The journal of nutrition, health & aging

, Volume 22, Issue 1, pp 82–88 | Cite as

Physical Frailty is Associated with Longitudinal Decline in Global Cognitive Function in Non-Demented Older Adults: A Prospective Study

  • S. Chen
  • T. Honda
  • K. Narazaki
  • T. Chen
  • H. Kishimoto
  • Y. Haeuchi
  • Shuzo Kumagai



To assess the relationship between physical frailty and subsequent decline in global cognitive function in the non-demented elderly.

Design and setting

A prospective population-based study in a west Japanese suburban town, with two-year follow-up.


Community-dwellers aged 65 and older without placement in long-term care, and not having a history of dementia, Parkinson’s disease and depression at baseline, who participated in the cohort of the Sasaguri Genkimon Study and underwent follow-up assessments two years later (N = 1,045).


Global cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Physical frailty was identified according to the following five components: weight loss, low grip strength, exhaustion, slow gait speed and low physical activities. Linear regression models were used to examine associations between baseline frailty status and the MoCA scores at follow-up. Logistic regression models were used to estimate the risk of cognitive decline (defined as at least two points decrease of MoCA score) according to baseline frailty status.


Seven hundred and eight non-demented older adults were included in the final analyses (mean age: 72.6 ± 5.5 years, male 40.3%); 5.8% were frail, and 40.8% were prefrail at baseline. One hundred and fifty nine (22.5%) participants experienced cognitive decline over two years. After adjustment for baseline MoCA scores and all confounders, being frail at baseline was significantly associated with a decline of 1.48 points (95% confidence interval [CI], -2.37 to -0.59) in MoCA scores, as compared with non-frailty. Frail persons were over two times more likely to experience cognitive decline (adjusted odds ratio 2.28; 95% CI, 1.02 to 5.08), compared to non-frail persons.


Physical frailty is associated with longitudinal decline in global cognitive function in the non-demented older adults over a period of two years. Physically frail older community-dwellers should be closely monitored for cognitive decline that can be sensitively captured by using the MoCA.

Key words

Cognitive decline community-dweller elderly frailty prospective study 

Supplementary material

12603_2017_924_MOESM1_ESM.docx (16 kb)
Supplemental table 1: Comparisons between the excluded and included sample in this study


