Chen Chen, Li Xinwei, Wang Jun, Zhou Jinhui, Wei Yuan, Luo Yufei, Xu Lanjing, Liu Zuyun, Lv Yuebin, Shi Xiaoming
China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental and Health, Chinese Center for Disease Control and Prevention, Beijing, China.
Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China.
Innov Aging. 2023 Oct 17;7(9):igad114. doi: 10.1093/geroni/igad114. eCollection 2023.
Physical function deterioration is always accompanied by a cognitive decline in older adults. However, evidence is lacking for the long-term simultaneous changing patterns of cognition and physical frailty and their associations with mortality among older adults.
This study included 8,231 adults aged ≥65 with a baseline and at least one follow-up assessment of both cognition and physical frailty from the 2007-2018 Chinese Longitudinal Healthy Longevity Survey. Physical frailty (FRAIL phenotype) and cognition (Mini-Mental State Examination) were applied. Group-based joint trajectory modeling was used to fit the joint trajectories of cognition and physical frailty. Cox proportional hazards model was used to evaluate the trajectory-mortality associations.
Three distinct joint trajectories were identified: (34.4%), (47.0%), and (18.6%). During a median follow-up of 8.3 years, the group, compared to the , had the highest risk for all-cause mortality (hazard ratio (HR), 3.37 [95% CI: 2.99-3.81]), cardiovascular (CVD) mortality (3.21 [2.08-4.96]) and non-CVD mortality (2.99 [2.28-3.92]), respectively. Joint trajectory was found to be more predictive of mortality as compared to baseline measures of cognition and/or frailty (-statistic ranged from 0.774 to 0.798). Higher changing rates of cognition and frailty were observed among all-cause decedents compared to CVD and non-CVD decedents over a 45-year span (aged 65-110) before death.
Our study suggested that subjects with the worst cognitive decline and severest physical frailty progression were at the highest risk for all-cause and cause-specific mortality. Our findings expand the limited prior knowledge on the dynamic course of cognition and frailty.
身体功能衰退在老年人中总是伴随着认知能力下降。然而，关于老年人认知与身体虚弱的长期同步变化模式及其与死亡率的关联，目前仍缺乏相关证据。
本研究纳入了8231名年龄≥65岁的成年人，这些数据来自2007 - 2018年中国老年健康长寿纵向调查，且有基线以及至少一次关于认知和身体虚弱的随访评估。采用身体虚弱（衰弱表型）和认知（简易精神状态检查表）评估方法。基于群组的联合轨迹模型用于拟合认知和身体虚弱的联合轨迹。Cox比例风险模型用于评估轨迹与死亡率的关联。
识别出三种不同的联合轨迹：（34.4%）、（47.0%）和（18.6%）。在中位随访8.3年期间，与组相比，组全因死亡率风险最高（风险比（HR），3.37 [95%置信区间：2.99 - 3.81]），心血管（CVD）死亡率（3.21 [2.08 - 4.96]）和非CVD死亡率（2.99 [2.28 - 3.92]）也分别最高。与认知和/或虚弱的基线测量相比，联合轨迹被发现对死亡率的预测性更强（-统计量范围为0.774至0.798）。在死亡前45年（65 - 110岁）的时间段内，与CVD和非CVD死亡者相比，全因死亡者的认知和虚弱变化率更高。
我们的研究表明，认知能力下降最严重且身体虚弱进展最严重的受试者全因和特定病因死亡率风险最高。我们的研究结果扩展了关于认知和虚弱动态过程的有限先前知识。
