Cognitive frailty predicting death and disability in Chinese elderly

ABSTRACT

Objective

Cognitive frailty (CF) is associated with adverse health outcomes, but different CF models have been proposed in the literature. We explored whether cognitive impairment (CoI) assessed by the Revised Hasegawa dementia scale (HDS-R) and physical frailty (PF) assessed by the modified Frailty Phenotype can be combined to predict risks of adverse outcomes in elderly Chinese subjects.

Methods

The data collected in the Rugao Longevity and Aging Study were used. PF was assessed by the modified Frailty phenotype. CoI was defined as the lowest 20% of the HDS-R score. CF was defined as the co-existence of physical frailty and CoI, excluding those with severe CoI(HDR-S ≤ 10). The date and cause of death were acquired from the Death registry of Rugao’s Civil Affairs Bureau. Disability was measured using the activities of daily living (ADL) scale.

Results

The prevalence of CF was 2.9% at baseline. During 3-year follow-up, 130 (8.1%) of the 1607 elderly subjects died. The highest mortality risk was observed among subjects with CF (hazard ratio [HR] = 2.94, 95% confidence interval [CI] = 1.28–6.78). Fully adjusted survival plots showed that CF was associated with the highest risk for 3-year mortality. The incidence of ADL disability was 6.0% after 3 years. Compared with the robust and non-CoI elderly, CF was associated with a 10.48-fold (95% CI 2.98–36.80) higher risk of ADL disability.

Conclusions

The CF model defined as a combination of HDS-R and Frail Phenotypes showed predictive validity for all-cause death and new-onset ADL disability 3 years later.

KEYWORDS:

• Cognitive frailty
• mortality
• ADL disability
• longitudinal cohort study
• prediction

Acknowledgments

The authors are grateful to all subjects who participated in this study and wish to acknowledge the valuable advice and assistance obtained from theMinistry of Education Key Laboratory of Contemporary Anthropology, Human Phenome Institute, Fudan University; as well as the Department of Pathology and Pathophysiology, Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine; and all specialized physicians of the People’s Hospital of Rugao City.

Disclosure statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Data availability statement

The data that support the findings of this study are available from the corresponding author, Shujuan Li, upon reasonable request. The data are not publicly available due to privacy or ethical restrictions. 

Additional information

Funding

This work was supported by the National Key R&D Program of China [2018YFC2000400,2018YFC2002000] and the National Natural Science Foundation of China [81971102]. 

Notes on contributors

Yajun Ma

Yajun Ma, From 2018, as a master degree candidate and researcher have been participating in the research with Professor Xiaofeng Wang and Professor Shujuan Li in Rugao Longevity study.

Xiaodong Li

Xiaodong Li, Research fifield: Genetics study of Neurology. As a corresponding/co-corresponding author, he had published more than 40 papers or peer reviewed articles.

Yan Pan

Yan Pan is a master degree candidate studying in Affiliated Beijing Chaoyang Hospital of Capital Medical University. She has participated in the Rugao Ageing cohort since 2019.

Ruixue Zhao

Ruixue Zhao, since 2020, Miss Zhao has been admitted to Beijing Chaoyang Hospital to study for a master’s degree in neurology. She has been involved in the Rugao Longevity study. As the co-first author, she had published 1 paper in an international journal.

Xiaofeng Wang

Xiaofeng Wang, Research field: Epidemiology study of cardiovascular disease and geriatric disease based on longitudinal cohort. From 2007, Dr. Wang has been involved in the construction of Taizhou longitudinal study and Rugao Longevity study (field investigation leader). Since 2014, Dr. Wang leads the construction of the Rugao Ageing cohort. As a corresponding/co-corresponding author, he had published 70 papers peer-reviewed articles in international journals.

Xiaoyan Jiang

Xiaoyan Jiang, Ph.D., Professor of the key laboratory of arrhythmias of ministry of Education of China. Her research field is the molecular epidemiology in cardiovascular diseases, neurological diseases, and geriatric disease based on longitudinal cohort. As a first author, corresponding/co-corresponding author, she had published 22 peer-reviewed articles in international journals.

Shujuan Li

Shujuan Li, Research fifield: cerebrovascular disease and geriatric disease. From 2017, she has been involved in the Rugao Longevity study. As a corresponding/co-corresponding author, he had published 20 papers peer-reviewed articles in international journals.