Association between cognitive impairment and criteria for frailty syndrome among older adults

Abstract

The association between cognitive impairment and physical frailty has been studied in older adults. The criteria degree of frailty may be keys to associated cognitive impairment. Objective: To analyze the association between cognitive impairment and the criteria for frailty. Methods: We cross-sectionally examined data from 667 older adults (≥60 years of age) from a study entitled ‘Variables associated to cognition in elderly caregivers’ involving patients in an urban and rural primary healthcare center. We defined cognitive impairment based on different groups of scores on the Mini Mental State Examination, and defined frailty and prefrailty using the criteria by the Cardiovascular Health Study. We performed multinomial regression models to analyze the association between levels of frailty and cognitive impairment. Results: Similar proportions of women (54.8%) and men (45.2%) participated in the study (mean age: 71 years old). We found cognitive impairment, prefrailty and frailty in 34, 54, and 24% of the participants, respectively. Concomitant cognitive impairment and frailty was found in 13% of them. The chances of cognitive impairment increased up to 330% (Odds Ratio [OR]: 4.3; 95% confidence interval [95%CI] 2.4‒7.7; p<0.001) among frail individuals, and 70% (OR: 1.7; 95%CI 1.0‒2.8; p=0.033) among prefrail individuals compared to robust/non-frail individuals. After controlling for age, education, place of residence and functional dependence, slowness and fatigue criteria were significantly associated with cognitive impairment. Conclusion: Older adults with frailty have a greater likelihood of concomitant cognitive impairment than prefrail and robust older adults. The prevalence of cognitive impairment and frailty is consistent with data reported in literature. The present findings contribute to the investigation of cognitive frailty.

Resumo

A associação entre comprometimento cognitivo e fragilidade tem sida estudada em idosos e os critérios de fragilidade e níveis de fragilidade podem também apresentar influência na função cognitiva. Objetivo: Analisar a associação entre comprometimento cognitivo e os critérios de fragilidade em idosos. Métodos: O estudo analisou transversalmente dados de 667 idosos (≥60 anos) do estudo ‘Variables associated to cognition in elderly caregivers’ conduzido com usuários da atenção primária a saúde de áreas urbanas e rurais. Comprometimento cognitivo foi definido em função dos escores no Miniexame do Estado Mental baseado na escolaridade e a fragilidade e pré-fragilidade foi operacionalizada segundo os critérios do Cardiovascular Health Study. Foram realizados modelos de regressão multinominal para analisar a associação entre níveis de fragilidade e comprometimento cognitivo. Resultados: Proporções semelhantes de mulheres (54,8%) e homens (45,2%) participaram do estudo (média de idade: 71 anos). Comprometimento cognitivo, pré-fragilidade e fragilidade foram encontrados em 34, 54 e 24% dos participantes, respectivamente. Concomitante comprometimento cognitivo e fragilidade foi evidenciado em 13%. As chances de apresentar comprometimento cognitivo aumentaram em 330% (Odds Ratio [OR]: 4.3; intervalo de confiança de 95% [IC95%] 2.4‒7.7; p<0.001) entre indivíduos frágeis e 70% (OR: 1.7; IC95% 1.0‒2.8; p=0.033) entre indivíduos pré-frágeis em comparação com indivíduos robustos/não-frágeis. Após controle da idade, escolaridade, local de residência e dependência funcional, os critérios de lentidão e fadiga foram significativamente associados ao comprometimento cognitivo. Conclusão: Os idosos mais frágeis têm maior probabilidade de apresentar comprometimento cognitivo comparados a adultos idosos pré-frágeis ou robustos. A prevalência de comprometimento cognitivo e fragilidade é consistente com os dados relatados na literatura e fornece suporte para futuras investigações sobre a fragilidade cognitiva.

Keywords:

older adults - cognitive dysfunction - frailty

Palavras-chave:

idoso - disfunção cognitiva - fragilidade

Support:

Support: This paper was supported by São Paulo Research Foundation (Fundação de Amparo à Pesquisa do Estado de São Paulo - FAPESP) grant number #2013/26798-9; #2018/00265-8).

