BACKGROUND Cognitive frailty and depression are prevalent among the elderly,significantly impairing physical and cognitive functions,psychological well-being,and quality of life.Effective interventions are essential t...BACKGROUND Cognitive frailty and depression are prevalent among the elderly,significantly impairing physical and cognitive functions,psychological well-being,and quality of life.Effective interventions are essential to mitigate these adverse effects and enhance overall health outcomes in this population.AIM To evaluate the effects of exercise-cognitive dual-task training on frailty,cognitive function,psychological status,and quality of life in elderly patients with cognitive frailty and depression.METHODS A retrospective study was conducted on 130 patients with cognitive frailty and depression admitted between December 2021 and December 2023.Patients were divided into a control group receiving routine intervention and an observation group undergoing exercise-cognitive dual-task training in addition to routine care.Frailty,cognitive function,balance and gait,psychological status,and quality of life were assessed before and after the intervention.RESULTS After the intervention,the frailty score of the observation group was(5.32±0.69),lower than that of the control group(5.71±0.55).The Montreal cognitive assessment basic scale score in the observation group was(24.06±0.99),higher than the control group(23.43±1.40).The performance oriented mobility assessment score in the observation group was(21.81±1.24),higher than the control group(21.15±1.26).The self-efficacy in the observation group was(28.27±2.66),higher than the control group(30.05±2.66).The anxiety score in the hospital anxiety and depression scale(HADS)for the observation group was(5.86±0.68),lower than the control group(6.21±0.64).The depression score in the HADS for the observation group was(5.67±0.75),lower than the control group(6.27±0.92).Additionally,the scores for each dimension of the 36-item short form survey in the observation group were higher than those in the control group,with statistically significant differences(P<0.05).CONCLUSION Exercise-cognitive dual-task training is beneficial for improving frailty,enhancing cognitive function,and improving psychological status and quality of life in elderly patients with cognitive frailty and depression.展开更多
BACKGROUND Cognitive frailty,characterized by the coexistence of cognitive impairment and physical frailty,represents a multifaceted challenge in the aging population.The role of cardiovascular risk factors in this co...BACKGROUND Cognitive frailty,characterized by the coexistence of cognitive impairment and physical frailty,represents a multifaceted challenge in the aging population.The role of cardiovascular risk factors in this complex interplay is not yet fully understood.AIM To investigate the relationships between cardiovascular risk factors and older persons with cognitive frailty by pooling data from two cohorts of studies in Malaysia.METHODS A comprehensive approach was employed,with a total of 512 communitydwelling older persons aged 60 years and above,involving two cohorts of older persons from previous studies.Datasets related to cardiovascular risks,namely sociodemographic factors,and cardiovascular risk factors,including hypertension,diabetes,hypercholesterolemia,anthropometric characteristics and biochemical profiles,were pooled for analysis.Cognitive frailty was defined based on the Clinical Dementia Rating scale and Fried frailty score.Cardiovascular risk was determined using Framingham risk score.Statistical analyses were conducted using SPSS version 21.RESULTS Of the study participants,46.3%exhibited cognitive frailty.Cardiovascular risk factors including hypertension(OR:1.60;95%CI:1.12-2.30),low fat-free mass(OR:0.96;95%CI:0.94-0.98),high percentage body fat(OR:1.04;95%CI:1.02-1.06),high waist circumference(OR:1.02;95%CI:1.01-1.04),high fasting blood glucose(OR:1.64;95%CI:1.11-2.43),high Framingham risk score(OR:1.65;95%CI:1.17-2.31),together with sociodemographic factors,i.e.,being single(OR 3.38;95%CI:2.26-5.05)and low household income(OR 2.18;95%CI:1.44-3.30)were found to be associated with cognitive frailty.CONCLUSION Cardiovascular-risk specific risk factors and sociodemographic factors were associated with risk of cognitive frailty,a prodromal stage of dementia.Early identification and management of cardiovascular risk factors,particularly among specific group of the population might mitigate the risk of cognitive frailty,hence preventing dementia.展开更多
