Wallace Lindsay M K, Theou Olga, Godin Judith, Ward David D, Andrew Melissa K, Bennett David A, Rockwood Kenneth
Geriatric Medicine Research Centre for Health Care of the Elderly Nova Scotia Health Authority Halifax NS Canada.
Department of Medicine Dalhousie University Halifax NS Canada.
Aging Med (Milton). 2021 Dec 15;4(4):250-256. doi: 10.1002/agm2.12187. eCollection 2021 Dec.
Frailty is an established risk factor for cognitive decline and Alzheimer's disease. Few studies have examined the longitudinal relationship between frailty and cognition.
Participants of Rush Memory and Aging project ( = 625, 67.5% female, 83.2 ± 5.9 years at baseline) underwent annual clinical evaluations (average follow-up 5.6 ± 3.7 years) followed by neuropathologic assessment after death. A frailty index was calculated from 41 health variables at each evaluation. Clinical diagnosis of MCI and/or dementia was ascertained by clinical data review (blinded to neuropathological data) after death. Age, sex, education, and neuropathological burden (10-item index) were evaluated as covariates. Frailty trajectories were calculated using a mixed effects model.
At baseline the mean frailty index = 0.24 ± 0.12 and increased at rate of 0.026 or ~1 deficit per year. At death, 27.7% of the sample had MCI, and 38.6% had dementia. Frailty trajectories were significantly steeper among those individuals who were ultimately diagnosed as clinically impaired prior to death, even after controlling for age, sex, education, and neuropathological index.
Findings suggest a strong link between health status (frailty index) and dementia, even after considering neuropathology. Frailty trajectories were associated with risk for MCI and dementia, underscoring the importance of addressing frailty to manage dementia risk.
衰弱是认知能力下降和阿尔茨海默病的既定风险因素。很少有研究探讨衰弱与认知之间的纵向关系。
拉什记忆与衰老项目的参与者（n = 625，67.5%为女性，基线时年龄83.2±5.9岁）每年接受临床评估（平均随访5.6±3.7年），死后进行神经病理学评估。每次评估时根据41项健康变量计算衰弱指数。死亡后通过临床数据回顾（对神经病理学数据不知情）确定MCI和/或痴呆的临床诊断。将年龄、性别、教育程度和神经病理学负担（10项指标）作为协变量进行评估。使用混合效应模型计算衰弱轨迹。
基线时平均衰弱指数 = 0.24±0.12，每年以0.026的速率增加，即每年增加约1项缺陷。死亡时，27.7%的样本患有MCI，38.6%患有痴呆。即使在控制了年龄、性别、教育程度和神经病理学指数后，最终在死前被诊断为临床受损的个体的衰弱轨迹明显更陡。
研究结果表明，即使考虑了神经病理学因素，健康状况（衰弱指数）与痴呆之间也存在密切联系。衰弱轨迹与MCI和痴呆风险相关，强调了解决衰弱问题以管理痴呆风险的重要性。
