Yuan Yemin, Si Huaxin, Shi Zhenyu, Wang Yanshang, Xia Yiqi, Guan Xiaolong, He Ping
School of Public Health (YY, HS, ZS, YW, YX, XG), Peking University, Beijing, China; China Center for Health Development Studies (YY, HS, ZS, YW, YX, XG, PH), Peking University, Beijing, China.
China Center for Health Development Studies (YY, HS, ZS, YW, YX, XG, PH), Peking University, Beijing, China.
Am J Geriatr Psychiatry. 2025 Feb;33(2):178-191. doi: 10.1016/j.jagp.2024.08.009. Epub 2024 Aug 21.
Cognitive frailty refers to the co-occurrence of cognitive impairment and frailty without concurrent Alzheimer's disease or dementia. Studies of cognitive frailty and mortality have been limited to single country or older people. However, frailty and cognitive decline may occur much earlier. We aimed to examine the association between different cognitive frailty status and subsequent all-cause mortality among middle-aged and older people in 17 countries.
Participants aged 50 and over were drawn from six prospective cohorts of aging. We classified participants according to their cognitive impairment and frailty status into the following groups: none, only cognitive impairment, only frailty and cognitive frailty. Competing-risks regression models were used to evaluate the association of different cognitive frailty status at baseline with subsequent all-cause mortality.
The cognitive frailty group had a higher mortality risk compared to those without cognitive impairment and frailty groups. Meta-analysis results showed participants with cognitive frailty (pooled subhazard ratio [SHR] = 2.34, 95% confidence interval [CI]: 2.01-2.72, I = 68.0%) had a higher mortality risk compared with those with only cognitive impairment status (pooled SHR = 1.36, 95% CI: 1.25-1.48, I = 3.0%) or only frailty status (pooled SHR = 1.83, 95% CI: 1.72-1.95, I = 31.0%). The association between cognitive frailty and mortality were stronger among those who were aged 70 years and older, males, single and nonconsumers of alcohol.
Cognitive frailty, frailty or cognitive impairment alone, is associated with an increased risk of all-cause mortality in Asian, European and American countries. Physical and cognitive function screening should be conducted as early as possible in middle-aged and older people, and targeted intervention approaches should be developed to reduce the incidence of adverse health outcomes.
认知衰弱是指在没有并发阿尔茨海默病或痴呆症的情况下，认知障碍和衰弱同时出现。关于认知衰弱与死亡率的研究仅限于单个国家或老年人。然而，衰弱和认知衰退可能在更早的时候就会出现。我们旨在研究17个国家中老年人不同认知衰弱状态与随后全因死亡率之间的关联。
50岁及以上的参与者来自六个老龄化前瞻性队列。我们根据参与者的认知障碍和衰弱状态将其分为以下几组：无、仅认知障碍、仅衰弱和认知衰弱。使用竞争风险回归模型来评估基线时不同认知衰弱状态与随后全因死亡率之间的关联。
与没有认知障碍和衰弱的组相比，认知衰弱组的死亡风险更高。荟萃分析结果显示，与仅处于认知障碍状态（合并亚危险比[SHR]=1.36，95%置信区间[CI]：1.25-1.48，I=3.0%）或仅处于衰弱状态（合并SHR=1.83，95%CI：1.72-1.95，I=31.0%）的参与者相比，认知衰弱的参与者（合并SHR=2.34，95%CI：2.01-2.72，I=68.0%）有更高的死亡风险。在70岁及以上的人群、男性、单身者和不饮酒者中，认知衰弱与死亡率之间的关联更强。
在亚洲、欧洲和美国，认知衰弱、单独的衰弱或认知障碍都与全因死亡率增加有关。应尽早对中老年人进行身体和认知功能筛查，并制定针对性的干预措施以降低不良健康结局的发生率。
