Frailty Is Related to Subjective Cognitive Decline in Older Women without Dementia

Abstract

OBJECTIVES Physical frailty (or loss of physiologic reserve) is associated with cognitive impairment and dementia. Subjective cognitive decline (SCD) may represent early pathologic changes of dementia. The association between these disease markers is unclear. DESIGN Cross‐sectional analysis. SETTING Community‐based participants from the Vanderbilt Memory & Aging Project. PARTICIPANTS A total of 306 older adults with normal cognition (NC; n = 174) or mild cognitive impairment (MCI; n = 132). MEASUREMENTS Frailty was measured using standard methods, and a composite frailty score was calculated. SCD was quantified using the Everyday Cognition Scale (ECog; total score and four domain scores). Objective cognition was assessed with the Montreal Cognitive Assessment (MoCA). Proportional odds models, stratified by sex, related the frailty composite to MoCA and total ECog score adjusting for age, education, body mass index, cognitive diagnosis, depressed mood, Framingham Stroke Risk Profile, apolipoprotein E (APOE ε4) carrier status, and height (for gait speed models). Secondary models related individual frailty components to SCD domains and explored associations in NC only. RESULTS In women, frailty composite was related to MoCA (odds ratio [OR] = .56; P = .04), a finding attenuated in sensitivity analysis (OR = .59; P = .08). Frailty composite related to ECog total (OR = 2.27; P = .02), planning (OR = 2.63; P = .02), and organization scores (OR = 2.39; P = .03). Increasing gait speed related to lower ECog total (OR = .06; P = .003) and memory scores (OR = .03; P < .001). Grip strength related to lower ECog planning score (OR = .91; P = .04). In men, frailty was unrelated to objective and subjective cognition (P values >.07). Findings were consistent in the NC group. CONCLUSION Frailty component and composite scores are related to SCD before the presence of overt dementia. Results suggest that this association is present before overt cognitive impairment. Results suggest a possible sex difference in the clinical manifestation of frailty, with primary associations noted in women. Further studies should investigate mechanisms linking early changes among frailty, SCD, and cognition. J Am Geriatr Soc, 1–9, 2019. J Am Geriatr Soc 67:1803–1811, 2019

Portals to frailty? Data-driven analyses detect early frailty profiles

“…Looman and colleagues [ 15 ] also examined whether profile membership generalized across sex and reported findings that converge with our own. Previous literature suggests that there may be sex differences in the impact of frailty on cognitive aging trajectories [ 4 , 5 , 26 ]. However, we did not detect such a pattern in our data.…”

“…Of note, these effects were moderated by sex, such that frailty change predicted the change in speed selectively for females, whereas frailty was unrelated to level or change in speed for males. At least one other study pointed to sex differences in the mechanisms linking frailty with early changes in cognitive function [ 26 ]. Given these findings and those from related research [ 27 , 28 ], we tested whether our results were robust across sex.…”

Clinical and Neuropsychological Correlates of Prefrailty Syndrome

“…Frailty is a common clinical syndrome in older adults due to age-related cumulative decline in multiple physiological systems, associated with negative health outcomes, including deterioration of daily living activities, disability, institutionalization, morbidity, and mortality (1). Cross-sectional and longitudinal research has demonstrated that older adults with physical frailty exhibit poorer cognitive performance and greater risk of cognitive decline and dementia than individuals without frailty (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), and that individuals with cognitive decline or dementia show a higher risk of physical frailty (16)(17)(18). It has also been demonstrated that the coexistence of physical frailty and cognitive impairment (cognitive frailty), ranging from 1 to 5% in community-dwelling older adults (19), increases the risk of mortality (20)(21)(22)(23)(24)(25), functional disability (26), and incident neurocognitive disorders (9,27) in later life.…”

Differential Impact of Cigarette Smoking on Fracture Risks in Subjective Cognitive Decline and Dementia: A Nationwide Longitudinal Study

“…Frailty was closely associated with SCD long before manifestation of objective cognitive impairment. 35 Especially, subjective complaints in mathematic reasoning were highly associated with frailty. 36 Smokers in SCD group in our study was likely to have been exposed to increased chance of frailty than their NC counterpart.…”

“…The reason for this increase in risk of falls or fracture in SCD could be attributed to additive role of frailty on harmful effects of smoking. Frailty was closely associated with SCD long before manifestation of objective cognitive impairment [ 35 ]. Especially, subjective complaints in mathematic reasoning were highly associated with frailty [ 36 ].…”