Objective:To systematically review the epidemiological characteristics and influencing factors of cognitive frailty in Chinese elderly with diabetes mellitus.Methods:PubMed,Embase,Web of Science,CINAHL,Cochrane Librar...Objective:To systematically review the epidemiological characteristics and influencing factors of cognitive frailty in Chinese elderly with diabetes mellitus.Methods:PubMed,Embase,Web of Science,CINAHL,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang and Chinese biomedical literature database(CBM)were electronically searched to collect cross-sectional studies on the prevalence and influencing factors of cognitive frailty in Chinese elderly with diabetes mellitus from inception to November 1st,2022.After quality evaluation and data extraction of included studies,R4.2.2 software was used to perform metaanalysis.Results:A total of 7 Chinese and one English literatures involving 2208 participants were included.The results of meta-analysis showed that the prevalence rate of cognitive frailty in elderly diabetic patients was 17.1%(95%CI 8.7%to 30.9%).Subgroup analysis showed that the prevalence rate of cognitive frailty was 10.2%(95%CI 5.0%to 19.7%)in old diabetic adults in community,35.7%(95%CI 20.8%to 53.9%)in hospital,and the difference was statistically significant(P=0.01).The prevalence rate of cognitive frailty was 21.7%(95%CI 10.3%to 40.2%)in male diabetic old adults,24.2%(95%CI 13.3%to 40.1%)in female diabetic old adults,and the difference was not statistically significant(P=0.81).The rate was 12.6%(95%CI 6.6%to 22.5%)in 60~69 years old group,25.8%(95%CI 12.6%to 45.5%)in 70~79 years old group,53.0%(95%CI 23.9%to 80.2%)in diabetic old adults aged 80 years and above,and the difference was statistically significant(P=0.02).The influencing factors for cognitive frailty in diabetic old adults included educational level[OR=0.230,95%CI(0.117~0.454),P<0.0001],regular exercise[OR=0.357,95%CI(0.217~0.588),P<0.01],malnutrition[OR=2.372,95%CI(1.472~3.822),P=0.0004],depression[OR=3.207,95%CI(2.156~4.768),P<0.0001],and HbA1c≥7.0%[OR=3.112,95%CI(1.880~5.152),P<0.0001].Conclusion:The prevalence of cognitive frailty in Chinese elderly patients with diabetes is high,and there are differences in cognitive frailty prevalence among different sources and different ages.Educational level,exercise habits,nutritional status,depression and HbA1c are the factors affecting cognitive frailty in elderly patients with diabetes.Depression,malnutrition,HbA1c≥7.0%were risk factors,and high educational level,regular exercise were protective factors.Attention should be paid to early and accurate identification of cognitive frailty and intervention targeting influencing factors to delay or reverse its progression to adverse health outcomes.展开更多
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
Frailty is a geriatric syndrome characterized by a reduced ability to maintain homeostasis due to age-related declines in physiological reserves.It increases the risk of adverse health outcomes such as falls,hospitali...Frailty is a geriatric syndrome characterized by a reduced ability to maintain homeostasis due to age-related declines in physiological reserves.It increases the risk of adverse health outcomes such as falls,hospitalization,disability,and mortality,especially in older adults.Key risk factors for frailty include cancer,chronic obstructive pulmonary disease,and cerebrovascular disease.Several models of frailty exist,including the physical frailty phenotype,the deficit accu-mulation model,and mixed physical-psychosocial models.Numerous tools are available for assessment.Cognitive dysfunction is closely related to frailty,sharing underlying mechanisms such as oxidative stress,inflammation,and vascular pathologies.Additionally,social frailty,which can be exacerbated by isolation and limited social support,further complicates the challenges faced by frail individuals.It is recommended that frailty screening,particularly through gait speed assessment,can be conducted in primary healthcare settings.Despite existing guidelines,there is still no consensus on the definition,screening,and diagnosis of frailty.This emphasizes the necessity for additional research to conduct a conceptual diagnosis and screen the older population.Artificial intel-ligence approaches show promise in identifying frail patients and managing their care.展开更多
Frailty is a critical intermediate status of the aging process with a multidimensional and multisystem nature and at higher risk for adverse health-related outcomes,including falls,disability,hospitalizations,institut...Frailty is a critical intermediate status of the aging process with a multidimensional and multisystem nature and at higher risk for adverse health-related outcomes,including falls,disability,hospitalizations,institutionalization,mortality,dementia,and Alzheimer’s disease.Among different frailty phenotypes,oral frailty has been recently suggested as a novel construct defined as a decrease in oral function with a coexisting decline in cognitive and physical functions.We briefly reviewed existing evidence on operational definitions of oral frailty,assessment and screening tools,and possible relationships among oral frailty,oral microbiota,and Alzheimer’s disease neurodegeneration.Several underlying mechanism may explain the oral health-frailty links including undernutrition,sarcopenia linked to both poor nutrition and frailty,psychosocial factors,and the chronic inflammation typical of oral disease.Oral microbiota may influence Alzheimer’s disease risk through circulatory or neural access to the brain and the interplay with periodontal disease,often causing tooth loss also linked to an increased Alzheimer’s disease risk.On this bases,COR388,a bacterial protease inhibitor targeting Porphyromonas gingivalis implicated in periodontal disease,is now being tested in a double-blind,placebocontrolled Phase II/III study in mild-to-moderate Alzheimer’s disease.Therefore,oral status may be an important contributor to general health,including Alzheimer’s disease and latelife cognitive disorders,suggesting the central role of preventive strategies targeting the novel oral frailty phenotype and including maintenance and improvement of oral function and nutritional status to reduce the burden of both oral dysfunction and frailty.展开更多
