Self-reported fatigue as a risk index for dementia diagnosis

  • Symeon H. Panagiotakis
  • Panagiotis Simos
  • Ioannis Zaganas
  • Maria Basta
  • Garyfalia S. Perysinaki
  • Nikolaos Fountoulakis
  • Maria Giaka
  • Stefania Kapetanaki
  • Irini Koutentaki
  • Antonios Bertsias
  • George Duijker
  • Nikolaos Scarmeas
  • Chariklia Tziraki
  • Christos Lionis
  • Alexandros Vgontzas
  • Dimitrios T. Boumpas
Research Paper



Cognitive impairment and frailty are major problems of older age. This study aims to explore the association between frailty and cognitive impairment in a rural cohort of older subjects in southern Europe (Cretan Aging Cohort).


Community-based, primary care, cross-sectional, study in the Heraklion Prefecture, Crete, Greece. Four hundred and two persons aged 60–100 years from the Cretan Aging Cohort [100 with dementia, 175 with mild cognitive impairment (MCI) and 127 cognitively non-impaired] were enrolled, mostly rural dwellers (86.2%). Frailty was assessed with the Simple “Frail” Questionnaire Screening Tool. Demographic data, BMI, Mini-Mental State Examination scores (MMSE), severity of dementia according to the Clinical Dementia Rating Scale, and depressive symptoms according to the Geriatric Depression Scale (GDS) were recorded.


Frailty was present in 17% of persons with dementia (73.8% of mild severity), in 6.3% of persons with MCI and in 8.7% of cognitively non-impaired persons (P < 0.05). Among the various frailty variables, fatigue and difficulty walking were significantly more frequently reported by persons with dementia. Each frailty variable and the frailty score correlated negatively with MMSE score and positively with GDS score and polypharmacy. Multivariate analysis revealed that reported fatigue improved the identification of dementia in addition to MMSE, significantly and independently of symptoms of depression (P = 0.04).


Frailty rates are significantly higher in persons with dementia. In this predominantly rural cohort of older subjects, reported fatigue could serve as a marker of physical decline and a complementary index for referral for further neuropsychological and neuropsychiatric evaluation.


Frailty Fatigue Cognitive impairment 



This paper is based on data from a project entitled “UOC-Multidisciplinary network for the study of Alzheimer’s Disease” (Grant code: MIS 377299) supported by a grant from the European Union (European Social Fund—ESF) and Greek National Funds through the Operational Program “Education and Lifelong Learning” of the National Strategic Reference Framework (NSRF). The study sponsor had no role in the design, methods, participant recruitment, data collection, analysis, or preparation of the manuscript.

Author contributions

SHP: study concept and design, acquisition of participants and data, interpretation, and manuscript write up. PS: study concept and design, acquisition of data, statistical analysis, interpretation, and manuscript write up. IZ: study concept and design, acquisition of participants and data. MB: study design, acquisition of participants and data, critical revision of the manuscript. GSP: manuscript write up, critical revision of the manuscript. NF: participant recruitment and data collection. MG: participant recruitment and data collection. SK: participant recruitment and data collection. IK: participant recruitment and data collection. AB: data management and analysis. GD: data management and analysis. NS: critical revision of the manuscript. CT: study design, critical revision of the manuscript. CL: study design, critical revision of the manuscript. AV: study design, critical revision of the manuscript. DTB: study design, critical revision of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

The study was approved by the University of Crete Hospital Ethics Board.

Informed consent

All patients provided informed consent prior to enrollment in the study.


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Copyright information

© European Geriatric Medicine Society 2018

Authors and Affiliations

  • Symeon H. Panagiotakis
    • 1
  • Panagiotis Simos
    • 2
    • 10
  • Ioannis Zaganas
    • 3
  • Maria Basta
    • 2
  • Garyfalia S. Perysinaki
    • 4
  • Nikolaos Fountoulakis
    • 1
  • Maria Giaka
    • 1
  • Stefania Kapetanaki
    • 3
  • Irini Koutentaki
    • 2
  • Antonios Bertsias
    • 5
  • George Duijker
    • 5
  • Nikolaos Scarmeas
    • 6
  • Chariklia Tziraki
    • 7
  • Christos Lionis
    • 5
  • Alexandros Vgontzas
    • 2
  • Dimitrios T. Boumpas
    • 8
    • 9
  1. 1.Internal Medicine DepartmentHeraklion University HospitalHeraklionGreece
  2. 2.Psychiatry Department, Medical SchoolUniversity of CreteHeraklionGreece
  3. 3.Neurology Department, Medical SchoolUniversity of CreteHeraklionGreece
  4. 4.Rethymnon General HospitalRethymnonGreece
  5. 5.Clinic of Social and Family Medicine, Medical SchoolUniversity of CreteHeraklionGreece
  6. 6.Neurology Department, Medical SchoolUniversity of AthensAthensGreece
  7. 7.MELABEV, Research Institute, Community Elders Clubs and Institute for Gerontological Data BasesHebrew UniversityJerusalemIsrael
  8. 8.4th Department of MedicineNational and Kapodistrian University of AthensAthensGreece
  9. 9.University of Cyprus, Medical SchoolNicosiaCyprus
  10. 10.Institute of Computer Science, Computational Biomedicine LaboratoryFoundation for Research and TechnologyHeraklionGreece

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