Davide Angioni, Gerontopole of Toulouse, 37 A Jules Guesde, 31000 Toulouse,
J Nutr Health Aging. 2020;24(10):1144-1151. doi: 10.1007/s12603-020-1518-x.
No study has tried to distinguish subjects that become frail due to diseases (frailty related to diseases) or in the absence of specific medical events; in this latter case, it is possible that aging process would act as the main frailty driver (age-related frailty).
To classify subjects according to the origin of physical frailty: age-related frailty, frailty related to diseases, frailty of uncertain origin, and to compare their clinical characteristics.
We performed a secondary analysis of the Multidomain Alzheimer Preventive Trial (MAPT), including 195 subjects ≥70 years non-frail at baseline who became frail during a 5-year follow-up (mean age 77.8 years ± 4.7; 70% female). Physical frailty was defined as presenting ≥3 of the 5 Fried criteria: weight loss, exhaustion, weakness, slowness, low physical activity. Clinical files were independently reviewed by two different clinicians using a standardized assessment method in order to classify subjects as: "age-related frailty", "frailty related to diseases" or "frailty of uncertain origin". Inconsistencies among the two raters and cases of uncertain frailty were further assessed by two other experienced clinicians.
From the 195 included subjects, 82 (42%) were classified as age-related frailty, 53 (27%) as frailty related to diseases, and 60 (31%) as frailty of uncertain origin. Patients who became frail due to diseases did not differ from the others groups in terms of functional, cognitive, psychological status and age at baseline, however they presented a higher burden of comorbidity as measured by the Cumulative Illness Rating Scale (CIRS) (8.20 ± 2.69; vs 6.22 ± 2.02 frailty of uncertain origin; vs. 3.25 ± 1.65 age-related frailty). Time to incident frailty (23.4 months ± 12.1 vs. 39.2 ± 19.3 months) and time spent in a pre-frailty condition (17.1 ± 11.4 vs 26.6 ± 16.6 months) were shorter in the group of frailty related to diseases compared to age-related frailty. Orthopedic diseases (n=14, 26%) were the most common pathologies leading to frailty related to diseases, followed by cardiovascular diseases (n=9, 17%) and neurological diseases (n = 8, 15%).
People classified as age-related frailty and frailty related to diseases presented different frailty-associated indicators. Future research should target the underlying biological cascades leading to these two frailty classifications, since they could ask for distinct strategies of prevention and management.
尚无研究试图区分因疾病而变得虚弱的受试者（与疾病相关的虚弱）或在没有特定医疗事件的情况下变得虚弱；在后一种情况下，衰老过程可能是导致虚弱的主要因素（与年龄相关的虚弱）。
根据身体虚弱的来源对受试者进行分类：与年龄相关的虚弱、与疾病相关的虚弱、原因不明的虚弱，并比较其临床特征。
我们对多领域阿尔茨海默病预防试验（MAPT）进行了二次分析，纳入了 195 名基线时无虚弱但在 5 年随访期间变得虚弱的年龄≥70 岁的受试者（平均年龄 77.8 岁±4.7；70%为女性）。身体虚弱定义为出现≥5 项 Fried 标准中的 3 项：体重减轻、乏力、虚弱、行动缓慢、体力活动减少。临床档案由两名不同的临床医生使用标准化评估方法独立审查，以将受试者分类为：“与年龄相关的虚弱”、“与疾病相关的虚弱”或“原因不明的虚弱”。两名评分者之间的不一致和不确定的虚弱病例由另外两名经验丰富的临床医生进一步评估。
在纳入的 195 名受试者中，82 名（42%）被归类为与年龄相关的虚弱，53 名（27%）为与疾病相关的虚弱，60 名（31%）为原因不明的虚弱。与其他组相比，因疾病而变得虚弱的患者在基线时的功能、认知、心理状态和年龄方面没有差异，但他们的累积疾病评分量表（CIRS）所衡量的合并症负担更高（8.20±2.69；与原因不明的虚弱相比为 6.22±2.02；与年龄相关的虚弱相比为 3.25±1.65）。发生虚弱的时间（23.4 个月±12.1 vs. 39.2±19.3 个月）和处于虚弱前期的时间（17.1±11.4 vs. 26.6±16.6 个月）在与疾病相关的虚弱组中比在与年龄相关的虚弱组中更短。导致与疾病相关的虚弱的最常见疾病（n=14，26%）是骨科疾病，其次是心血管疾病（n=9，17%）和神经系统疾病（n=8，15%）。
被归类为与年龄相关的虚弱和与疾病相关的虚弱的人表现出不同的虚弱相关指标。未来的研究应该针对导致这两种虚弱分类的潜在生物学级联，因为它们可能需要不同的预防和管理策略。