文摘BACKGROUND Cognitive frailty and depression are prevalent among the elderly,significantly impairing physical and cognitive functions,psychological well-being,and quality of life.Effective interventions are essential to mitigate these adverse effects and enhance overall health outcomes in this population.AIM To evaluate the effects of exercise-cognitive dual-task training on frailty,cognitive function,psychological status,and quality of life in elderly patients with cognitive frailty and depression.METHODS A retrospective study was conducted on 130 patients with cognitive frailty and depression admitted between December 2021 and December 2023.Patients were divided into a control group receiving routine intervention and an observation group undergoing exercise-cognitive dual-task training in addition to routine care.Frailty,cognitive function,balance and gait,psychological status,and quality of life were assessed before and after the intervention.RESULTS After the intervention,the frailty score of the observation group was(5.32±0.69),lower than that of the control group(5.71±0.55).The Montreal cognitive assessment basic scale score in the observation group was(24.06±0.99),higher than the control group(23.43±1.40).The performance oriented mobility assessment score in the observation group was(21.81±1.24),higher than the control group(21.15±1.26).The self-efficacy in the observation group was(28.27±2.66),higher than the control group(30.05±2.66).The anxiety score in the hospital anxiety and depression scale(HADS)for the observation group was(5.86±0.68),lower than the control group(6.21±0.64).The depression score in the HADS for the observation group was(5.67±0.75),lower than the control group(6.27±0.92).Additionally,the scores for each dimension of the 36-item short form survey in the observation group were higher than those in the control group,with statistically significant differences(P<0.05).CONCLUSION Exercise-cognitive dual-task training is beneficial for improving frailty,enhancing cognitive function,and improving psychological status and quality of life in elderly patients with cognitive frailty and depression.
基金Supported by Long-term Research Grant Scheme provided by Ministry of Education Malaysia,No.LRGS/1/2019/UM-UKM/1/4Grand Challenge Grant Project 1 and Project 2,No.DCP-2017-002/1,No.DCP-2017-002/2.
文摘BACKGROUND Cognitive frailty,characterized by the coexistence of cognitive impairment and physical frailty,represents a multifaceted challenge in the aging population.The role of cardiovascular risk factors in this complex interplay is not yet fully understood.AIM To investigate the relationships between cardiovascular risk factors and older persons with cognitive frailty by pooling data from two cohorts of studies in Malaysia.METHODS A comprehensive approach was employed,with a total of 512 communitydwelling older persons aged 60 years and above,involving two cohorts of older persons from previous studies.Datasets related to cardiovascular risks,namely sociodemographic factors,and cardiovascular risk factors,including hypertension,diabetes,hypercholesterolemia,anthropometric characteristics and biochemical profiles,were pooled for analysis.Cognitive frailty was defined based on the Clinical Dementia Rating scale and Fried frailty score.Cardiovascular risk was determined using Framingham risk score.Statistical analyses were conducted using SPSS version 21.RESULTS Of the study participants,46.3%exhibited cognitive frailty.Cardiovascular risk factors including hypertension(OR:1.60;95%CI:1.12-2.30),low fat-free mass(OR:0.96;95%CI:0.94-0.98),high percentage body fat(OR:1.04;95%CI:1.02-1.06),high waist circumference(OR:1.02;95%CI:1.01-1.04),high fasting blood glucose(OR:1.64;95%CI:1.11-2.43),high Framingham risk score(OR:1.65;95%CI:1.17-2.31),together with sociodemographic factors,i.e.,being single(OR 3.38;95%CI:2.26-5.05)and low household income(OR 2.18;95%CI:1.44-3.30)were found to be associated with cognitive frailty.CONCLUSION Cardiovascular-risk specific risk factors and sociodemographic factors were associated with risk of cognitive frailty,a prodromal stage of dementia.Early identification and management of cardiovascular risk factors,particularly among specific group of the population might mitigate the risk of cognitive frailty,hence preventing dementia.
