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; Emmeline Ayers

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

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, Emmeline Ayers

Neurology

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

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.

Original language	English (US)
Pages (from-to)	1795-1809
Number of pages	15
Journal	Journal of Alzheimer's Disease
Volume	84
Issue number	4
DOIs	https://doi.org/10.3233/JAD-215111
State	Published - 2021

Keywords

Cognition
cohort study
frailty
mortality

ASJC Scopus subject areas

Neuroscience(all)
Clinical Psychology
Geriatrics and Gerontology
Psychiatry and Mental health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.3233/JAD-215111

Cite this

@article{b80fd80e27f44664b086e131e153fce0,

title = "A Longitudinal Study on the Association of Interrelated Factors among Frailty Dimensions, Cognitive Domains, Cognitive Frailty, and All-Cause Mortality",

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",

author = "Chen, {Jen Hau} and Shih, {Hua San} and Jennifer Tu and Chiou, {Jeng Min} and Chang, {Shu Hui} and Hsu, {Wei Li} and Lai, {Liang Chuan} and Chen, {Ta Fu} and Chen, {Yen Ching} and Emmeline Ayers",

note = "Funding Information: Taken together, we found that physical prefrailty increased faster than psychosocial prefrailty over time, which had not been previously reported. In addition, physical and psychosocial frailty were associated with different cognitive domains, which suggests the involvement of different biological mechanisms. Last, this study, for the first time, explored the extended definitions of cognitive frailty, of which “MCI-psychosocial frailty,” “MCI-global frailty,” and “impaired verbal fluency-global frailty” outperformed traditional cognitive frailty for predicting all-cause mortality. In summary, our findings suggested that the different frailty dimensions were associated with the impairment of different cognitive domains, so did their combination with all-cause mortality over time. Prevention toward multiple frailty dimensions (e.g., physical exercise, psychological, and social support) may effectively reduce cogni- This study was supported by the Ministry of Science and Technology in Taiwan (100-2314-B-002-103, 101-2314-B-002-126-MY3, 103-2314-B-002-033-MY3, 104-2314-B-002-038-MY3, 107-23 14-B-002-186-MY3, 107-2314-B-002-230, and 108-2314-B-002-128-MY2). We thank Prof. Marion Lee and Prof. Wen-Chung Lee for scientific suggestions, and the staff of the Sequencing Core, Department of Medical Research, National Taiwan University Hospital for technical support. Publisher Copyright: {\textcopyright} 2021 - IOS Press. All rights reserved.",

year = "2021",

doi = "10.3233/JAD-215111",

language = "English (US)",

volume = "84",

pages = "1795--1809",

journal = "Journal of Alzheimer's Disease",

issn = "1387-2877",

publisher = "IOS Press",

number = "4",

}

TY - JOUR

T1 - A Longitudinal Study on the Association of Interrelated Factors among Frailty Dimensions, Cognitive Domains, Cognitive Frailty, and All-Cause Mortality

AU - Chen, Jen Hau

AU - Shih, Hua San

AU - Tu, Jennifer

AU - Chiou, Jeng Min

AU - Chang, Shu Hui

AU - Hsu, Wei Li

AU - Lai, Liang Chuan

AU - Chen, Ta Fu

AU - Chen, Yen Ching

AU - Ayers, Emmeline

N1 - Funding Information: Taken together, we found that physical prefrailty increased faster than psychosocial prefrailty over time, which had not been previously reported. In addition, physical and psychosocial frailty were associated with different cognitive domains, which suggests the involvement of different biological mechanisms. Last, this study, for the first time, explored the extended definitions of cognitive frailty, of which “MCI-psychosocial frailty,” “MCI-global frailty,” and “impaired verbal fluency-global frailty” outperformed traditional cognitive frailty for predicting all-cause mortality. In summary, our findings suggested that the different frailty dimensions were associated with the impairment of different cognitive domains, so did their combination with all-cause mortality over time. Prevention toward multiple frailty dimensions (e.g., physical exercise, psychological, and social support) may effectively reduce cogni- This study was supported by the Ministry of Science and Technology in Taiwan (100-2314-B-002-103, 101-2314-B-002-126-MY3, 103-2314-B-002-033-MY3, 104-2314-B-002-038-MY3, 107-23 14-B-002-186-MY3, 107-2314-B-002-230, and 108-2314-B-002-128-MY2). We thank Prof. Marion Lee and Prof. Wen-Chung Lee for scientific suggestions, and the staff of the Sequencing Core, Department of Medical Research, National Taiwan University Hospital for technical support. Publisher Copyright: © 2021 - IOS Press. All rights reserved.

PY - 2021

Y1 - 2021

N2 - 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.

AB - 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.

KW - Cognition

KW - cohort study

KW - frailty

KW - mortality

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JO - Journal of Alzheimer's Disease

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

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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