Publication History

Received: 21 June 2019

Accepted: 06 August 2019

Article published online:
13 June 2023

• References

• 1 Woodford HJ, George J. Cognitive assessment in the elderly: a review of clinical methods. QJM. 2007 Aug;100(8):469-84. https://doi.org/10.1093/qjmed/hcm051
• 2 Eshkoor SA, Hamid TA, Mun CY, Ng CK. Mild cognitive impairment and its management in older people. Clin Interv Aging. 2015 Apr;10:687-93. https://doi.org/10.2147/CIA.S73922
• 3 Brigola AG, Luchesi BM, Alexandre T da S, Inouye K, Mioshi E, Pavarini SCI. High burden and frailty: association with poor cognitive performance in older caregivers living in rural areas. Trends. Psychiatry Psychother. 2017 Oct/Dec;39(4):257-63. https://doi.org/10.1590/2237-6089-2016-0085
• 4 Aguilar-Navarro SG, Mimenza-Alvarado AJ, Anaya-Escamilla A, Gutierrez-Robledo LM. Frailty and Vascular Cognitive Impairment: Mechanisms Behind the Link. Rev Invest Clin. 2016 Jan/Feb;68(1):25-32.
• 5 Sargent L, Nalls M, Starkweather A, Hobgood S, Thompson H, Amella EJ, et al. Shared biological pathways for frailty and cognitive impairment: A systematic review. Ageing Res Rev. 2018 Nov;47:149-58. https://doi.org/10.1016/j.arr.2018.08.001
• 6 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 Mar;56(3):M146-56. https://doi.org/10.1093/gerona/56.3.m146
• 7 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 Jun;14(6):392-7. https://doi.org/10.1016/j.jamda.2013.03.022
• 8 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 Dec;15(10):863-7. https://doi.org/10.1007/s12603-011-0066-9
• 9 Robertson DA, Savva GM, Kenny RA. Frailty and cognitive impairment--a review of the evidence and causal mechanisms. Ageing Res Rev. 2013 Sep;12(4):840-51. https://doi.org/10.1016/j.arr.2013.06.004
• 10 Borges MK, Canevelli M, Cesari M, Aprahamian I. Frailty as a predictor of cognitive disorders: A systematic review and meta-analysis. Front Med (Lausanne). 2019;6:26. https://doi.org/10.3389/fmed.2019.00026
• 11 Yassuda MS, Lopes A, Cachioni M, Falcao DVS, Batistoni SST, Guimaraes V V, et al. Frailty criteria and cognitive performance are related: data from the FIBRA study in Ermelino Matarazzo, Sao Paulo, Brazil. J Nutr Health Aging. 2012 Jan;16(1):55-61. https://doi.org/10.1007/s12603-012-0003-6
• 12 Macuco CRM, Batistoni SST, Lopes A, Cachioni M, da Silva Falcao DV, Neri AL, et al. Mini-Mental State Examination performance in frail, pre-frail, and non-frail community dwelling older adults in Ermelino Matarazzo, Sao Paulo, Brazil. Int Psychogeriatr. 2012 Nov;24(11):1725-31. https://doi.org/10.1017/S1041610212000907
• 13 Faria C de A, Lourenco RA, Ribeiro PCC, Lopes CS. [Cognitive performance and frailty in older adults clients of a private health care plan]. Rev Saude Publica. 2013 Oct;47(5):923-30. https://doi.org/10.1590/s0034-8910.2013047004451
• 14 Neri AL, Yassuda MS, Araujo LF, Eulalio MC, Cabral BE, Siqueira MEC, et al. Metodologia e perfil sociodemográfico, cognitivo e de fragilidade de idosos comunitários de sete cidades brasileiras: Estudo FIBRA. Cad Saude Publica. 2013;29(4):778-92. http://dx.doi.org/10.1590/S0102-311X2013000400015
• 15 Brigola AG, Rossetti ES, dos Santos BR, Neri AL, Zazzetta MS, Inouye K, et al. Relationship between cognition and frailty in elderly: A systematic review | Relação entre cognição e fragilidade em idosos: uma revisão sistemática. Dement Neuropsychol. 2015 Apr-Jun;9(2):110-9. https://doi.org/10.1590/1980-57642015DN92000005
