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Frailty Is Related to Subjective Cognitive Decline in Older Women without Dementia.
J Am Geriatr Soc. 2019 09; 67(9):1803-1811.JA

Abstract

OBJECTIVES

Physical frailty (or loss of physiologic reserve) is associated with cognitive impairment and dementia. Subjective cognitive decline (SCD) may represent early pathologic changes of dementia. The association between these disease markers is unclear.

DESIGN

Cross-sectional analysis.

SETTING

Community-based participants from the Vanderbilt Memory & Aging Project.

PARTICIPANTS

A total of 306 older adults with normal cognition (NC; n = 174) or mild cognitive impairment (MCI; n = 132).

MEASUREMENTS

Frailty was measured using standard methods, and a composite frailty score was calculated. SCD was quantified using the Everyday Cognition Scale (ECog; total score and four domain scores). Objective cognition was assessed with the Montreal Cognitive Assessment (MoCA). Proportional odds models, stratified by sex, related the frailty composite to MoCA and total ECog score adjusting for age, education, body mass index, cognitive diagnosis, depressed mood, Framingham Stroke Risk Profile, apolipoprotein E (APOE ε4) carrier status, and height (for gait speed models). Secondary models related individual frailty components to SCD domains and explored associations in NC only.

RESULTS

In women, frailty composite was related to MoCA (odds ratio [OR] = .56; P = .04), a finding attenuated in sensitivity analysis (OR = .59; P = .08). Frailty composite related to ECog total (OR = 2.27; P = .02), planning (OR = 2.63; P = .02), and organization scores (OR = 2.39; P = .03). Increasing gait speed related to lower ECog total (OR = .06; P = .003) and memory scores (OR = .03; P < .001). Grip strength related to lower ECog planning score (OR = .91; P = .04). In men, frailty was unrelated to objective and subjective cognition (P values >.07). Findings were consistent in the NC group.

CONCLUSION

Frailty component and composite scores are related to SCD before the presence of overt dementia. Results suggest that this association is present before overt cognitive impairment. Results suggest a possible sex difference in the clinical manifestation of frailty, with primary associations noted in women. Further studies should investigate mechanisms linking early changes among frailty, SCD, and cognition. J Am Geriatr Soc, 1-9, 2019. J Am Geriatr Soc 67:1803-1811, 2019.

Links

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Authors+Show Affiliations

Gifford KA
Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee.
Bell SP
Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee. Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Liu D
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
Neal JE
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
Turchan M
Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee.
Shah AS
Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. Center for Quality Aging, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee.
Jefferson AL
Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee. Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.

MeSH

AgedAged, 80 and overCognitive AgingCognitive DysfunctionCross-Sectional StudiesDementiaFemaleFrail ElderlyFrailtyHumansMaleMental Status and Dementia TestsOdds RatioSex Factors

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31095735

Citation

Gifford, Katherine A., et al. "Frailty Is Related to Subjective Cognitive Decline in Older Women Without Dementia." Journal of the American Geriatrics Society, vol. 67, no. 9, 2019, pp. 1803-1811.
Gifford KA, Bell SP, Liu D, et al. Frailty Is Related to Subjective Cognitive Decline in Older Women without Dementia. J Am Geriatr Soc. 2019;67(9):1803-1811.
Gifford, K. A., Bell, S. P., Liu, D., Neal, J. E., Turchan, M., Shah, A. S., & Jefferson, A. L. (2019). Frailty Is Related to Subjective Cognitive Decline in Older Women without Dementia. Journal of the American Geriatrics Society, 67(9), 1803-1811. https://doi.org/10.1111/jgs.15972
Gifford KA, et al. Frailty Is Related to Subjective Cognitive Decline in Older Women Without Dementia. J Am Geriatr Soc. 2019;67(9):1803-1811. PubMed PMID: 31095735.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Frailty Is Related to Subjective Cognitive Decline in Older Women without Dementia. AU - Gifford,Katherine A, AU - Bell,Susan P, AU - Liu,Dandan, AU - Neal,Jacquelyn E, AU - Turchan,Maxim, AU - Shah,Avantika S, AU - Jefferson,Angela L, Y1 - 2019/05/16/ PY - 2018/06/15/received PY - 2019/03/14/revised PY - 2019/04/05/accepted PY - 2019/5/17/pubmed PY - 2020/5/14/medline PY - 2019/5/17/entrez KW - frailty KW - mild cognitive impairment KW - subjective cognitive decline SP - 1803 EP - 1811 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 67 IS - 9 N2 - OBJECTIVES: Physical frailty (or loss of physiologic reserve) is associated with cognitive impairment and dementia. Subjective cognitive decline (SCD) may represent early pathologic changes of dementia. The association between these disease markers is unclear. DESIGN: Cross-sectional analysis. SETTING: Community-based participants from the Vanderbilt Memory & Aging Project. PARTICIPANTS: A total of 306 older adults with normal cognition (NC; n = 174) or mild cognitive impairment (MCI; n = 132). MEASUREMENTS: Frailty was measured using standard methods, and a composite frailty score was calculated. SCD was quantified using the Everyday Cognition Scale (ECog; total score and four domain scores). Objective cognition was assessed with the Montreal Cognitive Assessment (MoCA). Proportional odds models, stratified by sex, related the frailty composite to MoCA and total ECog score adjusting for age, education, body mass index, cognitive diagnosis, depressed mood, Framingham Stroke Risk Profile, apolipoprotein E (APOE ε4) carrier status, and height (for gait speed models). Secondary models related individual frailty components to SCD domains and explored associations in NC only. RESULTS: In women, frailty composite was related to MoCA (odds ratio [OR] = .56; P = .04), a finding attenuated in sensitivity analysis (OR = .59; P = .08). Frailty composite related to ECog total (OR = 2.27; P = .02), planning (OR = 2.63; P = .02), and organization scores (OR = 2.39; P = .03). Increasing gait speed related to lower ECog total (OR = .06; P = .003) and memory scores (OR = .03; P < .001). Grip strength related to lower ECog planning score (OR = .91; P = .04). In men, frailty was unrelated to objective and subjective cognition (P values >.07). Findings were consistent in the NC group. CONCLUSION: Frailty component and composite scores are related to SCD before the presence of overt dementia. Results suggest that this association is present before overt cognitive impairment. Results suggest a possible sex difference in the clinical manifestation of frailty, with primary associations noted in women. Further studies should investigate mechanisms linking early changes among frailty, SCD, and cognition. J Am Geriatr Soc, 1-9, 2019. J Am Geriatr Soc 67:1803-1811, 2019. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/31095735/Frailty_Is_Related_to_Subjective_Cognitive_Decline_in_Older_Women_without_Dementia_ DB - PRIME DP - Unbound Medicine ER -