Frailty syndrome and all-cause mortality in demented patients: the Italian Longitudinal Study on Aging

Memory Unit, Center for Aging Brain, Department of Geriatrics, University of Bari-Policlinico, Italy.
Age (Impact Factor: 3.45). 04/2011; 34(2):507-17. DOI: 10.1007/s11357-011-9247-z
Source: PubMed


Cognition has already been considered as a component of frailty, and it has been demonstrated that it is associated with adverse health outcomes. We estimated the prevalence of frailty syndrome in an Italian older population and its predictive role on all-cause mortality and disability in nondemented subjects and in demented patients. We evaluated 2,581 individuals recruited from the Italian Longitudinal Study on Aging, a population-based sample of 5,632 subjects, aged 65-84 years old. Participants received identical baseline evaluation at the 1st survey (1992-1993) and were followed at 2nd (1995-1996) and 3rd survey (2000-2001). A phenotype of frailty according to partially modified measurement of Cardiovascular Health Study criteria was operationalized. The overall prevalence of frailty syndrome in this population-based study was 7.6% (95% confidence interval (CI) 6.55-8.57). Frail individuals noncomorbid or nondisable were 9.1% and 39.3%, respectively, confirming an overlap but not concordance in the co-occurrence among these conditions. Frailty was associated with a significantly increased risk of all-cause mortality over a 3-year follow-up (hazard ratio (HR) 1.98, 95% confidence interval (CI) 1.52-2.60) and over a 7-year follow-up (HR 1.74, 95% CI 1.44-2.16), but with significant increased risk of disability only over a 3-year follow-up (HR 1.32, 95% CI 1.06-1.86 over a 3-year follow-up and HR 1.16, 95% CI 0.88-1.56 over a 7-year follow-up). Frail demented patients were at higher risk of all-cause mortality over 3- (HR 3.33, 95% CI 1.28-8.29) and 7-year follow-up periods (HR 1.89, 95% CI 1.10-3.44), but not of disability. Frailty syndrome was a short-term predictor of disability in nondemented older subjects and short- and long-term predictor of all-cause mortality in nondemented and demented patients.

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Available from: Emanuele Scafato, Oct 09, 2015
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    • "In particular, in the last three years, a series of cross-sectional [33] [34] [35] [36] [37] [38] [39] [40] [41] [42] [43] [44] [45] [46] [47] [48] [49] [50] [51] and longitudinal studies "
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    ABSTRACT: Late-life cognitive disorders may be prevented by influencing age-related conditions such as frailty, characterized by decreased resistance to stressors and increased risk for adverse health outcomes. In the present review article, we examined clinical and epidemiological studies investigating the possible role of different frailty models in modulating the risk of Alzheimer's disease (AD), dementia, vascular dementia (VaD), mild cognitive impairment (MCI), and late-life cognitive impairment/decline that have been published over the past 3 years. Both deficit accumulation and physical frailty models were associated with late-life cognitive impairment/decline, incident dementia, AD, MCI, VaD, non-AD dementias, and AD pathology, proposing cognitive frailty as a new clinical construct with coexisting physical frailty and cognitive impairment in nondemented older subjects. Two subtypes of this new clinical condition have been recently proposed: " potentially reversible " cognitive frailty and " reversible " cognitive frailty. The physical factors should be physical prefrailty and frailty, while the cognitive impairment of potentially reversible cognitive frailty should be MCI (Clinical Dementia rating Scale = 0.5), while the cognitive impairment of reversible cognitive frailty should be pre-MCI Subjective Cognitive Decline (SCD), as recently proposed by the SCD Initiative Working Group. The mechanisms underlying the cognitive-frailty link are multifactorial and vascular, inflammatory, nutritional, and metabolic influences may be of major relevance. Considering both physical frailty and cognition as a single complex phenotype may be crucial in the prevention of dementia and its subtypes with secondary preventive trials on cognitive frail older subjects.
    Journal of Alzheimer's disease: JAD 08/2015; 47(4):793-813. DOI:10.3233/JAD-150358 · 4.15 Impact Factor
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    • "Frailty at baseline was associated with the incidence of AD and dementia of all types over 5-and 10-year intervals Solfrizzi et al., 2012 Population-based, longitudinal study (3 and 7 years); 2581 individuals from the ILSA sample of 5632 subjects aged 65–84 years Physical frailty phenotype operalizionated slightly modifying the CHS criteria and diagnosis of dementia according to the DSM-III-R, NINCDS-ADRDA, and ICD-10 criteria Lower cognition was associated with physical frailty. Frail demented patients were at higher risk of all-cause mortality over 3- and 7-years follow-up periods, but not of disability Cano et al., 2012 Population-based, longitudinal study (10 years); 1815 Mexican American men and women aged 67 years and older from the H-EPESE "
    Frontiers in Aging Neuroscience 08/2014; 6:221. DOI:10.3389/fnagi.2014.00221 · 4.00 Impact Factor
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    • "Frailty is a geriatric syndrome operationally defined by Fried and colleagues as the presence of slowness, weakness, exhaustion, low physical activity, and unintentional weight loss [1]. Because people with frailty have higher risks of subsequent disability, falls, hospitalization, and death than those without frailty [1-3], the prevention of frailty is important in preventing these adverse health outcomes and in meeting the challenge of successful aging in rapidly aging countries, including Japan [4]. Interventions aimed at improving frailty in frail subjects have been conducted [5,6]. "
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    ABSTRACT: Protein intake has been inversely associated with frailty. However, no study has examined the effect of the difference of protein sources (animal or plant) or the amino acid composing the protein on frailty. Therefore, we examined the association of protein and amino acid intakes with frailty among elderly Japanese women. A total of 2108 grandmothers or acquaintances of dietetic students aged 65 years and older participated in this cross-sectional multicenter study, which was conducted in 85 dietetic schools in 35 prefectures of Japan. Intakes of total, animal, and plant protein and eight selected amino acids were estimated from a validated brief-type self-administered diet history questionnaire and amino acid composition database. Frailty was defined as the presence of three or more of the following four components: slowness and weakness (two points), exhaustion, low physical activity, and unintentional weight loss. The number of subjects with frailty was 481 (23%). Adjusted ORs (95% CI) for frailty in the first, second, third, fourth, and fifth quintiles of total protein intake were 1.00 (reference), 1.02 (0.72, 1.45), 0.64 (0.45, 0.93), 0.62 (0.43, 0.90), and 0.66 (0.46, 0.96), respectively (P for trend = 0.001). Subjects categorized to the third, fourth, and fifth quintiles of total protein intake (>69.8 g/d) showed significantly lower ORs than those to the first quintile (all P <0.03). The intakes of animal and plant protein and all selected amino acids were also inversely associated with frailty (P for trend <0.04), with the multivariate adjusted OR in the highest compared to the lowest quintile of 0.73 for animal protein and 0.66 for plant protein, and 0.67-0.74 for amino acids, albeit that the ORs for these dietary variables were less marked than those for total protein. Total protein intake was significantly inversely associated with frailty in elderly Japanese women. The association of total protein with frailty may be observed regardless of the source of protein and the amino acid composing the protein.
    Nutrition Journal 12/2013; 12(1):164. DOI:10.1186/1475-2891-12-164 · 2.60 Impact Factor
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