Frailty criteria and cognitive performance are related: Data from the Fibra study in Ermelino Matarazzo, Sao Paulo, Brazil



To assess the relationship between the CHS frailty criteria (Fried et al., 2001) and cognitive performance.


Cross sectional and population-based. Setting: Ermelino Matarazzo, a poor sub district of the city of São Paulo, Brazil.


384 community dwelling older adults, 65 and older.


Assessment of the CHS frailty criteria, the Brief Cognitive Screening Battery (memorization of 10 black and white pictures, verbal fluency animal category, and the Clock Drawing Test) and the Mini-Mental State Examination (MMSE).


Frail older adults performed significantly lower than non-frail and pre frail elderly in most cognitive variables. Grip strength and age were associated to MMSE performance, age was associated to delayed memory recall, gait speed was associated to verbal fluency and CDT performance, and education was associated to CDT performance.


Being frail may be associated with cognitive decline, thus, gerontological assessments and interventions should consider that these forms of vulnerability may occur simultaneously.

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  1. 1.

    Hogan DB, Macknight, C, Bergman H (2003) Models, definitions, and criteria of frailty. Aging Clinical & Experimental Research 15:2–29.

    Google Scholar 

  2. 2.

    Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL, Hillier TA, Cauley JA, Hochberg MC, Rodondi N, Tracy JK, Cummings SR (2008) Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. Archives of Internal Medicine 168:382–389.

    PubMed  Article  Google Scholar 

  3. 3.

    Ensrud KE, Ewing SK, Cawthon PM, Fink HA, Taylor BC, Cauley JA, Dam TT, Marshall LM, Orwoll ES, Cummings SR (2009) Osteoporotic Fractures in Men Research Group. A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men. Journal of the American Geriatrics Society 57: 492–498.

    PubMed  Article  Google Scholar 

  4. 4.

    Fried LP, Tangen C, Walston J, Newman A, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA for the Cardiovascular Health Study Collaborative Research Group (2001) Frailty in older adults: Evidence for a phenotype. The Journals of Gerontology, 56A:M146–156.

    Google Scholar 

  5. 5.

    Song X, Mitnitski A, Rockwood K (2010). Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. Journal of the American Geriatrics Society 58:681–687.

    PubMed  Article  Google Scholar 

  6. 6.

    Ávila-Funes J A, Amieva H, Barberger-Gateau P, Le Goff M, Raoux N, Ritchie K, Carrière I, Tavernier B, Tzourio C, Gutiérrez-Robledo LM, Dartigues JF (2009) Cognitive impairment improves the predictive validity of the phenotype of frailty for adverse health outcomes: the three-city study. Journal of the American Geriatrics Society 57:453–461.

    PubMed  Article  Google Scholar 

  7. 7.

    Rockwood K, Mitnitski AB (2007) A frailty in relation to the accumulation of deficits. Journal of Gerontology Medical Sciences 62A:722–727.

    Article  Google Scholar 

  8. 8.

    Folstein MF, Folstein SE, McHugh PR (1975) Mini-Mental State: A Practical Method for Grading the Cognitive State of Patients for the Clinician. Journal of Psychiatric Research 12:189–198.

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Ávila-Funes JA, Helmer C, Amieva H, Barberger-Gateau P, Le Goff M, Ritchie K, Portet F, Carrière I, Tavernier B, Gutiérrez-Robledo LM, Dartigues JF (2008) Frailty among community-dwelling elderly people in France: The Three-City Study. Journal of Gerontology: Medical Sciences 63A:1089–1096.

    Article  Google Scholar 

  10. 10.

    Samper-Ternent R, Al Snih S, Raji MA, Markides KS, Ottenbacher KJ (2008) Relationship between frailty and cognitive decline in older Mexican Americans. Journal of the American Geriatrics Society 56:1845–1852.

    PubMed  Article  Google Scholar 

  11. 11.

