as well as on healthcare systems.…”