Feng Liang, Nyunt Ma Shwe Zin, Gao Qi, Feng Lei, Lee Tih Shih, Tsoi Tung, Chong Mei Sian, Lim Wee Shiong, Collinson Simon, Yap Philip, Yap Keng Bee, Ng Tze Pin
Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore.
Neuroscience and Behavioral Disorders Program, Duke-National University of Singapore Graduate Medical School, Singapore.
J Gerontol A Biol Sci Med Sci. 2017 Mar 1;72(3):369-375. doi: 10.1093/gerona/glw050.
The independent and combined effects of physical and cognitive domains of frailty in predicting the development of mild cognitive impairment (MCI) or dementia are not firmly established.
This study included cross-sectional and longitudinal analyses of physical frailty (Cardiovascular Health Study criteria), cognitive impairment (Mini-Mental State Examination [MMSE]), and neurocognitive disorder (DSM-5 criteria) among 1,575 community-living Chinese older adults from the Singapore Longitudinal Ageing Studies.
At baseline, 2% were frail, 32% were prefrail, and 9% had cognitive impairment (MMSE score < 23). Frailty at baseline was significantly associated with prevalent cognitive impairment. Physical frailty categories were not significantly associated with incident NCD, but continuous physical frailty score and MMSE score showed significant individual and joint associations with incident mild NCD and dementia. Compared with those who were robust and cognitively normal, prefrail or frail old adults without cognitive impairment had no increased risk of incident NCD, but elevated odds of association with incident NCD were observed for robust with cognitive impairment (odds ratio [OR] = 4.04, p < .001), prefrail with cognitive impairment (OR = 2.22, p = .044), and especially for frail with cognitive impairment (OR = 6.37, p = .005). The prevalence of co-existing frailty and cognitive impairment (cognitive frailty) was 1% (95% confidence interval [CI]: 0.5-1.4), but was higher among participants aged 75 and older at 5.0% (95% CI: 1.8-8.1).
Physical frailty is associated with increased prevalence and incidence of cognitive impairment, and co-existing physical frailty and cognitive impairment confers additionally greater risk of incident NCD.
衰弱的身体和认知领域在预测轻度认知障碍（MCI）或痴呆症发展中的独立及联合作用尚未明确。
本研究对来自新加坡纵向老龄化研究的1575名社区居住的中国老年人进行了横断面和纵向分析，内容包括身体衰弱（心血管健康研究标准）、认知障碍（简易精神状态检查表[MMSE]）和神经认知障碍（《精神疾病诊断与统计手册》第5版标准）。
在基线时，2%的人衰弱，32%的人处于衰弱前期，9%的人有认知障碍（MMSE评分<23）。基线时的衰弱与普遍存在的认知障碍显著相关。身体衰弱类别与新发神经认知障碍无显著关联，但连续的身体衰弱评分和MMSE评分显示出与新发轻度神经认知障碍和痴呆症的显著个体及联合关联。与身体健壮且认知正常的人相比，没有认知障碍的衰弱前期或衰弱老年人发生新发神经认知障碍的风险没有增加，但身体健壮且有认知障碍者（比值比[OR]=4.04，p<.001）、衰弱前期且有认知障碍者（OR=2.22，p=.044），尤其是衰弱且有认知障碍者（OR=6.37，p=.005）发生新发神经认知障碍的关联几率升高。衰弱与认知障碍并存（认知衰弱）的患病率为1%（95%置信区间[CI]：0.5-1.4），但在75岁及以上参与者中更高，为5.0%（95%CI：1.8-8.1）。
身体衰弱与认知障碍的患病率和发病率增加相关，身体衰弱与认知障碍并存会使发生新发神经认知障碍的风险进一步增加。
