Cognitive frailty predictors to aid dementia, adverse health outcome prevention

Progression to cognitive frailty may be predicted by factors including vision, high-density lipoprotein cholesterol (HDL-C) levels, education levels, and participation in cognitively stimulating activities, according to a Singapore study.

“The readily accessible predictors in our models could aid early identification and targeted interventions for older adults at risk of cognitive frailty,” the investigators said.

The analysis was based on data from 1,054 Singapore Longitudinal Ageing Study 2 participants (mean age 65.2 years, 63.1 percent women) who were at least 55 years of age and free of cognitive frailty at baseline. Of these participants, 48.1 percent had secondary or tertiary education, 58.3 percent resided in high-end housing, 29.7 percent were not married, 7.6 percent were current smokers, and 23.2 percent were at moderate-to-high risk of malnutrition. [Gerontology 2023;doi:10.1159/000531421]

At baseline, around 40.8 percent of participants had only prefrail/frail status and 2.1 percent had only Mini-Mental State Examination (MMSE) score <26. The remaining 57.1 percent of participants had normal cognition and robust physical function.

Over a mean follow-up of 4.4 years, of 51 participants (4.8 percent) were diagnosed with cognitive frailty, which was defined by one or more criteria of the physical frailty phenotype and having a score of <26 on the MMSE. Of these, 21 were cognitively normal and physically robust, 20 were physically prefrail/frail, and 10 had impaired cognitive function at baseline.

The sex- and age-adjusted odds of progression to cognitive frailty were 1.05 (95 percent confidence interval [CI], 0.55–2.01) for baseline physical prefrailty/frailty only and 16.8 (95 percent CI, 6.07–46.0) for baseline cognitive impairment only.

Who’s vulnerable to cognitive frailty?

“We found that predictors of cognitive frailty transition encompassed several domains, including sociodemographic, medical history, biochemical, and [psychosocial],” according to the investigators.

Specifically, the odds of transition to cognitive frailty were more than twofold greater among participants with an eye problem (odd ratio [OR], 2.6, 95 percent CI, 1.24–5.43) and about fourfold greater among those with low HDL-C levels (OR, 4.1, 95 percent CI, 2.03–8.40). On the other hand, higher levels of education (OR, 0.3, 95 percent CI, 0.10–0.74) and participation in cognitively stimulating activities (OR, 0.4, 95 percent CI, 0.17–0.82) had protective benefits.

“It is unsurprising that eye problems are associated with transition to cognitive frailty, in our population of community-dwelling older adults. The relation between vision and cognitive frailty is not fully understood but may share common pathophysiology with cognitive impairment, including amyloid beta deposition or microvascular disease,” the investigators pointed out. [Mol Vis 2003;9:184-190; JAMA Netw Open 2021;4:e2117416]

Furthermore, visual impairment may hinder individuals from engaging in physical activity, participating in social activities, and seeking support, which can lead to cognitive frailty. [Ophthalmology 2012;119:2486-2492; BMC Geriatrics 2022;22:162]

Meanwhile, the findings on HDL-C and participation in cognitively stimulating activities suggest that cognitive frailty is modifiable, and future interventions targeted at improving cognitive frailty outcomes should include cognitive, physical, and social interaction domains, according to the investigators.

Interventions and behavioural modifications that increase the levels of HDL-C (such as physical activity, moderate alcohol consumption, and smoking cessation) and encourage participation in cognitively stimulating activities with social interaction may help improve executive, attention, verbal memory, and cognitive functions in older adults, the investigators said.

Therefore, such modifications should be promoted to reduce the risk of cognitive frailty, they added.