Chen Sanmei, Chen Tao, Honda Takanori, Kishimoto Hiro, Nofuji Yu, Narazaki Kenji
Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami Ward, 1-2-3 Kasumi, Hiroshima, 734-8551, Japan.
Sports and Health Research Center, Department of Physical Education, Tongji University, 1239 Siping Road, Shanghai, 200-092, China.
Geroscience. 2024 Dec 3. doi: 10.1007/s11357-024-01461-0.
Cognitive frailty is considered a clinical entity associated with a high risk for adverse health outcomes. However, its clinical significance remains poorly understood. This study investigated the association between cognitive frailty and risk for functional disability among community-dwelling older adults. In total, 1,597 Japanese adults aged ≥ 65 years that were free of dementia and functional disability at baseline were prospectively followed for 10 years. Cognitive frailty was defined as the presence of both physical frailty (using Cardiovascular Health Study criteria) and cognitive impairment (Mini-Mental State Examination score < 26 points). Functional disability was identified using Japan's Long-term Care Insurance System database. Cox proportional hazard models were used to estimate the hazard ratios (HR) for cognitive frailty on the risk for functional disability. Functional disability was identified in 488 participants during follow-up. A multiplicative interaction effect between cognitive impairment and physical frailty on the risk of disability was observed (p = 0.045). Compared with the robust group, the multivariable-adjusted HRs (95% confidence interval) for functional disability were 3.70 (2.37‒5.77) for cognitive frailty, 2.51 (1.81‒3.47) for physical pre-frailty with cognitive impairment, 2.16 (1.42‒3.29) for cognitive impairment only, 1.95 (1.36‒2.80) for physical frailty only, and 1.94 (1.53‒2.46) for physical pre-frailty only. These associations remained after adjusting for the competing risk for death and in sensitivity analyses to minimize potential reverse causality. Cognitive frailty is associated with an increased risk for functional disability in community-dwelling older adults. Cognitive frailty may be a clinically important target for the prevention of functional disability.
认知衰弱被认为是一种与不良健康结局高风险相关的临床实体。然而，其临床意义仍知之甚少。本研究调查了社区居住的老年人中认知衰弱与功能残疾风险之间的关联。总共对1597名年龄≥65岁、基线时无痴呆和功能残疾的日本成年人进行了为期10年的前瞻性随访。认知衰弱定义为同时存在身体衰弱（采用心血管健康研究标准）和认知障碍（简易精神状态检查表评分<26分）。使用日本长期护理保险系统数据库确定功能残疾情况。采用Cox比例风险模型估计认知衰弱对功能残疾风险的风险比（HR）。随访期间在488名参与者中发现了功能残疾。观察到认知障碍和身体衰弱对残疾风险存在相乘交互作用（p = 0.045）。与健康组相比，功能残疾的多变量调整后HR（95%置信区间）在认知衰弱组为3.70（2.37 - 5.77），在伴有认知障碍的身体虚弱前期组为2.51（1.81 - 3.47），仅认知障碍组为2.16（1.42 - 3.29），仅身体衰弱组为1.95（1.36 - 2.80），仅身体虚弱前期组为1.94（1.53 - 2.46）。在对死亡的竞争风险进行调整后以及在敏感性分析中以尽量减少潜在的反向因果关系后，这些关联依然存在。认知衰弱与社区居住老年人功能残疾风险增加相关。认知衰弱可能是预防功能残疾的一个重要临床靶点。
