身体虚弱表型标准及其对认知功能的协同关联。
Physical Frailty Phenotype Criteria and Their Synergistic Association on Cognitive Functioning.
机构信息
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
出版信息
J Gerontol A Biol Sci Med Sci. 2021 Aug 13;76(9):1633-1642. doi: 10.1093/gerona/glaa267.
BACKGROUND
Frailty (physical frailty phenotype [PFP]) and its criteria (slow gait, weakness, weight loss, low activity, and exhaustion) are each associated with cognitive dysfunction. The extent to which the PFP is associated with cognition beyond that expected from its component parts remains uncertain.
METHOD
We used the National Health and Aging Trends Study to quantify associations between PFP criteria and cognitive performance (level/change) using adjusted mixed effects models. We tested whether frailty was associated with excess cognitive vulnerability (synergistic/excess effects, Cohen's d) beyond criteria contributions by assessing interactions between each criterion and frailty.
RESULTS
Among 7439 community-dwelling older adults (mean age = 75.2 years) followed for a mean of 3.2 years (SE = 0.03), 14.1% were frail. The PFP and PFP criteria were all associated with lower baseline cognitive performance, among which slow gait (-0.31 SD, SE = 0.02) and frailty (-0.23 SD, SE = 0.02) were strongest. Only slow gait (-0.03 SD/year, SE = 0.01), frailty (-0.02 SD/year, SE = 0.01), weight loss (-0.02 SD/year, SE = 0.01), and weakness (-0.02 SD/year, SE = 0.01) were associated with cognitive decline. Frailty was associated with cognitive performance above and beyond each criterion (excess effects ranging from -0.07 SD [SE = -0.05] for slow gait to -0.23 SD [SE = 0.03] for weakness); the same was not true for cognitive decline. Slow gait was the only criterion associated with cognitive change among both frail and nonfrail participants (frail: Cohen's d/year = -0.03, SE = 0.01; nonfrail: Cohen's d/year = -0.02, SE = 0.01).
CONCLUSIONS
PFP is an important frailty measure that is cross-sectionally associated with lower cognitive performance, but not with subsequent cognitive decline, above and beyond its criteria contributions. Further research into the construct of frailty as a "syndrome" correlated with cognition and other adverse outcomes is needed.
背景
衰弱（身体衰弱表型[PFP]）及其标准（缓慢的步态、虚弱、体重减轻、低活动量和疲惫）均与认知功能障碍相关。PFP 与认知功能的关联程度超出其组成部分所预期的程度仍不确定。
方法
我们使用国家健康老龄化趋势研究（National Health and Aging Trends Study），使用调整后的混合效应模型来量化 PFP 标准与认知表现（水平/变化）之间的关联。我们通过评估每个标准与衰弱之间的相互作用，测试衰弱是否与认知脆弱性的过度增加（协同/过度效应，Cohen's d）有关，超过了标准的贡献。
结果
在 7439 名居住在社区的老年人（平均年龄=75.2 岁）中，平均随访 3.2 年（SE=0.03），14.1%的人衰弱。PFP 和 PFP 标准均与较低的基线认知表现相关，其中缓慢的步态（-0.31 SD，SE=0.02）和衰弱（-0.23 SD，SE=0.02）最强。只有缓慢的步态（-0.03 SD/年，SE=0.01）、衰弱（-0.02 SD/年，SE=0.01）、体重减轻（-0.02 SD/年，SE=0.01）和虚弱（-0.02 SD/年，SE=0.01）与认知下降相关。衰弱与认知表现有关，超出了每个标准（过度效应范围从缓慢的步态为-0.07 SD[SE=0.05]到虚弱为-0.23 SD[SE=0.03]）；但认知下降则不然。在衰弱和非衰弱参与者中，只有缓慢的步态与认知变化相关（衰弱：Cohen's d/年=-0.03，SE=0.01；非衰弱：Cohen's d/年=-0.02，SE=0.01）。
结论
PFP 是一个重要的衰弱测量指标，它与较低的认知表现相关，但与认知表现的后续下降无关，超过了其标准的贡献。需要进一步研究衰弱作为与认知和其他不良结果相关的“综合征”的结构。
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