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Prevalence of Cognitive Frailty Phenotypes and Associated Factors in a Community-Dwelling Elderly Population

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The journal of nutrition, health & aging

Abstract

Objectives

Cognitive frailty was notable target for the prevention of adverse health outcomes in future. The goal of this study was to use a population-based survey to investigate cognitive frailty phenotypes and potentially sociodemographic factors in elderly Chinese individuals.

Design

Cross-sectional study.

Setting

General community.

Participants

A total of 5328 elderly adults (aged 60 years or older, mean age 71.36 years) enrolled in the Shanghai study of health promotion for elderly individuals with frailty.

Measurements

The 5-item FRAIL scale and the 3-item Rapid Cognitive Screen tools were used to assess physical frailty and cognitive impairment, including dementia or mild cognitive impairment (MCI). Physical frailty was diagnosed by limitations in 3 or more of the FRAIL scale domains and pre-physical frailty by 1–2 limitations. Subjective cognitive decline (SCD) and pre-MCI SCD, was diagnosed with two self-report measures based on memory and other cognitive domains in elderly adults.

Results

Of the participating individuals, 97.17% (n= 5177, female 53.4%) were eligible. Notably, 9.67%, 41.61% and 35.20% of participants were MCI, SCD and pre-MCI SCD; 35.86% and 4.41% exhibited physical pre-frailty and frailty; and 19.86% and 6.30% exhibited reversible and potential reversible cognitive frailty. Logistic regression analyses indicated that physical frailty phenotypes were significantly associated with MCI with SCD, and pre-MCI with SCD. Older single females with a high education level were more likely to exhibit the reversible cognitive frailty; and younger elderly individuals with a middle education level were at lower risk for potentially reversible cognitive frailty.

Conclusions

The prevalence of pre-physical and reversible cognitive frailty was high in elderly individuals and age was the most significant risk factor for all types of frailty phenotypes. To promote the rapid screening protocol of cognitive frailty in community-dwelling elderly is important to find high-risk population, implement effective intervention, and decrease adverse prognosis.

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References

  1. Fried, L.P., Tangen, C.M., Walston, J., Newman, A.B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W.J., Burke, G., McBurnie, M.A. Frailty in older adults: evidence for a phenotype. The journals of gerontology. Series A, Biological sciences and medical sciences 2001;56 (3):M146–156. doi:https://doi.org/10.1093/gerona/56.3.m146

    CAS  Google Scholar 

  2. Kelaiditi, E., Cesari, M., Canevelli, M., van Kan, G.A., Ousset, P.J., Gillette-Guyonnet, S., Ritz, P., Duveau, F., Soto, M.E., Provencher, V., Nourhashemi, F., Salva, A., Robert, P., Andrieu, S., Rolland, Y., Touchon, J., Fitten, J.L., Vellas, B. Cognitive frailty: rational and definition from an (I.A.N.A./I.A.G.G.) international consensus group. The journal of nutrition, health & aging 2013;17 (9):726–734. doi:https://doi.org/10.1007/s12603-013-0367-2

    CAS  Google Scholar 

  3. Ma, L., Sun, F., Tang, Z. Social Frailty Is Associated with Physical Functioning, Cognition, and Depression, and Predicts Mortality. The journal of nutrition, health & aging 2018;22 (8):989–995. doi:https://doi.org/10.1007/s12603-018-1054-0

    CAS  Google Scholar 

  4. Yamada, M., Arai, H. Social Frailty Predicts Incident Disability and Mortality Among Community-Dwelling Japanese Older Adults. Journal of the American Medical Directors Association 2018;19 (12):1099–1103. doi:https://doi.org/10.1016/j.jamda.2018.09.013

    PubMed  Google Scholar 

  5. Rietman, M.L., Spijkerman, A.M.W., Wong, A., Steeg, H.V., Bürkle, A., Moreno-Villanueva, M., Sindlinger, T., Franceschi, C., Grubeck-Loebenstein, B., Bernhardt, J. Antioxidants linked with physical, cognitive and psychological frailty: Analysis of candidate biomarkers and markers derived from the MARK-AGE Study. Mechanisms of Ageing & Development 2018:1043659618772347

  6. Solfrizzi V, Scafato E, Lozupone M, al., e. Biopsychosocial frailty and the risk of incident dementia: The Italian longitudinal study on aging. Alzheimers Dement. 2019:pii: S1552–5260(1519)30120–30127.

