Cognitive Impairment Center, Local Health Authority n. 2 Marca Trevigiana, 31100 Treviso, Italy,; ODV Associazione Alzheimer Treviso, 31100 Treviso, Italy.
Department of Statistical Sciences, University of Padova, 35121 Padova, Italy.
Exp Gerontol. 2022 Oct 1;167:111894. doi: 10.1016/j.exger.2022.111894. Epub 2022 Jul 15.
An association between frailty and vascular brain damage (VBD) has been described in older adults. However, most studies have identified frailty according to the phenotypic model. It is less clear whether frailty, operationalized as an accumulation of health deficits, is associated with the presence and severity of VBD. The present study was therefore undertaken to verify whether a 50-item frailty index (FI) is related to VBD in a large and relatively unselected cohort of attendees of a memory clinic.
The TREDEM (Treviso Dementia) registry includes retrospective observational data of 1584 participants. A modified FI was calculated from 50 variables comprising diseases, disability, behavioral disorders, and blood biochemistry. The presence and severity of VBD, including leukoaraiosis, lacunes, larger infarctions and the hierarchical vascular rating scale (HVRS), were determined based on brain computerized tomography imaging. Multiple logistic regression models were built according to the stepwise method.
Mean age of the 1584 participants was 79.6 ± 7.5 years and 1033 (65.2 %) were females. The average number of health deficits was 11.6 ± 6.2, corresponding to an FI of 0.23 ± 0.12 (range: 0.00-0.56). Each 0.01-point increase in the FI was associated with an increased probability of leukoaraiosis (+2.3 %) and severe leukoaraiosis (+5 %), lacunas in the basal ganglia (+1.73 %), occipital lobes (+2.7 %), parietal lobes (+3 %), frontal lobes (+3.6 %), temporal lobes (+4.2 %), and thalamus (+4.4 %). Moreover, an increase of 0.01 points in the FI was associated with a 3.1 % increase in the probability of HVRS score (≥2).
An FI based on routine clinical and laboratory variables was associated with the presence, degree, and some localizations of VBD in a population of older adults with cognitive decline. This frailty assessment tool may therefore be used to identify individuals at risk of developing cerebrovascular disease and, consequently, to implement strategies for vascular risk factor control.
虚弱与血管性脑损伤（VBD）之间的关联已在老年人中得到描述。然而，大多数研究都是根据表型模型来确定虚弱。那么，虚弱是否与 VBD 的存在和严重程度有关，这一点还不太清楚，虚弱可以被定义为健康缺陷的积累。因此，本研究旨在验证在一个较大且相对未经选择的记忆诊所就诊者队列中，使用 50 项虚弱指数（FI）是否与 VBD 相关。
TREDEM（特雷维索痴呆）登记处包含 1584 名参与者的回顾性观察数据。从包含疾病、残疾、行为障碍和血液生化的 50 个变量中计算出修正后的 FI。根据脑计算机断层扫描成像，确定 VBD 的存在和严重程度，包括脑白质疏松症、腔隙性梗死、较大的梗死和血管分级评分量表（HVRS）。根据逐步法建立了多个逻辑回归模型。
1584 名参与者的平均年龄为 79.6±7.5 岁，1033 名（65.2%）为女性。平均健康缺陷数为 11.6±6.2，对应的 FI 为 0.23±0.12（范围：0.00-0.56）。FI 每增加 0.01 分，脑白质疏松症的概率增加 2.3%（+2.3%），严重脑白质疏松症的概率增加 5%（+5%），基底节腔隙的概率增加 1.73%（+1.73%），枕叶腔隙的概率增加 2.7%（+2.7%），顶叶腔隙的概率增加 3%（+3%），额叶腔隙的概率增加 3%（+3%），颞叶腔隙的概率增加 4.2%（+4.2%），丘脑腔隙的概率增加 4.4%（+4.4%）。此外，FI 增加 0.01 分，HVRS 评分（≥2）的概率增加 3.1%（+3.1%）。
基于常规临床和实验室变量的 FI 与认知下降的老年人群中 VBD 的存在、程度和某些定位相关。因此，这种虚弱评估工具可用于识别有发生脑血管疾病风险的个体，并相应地实施血管危险因素控制策略。