    Boyle PA, Buchman AS, Wilson RS, Leurgans SE, Bennett DA (2010) Physical frailty is associated with incident Mild Cognitive Impairment in community-based older persons. Journal of the American Geriatrics Society 58:248–255.

    PubMed  Article  Google Scholar 

  12. 12.

    Nourhashémi F, Andrieu S, Gillette-Guyonnet S, Reynish E, Albarède JL, Grandjean H, Vellas B (2002) Is there a relationship between fat-free soft tissue mass and low cognitive function? Results from a study of 7,105 women. Journal of the American Geriatrics Society 50:1796–1801.

    PubMed  Article  Google Scholar 

  13. 13.

    Buchman AS, Boyle MA, Wilson RS, Tang Y, Bennett DA (2007) Frailty is associated with incident Alzheimer_s Disease and cognitive decline in the elderly. Psychossomatic Medicine 69:483–489.

    Article  Google Scholar 

  14. 14.

    Alfaro-Acha A, Snih SA, Raji MA, Yong-Fang K, Markides KS, Ottenbacher KJ (2006) Handgrip strength and cognitive decline in older Mexican Americans. Journal of Gerontology Medical Sciences 61A: 859–865.

    Article  Google Scholar 

  15. 15.

    Camicioli R, Wang Y, Powell C, Mitnitski K, Rockwood K (2007). Gait and posture impairment, parkinsonism, and cognitive decline in older people. Journal of Neural Transmission 114:1355–1361.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Alfaro-Acha A, Al Snih S, Raji MA, Markides KS, Ottenbacher KJ (2007) Does 8-foot walk time predict cognitive decline in older Mexicans Americans? J Am Geriatr Soc 55:245–51.

    PubMed  Article  Google Scholar 

  17. 17.

    Marquis S, Moore MM, Howieson DB, Sexton G, Payami H, Kaye JA, Camicioli R (2002) Independent predictors of cognitive decline in healthy elderly persons. Archives of Neurology 59: 601–606.

    PubMed  Article  Google Scholar 

  18. 18.

    Wang, L., Larson, E.B., Bowen, J.D., & van Belle, G. (2006). Performance based physiological function and future dementia in older people. Archives of Internal Medicine, 166, 1115–20.

    PubMed  Article  Google Scholar 

  19. 19.

    Buchman A S, Wilson RS, Bienias JL, Shah RC, Evans DA, Bennett DA (2005) Change in body mass index and risk of incident Alzheimer disease. Neurology 65:892–897.

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    SEADE (2010). Fundação Sistema Estadual de Análise de Dados. Município de São Paulo: População e Estatísticas Vitais. Disponível em:

  21. 21.

    Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB, Walston J. (2004). Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. Journal of the American Geriatrics Society 52:625–634.

    PubMed  Article  Google Scholar 

  22. 22.

    Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH (2003) Sugestões para o uso do mini-exame do estado mental no Brasil. Arquivos de Neuropsiquiatria, 61:777–781.

    Article  Google Scholar 

  23. 23.

    Nitrini R, Caramelli P, Herrera Junior E, Porto CS, Charchat-Fichman H, Carthery MT, Takada LT, Lima EP (2004) Performance of literated and illiterated elderly subjects in two long-term memory tests. Journal of the Neuropsychological Society 10:634–638.

    Article  Google Scholar 

  24. 24.

    Caramelli P, Carthery MTG, Porto CS, Charchat HF, Nitrini R (2007) Category fluency as a screening test for Alzheimer Disease in illiterate and literate patients. Alzheimer Disease and Associated Disorders 21:65–67.

    PubMed  Article  Google Scholar 

  25. 25.

    Shulman K, Gold DP, Cohen CA, Zuchero CA (1993) Clock drawing and dementia in the community: a longitudinal study. International Journal of Geriatric Psychiatry 8:487–496.

    Article  Google Scholar 

  26. 26.

