Cognitive frailty


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cognitive affection in Frail elderly

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Cognitive frailty

  1. 1. Cognition and Frailty inCognition and Frailty in Older Adults: Evidence forOlder Adults: Evidence for a Possible Linka Possible Link Doha Rasheedy, MD Lecturer of Geriatrics and Gerontology Geriatrics and Gerontology Department Ain Shams University
  2. 2. Frailty refers to a geriatric syndrome characterized by loss of physiologic reserve, and increased vulnerability to stressors leading to increased risk of negative health-related events The prevalence and the consequences of frailty present a considerable burden to older people, their carers, health care services and the community. (Houles M. et al.,2012)
  3. 3. However, data concerning the biological and clinical basis of this syndrome are still limited. To overcome the absence of clear biological and clinical markers, researchers have been developing various operational definitions aimed at capturing the syndromic nature of this condition. (Houles M. et al.,2012)
  4. 4. Researchers focused on physical frailty in different outcome models despite the multidimensional pattern of the syndrome. The relationship between frailty and cognition is of growing importance. Cognitive impairment is increasingly recognized as a potential contributor to the clinical vulnerability of older persons, being a strong predictor of several adverse health related outcomes. (Sternberg SA; et al. 2011).
  5. 5. This Frailty definition is based on a scoring system related to physical fitness not including mood and cognitive status. The Fried frailty modelThe Fried frailty model Fried LP, Tangen CM, Walston J, et al. 2001Fried LP, Tangen CM, Walston J, et al. 2001
  6. 6. It includes disability, diseases, physical and cognitive impairments, psychosocial risk factors and geriatric syndromes (eg, falls, delirium, and urinary incontinence) The FI seems to be more sensitive in predicting adverse health outcomes than the Fried and colleagues’ physical phenotype. Frailty indexFrailty index Rockwood K et al., (2001)
  7. 7. The Edmonton frail scaleThe Edmonton frail scale ROLFSON DB et al.,2006
  8. 8. COGNITIVE IMPAIRMENT AS ACOGNITIVE IMPAIRMENT AS A COMPONENT OF FRAILTYCOMPONENT OF FRAILTY Cognitive and physical function are closely interrelated, and a measure of frailty that includes cognitive performance, is a better predictor of adverse-health outcomes – Incorporating cognitive impairment improves the predictive value of frailty for adverse outcomes
  9. 9. FRAILTY AS RISK FACTOR FORFRAILTY AS RISK FACTOR FOR COGNITIVE IMPAIRMENTCOGNITIVE IMPAIRMENT Cross-sectional studies have reported associations between physical frailty and cognitive function. Higher level of physical frailty is associated with an increased risk of incident MCI. Frailty is predictive of incident AD and is associated with the rate of cognitive decline
  10. 10. • Frailty was found to be a Prodromal Stage of Vascular Dementia Individual components of frailty; impaired grip strength, slowed gait and low body mass index (BMI), have been shown to predict development of dementia and are associated with incident MCI. Stewart R et al.,2005 (Ávila-Funes et al., 2011)
  11. 11. Although physical frailty and cognitive impairment have shown to be related in epidemiological studies, their pathophysiological mechanisms have generally been studied separately. Moreover, The mechanisms thatMoreover, The mechanisms that underlie the relationshipsunderlie the relationships between frailty and cognitivebetween frailty and cognitive impairment remain unclearimpairment remain unclear.
  12. 12. The biological basis of frailty could be constituted as the cumulative result of pathophysiological modifications caused by: 1. Genetic variation 2. concurrent chronic conditions (e.g., cardiovascular and pulmonary disease, diabetes), 3. subclinical adaptations of the systemic homeostatic mechanisms (e.g., inflammation, oxidative damage), 4. metabolic modifications (hyperglycemia, 5. behavioral factors (e.g., reduced physical activity). some of these pathways are shared by both frailty and AD. Walston J et al.,2006
  13. 13. Biologic model for frailty describing theBiologic model for frailty describing the hypothesized molecular, physiological,hypothesized molecular, physiological, and clinical pathways to frailtyand clinical pathways to frailty )Walston, et al., 2006, pp.993(
  14. 14. Does cognitive frailty exist? The similar model of physical frailty can be adapted to the aged brain and the concept of cognitive frailty applies to dysfunction of the neuron’s energetics and the effects of this dysfunction on neuronal energy production, survival and synaptic operations. )Manton et al., 2004(
  15. 15. Does cognitive frailty exist? CNS , muscle tissue are both high energy consuming tissues.  CNS is very sensitive to circulatory dysfunction (caused by chronic disorders), oxidative damage, and inflammatory cytokines which are major predictors of physical frailty. The mitotic index of neurons in adults is low making it difficult to replace damaged neuronal cells than replacement of myocytes in damaged muscle tissue. )Manton et al., 2004(
  16. 16. Cognitive frailty is identified as a heterogeneous clinical manifestation characterized by the simultaneous presence of both physical frailty and cognitive impairment.
  17. 17. The key factors defining such a condition include: 1) presence of physical frailty and cognitive impairment (Clinical Dementia Rating score of 0.5); and 2) exclusion of concurrent Alzheimer disease dementia or other dementias.
  18. 18. The concept of “cognitive frailty” recognizes the synergistic effect that Mild Cognitive Impairment (MCI) have in persons with physical frailty on adverse outcomes. cognitive frailty may represent a precursor of neurodegenerative processes. A potential for reversibility may also characterize this entity. A psychological component of the condition is evident and participates at increasing the vulnerability of the individual to stressors.
  19. 19. Addition of a cognitive assessment in the operational definitions of frailty should be carefully considered, being the cognitive domain strongly associated with a wide spectrum of adverse outcomes in the elderly. Future studies are needed to promote the study of the proposed new syndrome of cognitive frailty.