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A Scoping Review for Usage of Telerehabilitation among Older Adults with Mild Cognitive Impairment or Cognitive Frailty. International journal of environmental research and public health Older adults are vulnerable towards cognitive frailty that can lead to adverse health outcomes and telerehabilitation appears to be a potential platform to reverse cognitive frailty among older adults. The aim of this coping review is to identify the usage of telerehabilitation and its common platform of delivery among older adults with mild cognitive impairment (MCI) or cognitive frailty (CF). Articles published from January 2015 until October 2020 were selected. Out of the 1738 articles retrieved, six studies were identified. Two articles were randomized controlled trials, one was a pilot study and three were qualitative studies. The outcome suggests that telerehabilitation may improve the quality of life among participants as well as it can be a useful and supportive digital platform for health care. Some types of technologies commonly used were smartphones or telephones with internet, television-based assistive integrated technology, mobile application and videoconference. Telerehabilitation utilization in managing cognitive frailty among older adults is still limited and more research is required to evaluate its feasibility and acceptability. Although telerehabilitation appears to be implemented among older adults with MCI and CF, some social support is still required to improve the adherence and effectiveness of telerehabilitation. Future research should focus on the evaluation of acceptance and participants' existing knowledge towards telerehabilitation to achieve its target. 10.3390/ijerph19074000
Longitudinal Relationship Between Frailty and Cognitive Impairment in Chinese Older Adults: A Prospective Study. Journal of applied gerontology : the official journal of the Southern Gerontological Society We aimed to examine the longitudinal association between frailty and cognitive impairment in the older Chinese population. This prospective cohort study used data from the Chinese Longitudinal Healthy Longevity Study 2011 wave. We calculated the follow-up duration as 3 years from the baseline year. Frailty was measured using the frailty index, and cognitive function was calculated by Mini-Mental State Examination Scale. Participants who were non-frailty and those with normal cognitive function were included in 2011 and followed up in 2014, respectively. Frailty was an independent risk factor for early-onset cognitive impairment. Age, hearing impairment, and a decreased ability to perform daily activities were the main risk factors for cognitive impairment, while affluent economic status was a protective factor. Cognitive impairment was not found to be an independent risk factor for frailty. We concluded that the frailty index is a significant predictor of cognitive impairment among community-dwelling older adults. 10.1177/07334648221118352
Motoric cognitive risk syndrome, physio-cognitive decline syndrome, cognitive frailty and reversibility with dual-task exercise. Merchant Reshma Aziz,Chan Yiong Huak,Hui Richard Jor Yeong,Tsoi Chris Tung,Kwek Sing Cheer,Tan Weng Mooi,Lim Jia Yi,Sandrasageran Surein,Wong Beatrix Ling Ling,Chen Matthew Zhixuan,Ng Shu Ee,Morley John E Experimental gerontology INTRODUCTION:Cognitive frailty (CF) is associated with dementia and disability. It was initially proposed in 2013 by the International Institute of Nutrition and Aging and the International Geriatrics Association. Over the years, there have been many emerging definitions e.g., Motoric Cognitive Risk Syndrome (MCR), Physio-cognitive Decline Syndrome (PCDS), reversible CF and potentially reversible CF. OBJECTIVE:Our objective was to determine the demographics including physical, functional, and psychosocial factors for the four CF definitions amongst community-dwelling older adults. In addition, the effect of dual-task exercise on the reversibility of different definitions of CF was also studied. METHODS:Participants were community-dwelling older adults aged ≥60 years recruited between August 2017 and December 2019. Older adults screened to be frail, prefrail or have cognitive impairment were invited to participate in dual-task exercise program called HAPPY (Healthy Ageing Promotion Program for You). Improvement in cognition, frailty, and physical performance after a 3-month dual-task exercise intervention program was compared with controls. RESULTS:The prevalence of CF depending on definition ranged from 8.8% to 28.7% with minimal overlap. The cognitive scores were significantly lower in all the groups predominantly affecting non-memory domains except for reversible CF. Frailty was three to seven times more prevalent in CF. MCR group had higher prevalence of functional limitation, pain and depression. All four groups had significant increase in global cognition scores especially in the attention domain where the control group declined, and reduction in the prevalence of frailty post intervention. MCR and reversible CF were significantly associated with increased odds of cognitive improvement after 3 months of intervention compared with control. CONCLUSION:CF is a novel concept and regardless of the definitions, is a target for reversing frailty, functional limitation and cognitive impairment through dual-task exercise. Long-term prospective studies are needed to evaluate the effectiveness of dual-task interventions in delaying the conversion to dementia and reduction of disability. 10.1016/j.exger.2021.111362
Effects of cognitive reserve on cognitive frailty among older adults: A population-based prospective cohort study. Geriatrics & gerontology international AIM:We investigated the effect of lifespan cognitive reserve and its components on cognitive frailty among older adults. METHODS:A total of 4922 participants aged ≥65 years were recruited in 2008 and were followed up in 2011 from the Chinese Longitudinal Healthy Longevity Survey. Cognitive frailty was determined through the simultaneous presence of physical frailty (pre-frailty or frailty) and mild cognitive impairment, excluding concurrent dementia. The assessment of physical frailty and mild cognitive impairment was based on the Fatigue, Resistence, Ambulation, Illness, Loss of weight (FRAIL) (Fatigue, Resistence, Ambulation, Illness, Loss) and Mini-Mental State Examination scale, respectively. The lifespan cognitive reserve consisted of education attainment, occupational complexity and later-life leisure activities. We used logistic regression models to estimate the risk of cognitive frailty associated with the lifespan cognitive reserve and its components. RESULTS:A higher level of lifespan cognitive reserve, higher educational attainment or leisure activities engagement, but not occupational complexity, were associated with lower risk of incident cognitive frailty. Furthermore, cognitive, social and physical activities were associated with lower risk of incident cognitive frailty. CONCLUSION:Cognitive reserve, particularly educational attainment and leisure activities, can protect from cognitive frailty. This implicates that individuals should accumulate cognitive reserve in their lifespan, and older adults should actively participate in leisure activities to prevent cognitive frailty. Geriatr Gerontol Int 2024; 24: 398-403. 10.1111/ggi.14855