  1. 1.
    Robertson DA, Savva GM, Kenny RA. Frailty and cognitive impairment -A review of the evidence and causal mechanisms. Ageing Res Rev. 2013;12(4):840–851.CrossRefPubMedGoogle Scholar
  2. 2.
    Shimada H, Makizako H, Doi T, Yoshida D, Tsutsumimoto K, Anan Y, et al. Combined prevalence of frailty and mild cognitive impairment in a population of elderly Japanese people. J Am Med Dir Assoc. 2013;14(7):518–524.CrossRefPubMedGoogle Scholar
  3. 3.
    Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392–397.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–156.CrossRefPubMedGoogle Scholar
  5. 5.
    Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–762.CrossRefPubMedGoogle Scholar
  6. 6.
    Solfrizzi V, Scafato E, Frisardi V, Seripa D, Logroscino G, Maggi S, et al. Frailty syndrome and the risk of vascular dementia: the Italian Longitudinal Study on Aging. Alzheimers Dement. 2013;9(2):113–122.CrossRefPubMedGoogle Scholar
  7. 7.
    Gray SL, Anderson ML, Hubbard RA, LaCroix A, Crane PK, McCormick W, et al. Frailty and incident dementia. J Gerontol A Biol Sci Med Sci. 2013;68(9):1083–1090.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Avila-Funes JA, Carcaillon L, Helmer C, Carrière I, Ritchie K, Rouaud O, et al. Is frailty a prodromal stage of vascular dementia? Results from the Three-City Study. J Am Geriatr Soc. 2012;60(9):1708–1712.CrossRefPubMedGoogle Scholar
  9. 9.
    Buchman A, Boyle PA, Wilson RS, Tang Y, Bennett DA. Frailty is associated with incident Alzheimer’s disease and cognitive decline in the elderly. Psychosom Med. 2007;69(5):483–489.CrossRefPubMedGoogle Scholar
  10. 10.
    Boyle PA, Buchman AS, Wilson RS, Leurgans SE, Bennett DA. Physical frailty is associated with incident mild cognitive impairment in community-based older persons. J Am Geriatr Soc. 2010;58(2):248–255.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Samper-Ternent R, Al Snih S, Raji MA, Markides KS, Ottenbacher KJ. Relationship between frailty and cognitive decline in older Mexican Americans. J Am Geriatr Soc. 2008;56(10):1845–1852.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Robertson DA, Savva GM, Coen RF, Kenny RA. Cognitive function in the prefrailty and frailty syndrome. J Am Geriatr Soc. 2014;62(11):2118–2124.CrossRefPubMedGoogle Scholar
  13. 13.
    Wu Y, Liu L, Chen W. Cognitive function in individuals with physical frailty but without dementia or cognitive complaints: results from the I-Lan Longitudinal Aging Study. J Am Med Dir Assoc. 2015;16(10):899.e9-16.Google Scholar
  14. 14.
    Montero-Odasso MM, Barnes B, Speechley M, Muir SW, Doherty TJ, Duque G, et al. Disentangling cognitive-frailty: results from the Gait and Brain Study. J Gerontol A Biol Sci Med Sci. 2016;71(11):1476–1482.CrossRefPubMedGoogle Scholar
  15. 15.
    Dramé M, Novella J-L, Jolly D, Lanièce I, Somme D, Heitz D, et al. Rapid cognitive decline, one-year institutional admission and one-year mortality: analysis of the ability to predict and inter-tool agreement of four validated clinical frailty indexes in the SAFEs cohort. J Nutr Health Aging. 2011;15(8):699–705.CrossRefPubMedGoogle Scholar
  16. 16.
    Auyeung TW, Lee JSW, Kwok T, Woo J. Physical frailty predicts future cognitive decline -a four-year prospective study in 2737 cognitively normal older adults. J Nutr Health Aging. 2011;15(8):690–694.CrossRefPubMedGoogle Scholar
  17. 17.
    Mitnitski A, Fallah N, Rockwood MRH, Rockwood K. Transitions in cognitive status in relation to frailty in older adults: a comparison of three frailty measures. J Nutr Health Aging. 2011;15(10):863–867.CrossRefPubMedGoogle Scholar
  18. 18.
    Alencar MA, Dias JMD, Figueiredo LC, Dias RC. Frailty and cognitive impairment among community-dwelling elderly. Arq Neuropsiquiatr. 2013;71(6):362–367.CrossRefPubMedGoogle Scholar
  19. 19.
    Dong Y, Sharma VK, Chan BP, Venketasubramanian N, Teoh HL, Seet RC, et al. The Montreal Cognitive Assessment (MoCA) is superior to the Mini-Mental State Examination (MMSE) for the detection of vascular cognitive impairment after acute stroke. J Neurol Sci. 2010;299(1-2):15–18.CrossRefPubMedGoogle Scholar
  20. 20.
    Haley GE, Berteau-Pavy F, Berteau-Pavy D, Raber J. Novel image-novel location object recognition task sensitive to age-related cognitive decline in nondemented elderly. Age (Dordr). 2012;34(1):1–10.CrossRefPubMedGoogle Scholar
  21. 21.
    Julayanont P, Phillips N, Chertkow H, Nasreddine ZS. The Montreal Cognitive Assessment (MoCA): concept and clinical review. In: Larner AJ, editor. Cognitive Screening Instruments: A Practical Approach. Berlin: Springer-Verlag; 2013. pp 111–152.CrossRefGoogle Scholar
  22. 22.
    Chen S, Honda T, Narazaki K, Chen T, Nofuji Y, Kumagai S. Global cognitive performance and frailty in non-demented community-dwelling older adults: Findings from the Sasaguri Genkimon Study. Geriatr Gerontol Int. 2016;16(6):729–736.CrossRefPubMedGoogle Scholar
