Frailty and cognitive decline

Canevelli, Marco; Cesari, Matteo; Kan, Gabor Abellán van

doi:10.1097/mco.0000000000000133

Cited by 85 publications

(72 citation statements)

References 29 publications

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“…Furthermore, physical frailty predicts incident cognitive impairment (Canevelli et al, 2015). However, previous research yielded mixed results as to whether cognitive impairment had additional impact on disability for those who are already physically frail (Ament et al, 2014;Avila-Funes et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

Pathways from physical frailty to activity limitation in older people: Identifying moderators and mediators in the English Longitudinal Study of Ageing

Ding

Kuha

Murphy

2017

Experimental Gerontology

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Physical frailty increases the risk of future activity limitation, which in turn, compromises independent living of older people and limits their healthspan. Thus, we seek to identify moderators and mediators of the effect of physical frailty on activity limitation change in older people, including gender- and age-specific effects. In a longitudinal study using data from waves 2, 4, and 6 of the English Longitudinal Study of Ageing, unique physical frailty factor scores of 4638 respondents aged 65 to 89years are obtained from confirmatory factor analysis of physical frailty, which is specified by three indicators, namely slowness, weakness, and exhaustion. Using a series of autoregressive cross-lagged models, we estimate the effect of physical frailty factor score on activity limitation change, including its moderation by social conditions, and indirect effects through physical and psychological conditions. We find that the effect of physical frailty on activity limitation change is significantly stronger with older age, while it has significant indirect effects through low physical activity, depressive symptoms, and cognitive impairment. In turn, indirect effects of physical frailty through low physical activity and cognitive impairment are stronger with older age. Sensitivity analyses suggest that these effects vary in their robustness to unmeasured confounding. We conclude that low physical activity, depressive symptoms, and cognitive impairment are potentially modifiable mediators on pathways from physical frailty to activity limitation in older people, including those who are very old. This evidence offers support for population-level interventions that target these conditions, to mitigate the effect of physical frailty on activity limitation, and thereby enhance healthspan.

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Section: Discussionmentioning

confidence: 99%

Pathways from physical frailty to activity limitation in older people: Identifying moderators and mediators in the English Longitudinal Study of Ageing

Ding

Kuha

Murphy

2017

Experimental Gerontology

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“…25 Although we do not fully understand the mechanisms driving this association between frailty and cognition among adult KT recipients, recent reviews of frailty and cognition in older adults suggested potential effects of inflammation, cardiovascular disease, nutrition, and neuropathology. 23,24 Among KT recipients especially, consumption of immunosuppressive medications may potentially serve as a chronic stressor. As shown by prior research, frail recipients may not recover from the physiologic stress of their immunosuppressive regimens as efficiently as nonfrail recipients; in theory, their underlying multisystem dysfunction hinders their ability to reach homeostasis in the face of stressors introduced by such medications with dose-dependent adverse events, putting them at higher risk of poor KT outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…27 In studies of older adults, frailty is associated with worse cognitive function. 23,24 The PFP has since been shown to be an important predictor of adverse outcomes in ESRD and KT populations. 29233 It occurs in approximately 20% of KT recipients of all ages, 34 and it has been identified as a key risk factor for poor health outcomes, including quality of life, delirium, delayed graft function, hospital length of stay, early hospital readmission, mycophenolate mofetil intolerance, and mortality.…”

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confidence: 99%

Frailty and Changes in Cognitive Function after Kidney Transplantation

Chu¹,

Gross²,

Shaffer³

et al. 2019

JASN

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Background Restoration of kidney function after kidney transplant generally improves cognitive function. It is unclear whether frail recipients, with higher susceptibility to surgical stressors, achieve such posttransplant cognitive improvements or whether they experience subsequent cognitive decline as they age with a functioning graft.Methods In this two-center cohort study, we assessed pretransplant frailty (Fried physical frailty phenotype) and cognitive function (Modified Mini-Mental State Examination) in adult kidney transplant recipients. To investigate potential short-and medium-term effects of frailty on post-transplant cognitive trajectories, we measured cognitive function up to 4 years post-transplant. Using an adjusted mixed effects model with a random slope (time) and intercept (person), we characterized post-transplant cognitive trajectories by pretransplant frailty, accounting for nonlinear trajectories. ResultsOf 665 recipients (mean age 52.0 years) followed for a median of 1.5 years, 15.0% were frail. After adjustment, pretransplant cognitive scores were significantly lower among frail patients compared with nonfrail patients (89.0 versus 90.8 points). By 3 months post-transplant, cognitive performance improved for both frail (slope =0.22 points per week) and nonfrail (slope =0.14 points per week) recipients. Between 1 and 4 years post-transplant, improvements plateaued among nonfrail recipients (slope =0.005 points per week), whereas cognitive function declined among frail recipients (slope =20.04 points per week). At 4 years post-transplant, cognitive scores were 5.8 points lower for frail recipients compared with nonfrail recipients.Conclusions On average, both frail and nonfrail recipients experience short-term cognitive improvement post-transplant. However, frailty is associated with medium-term cognitive decline post-transplant. Interventions to prevent cognitive decline among frail recipients should be identified.

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“…A review article examining the current evidence on the relation between frailty and cognition 13 found that the vast majority of the studies evaluated the frailty syndrome using the components defined by Fried et al 5 , since the objective was to analyze the physical dimension of the syndrome 13 . As for cognitive evaluation, the studies mainly used brief screening scales, such as the Mini-Mental State Examination (MMSE) 13 . These findings suggest the need to use more complex batteries for cognitive evaluation to determine the domains most altered by frailty.…”

Section: Introductionmentioning

confidence: 99%

Frailty and cognitive performance in older adults living in the community: a cross-sectional study

Fabrício

Alexandre

Chagas

2019

Arch. Clin. Psychiatry (São Paulo)

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Background: Cognitive impairment and frailty are important problems affecting the elderly population. Frail elderly present worse overall cognitive performance. Objective: The aim of this study was to investigate general and domain-specific cognitive performance among non-frail, pre-frail, and frail elderly persons. Methods: This is a cross-sectional study in which 267 elderly persons living in São Carlos, SP were divided into three groups according to the frailty criteria defined by Fried et al. Cognitive performance was evaluated with a battery of cognitive tests covering domains such as memory, attention, language, and executive functioning. A multinomial logistic regression analysis adjusted for age, gender, and education was performed to evaluate the association between performance in cognitive domains and levels of frailty. Results: Frailty was significantly associated with lower scores on the global cognitive test (RRR = 0.86; IC 95% 0.78-0.96; p < 0.01), word list memory (RRR = 0.92; IC 95% 0.86-0.99; p = 0.02), and figure list recognition (RRR = 0.78; IC 95% 0.62-0.99; p = 0.04). Pre-frailty was associated with lower scores on the word list memory (RRR = 0.92; IC 95% 0.86-1.00; p = 0.04) and naming test (RRR = 0.82; IC 95% 0.69-0.99; p = 0.03). Discussion: Frailty syndrome can influence general cognition and specific domains such as memory and language. Prospective studies will be fundamental to evaluate the causal relation between frailty and cognition.

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Frailty and cognitive decline

Cited by 85 publications

References 29 publications

Pathways from physical frailty to activity limitation in older people: Identifying moderators and mediators in the English Longitudinal Study of Ageing

Pathways from physical frailty to activity limitation in older people: Identifying moderators and mediators in the English Longitudinal Study of Ageing

Frailty and Changes in Cognitive Function after Kidney Transplantation

Frailty and cognitive performance in older adults living in the community: a cross-sectional study

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