Correlation among sleep quality, physical frailty and cognitive function of the older adults in China: the mediating role. Frontiers in public health Objective:To explore the correlation among sleep quality, physical frailty, and cognitive function in the older adults in community, and to explore the mediating role of sleep quality. Methods:A total of 1,182 community-based older adults were investigated with frailty phenotype (FP), Pittsburgh sleep quality index (PISQI), Montreal cognitive assessment (MoCA) and self-made general information questionnaire. Results:The incidence of physical frailty among the older adults in the community was 25.8% and the incidence of cognitive decline was 19.5%. Cognitive function was negatively correlated with physical frailty ( = -0.236,  < 0.01) and sleep quality ( = -0.558,  < 0.01). Sleep quality was positively correlated with physical frailty ( = 0.337,  < 0.01). Conclusion:The physical frailty of the older adults has a direct prediction effect on cognitive function, and is regulated by the mediating role of sleep quality. Sleep quality partially mediates the relationship between cognitive dysfunction and physical frailty, which is a new insight into the study of cognition and physical frailty in the older adults. In the future, we can take measures to improve the sleep quality of the older adults, so as to reduce the occurrence of cognitive dysfunction and physical frailty of the older adults. 10.3389/fpubh.2023.1143033
Technology-Assisted Cognitive Motor Dual-Task Rehabilitation in Chronic Age-Related Conditions: Systematic Review. Journal of medical Internet research BACKGROUND:Cognitive-motor dual-task (CMDT) is defined as the parallel processing of motor (eg, gait) and cognitive (eg, executive functions) activities and is an essential ability in daily life. Older adults living with frailty, chronic conditions (eg, neurodegenerative diseases), or multimorbidity pay high costs during CMDT. This can have serious consequences on the health and safety of older adults with chronic age-related conditions. However, CMDT rehabilitation can provide useful and effective therapies for these patients, particularly if delivered through technological devices. OBJECTIVE:This review aims to describe the current technological applications, CMDT rehabilitative procedures, target populations, condition assessment, and efficacy and effectiveness of technology-assisted CMDT rehabilitation in chronic age-related conditions. METHODS:We performed this systematic review, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, on 3 databases (Web of Science, Embase, and PubMed). Original articles that were published in English; involved older adults (>65 years) with ≥1 chronic condition and/or frailty; and tested, with a clinical trial, a technology-assisted CMDT rehabilitation against a control condition were included. Risk of bias (Cochrane tool) and the RITES (Rating of Included Trials on the Efficacy-Effectiveness Spectrum) tool were used to evaluate the included studies. RESULTS:A total of 1097 papers were screened, and 8 (0.73%) studies met the predefined inclusion criteria for this review. The target conditions for technology-assisted CMDT rehabilitation included Parkinson disease and dementia. However, little information regarding multimorbidity, chronicity, or frailty status is available. The primary outcomes included falls, balance, gait parameters, dual-task performance, and executive functions and attention. CMDT technology mainly consists of a motion-tracking system combined with virtual reality. CMDT rehabilitation involves different types of tasks (eg, obstacle negotiation and CMDT exercises). Compared with control conditions, CMDT training was found to be pleasant, safe, and effective particularly for dual-task performances, falls, gait, and cognition, and the effects were maintained at midterm follow-up. CONCLUSIONS:Despite further research being mandatory, technology-assisted CMDT rehabilitation is a promising method to enhance motor-cognitive functions in older adults with chronic conditions. 10.2196/44484
Prevalence and associated factors of cognitive frailty in community-dwelling older adults: Results from the Korean longitudinal study of aging. International journal of older people nursing BACKGROUND:Cognitive frailty, a condition characterized by physical frailty with cognitive impairment, is emerging as a determinant of adverse health outcomes in older adults. However, its prevalence and correlation with associated factors are unknown in the aging population of Korea. OBJECTIVES:To estimate the prevalence of cognitive frailty and identify factors associated with it among older Korean adults. METHODS:A secondary analysis was performed using the Korean Longitudinal Study of Aging seventh survey dataset collected in 2018. Multinomial logistic regression analyses were conducted to examine the association between cognitive frailty and demographic, psychosocial, oral health and physical function factors. Individuals aged ≥65 years and without dementia were included (N = 1024). Participants were classified into four groups based on the presence or absence of physical frailty and mild cognitive impairment. This article is executed in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. RESULTS:The prevalence of cognitive frailty in the study sample was 11.2%. The results of multinomial logistic regression showed that advanced age, being female, lower education levels, heart disease, arthritis or rheumatoid arthritis, underweight, depression, non-social activity, poor oral health and functional limitation were significantly associated with cognitive frailty. CONCLUSIONS:Cognitive frailty is prevalent among community-dwelling older adults in Korea. The findings provide primary care providers with insights about effective strategies for identifying at-risk individuals and will guide the development of population-level interventions to prevent or delay the onset of physical frailty and cognitive impairment in older adults. IMPLICATIONS FOR PRACTICE:The findings provide practical information to healthcare providers for identifying cognitive frailty in older adults. The risk factors of cognitive frailty, such as psychosocial, oral health, and physical function factors, should be thoroughly monitored for older adults. Health personnel working in primary care have a critical role in identifying risk and beneficial factors and promoting preventative strategies that enhance health outcomes. 10.1111/opn.12576