基金Military Medical Innovation Project (No.18CXZ034)National Key Research andDevelopment Program (No.2018YFC2001400,2020YFC2008601)。
文摘Objective:To systematically review the epidemiological characteristics and influencing factors of cognitive frailty in Chinese elderly with diabetes mellitus.Methods:PubMed,Embase,Web of Science,CINAHL,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang and Chinese biomedical literature database(CBM)were electronically searched to collect cross-sectional studies on the prevalence and influencing factors of cognitive frailty in Chinese elderly with diabetes mellitus from inception to November 1st,2022.After quality evaluation and data extraction of included studies,R4.2.2 software was used to perform metaanalysis.Results:A total of 7 Chinese and one English literatures involving 2208 participants were included.The results of meta-analysis showed that the prevalence rate of cognitive frailty in elderly diabetic patients was 17.1%(95%CI 8.7%to 30.9%).Subgroup analysis showed that the prevalence rate of cognitive frailty was 10.2%(95%CI 5.0%to 19.7%)in old diabetic adults in community,35.7%(95%CI 20.8%to 53.9%)in hospital,and the difference was statistically significant(P=0.01).The prevalence rate of cognitive frailty was 21.7%(95%CI 10.3%to 40.2%)in male diabetic old adults,24.2%(95%CI 13.3%to 40.1%)in female diabetic old adults,and the difference was not statistically significant(P=0.81).The rate was 12.6%(95%CI 6.6%to 22.5%)in 60~69 years old group,25.8%(95%CI 12.6%to 45.5%)in 70~79 years old group,53.0%(95%CI 23.9%to 80.2%)in diabetic old adults aged 80 years and above,and the difference was statistically significant(P=0.02).The influencing factors for cognitive frailty in diabetic old adults included educational level[OR=0.230,95%CI(0.117~0.454),P<0.0001],regular exercise[OR=0.357,95%CI(0.217~0.588),P<0.01],malnutrition[OR=2.372,95%CI(1.472~3.822),P=0.0004],depression[OR=3.207,95%CI(2.156~4.768),P<0.0001],and HbA1c≥7.0%[OR=3.112,95%CI(1.880~5.152),P<0.0001].Conclusion:The prevalence of cognitive frailty in Chinese elderly patients with diabetes is high,and there are differences in cognitive frailty prevalence among different sources and different ages.Educational level,exercise habits,nutritional status,depression and HbA1c are the factors affecting cognitive frailty in elderly patients with diabetes.Depression,malnutrition,HbA1c≥7.0%were risk factors,and high educational level,regular exercise were protective factors.Attention should be paid to early and accurate identification of cognitive frailty and intervention targeting influencing factors to delay or reverse its progression to adverse health outcomes.
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.
文摘Frailty is a geriatric syndrome characterized by a reduced ability to maintain homeostasis due to age-related declines in physiological reserves.It increases the risk of adverse health outcomes such as falls,hospitalization,disability,and mortality,especially in older adults.Key risk factors for frailty include cancer,chronic obstructive pulmonary disease,and cerebrovascular disease.Several models of frailty exist,including the physical frailty phenotype,the deficit accu-mulation model,and mixed physical-psychosocial models.Numerous tools are available for assessment.Cognitive dysfunction is closely related to frailty,sharing underlying mechanisms such as oxidative stress,inflammation,and vascular pathologies.Additionally,social frailty,which can be exacerbated by isolation and limited social support,further complicates the challenges faced by frail individuals.It is recommended that frailty screening,particularly through gait speed assessment,can be conducted in primary healthcare settings.Despite existing guidelines,there is still no consensus on the definition,screening,and diagnosis of frailty.This emphasizes the necessity for additional research to conduct a conceptual diagnosis and screen the older population.Artificial intel-ligence approaches show promise in identifying frail patients and managing their care.
文摘Frailty is a critical intermediate status of the aging process with a multidimensional and multisystem nature and at higher risk for adverse health-related outcomes,including falls,disability,hospitalizations,institutionalization,mortality,dementia,and Alzheimer’s disease.Among different frailty phenotypes,oral frailty has been recently suggested as a novel construct defined as a decrease in oral function with a coexisting decline in cognitive and physical functions.We briefly reviewed existing evidence on operational definitions of oral frailty,assessment and screening tools,and possible relationships among oral frailty,oral microbiota,and Alzheimer’s disease neurodegeneration.Several underlying mechanism may explain the oral health-frailty links including undernutrition,sarcopenia linked to both poor nutrition and frailty,psychosocial factors,and the chronic inflammation typical of oral disease.Oral microbiota may influence Alzheimer’s disease risk through circulatory or neural access to the brain and the interplay with periodontal disease,often causing tooth loss also linked to an increased Alzheimer’s disease risk.On this bases,COR388,a bacterial protease inhibitor targeting Porphyromonas gingivalis implicated in periodontal disease,is now being tested in a double-blind,placebocontrolled Phase II/III study in mild-to-moderate Alzheimer’s disease.Therefore,oral status may be an important contributor to general health,including Alzheimer’s disease and latelife cognitive disorders,suggesting the central role of preventive strategies targeting the novel oral frailty phenotype and including maintenance and improvement of oral function and nutritional status to reduce the burden of both oral dysfunction and frailty.
