Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Committee Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
Global Health Institute, King's College London, London, UK.
BMC Geriatr. 2020 Apr 15;20(1):138. doi: 10.1186/s12877-020-01539-2.
The relationship between frailty and dementia is unclear and there are very few population-based studies regarding this issue in China. The purpose of this study is to estimate the association between frailty and incident dementia in China, and to explore different effects of frailty established by three definitions of frailty on dementia incidence.
A five-year prospective cohort study was carried out in 2022 participants aged 65 years and over in urban and rural sites in Beijing, China. The participants were interviewed by trained community primary health care workers from 2004 to 2009. Frailty was defined using modified Fried frailty phenotype, physical frailty definition, and multidimensional frailty definition. Dementia was diagnosed using the 10/66 dementia criterion for calculating cumulative incidence. Both competing risk regression models and Cox proportional hazards models were applied to examine the associations between frailty at baseline and five-year cumulative incidence of dementia.
At the end of follow-up the five-year cumulative incidence rates of dementia with frailty and without frailty defined by the modified Fried frailty were 21.0% and 9.6%, those defined by the physical frailty were 19.9% and 9.0%, and those defined by the multidimensional frailty were 22.8% and 8.9%, respectively. Compared with non-frail participants, frail people had a higher risk of incident dementia using multidimensional frailty definition after adjusting covariates based on competing risk regression model (HR = 1.47, 95% CI 1.012.17) and Cox proportional hazards model (HR = 1.56, 95% CI 1.072.26). The association between frailty and incident dementia was statistically significant in participants in the upper three quartiles of age (aged 68 years and over) using the multidimensional frailty definition based on the competing risk regression model (HR = 1.61, 95% CI 1.062.43) and Cox proportional hazard model (HR = 1.76, 95% CI 1.192.61).
Multidimensional frailty may play an inherent role in incident dementia, especially in the people aged over 68, which is significant for distinguishing high risk people and determining secondary prevention strategies for dementia patients.
衰弱与痴呆之间的关系尚不清楚，且中国针对这一问题的人群研究较少。本研究旨在评估中国衰弱与痴呆发病的相关性，并探讨三种衰弱定义对痴呆发病的不同影响。
这是一项于 2022 年在中国北京城乡地区进行的为期 5 年的前瞻性队列研究，共纳入 2004 年至 2009 年接受过培训的社区初级保健工作者访谈的 2022 名 65 岁及以上老年人。采用改良 Fried 衰弱表型、躯体衰弱定义和多维衰弱定义来定义衰弱。使用 10/66 痴呆标准计算累积发病率来诊断痴呆。采用竞争风险回归模型和 Cox 比例风险模型来检验基线时衰弱与 5 年累积痴呆发病的相关性。
随访结束时，根据改良 Fried 衰弱定义，伴有和不伴有衰弱的人群 5 年累积痴呆发病率分别为 21.0%和 9.6%；根据躯体衰弱定义，分别为 19.9%和 9.0%；根据多维衰弱定义，分别为 22.8%和 8.9%。在调整基于竞争风险回归模型的协变量后（HR=1.47，95%CI 1.012.17）和 Cox 比例风险模型（HR=1.56，95%CI 1.072.26），与非衰弱参与者相比，多维衰弱定义下的衰弱者发生痴呆的风险更高。在基于竞争风险回归模型的年龄处于上 3 四分位数（68 岁及以上）的参与者中，多维衰弱与痴呆发病之间存在统计学关联（HR=1.61，95%CI 1.062.43），在 Cox 比例风险模型中也存在统计学关联（HR=1.76，95%CI 1.192.61）。
多维衰弱可能与痴呆发病有关，尤其是在 68 岁以上的人群中，这对识别高危人群和确定痴呆患者的二级预防策略具有重要意义。