The Association between Number of Teeth and Cognitive Frailty in Older Adults: A Cross-Sectional Study. The journal of nutrition, health & aging OBJECTIVES:This study aimed to explore the association between number of teeth and cognitive frailty in American older adults. DESIGN:Cross-sectional study. SETTING:Community. PARTICIPANTS:The participants were 1,531 community-dwelling older adults aged 60 or older from the NHANES database. METHODS:Frailty was assessed using a 49-item frailty index, with a cut-off value for frailty of more than 0.21. Cognitive dysfunction was evaluated by the Digit-Symbol Coding Test (DSCT), with the cut-off being below the lowest interquartile range (scores ≤37). Cognitive frailty was defined as participants who suffered from both frailty and cognitive dysfunction. Oral health indicators included number of teeth and other factors, such as the presence of gum disease, daily use of dental floss, daily use of mouthwash and self-rated oral health. Multivariable logistic regression models were used to explore the relationship between number of teeth and cognitive frailty. RESULTS:The mean age of the total sample was 69.67 (SD=6.60) years, and 52.71% (n=807) were female. Our study suggests there was a negative association between number of teeth and cognitive frailty (OR =0.98,95%CI:0.96-0.99, P=0.044) after controlling for potential confounding factors. In addition, older adults with 20 or more teeth had lower odds of being cognitively frail (OR=0.66,95%CI:0.44-0.99, P=0.046) than individuals who had less than 20 teeth. CONCLUSION:This study suggests that older adults who have more teeth are associated with a lower risk of cognitive frailty. This finding highlights the importance of maintaining as many teeth as possible throughout life and into old age. Cohort studies will be required in the future to determine this relationship. 10.1007/s12603-022-1783-y
Cognitive frailty and falls in Chinese elderly people: a population-based longitudinal study. Ma Y,Li X,Pan Y,Zhao R,Wang X,Jiang X,Li S European journal of neurology BACKGROUND AND PURPOSE:Falling is considered an important public health problem among older people. A recent cross-sectional study suggested that cognitive frailty (CF) is associated with falls. We aimed to explore whether CF is a risk factor for falls in a population-based longitudinal study. METHODS:Using data from the Rugao Longevity and Aging Study, physical frailty was assessed according to the modified Fried's phenotype, and the 20% of participants with the lowest scores on the Revised Hasegawa Dementia Scale were defined as having cognitive impairment (CoI). Cognitive frailty (CF) was defined as the coexistence of physical frailty and CoI, but excluded severe CoI (revised Hasegawa Dementia Scale score ≤ 10). The outcome of number of falls in the previous 12 months was measured using a questionnaire. RESULTS:At baseline, the prevalence of CF was 2.6% and the prevalence of two or more falls was 6.7%. Cross-sectional analysis found that two or more falls was associated with physical frailty without CoI (odds ratio [OR] 6.79, 95% confidence interval [CI] 3.17-14.56), pre-frailty with CoI (OR 4.54, 95% CI 2.44-8.44) and CF (OR 3.51, 95% CI 1.18-10.44). Slow gait with CoI was associated with two or more falls (OR 2.21, 95% CI 1.08-4.53). At 3-year follow-up, the prevalence of two or more falls was 10.6%. Logistic regression analysis showed that, compared with the robust and non-CoI elderly groups, the CF elderly group had a higher risk of two or more falls (OR 3.41, 95% CI 1.11-10.50). CONCLUSIONS:Cognitive frailty was associated with two or more falls at baseline and might be a risk factor for two or more falls after 3 years. Early screening of CF might be beneficial in the prevention of falls. 10.1111/ene.14572
Cognitive frailty in older cancer survivors and its association with health-related quality of life. European journal of oncology nursing : the official journal of European Oncology Nursing Society PURPOSE:This study aimed (1) to estimate the prevalence of cognitive frailty, (2) to identify factors associated with cognitive frailty and (3) to examine the association of cognitive frailty with health-related quality of life (HRQOL) in older cancer survivors. METHODS:This was a cross-sectional study. Participants were aged 65 or above, diagnosed with cancer and had completed cancer treatment. Measures on physical frailty, cognitive functioning and HRQOL were administered. Multiple linear regression models were used to examine the association of cognitive frailty with HRQOL. RESULTS:Among 293 recruited participants, 18.8% had a cognitive functioning decline, 8.9% were physically frail and 8.2% were cognitively frail. Regular exercise (OR = 0.383, p = .035) and shorter time since treatment completion were associated with less likelihood of cognitive frailty (OR = 1.004, p = .045). Cognitive frailty was significantly associated with global health status (β = -0.116; p = .044), physical functioning (β = -0.177; p = .002), social functioning (β = -0.123; p = .035) and fatigue symptoms (β = 0.212; p < .001) after adjusting for potential confounding variables. CONCLUSIONS:Cognitive frailty, found in 8.2% of older cancer survivors, is associated with various dimensions of HRQOL. Longitudinal research examining the trajectory and impact of cognitive frailty on more diverse health outcomes in older cancer survivors is warranted. The findings improve service providers' knowledge of cognitive frailty in older cancer survivors and inform surveillance and care for geriatric cancer survivorship. 10.1016/j.ejon.2023.102426
Association of Cognitive Performance with Frailty in Older Individuals with Cognitive Complaints. The journal of nutrition, health & aging OBJECTIVES:Frailty is a risk factor for poor cognitive performance in older adults. However, few studies have evaluated the association of cognitive performance with frailty in a low- to middle-income country (LMIC). This study aimed to investigate an association between cognitive performance and frailty in older adults with memory complaints in Brazil. Secondarily, we aim to assess an association of cognitive performance with gait speed and grip strength. DESIGN:Cross-sectional study. SETTING:Outpatient service from a LMIC. PARTICIPANTS:Older adults with memory complaints reported by the participants, their proxies, or their physicians. MEASUREMENTS:Frailty was evaluated using the Cardiovascular Health Study criteria. A neuropsychological battery evaluated memory, attention, language, visuospatial function, executive function. Linear regression analysis with adjustment for age, sex, and education was used. We also evaluated the interaction of education with frailty, grip strength, and gait speed. RESULTS:Prefrailty was associated with poor performance in the memory domain, as well as slower gait speed was associated with worse performance in memory, attention, language, and executive function. Frailty and grip strength were not associated with cognitive performance. Interactions of education with gait speed were significant for global performance, as well as for attention and visuospatial ability. CONCLUSION:In elderly patients with memory complaints, prefrailty was associated with poor memory performance. Slowness was associated with poorer performance in some cognitive domains, mainly in participants with low education. 10.1007/s12603-021-1712-5
