Frailty may portend cognitive decline

Initial frailty status appears to be a potential predictor of the occurrence of the composite of probable dementia (PD) and mild cognitive impairment (MCI), and this association is strengthened by intensive blood pressure control, as reported in a study.

The study was a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial), and a total of 8,537 participants (mean age 67.9 years, 35.1 percent women) were included. Based on the baseline frailty index, 1,670 participants were fit, 4,637 were less fit, and 2,230 were frail.

Participants in the frail group were more likely to be women, have a higher body mass index, be older, have a higher rate of current smokers, to be Black, have higher systolic blood pressure, have lower estimated glomerular filtration rate levels and cholesterol levels, and have higher rates of cardiovascular disease (CVD) compared with those in the fit and less fit groups.

Over a median follow-up of 4.61 years, 871 cases of PD or MCI were documented. The incidence of cognitive impairment was higher in the less fit group (hazard ratio [HR], 2.14, 95 percent confidence interval [CI], 1.65–2.77) and the frail group (HR, 4.28, 95 percent CI, 3.26–5.61) as compared with the fit group.

Of note, blood pressure control strategy interacted with the association between frailty and cognitive impairment. Specifically, the association between frailty and the incidence of the composite of PD and MCI became stronger with intensive blood pressure control (HR, 2.4, 95 percent CI, 2.0–2.8) but not so with standard treatment (HR, 1.8, 95 percent CI, 1.5–2.1; p=0.009 for interaction).