  7. Josep, G.O., Laia, C.P., Secundino, L.P., Manuel, D.G.B., Joan, V.F. Prevalence of frailty phenotypes and risk of mortality in a community-dwelling elderly cohort. Age & Ageing 2013;42 (1):46–51

    Google Scholar 

  8. Hiroyuki, S., Takehiko, D., Sangyoon, L., Hyuma, M., Liang-Kung, C., Hidenori, A. Cognitive Frailty Predicts Incident Dementia among Community-Dwelling Older People. Journal of Clinical Medicine 2016;20:729–735

    Google Scholar 

  9. Jha, S.R., Hannu, M.K., Gore, K., Chang, S., Newton, P., Wilhelm, K., Hayward, C.S., Jabbour, A., Kotlyar, E., Keogh, A. Cognitive impairment improves the predictive validity of physical frailty for mortality in patients with advanced heart failure referred for heart transplantation. Journal of Heart & Lung Transplantation the Official Publication of the International Society for Heart Transplantation 2016;35 (9):1092–1100

    Google Scholar 

  10. Yu, R., Morley, J.E., Kwok, T., Leung, J., Cheung, O., Woo, J. The Effects of Combinations of Cognitive Impairment and Pre-frailty on Adverse Outcomes from a Prospective Community-Based Cohort Study of Older Chinese People. Frontiers in Medicine 2018;5:50

    PubMed  PubMed Central  Google Scholar 

  11. Ruan, Q., Yu, Z., Chen, M., Bao, Z., Li, J., He, W. Cognitive frailty, a novel target for the prevention of elderly dependency. Ageing Research Reviews 2015;20:1–10

    PubMed  Google Scholar 

  12. Feng, L., Ma, S.Z.N., Gao, Q., Feng, L., Yap, K.B., Ng, T.P. Cognitive Frailty and Adverse Health Outcomes: Findings From the Singapore Longitudinal Ageing Studies (SLAS). Journal of the American Medical Directors Association 2017;18 (3):252–258

    PubMed  Google Scholar 

  13. Solfrizzi, V., Scafato, E., Seripa, D., Lozupone, M., Imbimbo, B.P., D’Amato, A., Tortelli, R., Schilardi, A., Galluzzo, L., Gandin, C. Reversible Cognitive Frailty, Dementia, and All-Cause Mortality. The Italian Longitudinal Study on Aging. Journal of the American Medical Directors Association 2017;18 (1):89.e81–89.e88

    Google Scholar 

  14. Panza, F., Lozupone, M., Solfrizzi, V., Stallone, R., Bellomo, A., Greco, A., Daniele, A., Seripa, D., Logroscino, G. Cognitive Frailty: A Potential Target for Secondary Pre-vention of Dementia. Expert Opinion on Drug Metabolism & Toxicology 2017; 13 (10):17425255.17422017.11372424

    Google Scholar 

  15. Panza, F., Lozupone, M., Solfrizzi, V., Sardone, R., Dibello, V., Lena, L.D., D’Urso, F., Stallone, R., Petruzzi, M., Giannelli, G. Different Cognitive Frailty Models and Health- and Cognitive-related Outcomes in Older Age: From Epidemiology to Prevention. Journal of Alzheimers Disease 2018;62 (3):993–1012

    Google Scholar 

  16. Sugimoto, T., Sakurai, T., Ono, R., Ai, K., Saji, N., Niida, S., Toba, K., Chen, L.K., Arai, H. Epidemiological and clinical significance of cognitive frailty: A mini review. Ageing Research Reviews 2018;44:1

    PubMed  Google Scholar 

  17. Delrieu, J., Andrieu, S., Pahor, M., Cantet, C., Cesari, M., Ousset, P.J., Voisin, T., Fougère, B., Gillette, S., Carrie, I. Neuropsychological profile of “cognitive frailty” subjects in MAPT study. Journal of Prevention of Alzheimers Disease 2016;3 (3):151

    CAS  Google Scholar 

  18. Roppolo, M., Mulasso, A., Rabaglietti, E. Cognitive frailty in italian community-dwelling older adults: Prevalence rate and its association with disability. Journal of Nutrition Health & Aging 2017;(6):631–636

  19. Rockwood, K., Mitnitski, A. Frailty in relation to the accumulation of deficits. The journals of gerontology. Series A, Biological sciences and medical sciences 2007;62 (7):722–727. doi:https://doi.org/10.1093/gerona/62.7.722