Cognitive Frailty and Falls in a National Cohort of Older Chinese Inpatients. The journal of nutrition, health & aging Previous studies have investigated the association between cognitive frailty and falls among older adults in community; however, no study investigated this relationship among older patients living in hospital. This study aimed to examine the relationship of cognitive frailty with falls among older inpatients in Chinese hospital. METHODS:This analysis consisted of 9192 older inpatients aged 65 years or over from six hospitals in China. We used FRAIL scale and Mini-Cog to assess frailty and cognitive impairment, respectively. A generalized estimating equation was used to examine the relationship between cognitive frailty and falls at 30-day follow-up. RESULTS:Among 9192 older inpatients enrolled in this present study, the mean (SD) age was 72.40(5.72) years, with 3850(41.88%) women. The cross-sectional analysis found that after controlling for variables (age, gender, education, depression, and hospital ward cluster effect), hospitalized patients with cognitive frailty, frailty only, or cognitive impairment only at baseline were all associated with history of falls (P<0.05). At 30-day follow-up, generalized estimating equation with full-adjustment showed that inpatients with cognitive frailty were at greater risk of falls than those of non-frail and cognitive intact (OR=3.0,95%CI:1.32-6.83). This association was also observed in individuals with frailty only (OR=2.11,95%CI:1.04-4.27) but not for patients with cognitive impairment only((OR=1.11,95%CI:0.43-2.85). CONCLUSION:Our study suggested that hospitalized Chinese older adults with cognitive frailty were independently associated with falls. Early screening frailty and cognitive impairment were significant for older patients by clinicians, and corresponding interventions, exercise training and nutritional programs, should be implemented to prevent falls. 10.1007/s12603-021-1670-y
Prevalence of cognitive frailty among older adults in China: a systematic review and meta-analysis. BMJ open OBJECTIVE:This study aimed to investigate the prevalence of cognitive frailty among older adults in China. DESIGN:Systematic review and meta-analysis. METHODS:We searched the Cochrane Library, PubMed, Web of Science, Embase, China National Knowledge Infrastructure(CNKI), Wanfang, Chinese Biomedical Literature and Weipu (VIP) databases to collect information on the epidemiology of cognitive frailty among older adults in China. The study period was from the establishment of the database to March 2022. Two researchers independently screened the literature, extracted the data and assessed the risk of bias in the included studies. All statistical analyses were performed using Stata V.15.0. RESULTS:We screened 522 records, of which 28 met the inclusion criteria. The results of the meta-analysis showed that the prevalence of cognitive frailty among older adults in China was 15%(95%CI (0.13%,0.17%)). The prevalence of cognitive frailty was higher in hospitals and nursing homes than in communities. Moreover, the prevalence of cognitive frailty was higher in women than in men. Furthermore, the prevalence rates of cognitive frailty in North China Hospital, older adults aged≥80 years, and illiterate individuals were 25%, 29%, and 55%, respectively. CONCLUSIONS:In conclusion, in China, the prevalence of cognitive frailty is higher among older adults, is higher in women than in men, is higher in hospitals and nursing homes than in communities, and is higher in North China than other regions. Moreover, the higher the educational level, the lower the prevalence of cognitive frailty. Multimodal interventions for cognitive frailty, including increased exercise, nutritional support, increased socialisation opportunities and multifactorial strategies, may be effective in preventing cognitive frailty. These findings have important implications for adjusting healthcare and social care systems. PROSPERO REGISTRATION NUMBER:CRD42023390486. 10.1136/bmjopen-2022-066630
Cognitive frailty among community-dwelling rural elderly population of West Bengal in India. Das Sayani Asian journal of psychiatry OBJECTIVES:There has been growing interest in the links between physical frailty and cognitive impairment: both can increase the risk of emerging life-threatening health problems and are currently prominent within the global geriatric health agenda. A recent consensus proposes the idea of 'cognitive frailty' defined by the presence of both physical frailty and cognitive impairment in the absence of dementia. Present study is intended to determine the prevalence of cognitive frailty and its associated factors. METHODS:Cross-sectional survey was conducted among the rural community-dwelling elderly population of West Bengal, India (n = 510), without diagnosed dementia at baseline. An Interview-based questionnaire was administered to obtain information on sociodemographic, physical and psychosocial characteristics. Study participants were categorized as non-cognitive impairment (NCI) and cognitive impairment (CI) by Bangla Adaptation of Mini-Mental State Exam (BMSE ≤ 25) scale, as non-physical frailty (NPF) and physical frailty (PF) using Modified Fried Frailty Phenotype (FP ≥ 3) scale, as robust (NPF + NCI), pre-cognitive frailty (NPF + CI or PF + NCI) and cognitive frailty (PF + CI). RESULTS:The overall prevalence of cognitive frailty was 21.8%. In multinomial regression analysis, final model indicated that increasing age, being woman, out-of-wedlock, poor education and non-working sociodemographic status had significant association with cognitive frailty. Poor nutritional status, low health-related quality of life and depression are also prone among the cognitively frail participants. CONCLUSIONS:Present study allows us to understand complementary relationships between sociodemographic, physical, psychosocial characteristics and cognitive frailty. There is a dire need for multidimensional approach for providing appropriate and comprehensive geriatric health care for developing countries like India. 10.1016/j.ajp.2022.103025
