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Studying the relationship between cognitive impairment and frailty phenotype: a cross-sectional analysis of the Bushehr Elderly Health (BEH) program

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Abstract

Background

Some pathophysiological effects of physical frailty and cognitive impairment might be similar; therefore, finding the associations in epidemiologic studies could guide clinicians and researchers to recognize effective strategies for each type of frailty such as frailty phenotype and frailty index, which in turn will result in a preventive approach. The study aimed to reveal which components of frailty phenotype are more associated with cognitive impairment. The findings of this study may help other researchers clarify the related pathways.

Methods

This is a cross-sectional analysis of the results of the second phase of Bushehr Elderly Health Program; a community-based elderly prospective cohort study conducted in 2015–2016. The participants were selected through a multistage stratified cluster random sampling method. Frailty was assessed based on the Fried frailty phenotype criteria. Cognitive impairment was assessed by the Mini-Mental State Examination (MMSE), the Mini-Cog, and the Category Fluency Test (CFT). Multiple logistic regression models were applied to determine the association between frailty and cognitive impairment. Depression trait was assessed using the Patient Health Questionnaire-9 (PHQ-9). Activities of daily living were assessed using the Barthel Index and Instrumental Activities of Daily Living (IADLs) using Lawton’s IADL.

Results

The studyp conducted among people ≥ 60 years old (N = 2336) with women consisting 51.44% of the sample group. The mean age of the participants was 69.26 years old. The prevalence of pre-frailty and frailty were 42.59% and 7.66%, respectively. In the fully adjusted model, the odds ratio of the association between pre-frailty and frailty with cognitive impairment was 1.239, 95% CI: 1.011 – 1.519 and 1.765, 95% CI: 1.071 – 2.908, respectively (adjusted for age, sex, education, body mass index, smoking, diabetes mellitus, PHQ- 9, Barthel Index, and IADLs). In the fully adjusted multiple logistic regression models, all of the components of Fried frailty phenotype were significantly related to cognitive impairment except weight loss.

Conclusion

Cognitive impairment may be associated with frailty phenotype. Moreover, low strength and function of muscles had a stronger association with cognitive impairment. It seems that a consideration of cognitive impairment assessment in older people along with frailty and vice versa in clinical settings is reasonable.

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Authors and Affiliations

  1. Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Farshad Sharifi, Mahtab Alizadeh Khoiee, Mahbube Ebrahimpur, Zhaleh Shadman, Hossein Fakhrzadeh, Seyed Masoud Arzaghi & Neda Mehrdad

  2. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

    Mahtab Alizadeh Khoiee & Reihane Aminroaya

  3. Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Gita Shafiee & Ramin Heshmat

  4. Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Moloud Payab

  5. Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Afshin Ostovar & Noushin Fahimfar

  6. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

    Ali Sheidaei

  7. The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran

    Iraj Nabipour

  8. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, NO. 10, Jalale-Al- Ahmad Ave, Chamran Highway, Tehran, Iran

    Bagher Larijani

Authors
  1. Farshad Sharifi
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  2. Mahtab Alizadeh Khoiee
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Correspondence to Bagher Larijani.

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Appendix

Table 6 Appendix- Association between cognitive impairment with different definition and frailty phenotype A in multivariable logistic regression models*. A. Defined by Mini-Cog, B. Defined by CFT, C. Cognitive impairment and normal cognition defined by both Mini-Cog and CFT, D. Defined by MMSE
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Sharifi, F., Khoiee, M.A., Aminroaya, R. et al. Studying the relationship between cognitive impairment and frailty phenotype: a cross-sectional analysis of the Bushehr Elderly Health (BEH) program. J Diabetes Metab Disord 20, 1229–1237 (2021). https://doi.org/10.1007/s40200-021-00847-7

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