    PubMed  Google Scholar 

  20. Morley, J.E., Malmstrom, T.K., Miller, D.K. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. Journal of Nutrition Health & Aging 2012;16 (7):601–608

    CAS  Google Scholar 

  21. Woo, J., Leung, J., Morley, J.E. Comparison of frailty indicators based on clinical phenotype and the multiple deficit approach in predicting mortality and physical limitation. Journal of the American Geriatrics Society 2012;60 (8):1478–1486

    PubMed  Google Scholar 

  22. Margioti, E., Kosmidis, M.H., Yannakoulia, M., Dardiotis, E., Hadjigeorgiou, G., Sakka, P., Ntanasi, E., Vlachos, G.S., Scarmeas, N. Exploring the association between subjective cognitive decline and frailty: the Hellenic Longitudinal Investigation of Aging and Diet Study (HELIAD). Aging & Mental Health 2019:1–11

  23. Peters, L.L., Han, B., Buskens, E., Slaets, J.P.J. Measurement Properties of the Groningen Frailty Indicator in Home-Dwelling and Institutionalized Elderly People. Journal of the American Medical Directors Association 2012;13 (6):546–551

    PubMed  Google Scholar 

  24. Jessen, F., Amariglio, R.E., Boxtel, M.V., Breteler, M., Ceccaldi, M., Chételat, G., Dubois, B., Dufouil, C., Ellis, K.A., Flier, W.M.V.D. A conceptual framework for research on subjective cognitive decline in preclinical Alzheimer’s disease. Alzheimers & Dementia the Journal of the Alzheimers Association 2014;10 (6):844–852

    Google Scholar 

  25. Perrotin, A., La, J.R., De, L.S.V., Barré, L., Mézenge, F., Mutlu, J., Guilloteau, D., Egret, S., Eustache, F., Chételat, G. Subjective cognitive decline in cognitively normal elders from the community or from a memory clinic: Differential affective and imaging correlates. Alzheimers & Dementia the Journal of the Alzheimers Association 2017;13 (5):550–560

    Google Scholar 

  26. Lorena, R., Mollica, M.A., Carmen, G.S., Judith, S.A., Belen, S., Isabel, S., Cinta, V.P., Magda, C., Jaume, O., Molinuevo, J.L. The Subjective Cognitive Decline Questionnaire (SCD-Q): a validation study. Journal of Alzheimers Disease 2014;41 (2):453

    Google Scholar 

  27. Steffen, W., Frank, J., Alexander, K., Luca, K., Klaus, S., Lutz, F.L., Alexander, K., Stefanie, S., Harald, H., Isabella, H. Subjective cognitive decline is related to CSF biomarkers of AD in patients with MCI. Neurology 2015;84 (12):1261–1268

    Google Scholar 

  28. Roehr, S., Luck, T., Pabst, A., Bickel, H., König, H.H., Lühmann, D., Fuchs, A., Wolfsgruber, S., Wiese, B., Weyerer, S. Subjective cognitive decline is longitudinally associated with lower health-related quality of life. International Psychogeriatrics 2017;29 (12):1–12

    Google Scholar 

  29. Malmstrom, T.K., Voss, V.B., Cruz-Oliver, D.M., Cummings-Vaughn, L.A., Tumosa, N., Grossberg, G.T., Morley, J.E. The Rapid Cognitive Screen (RCS): A point-of-care screening for dementia and mild cognitive impairment. Journal of Nutrition Health & Aging 2015;19 (7):741–744

    CAS  Google Scholar 

  30. Shimada, H., Makizako, H., Lee, S., Doi, T., Lee, S., Tsutsumimoto, K., Harada, K., Hotta, R., Bae, S., Nakakubo, S. Impact of cognitive frailty on daily activities in older persons. Journal of Nutrition Health & Aging 2016;20 (7):729–735

    CAS  Google Scholar 

  31. Merchant, R.A., Chen, M.Z., Tan, L., Lim, M.Y., Ho, H.K., van Dam, R.M. Singapore Healthy Older People Everyday (HOPE) Study: Prevalence of Frailty and Associated Factors in Older Adults. Journal of the American Medical Directors Association 2017;18 (8):S1525861017302438

