Background:While physical frailty(PF)and cognitive impairment(CI)are established independent predictors of adverse outcomes in older adults,the prognostic significance of their co-occurrence(cognitive frailty,CF)remai...Background:While physical frailty(PF)and cognitive impairment(CI)are established independent predictors of adverse outcomes in older adults,the prognostic significance of their co-occurrence(cognitive frailty,CF)remains underexplored in the Chinese population.We aimed to explore the epidemiology of CF and its mortality predictive value among community-dwelling older Chinese adults.Methods:Data from the Chinese Longitudinal Healthy Longevity Survey(2011–2018).PF was assessed with the Osteoporotic Fractures frailty index,while CI was defined by the Chinese Mini-Mental State Examination(MMSE)(<18/21/25).CF was defined as concurrent PF and CI in non-demented.Cox proportional hazard regression models were used to evaluate hazard ratios(HRs)and 95%confidence intervals(CIs).A systematic review and random-effects meta-analysis complemented primary analyses,incorporating data from 9 cohorts study(n=32,088).Results:This cohort study included 8,012 participants(mean age 85.35±11.06 years,54.6%females)with 49.8%all-cause mortality over 7 years.Baseline prevalence of PF,CI,and CF were 15.4%,21.1%,and 8.0%respectively.Kaplan-Meier analysis revealed significantly reduced survival in participants with CF compared to other groups(log-rank P<0.001).Fully adjusted Cox models demonstrated a mortality gradient:Non-PF and Normal Cognition(reference),PF alone(HR 1.397,95%CI 1.218–1.602),CI alone(HR 1.572,1.412–1.749),and CF(HR 1.919,1.666–2.210;P<0.001).Effect modification analyses showed heightened CF-associated mortality in males and the oldest-old adults(P for interaction<0.001).Meta-analysis confirmed these findings(pooled HR 2.45,95%CIs,1.91–3.31;I2=57%),with heterogeneity partly attributable to the CI assessment tool or and covariate adjustment strategies.Conclusion:This dual analytical approach substantiates CF as a critical mortality predictor in Chinese older adults,exceeding the risks associated with isolated PF or CI.The observed heterogeneity across studies underscores the need for standardized CF diagnostic criteria and adjustment protocols in prognostic research.Our findings advocate for routine CF screening in geriatric assessments,particularly for males and the oldest-old.Future investigations should clarify the temporal dynamics of CF progression and evaluate targeted interventions.展开更多
基金supported by The Innovation Team and Talents Cultivation Program of National Administration of Traditional Chinese Medicine(ZYYCXTD-C-202006)the 2025 High-level traditional Chinese medicine key subject construction project of National Administration of Traditional Chinese Medicine–Evidence-based Traditional Chinese Medicine.
文摘Background:While physical frailty(PF)and cognitive impairment(CI)are established independent predictors of adverse outcomes in older adults,the prognostic significance of their co-occurrence(cognitive frailty,CF)remains underexplored in the Chinese population.We aimed to explore the epidemiology of CF and its mortality predictive value among community-dwelling older Chinese adults.Methods:Data from the Chinese Longitudinal Healthy Longevity Survey(2011–2018).PF was assessed with the Osteoporotic Fractures frailty index,while CI was defined by the Chinese Mini-Mental State Examination(MMSE)(<18/21/25).CF was defined as concurrent PF and CI in non-demented.Cox proportional hazard regression models were used to evaluate hazard ratios(HRs)and 95%confidence intervals(CIs).A systematic review and random-effects meta-analysis complemented primary analyses,incorporating data from 9 cohorts study(n=32,088).Results:This cohort study included 8,012 participants(mean age 85.35±11.06 years,54.6%females)with 49.8%all-cause mortality over 7 years.Baseline prevalence of PF,CI,and CF were 15.4%,21.1%,and 8.0%respectively.Kaplan-Meier analysis revealed significantly reduced survival in participants with CF compared to other groups(log-rank P<0.001).Fully adjusted Cox models demonstrated a mortality gradient:Non-PF and Normal Cognition(reference),PF alone(HR 1.397,95%CI 1.218–1.602),CI alone(HR 1.572,1.412–1.749),and CF(HR 1.919,1.666–2.210;P<0.001).Effect modification analyses showed heightened CF-associated mortality in males and the oldest-old adults(P for interaction<0.001).Meta-analysis confirmed these findings(pooled HR 2.45,95%CIs,1.91–3.31;I2=57%),with heterogeneity partly attributable to the CI assessment tool or and covariate adjustment strategies.Conclusion:This dual analytical approach substantiates CF as a critical mortality predictor in Chinese older adults,exceeding the risks associated with isolated PF or CI.The observed heterogeneity across studies underscores the need for standardized CF diagnostic criteria and adjustment protocols in prognostic research.Our findings advocate for routine CF screening in geriatric assessments,particularly for males and the oldest-old.Future investigations should clarify the temporal dynamics of CF progression and evaluate targeted interventions.
