Frailty syndrome and cognitive impairment in older adults: systematic review of the literature

Miyamura, Karen; Fhon, Jack Roberto Silva; Bueno, Alexandre de Assis; Fuentes-Neira, Wilmer Luis; Silveira, Renata Cristina de Campos Pereira; Rodrigues, Rosalina Aparecida Partezani

doi:10.1590/1518-8345.3189.3202

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Revista Latino-Americana de Enfermagem

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Review Article • Rev. Latino-Am. Enfermagem 27 • 2019 • https://doi.org/10.1590/1518-8345.3189.3202 copy

Frailty syndrome and cognitive impairment in older adults: systematic review of the literature^* * Paper extracted from master’s thesis “Síndrome da fragilidade e o comprometimento cognitivo em idosos: revisão sistemática da literatura”, presented to Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Center for Nursing Research Development, Ribeirão Preto, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to synthesize the knowledge about the association of frailty syndrome and cognitive impairment in older adults.

Method:

the Joanna Briggs Institute’s systematic review of etiology and risk factors was adopted. The search for the studies was conducted by two independent reviewers in the databases MEDLINE, Embase, CINAHL and LILACS and by manual search was performed by tow reviewers independently. The measures of association Odds Ratio and Relative Risk were used in the meta-analysis. The software R version 3.4.3 and the meta-analysis package Metafor 2.0 were used for figure analysis.

Results:

three studies identified the association of frailty syndrome and cognitive impairment through Odds Ratio values show that frail older adults are 1.4 times more likely to present cognitive impairment than non-frail older adults. Four studies analyzed the association through the measure of Relative Risk and found no statistical significance, and four studies used mean values.

Conclusion:

despite of the methodological differences of the studies and the lack of definition of an exact proportion in the cause and effect relationship, most studies indicate Frailty Syndrome as a trigger for Cognitive decline.

Descriptors:
Aged; Frailty; Cognition; Cognitive Aging; Meta-analysis; Review

	Population (P)	Exposuse of interest (E)	Outcome (O)
Database	Older adults	Frailty syndrome	Cognitive decline
PubMed^* * PubMed = National Center for Biotechnology Information; (MeSH)	“aged”[Mesh] OR “aged, 80 and over”[Mesh] OR “older people” OR “elderly people”	Frail^* * PubMed = National Center for Biotechnology Information;	“cognitive frailty” OR “cognitive impairment” OR “cognitive decline” OR “cognition disorders”[Mesh]
EMBASE^† † EMBASE = Excerpta Medica Database; (EMTREE)	‘aged’/exp OR ‘very elderly’/exp OR ‘frail elderly’/exp	Frail^* * PubMed = National Center for Biotechnology Information;	‘cognitive defect’/exp OR ‘mild cognitive impairment’/exp OR ‘cognitive decline’/exp OR ‘cognitive impairment no dementia’/exp)
CINAHL^‡ ‡ CINAHL = Nursing and Allied Health Literature; (Headings-MH)	MH “aged” OR MH “aged, 80 and over” OR “older person”	Frail^* * PubMed = National Center for Biotechnology Information;	MH “cognition disorders” OR “cognitive impairment” OR “cognitive decline” OR “cognitive frailty”
LILACS^§ § LILACS = Latin-American and Caribbean Center on Health Sciences Information; (DeCS)	“idoso” OR “aged” OR “anciano” OR “idoso de 80 anos ou mais” OR “aged, 80 and over” OR “anciano de 80 o más años” OR “idoso fragilizado” OR “frail elderly” OR “anciano frágil”	“frágil” OR “frail” OR “frágil”	“disfunção cognitiva” OR “cognitive dysfunction” OR “disfunción cognitiva”

