A Longitudinal Study on the Association of Interrelated Factors Among Frailty Dimensions, Cognitive Domains, Cognitive Frailty, and All-Cause Mortality

Jen-Hau Chen; Hua-San Shih; Jennifer Tu; Jeng-Min Chiou; Shu-Hui Chang; Wei-Li Hsu; Liang-Chuan Lai; Ta-Fu Chen; Yen-Ching Chen

doi:10.3233/JAD-215111

A Longitudinal Study on the Association of Interrelated Factors Among Frailty Dimensions, Cognitive Domains, Cognitive Frailty, and All-Cause Mortality

J Alzheimers Dis. 2021;84(4):1795-1809. doi: 10.3233/JAD-215111.

Authors

Jen-Hau Chen¹, Hua-San Shih², Jennifer Tu³, Jeng-Min Chiou⁴, Shu-Hui Chang², Wei-Li Hsu^{5

6}, Liang-Chuan Lai⁷, Ta-Fu Chen⁸, Yen-Ching Chen^{2

9}

Affiliations

¹ Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan.
² Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
³ Duke University School of Medicine, Durham, NC, USA.
⁴ Institute of Statistical Science, Academia Sinica, Nankang District, Taipei, Taiwan.
⁵ School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁶ Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan.
⁷ Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁸ Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
⁹ Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.

PMID: 34719497
DOI: 10.3233/JAD-215111

Abstract

Background: Cognitive frailty integrating impaired cognitive domains and frailty dimensions has not been explored.

Objective: This study aimed to explore 1) associations among frailty dimensions and cognitive domains over time and 2) the extended definitions of cognitive frailty for predicting all-cause mortality.

Methods: This four-year cohort study recruited 521 older adults at baseline (2011-2013). We utilized 1) generalized linear mixed models exploring associations of frailty dimensions (physical dimension: modified from Fried et al.; psychosocial dimension: integrating self-rated health, mood, and social relationship and support; global frailty: combining physical and psychosocial frailty) with cognition (global and domain-specific) over time and 2) time-dependent Cox proportional hazard models assessing associations between extended definitions of cognitive frailty (cognitive domains-frailty dimensions) and all-cause mortality.

Results: At baseline, the prevalence was 3.0% for physical frailty and 37.6% for psychosocial frailty. Greater physical frailty was associated with poor global cognition (adjusted odds ratio = 1.43-3.29, β: -1.07), logical memory (β: -0.14 to -0.10), and executive function (β: -0.51 to -0.12). Greater psychosocial frailty was associated with poor global cognition (β: -0.44) and attention (β: -0.15 to -0.13). Three newly proposed definitions of cognitive frailty, "mild cognitive impairment (MCI)-psychosocial frailty," "MCI-global frailty," and "impaired verbal fluency-global frailty," outperformed traditional cognitive frailty for predicting all-cause mortality (adjusted hazard ratio = 3.49, 6.83, 3.29 versus 4.87; AIC = 224.3, 221.8, 226.1 versus 228.1).

Conclusion: Notably, extended definitions of cognitive frailty proposed by this study better predict all-cause mortality in older adults than the traditional definition of cognitive frailty, highlighting the importance of psychosocial frailty to reduce mortality in older adults.

Keywords: Cognition; cohort study; frailty; mortality.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cognition / physiology*
Cognitive Dysfunction / psychology*
Cohort Studies
Executive Function
Female
Frailty / psychology*
Geriatric Assessment*
Humans
Longitudinal Studies
Male
Mortality*