Godin Judith, Armstrong Joshua J, Rockwood Kenneth, Andrew Melissa K
J Alzheimers Dis. 2017;58(1):231-242. doi: 10.3233/JAD-161280.
Frailty has been considered an antecedent and, to a lesser extent, an outcome of cognitive impairment. Both frailty and cognitive impairment are multiply determined and each is strongly related to age, making it likely that the two interact, especially as people age. In consequence, understanding their interaction and co-occurrence can offer insight into pathophysiology, prevention, and management.
To examine the nature of the relationship between frailty and cognitive impairment using longitudinal data from the Survey of Health Aging and Retirement in Europe (SHARE), assessing for bidirectionality.
We conducted secondary analyses using data from the first two waves of SHARE. The sample (N = 11,941) was randomly split into two halves: one half for model development and one half for model confirmation. We used a 65 deficit Frailty Index and combined 5 cognitive deficits into a global cognitive impairment index. Cross-lagged path analysis within a structural equation modelling framework was used to examine the bi-directional relationship between the two measures.
After controlling for age, sex, social vulnerability, education, and initial cognitive impairment, each 0.10 increase in baseline frailty was associated with a 0.01 increase in cognitive impairment at follow-up (p < 0.001). Likewise, each 0.1 increase in baseline cognitive impairment was associated with a 0.003 increase frailty at follow-up (p < 0.01).
Our findings underscore the importance of considering cognitive impairment in the context of overall health. Many people with dementia are likely to have other health problems, which need to be considered in concert to achieve optimal health outcomes.
衰弱一直被视为认知障碍的一个先行因素，在较小程度上也是认知障碍的一个结果。衰弱和认知障碍都是由多种因素决定的，且二者都与年龄密切相关，这使得它们很可能相互作用，尤其是随着人们年龄的增长。因此，了解它们的相互作用和同时出现的情况有助于洞察病理生理学、预防和管理。
利用欧洲健康、老龄化与退休调查（SHARE）的纵向数据，研究衰弱与认知障碍之间关系的本质，并评估其双向性。
我们使用SHARE前两波的数据进行了二次分析。样本（N = 11941）被随机分成两半：一半用于模型开发，一半用于模型验证。我们使用了一个包含65项指标的衰弱指数，并将5项认知缺陷合并为一个总体认知障碍指数。在结构方程建模框架内进行交叉滞后路径分析，以检验这两个指标之间的双向关系。
在控制了年龄、性别、社会脆弱性、教育程度和初始认知障碍后，基线衰弱每增加0.10，随访时认知障碍就增加0.01（p < 0.001）。同样，基线认知障碍每增加0.1，随访时衰弱就增加0.003（p < 0.01）。
我们的研究结果强调了在整体健康背景下考虑认知障碍的重要性。许多患有痴呆症的人可能还有其他健康问题，需要综合考虑这些问题以实现最佳健康结果。