Author and Year	Type of analysis	Results	Dependent variable	Independent variable
Odds Ratio (OR)
Chen et al., 2017⁽¹⁹⁾19 Chen S, Honda T, Narazaki K, Chen T, Kishimoto H, Haeuchi Y, et al. Physical Frailty Is Associated with Longitudinal Decline in Global Cognitive Function in Non-Demented Older Adults: A Prospective Study. J Nutr Health Aging. 2018; 22(1): 82-8. doi: https://doi.org/10.1007/s12603-017-0924-1 https://doi.org/10.1007/s12603-017-0924-...	Logistic regression model	2.28 (1.02-5.08)	Cognitive decline	Frailty syndrome
Raji et al., 2010⁽²⁶⁾26 Raji MA, Al Snih S, Ostir GV, Markides KS, Ottenbacher KJ. Cognitive status and future risk of frailty in older Mexican Americans. J Gerontol A Biol Sci Med Sci. 2010; 65(11): 1228-34. doi: http://dx.doi.org/10.1093/gerona/glq121 http://dx.doi.org/10.1093/gerona/glq121...	General estimation equation model	1.04 (0.75-1.44)	Frailty syndrome	Cognitive decline
Samper-Ternent et al., 2008⁽²⁷⁾27 Samper-Ternent R, Al Snih S, Raji MA, Markides KS, Ottenbacher KJ. Relationship between frailty and cognitive decline in older Mexican Americans. J Am Geriatr Soc. 2008; 56(10): 1845-52. doi: http://dx.doi.org/10.1111/j.1532-5415.2008.01947.x http://dx.doi.org/10.1111/j.1532-5415.20...	General linear mixed models General estimation equations	1.27 (1.07-1.52)	Cognitive decline	Frailty syndrome
Relative Risk (RR)
Gale et al., 2017⁽²⁰⁾20 Gale CR, Ritchie SJ, Cooper C, Starr JM, Deary IJ. Cognitive Ability in Late Life and Onset of Physical Frailty: The Lothian Birth Cohort 1936. J Am Geriatr Soc. 2017; 65(6): 1289-95. doi: https://doi.org/10.11/jgs.14787 https://doi.org/10.11/jgs.14787...	Multinomial logistic regression	1) 0.95 (0.56-1.63) 2) 0.75 (0.48-1.15) 3) 0.26 (0.16-0.42) 4) 0.92 (0.69-1.24)	Frailty syndrome	1) Visuospatial ability 2) Memory 3) Processing speed 4) Crystallized cognitive ability
Alencar et al., 2013⁽²⁵⁾25 Alencar MA, Dias JM, Figueiredo LC, Dias RC. Frailty and cognitive impairment among community-dwelling elderly. Arq Neuropsiquiatr. 2013; 71(6): 362-7. doi: http://dx.doi.org/10.1590/0004-282X20130039 http://dx.doi.org/10.1590/0004-282X20130...	Chi-square test Fisher’s test	4.6 (1.93-11.2)	Cognitive decline	Frailty syndrome
Hazard Ratio (HR)
Gross et al., 2016⁽²³⁾23 Gross AL, Xue QL, Bandeen-Roche K, Fried LP, Varadhan R, McAdams-DeMarco MA, et al. Declines and impairment in executive function predict onset of physical frailty. J Gerontol A Biol Sci Med Sci. 2016; 71(12): 1624-30. doi: https://doi.org/10.1093/gerona/glw067 https://doi.org/10.1093/gerona/glw067...	Kaplan-Meier survival analysis	1) Psychomotor speed 2.0 (0.8-5.3) 2) Executive functioning 3.3 (1.4-7.6) 3) Memory 1.0 (0.3-3.4) 4) Delayed memory 1.8 (0.5-5.6)	Time to Onset of Frailty	1) Psychomotor speed 2) Executive functioning 3) Memory 4) Delayed memory