  23. 23.
    Chen S, Honda T, Chen T, Narazaki K, Haeuchi Y, Supartini A, et al. Screening for frailty phenotype with objectively-measured physical activity in a west Japanese suburban community: evidence from the Sasaguri Genkimon Study. BMC Geriatr. 2015;15:36.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Narazaki K, Nofuji Y, Honda T, Matsuo E, Yonemoto K, Kumagai S. Normative data for the montreal cognitive assessment in a Japanese community-dwelling older population. Neuroepidemiology. 2013;40(1):23–29.CrossRefPubMedGoogle Scholar
  25. 25.
    Fukutomi E, Okumiya K, Wada T, Sakamoto R, Ishimoto Y, Kimura Y, et al. Importance of cognitive assessment as part of the “Kihon Checklist” developed by the Japanese Ministry of Health, Labor and Welfare for prediction of frailty at a 2-year follow up. Geriatr Gerontol Int. 2013;13(3):654–662.CrossRefPubMedGoogle Scholar
  26. 26.
    Fujiwara Y, Suzuki H, Yasunaga M, Sugiyama M, Ijuin M, Sakuma N, et al. Brief screening tool for mild cognitive impairment in older Japanese: validation of the Japanese version of the Montreal Cognitive Assessment. Geriatr Gerontol Int. 2010;10(3):225–232.CrossRefPubMedGoogle Scholar
  27. 27.
    Julayanont P, Brousseau M, Chertkow H, Phillips N, Nasreddine ZS. Montreal Cognitive Assessment Memory Index Score (MoCA-MIS) as a predictor of conversion from mild cognitive impairment to Alzheimer’s disease. J Am Geriatr Soc. 2014;62(4):679–684.CrossRefPubMedGoogle Scholar
  28. 28.
    Suzuki H, Kawai H, Hirano H, Yoshida H, Ihara K, Kim H, et al. One-year change in the Japanese version of the Montreal Cognitive Assessment performance and related predictors in community-dwelling older adults. J Am Geriatr Soc. 2015;63(9):1874–1879.CrossRefPubMedGoogle Scholar
  29. 29.
    Vickers AJ, Altman DG. Analysing controlled trials with baseline and follow-up measurements. BMJ. 2001;323(7321):1123–1124.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Allison P. Change scores as dependent variables in regression analysis. Sociol Methodol. 1990;20:93–114.CrossRefGoogle Scholar
  31. 31.
    Krishnan K, Rossetti H, Hynan LS, Carter K, Falkowski J, Lacritz L, et al. Changes in Montreal Cognitive Assessment scores over time. Assessment. 2016 Jun 18. Doi: 10.1177/1073191116654217. (Epub ahead of print)Google Scholar
  32. 32.
    Hayden KM, Reed BR, Manly JJ, Tommet D, Pietrzak RH, Chelune GJ, et al. Cognitive decline in the elderly: an analysis of population heterogeneity. Age Ageing. 2011;40(6):684–689.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Mulero J, Zafrilla P, Martinez-Cacha A. Oxidative stress, frailty and cognitive decline. J Nutr Health Aging. 2011;15(9):756–760.CrossRefPubMedGoogle Scholar
  34. 34.
    Panza F, Solfrizzi V, Frisardi V, Maggi S. Different models of frailty in predementia and dementia syndromes. J Nutr Health Aging. 2011;15(8):711–720.CrossRefPubMedGoogle Scholar
  35. 35.
    Maggio M, Dall’ Aglio E, Lauretani F, Cattabiani C, Ceresini G, Caffarra P, et al. The hormonal pathway to cognitive impairment in older men. J Nutr Health Aging. 2012;16(1):40–54.CrossRefPubMedGoogle Scholar
  36. 36.
    Kelaiditi E, Cesari M, Canevelli M, Van Kan G, Ousset PJ, Gillette-Guyonnet S, et al. Cognitive frailty: rational and definition from an (I.A.N.A./I.A.G.G.) International Consensus Group. J Nutr Heal Aging. 2013;17(9):726–734.CrossRefGoogle Scholar
  37. 37.
    Delrieu J, Andrieu S, Pahor M, Cantet C, Cesari M, Ousset PJ, et al. Neuropsychological profile of “cognitive frailty” subjects in MAPT Study. J Prev Alzheimers Dis. 2016;3(3):151–159.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Shatenstein B. Frailty and cognitive decline: links, mechanisms and future directions. J Nutr Health Aging. 2011;15(8):665–666.CrossRefPubMedGoogle Scholar
  39. 39.
    Buchman AS, Yu L, Wilson RS, Boyle PA, Schneider JA, Bennett DA. Brain pathology contributes to simultaneous change in physical frailty and cognition in old age. J Gerontol A Biol Sci Med Sci. 2014;69(12):1536–1544.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Serdi and Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • S. Chen
    • 1
  • T. Honda
    • 2
    • 3
  • K. Narazaki
    • 4
  • T. Chen
    • 5
  • H. Kishimoto
    • 2
  • Y. Haeuchi
    • 5
  • Shuzo Kumagai
    • 5
    • 6
  1. 1.Xiangya Nursing School of Central South UniversityChangsha, Hunan ProvinceChina
  2. 2.Department of Epidemiology and Public Health, Graduate School of Medical SciencesKyushu UniversityKyushuJapan
  3. 3.Research Fellow of the Japan Society for the Promotion of ScienceTokyoJapan
  4. 4.Faculty of Socio-Environmental StudiesFukuoka Institute of TechnologyFukuokaJapan
  5. 5.Department of Behavior and Health Sciences, Graduate School of Human-Environment StudiesKyushu UniversityKasuga City, Fukuoka PrefectureJapan
  6. 6.Faculty of Arts and ScienceKasuga City, Fukuoka PrefectureJapan

Personalised recommendations