    Aprahamian I, Martinelli JE, Neri AL, Yassuda MS (2010) Clock Drawing Test accuracy compared to standard screening tests in Alzheimer s disease: results from a study in a sample of Brazilian elderly with heterogeneous educational background. International Psychogeriatrics 22:64–71.

    PubMed  Article  Google Scholar 

  27. 27.

    IBGE (2003) Agregado por setores censitários dos resultados do universo. (2a ed.). Rio de Janeiro: Instituto Brasileiro de Geografia e Estatísticas. Accessed 30 April 2007.

    Google Scholar 

  28. 28.

    Hocking R (1976) The analysis and selection of variables in linear regression. Biometrics 32:1–49.

    Article  Google Scholar 

  29. 29.

    Hototian SR, Lopes MA, Azevedo D, Tatsch M, Bazzarella MC, Bustamante SE, Litvoc J, Bottino CM (2008) Prevalence of cognitive and functional impairment in a community sample from São Paulo, Brazil. Dementia and Geriatric Cognitive Disorders 25:135–143.

    PubMed  Article  Google Scholar 

  30. 30.

    Flaks MK, Forlenza OV, Pereira FS, Viola LF, Yassuda MS (2009) Short cognitive performance test: diagnostic accuracy and education bias in older Brazilian adults. Archives of Clinical Neuropsychology 24:301–306.

    PubMed  Article  Google Scholar 

  31. 31.

    Yassuda MS, Diniz BST, Flaks MK, Pereira FS, Viola LF, Nunes PV, Forlenza OV (2009) Neuropsychological profile of Brazilian older adults with heterogeneous educational backgrounds. Archives of Clinical Neuropsychology 24:71–79.

    PubMed  Article  Google Scholar 

  32. 32.

    Lourenço RA, Ribeiro-Filho ST, Moreira IF, Paradela EM, Miranda AS (2008). The Clock Drawing Test: performance among elderly with low educational level. Revista Brasileira de Psiquiatria 30:309–315.

    PubMed  Article  Google Scholar 

  33. 33.

    Klusmann V, Evers A, Schwarzer R, Schlattmann P, Reischies FM, Heuser I, Dimeo FC (2010) Complex mental and physical activity in older women and cognitive performance: a 6-month randomized controlled trial. Journal of Gerontology A Biological Science Medical Science 65:680–688.

    Article  Google Scholar 

  34. 34.

    Lista I, Sorrentino G (2010) Biological mechanisms of physical activity in preventing cognitive decline. Cell and Molecular Neurobiology 30:493–503.

    Article  CAS  Google Scholar 

  35. 35.

    Birren JE, Cunningham W (1985) Research on the psychology of aging: Principles, concepts and theory. In: Birren JE, Schaie w (Eds.) Handbook of the Psychology, 2nd edn. Van Nostrand Reinhold, New York, pp. 3–34.

    Google Scholar 

  36. 36.

    Anstey KJ, Smith GA (1999) Interrelationships among biological markers of aging, health, activity, acculturation, and cognitive performance in late adulthood. Psychology and Aging 14:605–618.

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Baltes PB, Lindenberger U (1997) Emergence of a powerful connection between sensory and cognitive functions across the adult life span: a new window to the study of cognitive aging? Psychology and Aging 12:12–21.

    PubMed  Article  CAS  Google Scholar 

  38. 38.

    Reisberg B, Franssen EH, Souren LE, Auer SR, Akram I, Kenowsky S (2002) Evidence and mechanisms of retrogenesis in Alzheimer’s and other dementias: management and treatment import. American Journal of Alzheimers Disease and Other Dementias 17:202–212

    Article  Google Scholar 

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Correspondence to Mônica Sanches Yassuda.

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Yassuda, M.S., Lopes, A., Cachioni, M. et al. Frailty criteria and cognitive performance are related: Data from the Fibra study in Ermelino Matarazzo, Sao Paulo, Brazil. J Nutr Health Aging 16, 55–61 (2012).

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Key words

  • Frailty
  • cognition
  • aging