Relationship Between Cognitive Frailty and Mortality in Older Adults: A Systematic Review and Meta-Analysis. Journal of the American Medical Directors Association OBJECTIVE:To synthesize the pooled mortality risk estimate and determine whether cognitive frailty is a predictor of mortality. DESIGN:A systematic review and meta-analysis. SETTING AND PARTICIPANTS:The participants were community-dwelling older adults aged ≥60 years. METHODS:PubMed, Web of Science, Embase, CINAHL, and the Cochrane Library databases were systematically searched. Two researchers independently screened potentially eligible literature, evaluated the quality of the included studies, and then extracted the data. We used STATA, version 15.0 to perform the all data. RESULTS:Nineteen studies were included. The association between cognitive frailty and a higher risk of death was statistically significant [hazard ratio (HR), 2.01; 95% CI, 1.84-2.19; P < .001]. The outcomes indicated that cognitive frailty was a critical risk factor for predicting mortality (OR, 4.82; 95% CI, 1.59-14.57; P < .01). Based on different models of cognitive frailty, the results of subgroup analyses revealed that the risk of mortality was the highest in the Frail + mild cognitive impairment group (HR, 2.35; 95% CI, 2.05-2.70; P < .001). The subgroup analyses by region demonstrated that mortality risk was lowest in the European group (HR, 1.63; 95% CI, 1.4-1.87; P < .001). CONCLUSIONS AND IMPLICATIONS:This study quantitatively portrays the pooled mortality risk estimate of cognitive frailty. The results suggest that in older adults, cognitive frailty can be a predictor of mortality. The findings could alert health care providers to pay more attention to cognitive frailty. 10.1016/j.jamda.2023.08.001
Emerging biomarkers and screening for cognitive frailty. Ruan Qingwei,D'Onofrio Grazia,Sancarlo Daniele,Greco Antonio,Lozupone Madia,Seripa Davide,Panza Francesco,Yu Zhuowei Aging clinical and experimental research Physical frailty and cognitive frailty are two important targets of secondary intervention in aging research to narrow the gap between life and health span. The objective of the present narrative review was to examine clinical and epidemiological studies investigating the recently proposed construct of cognitive frailty and its subtypes, with a focus on operational definitions, clinical criteria, and emerging biomarkers potentially useful for the screening of this novel entity. Both physical frailty and frailty indexes with a multidimensional nature were associated with late-life cognitive impairment/decline, incident dementia, Alzheimer's disease (AD), mild cognitive impairment, vascular dementia, non-AD dementias, and AD pathology proposing cognitive frailty as a clinical entity with cognitive impairment related to physical causes with a potential reversibility. The new clinical and research AD criteria established by the National Institute on Aging-Alzheimer's Association and the American Psychiatric Association could improve the differential diagnosis of cognitive impairment within the cognitive frailty construct. The emerging biomarkers of sarcopenia, physical frailty, and cognitive impairment will provide the basis to establish more reliable clinical and research criteria for cognitive frailty, using different operational definitions for frailty and cognitive impairment and useful clinical, biological, and imaging markers for this novel clinical construct. 10.1007/s40520-017-0741-8
Cognitive impairment in people with physical frailty using the phenotype model: A systematic review and meta analysis. International journal of geriatric psychiatry OBJECTIVE:We performed a systematic review and meta-analysis to study the relationship between cognitive functioning and phenotypic frailty status. METHODS:We searched Pubmed, Cochrane Library and Epistemonikos from 2000 until March 2022, and used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Samples included both sexes, age ≥55 years, assessed with standardized measures of the different cognitive domains and the frailty phenotype model and analyzing the relationship between the frailty subtypes pre-frail, frail and robust and specific cognitive function. RESULTS:Eleven studies published from 2008 until March 2022 fulfilled the inclusion criteria, and 10 were included in our meta-analyses. Sample sizes varied from 104 to 4649 individuals. Mean Mini-Mental State Examination (MMSE) scores ranged from 17.0 to 27.6, with mean difference (MD) of -2.55 (95% confidence interval [CI] -3.32, -1.78) in frail compared to robust, MD -1.64 (95% CI -2.21, -1.06) in frail compared to prefrail and MD -0.68 (95% CI -0.94, -0.43) in prefrail compared to robust. In subgroup analyses, frail persons had lower scores in the memory domain with standardized mean difference (SMD) -1.01 (95% CI -1.42, -0.59). CONCLUSION:MMSE scores were significantly lower in frail compared to robust and prefrail persons and in prefrail compared to robust persons. Subgroup analysis of memory revealed significantly poorer scores in frail compared to robust. The results indicate a strong relationship between physical frailty and cognitive impairment suggesting incorporation of cognitive function in frailty assessments. 10.1002/gps.5822
Effects of Mindfulness-Based Tai Chi Chuan on Physical Performance and Cognitive Function among Cognitive Frailty Older Adults: A Six-Month Follow-Up of a Randomized Controlled Trial. The journal of prevention of Alzheimer's disease OBJECTIVE:To assess the effectiveness of a mindfulness-based Tai Chi Chuan on physical performance and cognitive function among cognitive frailty older adults. DESIGN:A single-blind,three-arm randomized controlled trial. SETTING:Three communities in Daqing, China. PARTICIPANTS:The study sample comprised 93 men and women aged 65 years or older who were able to walk more than 10 m without helping tools, scored 0.5 on Clinical Dementia Rating (CDR) and absence of concurrent dementia, identified pre-frailty (scored 1-2 on Fried Frailty Criteria) and frailty older adults (scored 3-5 on Fried Frailty Criteria). INTERVENTION:Subjects were randomly allocated to three groups: Group1, which received mindfulness intervention (formal and informal mindfulness practices); Group 2, which received Tai-Chi Chuan intervention; Group 3, which received MTCC intervention. MEASUREMENTS:The primary outcomes was cognitive frailty rate(measured by Fried Frailty Criteria and Clinical Dementia Rating-CDR) , the secondary outcome were cognitive function (measured by Min-Mental State Examination-MMES) and physical level (measured by Short physical performance battery- SPPB, Timed up and Go test-TUG and the 30-second Chair test). They were all assessed at Time 1-baseline, Time 2-after the end of 6-month intervention and the follow up (Time 3-half year after the end of 6-month intervention). RESULTS:The baseline characteristics did not differ among the groups.Improvements in the cognitive function (MMES), physical performance (SPPB, TUG, 30-second Chair test) were significantly difference between time-group interaction (p<.05). The rate of CF was significantly different among groups at 6-month follow-up period (χ2=6.37, p<.05). A lower prevalence of frailty and better cognitive function and physical performance were found in the Group 3 compared with other two groups at the follow-up period (p<.05). CONCLUSIONS:MTCC seems to be effectively reverse CF, improving the cognitive and physical function among older adults, suggesting that MTCC is a preferably intervention option in community older adults with cognitive frailty. 10.14283/jpad.2021.40