    Google Scholar 

  32. Feng, L., Nyunt, M.S., Gao, Q., Feng, L., Lee, T.S., Tsoi, T., Chong, M.S., Lim, W.S., Collinson, S., Yap, P. Physical Frailty, Cognitive Impairment, and the Risk of Neurocognitive Disorder in the Singapore Longitudinal Ageing Studies. The journals of gerontology. Series A, Biological sciences and medical sciences 2016;72 (3):369–375

    Google Scholar 

  33. Solfrizzi, V., Scafato, E., Lozupone, M., Seripa, D., Giannini, M., Sardone, R., Bonfiglio, C., Abbrescia, D.I., Galluzzo, L., Gandin, C. Additive Role of a Potentially Reversible Cognitive Frailty Model and Inflammatory State on the Risk of Disability: The Italian Longitudinal Study on Aging. Am J Geriatr Psychiatry 2017;20 (6):704

    Google Scholar 

  34. Matteo, C., Christiaan, L., Fulvio, L., Graziano, O., Stefania, B., Cinzia, M., Guralnik, J.M., Marco, P., Luigi, F. Frailty syndrome and skeletal muscle: results from the Invecchiare in Chianti study. American Journal of Clinical Nutrition 2006;83 (5):1142–1148

    Google Scholar 

  35. Avila-Funes, J.A., Helmer, C., Amieva, H., Barberger-Gateau, P., Le, G.M., Ritchie, K., Portet, F., Camã Re, I., Tavernier, B., Gutiã©Rrez-Robledo, L.M. Frailty among community-dwelling elderly people in France: the three-city study. The journals of gerontology. Series A, Biological sciences and medical sciences 2008;63 (10):1089–1096

    Google Scholar 

  36. Holly, S., Roberts, H.C., Maria, E., Cyrus, C., Howard, B., Avan, A.S. Prevalence and correlates of frailty among community-dwelling older men and women: findings from the Hertfordshire Cohort Study. Age & Ageing 2010;39 (2):197–203

    Google Scholar 

  37. Garcia-Garcia, F.J., Avila, G.G., Alfaro-Acha, A., Andres, M.S.A., Lanza, M.D.L.A.D.L.T., Aparicio, M.V.E., Aparicio, S.H., Zugasti, J.L.L., Reus, G.S., Rodriguez-Artalejo, F. The prevalence of frailty syndrome in an older population from Spain. The Toledo study for healthy aging. Journal of Nutrition Health & Aging 2011;15 (10):852–856

    CAS  Google Scholar 

  38. Castell, M.V., Sánchez, M., Julián, R., Queipo, R., Martin, S., Otero, Á. Frailty prevalence and slow walk-ing speed in persons age 65 and older: implications for primary care. BMC Family Practice 2013;14 (1):86–86

    PubMed  PubMed Central  Google Scholar 

  39. Shimada, H., Makizako, H., Doi, T., Yoshida, D., Tsutsumimoto, K., Anan, Y., Uemura, K., Ito, T., Lee, S., Park, H. Combined Prevalence of Frailty and Mild Cognitive Impairment in a Population of Elderly Japanese People. Journal of the American Medical Directors Association 2013;14 (7):518–524

    PubMed  Google Scholar 

  40. Rabin, L.A., Smart, C.M., Crane, P.K., Amariglio, R.E., Berman, L.M., Mercé, B., Buckley, R.F., GaL, C., Bruno, D., Ellis, K.A. Subjective Cognitive Decline in Older Adults: An Overview of Self-Report Measures Used Across 19 International Research Studies. Journal of Alzheimers Disease 2015;48 Suppl 1 (s1):S63

    Google Scholar 

  41. Hsieh, T.J., Chang, H.Y., Wu, I., Chen, C.C., Tsai, H.J., Chiu, Y.F., Chuang, S.C., Chao, A.H., Hsu, C.C. Independent association between subjective cognitive decline and frailty in the elderly. Plos One 2018;13 (8):e0201351

    PubMed  PubMed Central  Google Scholar 

  42. St John, P.D., Tyas, S.L., Griffith, L.E., Menec, V. The cumulative effect of frailty and cognition on mortality — results of a prospective cohort study. International Psychogeriatrics 2017;29 (4):535–543

    PubMed  Google Scholar 

  43. Monteroodasso, M.M., Barnes, B., Speechley, M., Muir Hunter, S.W., Doherty, T.J., Duque, G., Gopaul, K., Sposato, L.A., Casasherrero, A., Borrie, M.J. Disentangling cog-nitive-frailty: results from the gait and brain study. Journals of Gerontology 2016:glw044

