Frailty is associated with worse cognitive functioning in older adults

Chunmei Li; Song Ge; Yueheng Yin; Chong Tian; Yongxia Mei; Peijin Han

doi:10.3389/fpsyt.2023.1108902

Frailty is associated with worse cognitive functioning in older adults

Front Psychiatry. 2023 Feb 1:14:1108902. doi: 10.3389/fpsyt.2023.1108902. eCollection 2023.

Authors

Chunmei Li¹, Song Ge², Yueheng Yin³, Chong Tian⁴, Yongxia Mei⁵, Peijin Han⁶

Affiliations

¹ Infection Clinic, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
² Department of Natural Sciences, University of Houston-Downtown, Houston, TX, United States.
³ School of Nursing, Nanjing Medical University, Nanjing, China.
⁴ School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁵ School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China.
⁶ Department of Computational Medicine and Bioinformatics, Medical School, University of Michigan, Ann Arbor, MI, United States.

Abstract

Introduction: Frailty and impaired cognitive functioning often co-occur in older adults and are associated with adverse health outcomes. However, their relationship is unclear. This study sought to examine the association of frailty status with cognitive functioning in older adults.

Method: The study population consisted of 2,296 older adults aged ≥60 from the National Health and Nutrition Examination Survey 2011-2014. Frailty status was measured based on the Fried Phenotype and the participants were categorized into three groups- robust, pre-frailty, and frailty. Cognitive functioning was measured using the Consortium to Establish a Registry for Alzheimer's Disease Word Learning subtest (CERAD-WL) immediate and delayed recall tests, the Animal Fluency test (AFT), and the Digit Symbol Substitution Test (DSST). Test-specific and global cognition z-scores were calculated. Multinomial linear regression models were constructed to examine the association between frailty status (reference: robust) and test-specific and global cognition z-scores. Multiple linear regression models were used to examine the relationship between the number of frailty dimensions and test-specific and global cognition z-scores. All models controlled for age, race/ethnicity, education, total cholesterol level, and systolic blood pressure.

Results: About half of the participants (median age 68 years) were female (49.9%) and non-Hispanic White (48.7%). A quarter (23.3%) of the participants completed some college and above. Multinominal linear regression showed that compared with participants who were robust, those with frailty had worse DSST [β = -0.234, 95% confidence interval (CI): -0.391, -0.078, P = 0.003] and global cognition z scores (β = -0.129, 95% CI -0.233, -0.025, P = 0.02). Multiple linear regression model showed that the number of frailty dimensions was significantly associated with decreased the DSST (β = -0.065, 95% CI -0.103, -0.026, P = 0.001) and global cognition z-scores (β= -0.034, 95% CI -0.06, -0.009, P = 0.009).

Conclusion: Frailty is associated with worse processing speed, sustained attention, working memory, and global cognition in older adults. Prevention and treatment of frailty in older adults may help protect their cognitive functioning. Further, clinicians should consider assessing cognitive functioning, especially processing speed, sustained attention, and working memory, among frail older patients, which may allow early identification and interventions of cognitive impairment.

Keywords: NHANES; cognitive functioning; frailty; older adults; the fried phenotype.