Montero-Odasso et al., 2016⁽²²⁾22 Montero-Odasso MM, Barnes B, Speechley M, Muir Hunter SW, Doherty TJ, Duque G, et al. Disentangling cognitive-frailty: results from the gait and brain study. J Gerontol A Biol Sci Med Sci. 2016; 71(11): 1476-82. doi: https://doi.org/10.1093/gerona/glw044 https://doi.org/10.1093/gerona/glw044...	Logistic regression	0.2 (0.0-1.5)	Cognitive decline	1) Weight loss 2) Poor grip strength 3) Exhaustion 4) Slow walking speed 5) Low physical activity
Mean
Rosado-Artalejo et al., 2017⁽¹⁰⁾10 Rosado-Artalejo C, Carnicero JA, Losa-Reyna J, Guadalupe-Grau A, Castillo-Gallego C, Gutierrez-Avila G, et al. Cognitive performance across 3 frailty phenotypes: Toledo study for healthy aging. J Am Med Dir Assoc, 2017; 8(9): 785-90. doi: https://doi.org/10.1016/j.jamda.2017.04.008 https://doi.org/10.1016/j.jamda.2017.04....	Multiple linear regression	1) Frailty phenotype: -2.19 2) Frailty Trait Scale: -0.92 3) Frailty Index: -1.39	Cognitive decline	Frailty syndrome evaluated by 3 scales (Frailty phenotype, Frailty Trait Scale e FI^* * Frailty Index; )
Buchman et al., 2014⁽¹⁸⁾18 Buchman AS, Yu L, Wilson RS, Boyle PA, Schneider JA, Bennett DA. Brain pathology contributes to simultaneous change in physical frailty and cognition in old age. J Gerontol A Biol Sci Med Sci. 2014; 69(12): 1536-44. doi: https://doi.org/10.1093/gerona/glu117 https://doi.org/10.1093/gerona/glu117...	Bivariate random coefficient models Pearson coefficient	Fried phenotype 19 tests 0.07 (SD=0.63)^† † Standard Deviation;	Frailty	Cognitive function
Mitnitski et al., 2011⁽²¹⁾21 Mitnitski A, Fallah N, Rockwood MR, Rockwood K. Transitions in cognitive status in relation to frailty in older adults: a comparison of three frailty measures. J Nutr Health Aging. 2011; 15(10): 863-7. doi: https://doi.org/10.1007/s12603-011-0066-9 https://doi.org/10.1007/s12603-011-0066-...	Poisson Regression (CI 95%)^‡ ‡ 95% Confidence Interval;	1) FI - CGA: 1.01 (0.93-1.07)^§ § Frailty Index = Comprehensive Geriatric Assessment; 2) Frailty phenotype: 1.02 (0.97-1.09) 3) CFS: 1.01 (0.95-1.08)^‖	Cognitive decline	Frailty syndrome evaluated by 3 scales (FI-CGA^§ § Frailty Index = Comprehensive Geriatric Assessment; ; Frailty phenotype e CFS^‖)
Auyeung et al., 2011⁽²⁴⁾24 Auyeung TW, Lee JS, Kwok T, Woo J. Physical frailty predicts future cognitive decline - a four-year prospective study in 2737 cognitively normal older adults. J Nutr Health Aging. 2011; 15(8): 690-4. doi: https://doi.org/10.1007/s12603-011-0110-9 https://doi.org/10.1007/s12603-011-0110-...	Multiple linear regression (CI 95%)^‡ ‡ 95% Confidence Interval;	Female 1) 0.197 (0.037-0.354) 2) -0.059 (-0.214-0.095) 3) 0.020 (-0.142-0.182) 4) 0.055 (-0.105-0.215) 5) -0.042 (-0.209-0124) Male 1) 0.233 (0.086-0.375) 2) -0.233 (-0.373 - -0.088) 3) 0.162 (0.013-0.309) 4) 0.140 (-0.007-0.287) 5) 0.033 (-0.114-0.181)	Cognitive decline	1) Handgrip strenght 2) Chair-stand test 3) Step length 4) Timed walk

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[1] Corresponding author: Rosalina Aparecida Partezani Rodrigues. E-mail: rosalina@eerp.usp.br