Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei City 112, Taiwan; School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.
Aging and Health Research Center, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yi-Lan, Taiwan.
Arch Gerontol Geriatr. 2022 Sep-Oct;102:104754. doi: 10.1016/j.archger.2022.104754. Epub 2022 Jun 14.
Frailty has been shown to predict adverse outcomes in several diseases. We aimed to evaluate the associations between frailty profiles, both severity and subtype, and dementia risk in a community-based population with asymptomatic (without stroke and dementia) cerebral small vessel disease (CSVD).
Individuals with asymptomatic CSVD were recruited from the community-based I-Lan Longitudinal Aging Study between 2011 and 2014 (baseline) and were followed up between 2018 and 2019. All participants underwent CSVD assessment by 3T brain MRI, as well as physical and cognitive assessments at baseline. Univariate and multivariate logistic regression analyses were performed to evaluate the associations between each factor and dementia conversion at follow-up.
Among 261 participants with asymptomatic CSVD (64.8 [50.0-89.1, 8.4] years; 136 [52.1%] men), 13 (5.0%) developed dementia during a mean follow-up of 5.7 (0.7) years. Dementia converters were less likely to be robust (30.8% vs. 61.5%) and more likely to be pre-frail/frail (69.2% vs. 38.5%) than non-converters (p = 0.040). Meanwhile, there was significantly more frequent mobility frailty (53.8% vs. 19.8%, p = 0.009), but a similar prevalence of non-mobility frailty in dementia converters compared with non-converters. Univariate analyses showed that neither frailty severity nor CSVD burden was associated with a higher risk of dementia; it was the frailty subtype, the mobility frailty, which was significantly associated with dementia conversion in participants with asymptomatic CSVD, with an odds-ratio of 4.8 (95% CI = 1.5-14.8, p = 0.007). The significance remained after adjusting for age, sex, education and baseline cognitive function, respectively.
Mobility frailty was associated with a higher risk of incident dementia in individuals with subclinical CSVD. Mobility frailty might be involved in the pathology of cognitive decline in CSVD and potentially serve as a marker to identify people at risk of cognitive impairment at an early stage of CSVD.
虚弱已被证明与多种疾病的不良预后相关。我们旨在评估在社区人群中，无症状（无卒中和痴呆）脑小血管疾病（CSVD）患者中，虚弱严重程度和亚型与痴呆风险之间的关联。
2011 年至 2014 年（基线），我们从社区为基础的宜兰纵向老龄化研究中招募了无症状 CSVD 个体，并在 2018 年至 2019 年进行了随访。所有参与者均通过 3T 脑 MRI 进行 CSVD 评估，以及基线时的身体和认知评估。我们进行了单变量和多变量逻辑回归分析，以评估每个因素与随访期间痴呆转换的关系。
在 261 名无症状 CSVD 患者中（64.8[50.0-89.1, 8.4]岁；136[52.1%]为男性），有 13 人（5.0%）在平均 5.7（0.7）年的随访期间发展为痴呆。与非转化者相比，痴呆转化者更不可能为健壮（30.8%比 61.5%），更可能为虚弱/脆弱（69.2%比 38.5%）（p=0.040）。同时，痴呆转化者移动性虚弱的发生率显著更高（53.8%比 19.8%，p=0.009），但与非转化者相比，非移动性虚弱的患病率相似。单变量分析表明，虚弱严重程度或 CSVD 负担均与痴呆风险增加无关；而是虚弱亚型，即移动性虚弱，与无症状 CSVD 患者的痴呆转化显著相关，优势比为 4.8（95%可信区间 1.5-14.8，p=0.007）。在分别调整年龄、性别、教育和基线认知功能后，其意义仍然存在。
移动性虚弱与亚临床 CSVD 个体发生痴呆的风险增加相关。移动性虚弱可能与 CSVD 认知能力下降的病理学有关，并可能作为 CSVD 早期识别认知障碍风险的标志物。
