Frailty and cognitive performance in older adults living in the community: a cross-sectional study

FABRÍCIO, DAIENE DE MORAIS; ALEXANDRE, TIAGO DA SILVA; CHAGAS, MARCOS HORTES NISIHARA

doi:10.1590/0101-60830000000216

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Original article • Arc. Clin. Psychiatr. 46 (6) • Nov-Dec 2019 • https://doi.org/10.1590/0101-60830000000216 linkcopy

Frailty and cognitive performance in older adults living in the community: a cross-sectional study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Background Cognitive impairment and frailty are important problems affecting the elderly population. Frail elderly present worse overall cognitive performance.

Objective The aim of this study was to investigate general and domain-specific cognitive performance among non-frail, pre-frail, and frail elderly persons.

Methods This is a cross-sectional study in which 267 elderly persons living in São Carlos, SP were divided into three groups according to the frailty criteria defined by Fried et al. Cognitive performance was evaluated with a battery of cognitive tests covering domains such as memory, attention, language, and executive functioning. A multinomial logistic regression analysis adjusted for age, gender, and education was performed to evaluate the association between performance in cognitive domains and levels of frailty.

Results Frailty was significantly associated with lower scores on the global cognitive test (RRR = 0.86; IC 95% 0.78-0.96; p < 0.01), word list memory (RRR = 0.92; IC 95% 0.86-0.99; p = 0.02), and figure list recognition (RRR = 0.78; IC 95% 0.62-0.99; p = 0.04). Pre-frailty was associated with lower scores on the word list memory (RRR = 0.92; IC 95% 0.86-1.00; p = 0.04) and naming test (RRR = 0.82; IC 95% 0.69-0.99; p = 0.03).

Discussion Frailty syndrome can influence general cognition and specific domains such as memory and language. Prospective studies will be fundamental to evaluate the causal relation between frailty and cognition.

Cognition; elderly; frailty; mental health

Variable	Total (n = 267)	Non-frail (n = 36)	Pre-frail (n = 71)	Frail (n = 160)	p
Age	70.2 (±7.7)	68.0 (±5.9)	68.6 (±5.5)	71.5 (±8.6)	0.04
Sex					<0.01
F	61%	36.1%	60.6%	63.8%
M	39%	63.9%	39.4%	36.3%
Education					<0.01
≥4 year	43.8%	52.8%	56.3%	36.3%
<4 year	56.2%	47.2%	43.7%	63.8%
MMSE	22.2 (±5.0)	24.6 (±4.0)	23.0 (±4.7)	21.2 (±5.1)	<0.01
Word list memory (CERAD)	12.1 (5.8)	14.7 (±6.0)	12.5 (±5.4)	11.5 (±5.8)	<0.01
Delayed recall (CERAD)	3.0 (±2.5)	3.5 (±2.4)	3.1 (±2.5)	2.9 (±2.5)	0.32
Recognition (CERAD)	7.2 (±3.1)	7.9 (±3.2)	7.3 (±3.0)	7.0 (±3.0)	0.07
Constructional praxis (CERAD)	5.3 (±3.3)	5.7 (±3.4)	5.8 (±3.0)	5.0 (±3.4)	0.30
Figures list memory (BCSB)	19.8 (6.3)	20.2 (±5.8)	20.9 (±6.3)	19.3 (±6.4)	0.10
BCSB (Delayed recall)	6.5 (±2.7)	6.5 (±2.3)	7.0 (±2.8)	6.3 (±2.8)	<0.01
BCSB (Recognition)	8.4 (±2.7)	9.3 (±1.6)	8.5 (±2.6)	8.1 (±2.8)	<0.01
Abstraction subtest (CAMDEX)	2.7 (±2.2)	3.3 (±2.6)	2.8 (±2.0)	2.4 (±2.2)	0.11
Clock Drawing Test	4.8 (±3.6)	5.0 (±3.5)	5.2 (±3.6)	4.7 (±3.6)	0.32
Verbal fluency	10.4 (±4.0)	10.9 (±4.4)	10.7 (±4.1)	10.1 (±3.7)	0.68
Boston Naming test	11.2 (±2.9)	12.4 (±2.3)	11.0 (±3.0)	11.0 (±2.8)	0.04
Digit extension test (Forward)	4.3 (±1.4)	4.5 (±1.2)	4.6 (±1.4)	4.2 (±1.4)	0.14
Digit extension test (Backward)	2.3 (±1.2)	2.7 (±0.9)	2.4 (±1.1)	2.1 (±1.3)	0.03

Variable Reference group (non-frail)	Groups
	Pre-frail		Frail
	RRR	p	RRR	p
MMSE	0.90 (0.80-1.00)	0.06	0.86 (0.78-0.96)	< 0.01
Word list memory (CERAD)	0.93 (0.86-1.00)	0.04	0.92 (0.86-0.99)	0.02
Delayed recall (CERAD)	0.91 (0.76-1.07)	0.25	0.92 (0.79-1.07)	0.28
Recognition (CERAD)	0.91 (0.77-1.06)	0.22	0.93 (0.81-1.08)	0.35
Constructional praxis (CERAD)	1.01 (0.88-1.17)	0.84	1.00 (0.87-1.13)	0.91
Figures list memory (BCSB)	1.01 (0.94-1.09)	0.78	0.98 (0.92-1.05)	0.67
Delayed recall (BCSB)	1.03 (0.88-1.22)	0.69	0.97 (0.84-1.13)	0.70
Recognition (BCSB)	0.79 (0.62-1.01)	0.06	0.78 (0.62-0.99)	0.04
Abstraction subtest (CAMDEX)	0.87 (0.72-1.06)	0.17	0.88 (0.73-1.05)	0.15
Clock Drawing Test	1.00 (0.88-1.14)	0.93	1.02 (0.90-1.15)	0.75
Verbal fluency	1.00 (0.90-1.10)	0.93	0.99 (0.90-1.09)	0.81
Boston Naming test	0.82 (0.69 -0.99)	0.03	0.89 (0.75-1.06)	0.19
Digit extension test (Forward)	1.15 (0.84-1.56)	0.39	1.01 (0.76-1.34)	0.94
Digit extension test (Backward)	0.89 (0.61-1.31)	0.57	0.80 (0.57-1.13)	0.21

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[TFN1] MMSE: Mini-Mental State Examination; CERAD: Consortium to Establish a Registry for Alzheimer’s disease neuropsychological battery; BCSB: Brief Cognitive Screening Battery.