Aguilar-Navarro Sara Gloria, Mimenza-Alvarado Alberto José, Yeverino-Castro Sara Gabriela, Caicedo-Correa Sandra Milena, Cano-Gutiérrez Carlos
Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Arch Med Res. 2025 Jan;56(1):103106. doi: 10.1016/j.arcmed.2024.103106. Epub 2024 Nov 9.
Frailty has been conceptualized not only as a physical disease, but also as a multidomain entity that encompasses a multimorbid status, disability, cognitive impairment, psychosocial risk factors, and even geriatric syndromes. In addition to physical ailments and depending on the diagnostic model. Standardized neuropsychological tests can identify cognitive deficiencies along with mild cognitive impairment, a pre-dementia stage characterized by memory and/or other cognitive domain impairments with relatively preserved instrumental activities of daily living. Hence, the possibility of cognitive frailty (CF), a construct that refers to physical frailty in concurrence with non-dementia cognitive decline, is proposed. The estimated prevalence of CF ranges from 10.3 to 42.8%. It is likely that the pathway to overt cognitive impairment, which does not yet involve physical function, begins with the asymptomatic early accumulation of progressive brain damage. Thus, timely detection strategies that target the initial phases of CF are warranted. The pathophysiological components of CF include dysregulation of the hypothalamic-pituitary axis stress response, imbalance in energy metabolism, impaired cardiovascular function, mitochondrial deterioration, and vascular age-related arterial stiffness. Changes that contribute to this disease can also occur at the cellular level, including overexpression of the renin-angiotensin-aldosterone system, activation of proinflammatory pathways, endothelial dysfunction, reduced nitric oxide production, and increased oxidative stress. Non-pharmacological interventions, that range from dietary and nutritional counseling to psychosocial therapy, are currently the main approaches. Both cognitive and physical training programs are considered to be the best researched and most useful multidomain interventions. Clinicians recognize CF as a valid concept that warrants prevention and treatment strategies supported by current research.
衰弱不仅被概念化为一种身体疾病，还被视为一个多领域实体，涵盖多种疾病状态、残疾、认知障碍、心理社会风险因素，甚至老年综合征。除身体疾病外，根据诊断模型，标准化神经心理学测试可识别认知缺陷以及轻度认知障碍，这是一种痴呆前阶段，其特征为记忆和/或其他认知领域受损，而日常生活工具性活动相对保留。因此，提出了认知衰弱（CF）这一概念，它指的是身体衰弱与非痴呆性认知衰退同时存在的情况。CF的估计患病率在10.3%至42.8%之间。尚未涉及身体功能的明显认知障碍的发展途径可能始于渐进性脑损伤的无症状早期积累。因此，有必要制定针对CF初始阶段的及时检测策略。CF的病理生理成分包括下丘脑 - 垂体轴应激反应失调、能量代谢失衡、心血管功能受损、线粒体退化以及与血管年龄相关的动脉僵硬度增加。导致这种疾病的变化也可能发生在细胞水平，包括肾素 - 血管紧张素 - 醛固酮系统的过度表达、促炎途径的激活、内皮功能障碍、一氧化氮产生减少以及氧化应激增加。目前，从饮食和营养咨询到心理社会治疗的非药物干预是主要方法。认知和体育训练计划都被认为是研究最多且最有用的多领域干预措施。临床医生将CF视为一个有效的概念，值得采用当前研究所支持的预防和治疗策略。
