Nadia M Chu1,2, Karen Bandeen-Roche3,4, Jing Tian3,4, Judith D Kasper5, Alden L Gross1,4,6, Michelle C Carlson1,4,6, Qian-Li Xue1,3,4,7. 1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 2. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. 3. Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 4. Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland. 5. Department of Health Policy and Management, Johns Hopkins Medical Institutions, Baltimore, Maryland. 6. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 7. Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Abstract
BACKGROUND: Frailty and cognitive impairment (CI) are associated and often coexist in older adults. Whether temporal patterns of occurrence reflect different etiologies remain unknown. METHODS: Participants from the National Health and Aging Trends Study were assessed annually (2011-2016) for frailty (Fried's criteria) and CI (bottom quintile of clock drawing test or immediate and delayed recall; proxy-report of dementia diagnosis or AD8 ≥ 2). We used the Fine & Gray model to identify correlates of frailty onset before CI, CI onset before frailty, and frailty-CI co-occurrence, accounting for death as a competing risk. RESULTS: Of 3,848 free of frailty, CI, and dementia at baseline, 2,183 (61.2%) developed neither frailty nor CI during the 5-year follow-up; 343 (8.3%) developed frailty first; 1,014 (24.4%) developed CI first; and 308 (6.0%) developed frailty-CI co-occurrence. Incident dementia, as a marker of underlying neuropathologies, was associated with greater likelihood of CI onset first (subdistribution hazard ratios [SHR] = 2.60, 95% confidence interval [ci] 2.09 to 3.24), and frailty-CI co-occurrence (SHR = 8.77, 95% ci 5.79 to 13.28), but lower likelihood of frailty onset first (SHR = 0.38, 95% ci 0.21 to 0.68). Number of comorbidities was only associated with frailty occurrence first (1 comorbidity: SHR = 2.51, 95% ci 1.15 to 5.47; 4+ comorbidities: SHR = 6.48, 95% ci 2.78 to 15.48). CONCLUSIONS: Different patterns of frailty and CI occurrence exist, and dementia-related pathologies and comorbidities may be important correlates of order of emergence, potentially reflecting different etiologies. Future investigation into relationships between these patterns and dementia subtypes and related pathologies is needed to elucidate etiologic pathways and to provide new targets for prevention, intervention, and risk screening.
BACKGROUND: Frailty and cognitive impairment (CI) are associated and often coexist in older adults. Whether temporal patterns of occurrence reflect different etiologies remain unknown. METHODS:Participants from the National Health and Aging Trends Study were assessed annually (2011-2016) for frailty (Fried's criteria) and CI (bottom quintile of clock drawing test or immediate and delayed recall; proxy-report of dementia diagnosis or AD8 ≥ 2). We used the Fine & Gray model to identify correlates of frailty onset before CI, CI onset before frailty, and frailty-CI co-occurrence, accounting for death as a competing risk. RESULTS: Of 3,848 free of frailty, CI, and dementia at baseline, 2,183 (61.2%) developed neither frailty nor CI during the 5-year follow-up; 343 (8.3%) developed frailty first; 1,014 (24.4%) developed CI first; and 308 (6.0%) developed frailty-CI co-occurrence. Incident dementia, as a marker of underlying neuropathologies, was associated with greater likelihood of CI onset first (subdistribution hazard ratios [SHR] = 2.60, 95% confidence interval [ci] 2.09 to 3.24), and frailty-CI co-occurrence (SHR = 8.77, 95% ci 5.79 to 13.28), but lower likelihood of frailty onset first (SHR = 0.38, 95% ci 0.21 to 0.68). Number of comorbidities was only associated with frailty occurrence first (1 comorbidity: SHR = 2.51, 95% ci 1.15 to 5.47; 4+ comorbidities: SHR = 6.48, 95% ci 2.78 to 15.48). CONCLUSIONS: Different patterns of frailty and CI occurrence exist, and dementia-related pathologies and comorbidities may be important correlates of order of emergence, potentially reflecting different etiologies. Future investigation into relationships between these patterns and dementia subtypes and related pathologies is needed to elucidate etiologic pathways and to provide new targets for prevention, intervention, and risk screening.
Authors: Shelly L Gray; Melissa L Anderson; Rebecca A Hubbard; Andrea LaCroix; Paul K Crane; Wayne McCormick; James D Bowen; Susan M McCurry; Eric B Larson Journal: J Gerontol A Biol Sci Med Sci Date: 2013-02-18 Impact factor: 6.053
Authors: Karen Bandeen-Roche; Christopher L Seplaki; Jin Huang; Brian Buta; Rita R Kalyani; Ravi Varadhan; Qian-Li Xue; Jeremy D Walston; Judith D Kasper Journal: J Gerontol A Biol Sci Med Sci Date: 2015-08-21 Impact factor: 6.053
Authors: Alden L Gross; Qian-Li Xue; Karen Bandeen-Roche; Linda P Fried; Ravi Varadhan; Mara A McAdams-DeMarco; Jeremy Walston; Michelle C Carlson Journal: J Gerontol A Biol Sci Med Sci Date: 2016-04-15 Impact factor: 6.053
Authors: E Kelaiditi; M Cesari; M Canevelli; G Abellan van Kan; P-J Ousset; S Gillette-Guyonnet; P Ritz; F Duveau; M E Soto; V Provencher; F Nourhashemi; A Salvà; P Robert; S Andrieu; Y Rolland; J Touchon; J L Fitten; B Vellas Journal: J Nutr Health Aging Date: 2013-09 Impact factor: 4.075
Authors: Nadia M Chu; Qian-Li Xue; Mara A McAdams-DeMarco; Michelle C Carlson; Karen Bandeen-Roche; Alden L Gross Journal: Age Ageing Date: 2021-09-11 Impact factor: 12.782
Authors: Nadia M Chu; Karen Bandeen-Roche; Qian-Li Xue; Michelle C Carlson; A Richey Sharrett; Alden L Gross Journal: J Gerontol A Biol Sci Med Sci Date: 2021-08-13 Impact factor: 6.591
Authors: Nadia M Chu; Xiaomeng Chen; Alden L Gross; Michelle C Carlson; Jacqueline M Garonzik-Wang; Silas P Norman; Aarti Mathur; Maheen Z Abidi; Daniel C Brennan; Dorry L Segev; Mara A McAdams-DeMarco Journal: Clin Transplant Date: 2021-08-03 Impact factor: 3.456