Role of Cognitive Frailty in Older Adults With Cardiovascular Disease. Journal of the American Heart Association As the older adult population expands, an increasing number of patients affected by geriatric syndromes are seen by cardiovascular clinicians. One such syndrome that has been associated with poor outcomes is cognitive frailty: the simultaneous presence of cognitive impairment, without evidence of dementia, and physical frailty, which results in decreased cognitive reserve. Driven by common pathophysiologic underpinnings (eg, inflammation and neurohormonal dysregulation), cardiovascular disease, cognitive impairment, and frailty also share the following risk factors: hypertension, diabetes, obesity, sedentary behavior, and tobacco use. Cardiovascular disease has been associated with the onset and progression of cognitive frailty, which may be reversible in early stages, making it essential for clinicians to diagnose the condition in a timely manner and prescribe appropriate interventions. Additional research is required to elucidate the mechanisms underlying the development of cognitive frailty, establish preventive and therapeutic strategies to address the needs of older patients with cardiovascular disease at risk for cognitive frailty, and ultimately facilitate targeted intervention studies. 10.1161/JAHA.123.033594
Frailty and Cognitive Function in Older Adults: A Systematic Review and Meta-Analysis of Cross-Sectional Studies. Neuropsychology review The relationship between cognitive function and frailty among older adults is a growing area of research due to the implications of cognitive and physical decline for functional independence in late life. Multiple studies demonstrate a meaningful relationship between these two factors, which together may constitute increased risk of negative health outcomes for older adults. The current analysis was conducted to 1) systematically review current evidence for differences in cognitive performance based on frailty status among older adults and provide quantitative evidence for the magnitude of this effect, and 2) assess the influence of demographic and methodological variables on this effect. The preregistered protocol (CRD42018087138) included a search of EBSCOhost, Pubmed, and Embase online databases and reference lists to identify cross-sectional studies comparing frail and non-frail or robust older adults (60+) on cognitive performance. In total, 42 effects were retrieved from 38 studies, expressed as Hedges' g, and pooled based on a random-effects model. Results indicated an overall significant, negative effect of frailty status on cognitive function among tests of global cognitive function (g = 0.734: 95% CI = 0.601-0.867) and individual cognitive domains (g = 0.439: 95% CI = 0.342-0.535). Age, frailty assessment used, and cognitive status of the sample did not significantly moderate the overall effect. Post-hoc moderator analysis revealed that difference in mean age of frail and robust groups significantly moderated the overall effect (R = 0.38, β = .0974, 95% CI = 0.0537-0.141). Implications for future research are discussed. 10.1007/s11065-021-09497-1
Cognitive Frailty as a Predictor of Future Falls in Older Adults: A Systematic Review and Meta-Analysis. Journal of the American Medical Directors Association OBJECTIVES:To examine the association between cognitive frailty and the risk of future falls among older adults. DESIGN:Systematic review and meta-analysis. SETTING AND PARTICIPANTS:Older people aged ≥60 years with cognitive frailty from community, hospital, or both. METHODS:PubMed, EMBASE, Web of Science, the Cochrane Library, Wanfang Database, China Knowledge Resource Integrated Database (CNKI), Weipu Database (VIP), and Chinese Biomedical Database (CBM) were searched for relevant studies published from the inception of the database until June 14, 2022. Stata 16.0 software was used to perform the meta-analysis. A random effects model was used to pool the prevalence of falls in older adults over age 60 years with cognitive frailty and the strength of the association between cognitive frailty and falls [odds ratios (ORs) and 95% CIs]. Quality assessment, heterogeneity, and sensitivity analyses were also conducted. A study protocol was registered in PROSPERO (CRD42022331323). RESULTS:The review included 18 studies in qualitative synthesis, 14 of which were in meta-analysis. Eleven sets of cross-sectional data involving 23,025 participants and 5 sets of longitudinal data involving 11,924 participants were used in the meta-analysis. The results showed that the overall prevalence of falls in 1742 people with cognitive frailty was 36.3% (95% CI 27.9-44.8, I = 93.4%). Longitudinal study results showed that cognitively frail individuals had a higher risk of falls (OR 3.02, 95% CI 2.11-4.32, I = 0.0%, P = .406), compared to robust participants without cognitive impairment; physically frail people (alone) had a moderate risk of falls (OR 2.16, 95% CI 1.42-3.30, I = 9.7%, P = .351); cognitively impaired people (alone) had a lower risk of falls (OR 1.36, 95% CI 1.03-1.79, I = 0.0%, P = .440). Among cross-sectional studies, cognitive frailty was associated with the risk of falls (OR 2.74, 95% CI 2.20-3.40, I = 53.1%, P = .019). Although high heterogeneity was noted among 11 cross-sectional studies reporting ORs, the sensitivity analysis showed that no single study significantly affected the final pooled results. CONCLUSIONS AND IMPLICATIONS:This systematic review and meta-analysis confirms the findings that cognitive frailty was demonstrated to be a significant predictor of future falls in older adults. However, further prospective investigations are warranted. 10.1016/j.jamda.2022.10.011