  44. Fougere, B., Daumas, M., Lilamand, M., Sourdet, S., Delrieu, J., Vellas, B., Abellan van Kan, G. Association Between Frailty and Cognitive Impairment: Cross-Sectional Data From Toulouse Frailty Day Hospital. J Am Med Dir Assoc 2017;18 (11):990. e991–990.e995. doi:https://doi.org/10.1016/j.jamda.2017.06.024

    Google Scholar 

  45. Wanaratna, K., Muangpaisan, W., Kuptniratsaikul, V., Chalermsri, C., Nuttamonwarakul, A. Prevalence and Factors Associated with Frailty and Cognitive Frailty Among Community-Dwelling Elderly with Knee Osteoarthritis. Journal of Community Health 2019;44(3):587–595

    PubMed  Google Scholar 

  46. Brigola, A.G., Alexandre, T.D.S., Inouye, K., Yassuda, M.S., Pavarini, S.C.I., Mioshi, E. Limited formal education is strongly associated with lower cognitive status, functional disability and frailty status in older adults. Dement Neuropsychol 2019;13 (2):216–224. doi:https://doi.org/10.1590/1980-57642018dn13-020011

    PubMed  PubMed Central  Google Scholar 

  47. Brigola, A.G., Rossetti, E.S., Santos, B.R.D., Neri, A.L., Zazzetta, M.S., Inouye, K., Pavarini, S.C.I. Relationship between cognition and frailty in elderly: A systematic review. Dementia & Neuropsychologia 2015;9 (2):110–119

    Google Scholar 

  48. Chu, N.M., Bandeen-Roche, K., Tian, J., Kasper, J.D., Gross, A.L., Carlson, M.C., Xue, Q.L. Hierarchical Development of Frailty and Cognitive Impairment: Clues into Etiological Pathways. J Gerontol A Biol Sci Med Sci. 2019:pii: glz134.

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Acknowledgements

We would like to thank the healthcare staff members who were involved in this study.

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Authors and Affiliations

  1. Shanghai Institute of Geriatrics and Gerontology, Shanghai Key Laboratory of Clinical Geriatrics, Department of Geriatrics, Huadong Hospital, and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, 221 West Yan An Road, Shanghai, 200040, P.R. China

    Q. Ruan, W. Zhang & Zhuowei Yu

  2. Zhoujiaqiao Primary Health Service Centre, 1700 chongning road, Shanghai, 200040, China

    F. Xiao & M. Zhang

  3. Department of social work, Huadong Hospital, Shanghai Medical College, Fudan University, 221 West Yan An Road, Shanghai, 200040, China

    K. Gong, X. Zhang & Q. Chen

  4. Molecular and Cellular Biology Core Facility, institute of neuroscience, Chinese academy of science, 320, Yueyang Road, Shanghai, 200031, China

    J. Ruan

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  1. Q. Ruan
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Contributions

Statement of author’s contributions to manuscript: RQ, YZ: Study design. RQ, YZ: Writing the manuscript. RQ, XF, GK, ZW, RJ: Analysis and interpretation of data. All authors contributed to experimental investigation and gave final approval of this version.

Corresponding author

Correspondence to Zhuowei Yu.

Ethics declarations

Ethics approval: Informed consent was obtained from all individual participants included in the study. And the study protocol was approved by Hudong Hospital Research Ethics Committee, Fudan University

Sources of Financial Support: The Shanghai study of health promotion for elderly individuals with frailty was supported by the Medical Science and Technology Support Project of Shanghai Science and Technology Commission (grant no.18411962200), the Shanghai Hospital Development Center (grant no. SHDC12014221) and the Shanghai key Clinical Geriatric Medicine Center Construction (grant no. 2017ZZ02010).

Conflicts of interest: There are no conflicts of interest.

Electronic supplementary material

Supplementary Figure 1

Prevalence and co-occurrence of physical frailty, physical pre-frailty, SCD, pre-MCI, and MCI.

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Ruan, Q., Xiao, F., Gong, K. et al. Prevalence of Cognitive Frailty Phenotypes and Associated Factors in a Community-Dwelling Elderly Population. J Nutr Health Aging 24, 172–180 (2020). https://doi.org/10.1007/s12603-019-1286-7

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  • DOI: https://doi.org/10.1007/s12603-019-1286-7

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