M S Chong1, L Tay, M Chan, W S Lim, R Ye, W C Wong, J P Lim, E K Tan, Y Y Ding. 1. Dr Chong Mei Sian, Senior Consultant, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, S308433, Singapore, Email address: Mei_Sian_Chong@ttsh.com.sg, Telephone: (65)63596251, Fax number: (65)63596294.
Abstract
BACKGROUND: It is unclear if the complex relationship between physical frailty and cognition varies across the severity of cognitive impairment. OBJECTIVES: We therefore aimed to explore if there are stage-specific differences in the relationship between frailty and cognitive impairment. DESIGN: Cross-sectional study. SETTING: A specialist Memory Clinic setting. PARTICIPANTS: Mild cognitive impairment (MCI) and mild-moderate Alzheimer's disease (AD) community-dwelling subjects. MEASUREMENTS: We obtained data on demographics, multimorbidity, cognition-related measures, nutrition, neuroimaging measures, muscle mass, Vitamin D level, apolipoprotein - e (APOE) status and physical performance measures. Frailty measures of gait speed, hand grip strength, question on exhausation and weight loss, classified subjects according to the Buchmann criteria into non-frail and frail categories. RESULTS: Forty-five MCI, 64 mild AD and 13 moderate AD subjects (total n=122) were studied. The prevalence of frailty for MCI, mild AD and moderate AD was 35.6%, 21.9% and 46.2% respectively, indicating a u-shaped trend. Significant differences were noted in fatigue, grip strength and gait speed frailty sub-items. Significant correlation of frailty with cognition were noted in mild-moderate AD (Spearman's coefficient 0.26, p<0.05) but not in MCI (0.01, p=0.6). No other differences in multimorbidity, Vitamin D, APOE, nutritional measures, white matter lesions were observed. Sarcopenia interestingly had an inverse stage-specific relationship unlike frailty. CONCLUSIONS: Our results suggest a U-shaped relationship between frailty and cognition, characterized by initial dissociation with cognitive impairment and subsequent convergence at later stages. Future studies incorporating immune markers and endocrine pathways with longitudinal follow-up could potentially elucidate intermediary mechanisms in the frailty cascade.
BACKGROUND: It is unclear if the complex relationship between physical frailty and cognition varies across the severity of cognitive impairment. OBJECTIVES: We therefore aimed to explore if there are stage-specific differences in the relationship between frailty and cognitive impairment. DESIGN: Cross-sectional study. SETTING: A specialist Memory Clinic setting. PARTICIPANTS: Mild cognitive impairment (MCI) and mild-moderate Alzheimer's disease (AD) community-dwelling subjects. MEASUREMENTS: We obtained data on demographics, multimorbidity, cognition-related measures, nutrition, neuroimaging measures, muscle mass, Vitamin D level, apolipoprotein - e (APOE) status and physical performance measures. Frailty measures of gait speed, hand grip strength, question on exhausation and weight loss, classified subjects according to the Buchmann criteria into non-frail and frail categories. RESULTS: Forty-five MCI, 64 mild AD and 13 moderate AD subjects (total n=122) were studied. The prevalence of frailty for MCI, mild AD and moderate AD was 35.6%, 21.9% and 46.2% respectively, indicating a u-shaped trend. Significant differences were noted in fatigue, grip strength and gait speed frailty sub-items. Significant correlation of frailty with cognition were noted in mild-moderate AD (Spearman's coefficient 0.26, p<0.05) but not in MCI (0.01, p=0.6). No other differences in multimorbidity, Vitamin D, APOE, nutritional measures, white matter lesions were observed. Sarcopenia interestingly had an inverse stage-specific relationship unlike frailty. CONCLUSIONS: Our results suggest a U-shaped relationship between frailty and cognition, characterized by initial dissociation with cognitive impairment and subsequent convergence at later stages. Future studies incorporating immune markers and endocrine pathways with longitudinal follow-up could potentially elucidate intermediary mechanisms in the frailty cascade.
Authors: Mei Sian Chong; Laura Tay; Mark Chan; Wee Shiong Lim; Ruijing Ye; Eng King Tan; Yew Yoong Ding Journal: BMC Geriatr Date: 2015-12-29 Impact factor: 3.921