The association of cognitive frailty and the risk of falls among older adults: A systematic review and meta-analysis. International journal of nursing practice BACKGROUND:Falls lead to numerous negative health outcomes and jeopardize the physical function and quality of life in older adults. Cognitive impairment and physical frailty were found to be associated with the risk of falls, but there was no systematic review that estimated the association between cognitive frailty and the risk of falls. METHODS:A systematic literature search of the cross-sectional, cohort, and case-control studies in Cochrane library, Scopus, CINAHL, EMBASE and PsycINFO was conducted on 3 September 2021. Study quality was assessed by using the Joanna Briggs Institute critical appraisal tool. A random effects meta-analysis was performed to estimate the odds ratio of the incidence of falls in older adults with cognitive frailty. RESULTS:Seven studies were included. The overall quality of the included studies was acceptable. The meta-analysis of cohort studies showed older adults aged 60 and above with cognitive frailty had a pooled odds ratio of 1.45 (95% confidence interval 1.30, 1.61) for at least one fall compared with those without cognitive frailty. The meta-analysis of cross-sectional studies showed that the odds of older adults with cognitive frailty experiencing at least one fall was 1.64 times (95% confidence interval 1.51, 1.79) higher than those without cognitive frailty. CONCLUSION:The association between cognitive frailty and the risk of falls is statistically significant. Timely detection of cognitive frailty is essential especially in the community nursing level for preventing falls. 10.1111/ijn.13181
Association of cognitive frailty and abdominal obesity with cardiometabolic multimorbidity among middle-aged and older adults: A longitudinal study. Journal of affective disorders BACKGROUND:Cognitive frailty and abdominal obesity are deemed to be important targets for disease prevention. However, a possible cardiometabolic multimorbidity (CMM) link with cognitive frailty and abdominal obesity is unknown. The aim of this study was to investigate the association of cognitive frailty and abdominal obesity with CMM in the middle-aged and older people. METHODS:The sample comprised 11,503 participants aged 45 and over from the China Health and Retirement Longitudinal Study (CHARLS) 2011. Cognitive frailty was defined as the coexisting cognitive impairment and physical frailty. Abdominal obesity was assessed using waist circumference. CMM was defined as the presence of two or more cardiometabolic diseases (CMDs), including diabetes, heart disease, and stroke. A total of 9177 participants without CMM recruited from CHARLS 2011 and were followed up in 2018. RESULTS:Compared with 0 CMD, coexisting cognitive frailty and abdominal obesity was associated with the risk of 1 CMD (OR: 1.734, 95 % CI: 1.133-2.655), and ≥ 2 CMDs (OR: 7.218, 95%CI: 3.216-16.198). Longitudinal analysis showed that individuals with both cognitive frailty and abdominal obesity (HR: 2.162, 95%CI: 1.032-4.531) were more likely to have new onset CMM than cognitive frailty alone peers (HR: 1.667, 95 % CI: 0.721-3.853). Among the participants with first CMD, the likelihood of CMM was substantially higher in the co-existence of cognitive frailty and abdominal obesity (HR: 3.073, 95%CI: 1.254-7.527) than in the abdominal obesity alone (HR: 1.708, 95%CI: 1.201-2.427). Cognitive frailty alone was not significantly associated with CMM. CONCLUSION:Cognitive frailty is not independently associated with the risk of CMM, but cognitive frailty and abdominal obesity together has a greater risk of CMM. 10.1016/j.jad.2023.08.067
Understanding cognitive frailty in aging adults: prevalence, risk factors, pathogenesis and non-pharmacological interventions. Bratislavske lekarske listy The worldwide increase in the aged population raises health concerns for elderly individuals. Cognitive frailty of the elderly (apart from those suffering from Alzheimer´s disease or other type of dementia) is a complex construct associated with aging, which is composed of physical and cognitive components, while physical frailty and cognitive impairment mutually affect each other. Although the prevalence of cognitive frailty in community-dwelling older adults without neurodegenerative disease is low, it can rise dramatically in clinical settings. Early identification of this condition can contribute to delaying the adverse outcomes that lead to higher mortality rates. This review aims to define cognitive frailty, its prevalence, risk factors, and pathogenesis, while highlighting the need for further research on identification, prevention, and non-pharmacological management of cognitive frailty in older adults in view of promoting healthy aging and secondary prevention strategies for dementia (Fig. 1, Ref. 93). Keywords: cognitive frailty, older adults, risk factors, nutrition, exercise. 10.4149/BLL_2023_100
Effects of Resistance Exercise Training on Cognitive Function and Physical Performance in Cognitive Frailty: A Randomized Controlled Trial. The journal of nutrition, health & aging BACKGROUND:Cognitive frailty is defined as the presence of both physical frailty and cognitive impairment (clinical dementia rating score = 0.5), in the absence of dementia. It is characterized by concurrent physical frailty and potentially reversible cognitive impairment. In this study, we sought to elucidate the effects of high-speed resistance exercise training on cognitive function and physical performance in older adults with cognitive frailty. METHODS:We conducted a parallel-group, randomized controlled trial involving community-living older adults with cognitive frailty. The participants' mean age was 73.9 (± 4.3 SD) years, and 69.8% (n=30) were female. Two different 4-month interventions included high-speed resistance exercise training group (n=22) and a control group (balance and band stretching, n=23). Frailty score, cognitive function (memory, processing speed, cognitive flexibility, working memory, executive function), physical function (SPPB, TUG, gait speed), and muscle strength (grip strength, knee extension strength) were assessed at baseline, 8 weeks, and 16 weeks. RESULTS:Statistical analysis showed that exercise improved performance significantly in the tests for cognitive function (processing speed and executive function, both p < 0.05), physical function (SPPB, TUG, gait speed, both p < 0.05), and muscle strength (grip strength, knee extension strength, both p < 0.05). However, no significant changes in frailty score were observed between intervention and either control group (p < 0.05). CONCLUSION:In conclusion, our findings indicate that high-speed resistance exercise training approaches are effective in improving cognitive function and physical performance in older adults with cognitive frailty. This study shows that it is feasible to identify older adults with cognitive frailty in the community and primary care setting for effective intervention to reduce their level of frailty and cognitive impairment. 10.1007/s12603-018-1090-9