• 16 Instituto Brasileiro de Geografia e Estatística. Censo Demográfico 2010; 2010. Available from: http://www.ibge.gov.br/home/estatistica/populacao/censo2010/default.shtm
• 17 Luchesi BM, Alexandre TDS, De Oliveira NA, Brigola AG, Kusumota L, Pavarini SCI, et al. Factors associated with attitudes toward the elderly in a sample of elderly caregivers. Int Psychogeriatrics. 2016 Dec;28(12):2079-89. https://doi.org/10.1017/S1041610216001538
• 18 Pavarini SCI, Brigola AG, Ottaviani AC, Luchesi BM, Souza ÉN, Rossetti ES, et al. Factors associated with cognitive performance in elderly caregivers. Arq Neuropsiquiatr. 2018 Oct;76(10):685-91. https://doi.org/10.1590/0004-282X20180101
• 19 Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179-86. https://doi.org/10.1093/geront/9.3_Part_1.179
• 20 Santos RL dos, Virtuoso Júnior JS. Reliability of the Brazilian version of the Scale of Instrumental. Rev Bras Promoç Saúde. 2008 Dec;21(4):290-6.
• 21 Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189-98. https://doi.org/10.1016/0022-3956(75)90026-6
• 22 Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Suggestions for utilization of the mini-mental state examination in Brazil. Arq Neuro-Psiquiatr. 2003 Sep;61(3B):777-81. http://dx.doi.org/10.1590/S0004-282X2003000500014
• 23 Mioshi E, Dawson K, Mitchell J, Arnold R, Hodges JR. The Addenbrooke’s Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementia screening. Int J Geriatr Psychiatry. 2006 Nov;21(11):1078-85. https://doi.org/10.1002/gps.1610
• 24 Carvalho VA, Caramelli P. Brazilian adaptation of the Addenbrooke’s Cognitive Examination-Revised (ACE-R). Dement Neuropsychol. 2007 Apr/Jun;1(2):212-6. http://dx.doi.org/10.1590/s1980-57642008dn10200015
• 25 Dias EG, Andrade FB de, Duarte YA de O, Santos JLF, Lebrao ML. Advanced activities of daily living and incidence of cognitive decline in the elderly: the SABE Study. Cad Saude Publica. 2015 Aug;31(8):1623-35. https://doi.org/10.1590/0102-311X00125014
• 26 Gondim AS, Coelho Filho JM, Cavalcanti AA, Roriz Filho JS, Nogueira CB, Peixoto Junior AA, et al. Prevalence of functional cognitive impairment and associated factors in Brazilian community-dwelling older adults. Dement Neuropsychol. 2017 Jan/Mar;11(1):32-9. http://dx.doi.org/10.1590/1980-57642016dn11-010006
• 27 Curcio C-L, Henao G-M, Gomez F. Frailty among rural elderly adults. BMC Geriatr. 2014 Jan;14:2. https://doi.org/10.1186/1471-2318-14-2
• 28 Curcio C-L, Gomez F, Reyes-Ortiz CA. Activity restriction related to fear of falling among older people in the Colombian Andes mountains: are functional or psychosocial risk factors more important? J Aging Health. 2009;21(3):460-79. https://doi.org/10.1177/0898264308329024
• 29 Wu Y-H, Liu L-K, Chen W-T, Lee W-J, Peng L-N, Wang P-N, et al. 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 Oct;16(10):899.e9-16. https://doi.org/10.1016/j.jamda.2015.07.013
• 30 Gomes GAO, Luchesi BM, Gratão ACM, Orlandi FS, Say KG, Inouye K, et al. Prevalence of physical inactivity and associated factors among older caregivers of older adults. J Aging Health. 2019 Jun;31(5):793-813. https://doi.org/10.1177/0898264318756422
• 31 Feng L, Zin Nyunt MS, Gao Q, Feng L, Yap KB, Ng T-P. Cognitive frailty and adverse health outcomes: findings from the Singapore Longitudinal Ageing Studies (SLAS). J Am Med Dir Assoc. 2017 Mar;18(3):252-8. https://doi.org/10.1016/j.jamda.2016.09.015