Prevalence of cognitive frailty among community-dwelling older adults: A systematic review and meta-analysis. Qiu Yiming,Li Guichen,Wang Xinxin,Zheng Lufang,Wang Cong,Wang Chunyan,Chen Li International journal of nursing studies OBJECTIVE:The aim of this systematic review and meta-analysis was to investigate the pooled prevalence of cognitive frailty among community-dwelling older adults and provide evidence-based support for policy-makers planning health and social care policies. DESIGN:A systematic review and meta-analysis. METHODS:PubMed, Web of Science, Embase and the Cochrane Library were systematically searched from their inception to December 10, 2020. Descriptive studies (cross-sectional studies or population-based longitudinal studies) and cohort studies were available. Participants were community-dwelling older adults aged 60 years and above. Two researchers independently screened the literature, extracted the data and evaluated the quality of the included studies. All statistical analyses were conducted using Stata 15.0. RESULTS:We screened 2815 records, among which 24 studies met the inclusion criteria and were included in the review. The pooled prevalence of cognitive frailty was 9% (95% CI: 8%-11%, I = 99.3%). The results of the subgroup analysis showed that the pooled prevalence of cognitive frailty was 11% (95% CI: 9%-14%) in men and 15% (95% CI: 11%-19%) in women. The pooled prevalence of cognitive frailty based on the descriptive studies and cohort studies was 7% (95% CI: 5%-9%) and 17% (95% CI: 11%-22%), respectively. The pooled estimates of cognitive frailty prevalence were 6% (95% CI: 4%-8%) from 2012 to 2017 and 11% (95% CI: 9%-14%) from 2018 to 2020. CONCLUSIONS:This systematic review analyzed the available literature and revealed that the pooled prevalence of cognitive frailty among community-dwelling older adults was 9%. The stratified analysis showed that the prevalence of cognitive frailty was higher in older women. In addition, the prevalence has increased in recent years, which has important implications for adapting health and social care systems. 10.1016/j.ijnurstu.2021.104112
Management of cognitive frailty: A network meta-analysis of randomized controlled trials. International journal of geriatric psychiatry OBJECTIVES:We aimed to compare the effectiveness of interventions in cognitive function and frailty status and rank these interventions. METHODS:Data Sources-We searched PubMed, Embase, CINAHL, PsycINFO, Web of Science, Cochrane Library, Central Register of Controlled Trials (CENTRAL), CNKI, Wanfang, VIP and Google scholar. Data synthesis-The risk of bias was assessed using the Cochrane risk bias assessment tool. Statistical heterogeneity was assessed using the Chi-square test and quantified by I . The results were pooled using the standardized mean difference (SMD). The rank probability for each intervention was calculated using the surface under the cumulative ranking curve (SUCRA). Additionally, the quality of the evidence was evaluated using the GRADE approach. RESULTS:A total of 10 randomized controlled trials (RCTs) involving 1110 patients were included in our analysis. The network map of cognitive function comprised 9 RCTs with 1347 participants, examining eight different interventions. Nutritional support (SUCRA = 99.9%, SMD = 3.02, 95% CI: 2.53, 3.51) may be the most effective intervention to improve cognitive function. The network map of frailty (including 9 RCTs with 1017 participants and 9 interventions) suggested that multicomponent exercises (SUCRA = 96.4%, SMD = -5.10, 95% CI: -5.96, -4.23) tended to have a greater effect. CONCLUSIONS:Community-based multicomponent exercises have shown significant benefits for improving cognitive function and frailty status in older adults, with moderate certainty. For hospitalized older patients with Cognitive frailty (CF), current evidence suggests that nutritional support yields the most improvement. Additionally, aerobic exercise and dual-task training have proven effective in managing CF. Further studies are needed to validate these preliminary findings and exploring more accessible and effective physical and cognitive interventions to prevent CF in aging. 10.1002/gps.5994
Exercise interventions for older people with cognitive frailty-a scoping review. BMC geriatrics BACKGROUND:As the global population ages, the issue of frailty in older people is gaining international attention. As one of the major subtypes of frailty, cognitive frailty is a heterogeneous clinical manifestation characterised by the co-existence of physical decline and cognitive impairment. The occurrence of cognitive frailty increases the risk of adverse health outcomes in older people, affecting their daily functioning and quality of life. However, cognitive frailty is a reversible state, and many interventions have been explored, with exercise interventions playing an important role in the non-pharmacological management of cognitive frailty. This study describes and summarises current exercise interventions for older people with cognitive frailty (including parameters such as mode, frequency and duration of exercise) and identifies the limitations of existing studies to inform future exercise interventions for older people with cognitive frailty. METHODS:Using a scoping review approach, Chinese and English literature published in PubMed, Web of Science, Cochrane Library, Embase, China Knowledge Network, Wanfang Database, China Biomedical Literature Database (SinoMed) and Vipshop from April 2013, when the definition of cognitive frailty first appeared, to August 2021 was searched to select studies related to exercise interventions for this group, extract information from the included literature, and summarise and report the findings. RESULTS:Nine RCT trial studies and one quasi-experiment study were included, for a total of 10 articles. The exercise modalities involved walking, brisk walking, Otago exercise, resistance exercise, balance training, flexibility training and Baduanjin, etc.; the intensity of exercise was based on individualised guidance and graded exercise intensity; the frequency of exercise was mostly 3-4 times/week; the duration of exercise was mostly 30-60 min/time; compared to the control group, the included studies showed statistically significant improvements in cognitive function, frailty status, and depression with the exercise intervention. CONCLUSION:There is a paucity of evidence on exercise interventions for older people with cognitive frailty. The evidence provided in this study suggests that exercise interventions may be beneficial for older people with cognitive frailty. However, the existing studies suffer from small sample sizes, short intervention periods, inadequate monitoring of the entire exercise process, and non-uniformity in the assessment of exercise effects. More randomized controlled trials should be conducted in the future to explore the most effective, low-cost and simple interventions to meet the needs of the older people with cognitive frailty. 10.1186/s12877-022-03370-3