• 32 Feng L, Nyunt MSZ, Gao Q, Feng L, Lee TS, Tsoi T, et al. Physical frailty, cognitive impairment, and the risk of neurocognitive disorder in the Singapore longitudinal ageing studies. J Gerontol A Biol Sci Med Sci. 2017 Mar;72(3):369-75. https://doi.org/10.1093/gerona/glw050
• 33 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):518-24. http://dx.doi.org/10.1016/j.jamda.2013.03.010
• 34 Albala C, Lera L, Sanchez H, Angel B, Márquez C, Arroyo P, et al. Frequency of frailty and its association with cognitive status and survival in older Chileans. Clin Interv Aging. 2017 Jun;12:995-1001. https://doi.org/10.2147/CIA.S136906
• 35 da Silva Alves BB, de Oliveira Barbosa E, de Moraes Pimentel D, Carneiro LSF, Rodrigues ACMA, Deslandes AC, et al. Comparison of cognitive functions among frail and prefrail older adults: a clinical perspective. Int Psychogeriatrics. 2019 Feb;31(2):297-301. https://doi.org/10.1017/S1041610218000765
• 36 Armstrong JJ, Godin J, Launer LJ, White LR, Mitnitski A, Rockwood K, et al. Changes in frailty predict changes in cognition in older men: The Honolulu-Asia Aging Study. J Alzheimers Dis. 2016 Jun;53(3):1003-13. https://doi.org/10.3233/JAD-151172
• 37 Robertson DA, Savva GM, Coen RF, Kenny R-A. Cognitive function in the prefrailty and frailty syndrome. J Am Geriatr Soc. 2014 Nov;62(11):2118-24. https://doi.org/10.1111/jgs.13111
• 38 Krall JR, Carlson MC, Fried LP, Xue Q-L. Examining the dynamic, bidirectional associations between cognitive and physical functioning in older adults. Am J Epidemiol. 2014 Oct;180(8):838-46. https://doi.org/10.1093/aje/kwu198
• 39 Artaud F, Singh-Manoux A, Dugravot A, Tzourio C, Elbaz A. Decline in fast gait speed as a predictor of disability in older adults. J Am Geriatr Soc. 2015 Jun;63(6):1129-36. https://doi.org/10.1111/jgs.13442
• 40 Ávila-Funes JA, Pina-Escudero SD, Aguilar-Navarro S, Gutierrez-Robledo LM, Ruiz-Arregui L, Amieva H. Cognitive impairment and low physical activity are the components of frailty more strongly associated with disability. J Nutr Health Aging. 2011 Aug;15(8):683-9. https://doi.org/10.1007/s12603-011-0111-8
• 41 Halil M, Cemal Kizilarslanoglu M, Emin Kuyumcu M, Yesil Y, Cruz Jentoft AJ. Cognitive aspects of frailty: mechanisms behind the link between frailty and cognitive impairment. J Nutr Health Aging. 2015 Mar;19(3):276-83. https://doi.org/10.1007/s12603-014-0535-z
• 42 Montero-Odasso MM, Barnes B, Speechley M, Muir Hunter 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 Nov;71(11):1476-82. https://doi.org/10.1093/gerona/glw044
• 43 Dumurgier J, Artaud F, Touraine C, Rouaud O, Tavernier B, Dufouil C, et al. Gait Speed and Decline in Gait Speed as Predictors of Incident Dementia. J Gerontol A Biol Sci Med Sci. 2017 May;72(5):655-61. https://doi.org/10.1093/gerona/glw110
• 44 Aprahamian I, Suemoto CK, Aliberti MJR, de Queiroz Fortes Filho S, de Araujo Melo J, Lin SM, et al. Frailty and cognitive status evaluation can better predict mortality in older adults? Arch Gerontol Geriatr. 2018 Jul;77:51-6. https://doi.org/10.1016/j.archger.2018.04.005
• 45 Aliberti MJR, Cenzer IS, Smith AK, Lee SJ, Yaffe K, Covinsky KE. Assessing Risk for Adverse Outcomes in Older Adults: The Need to Include Both Physical Frailty and Cognition. J Am Geriatr Soc. 2019 Mar;67(3):477-83. https://doi.org/10.1111/jgs.15683