TY - JOUR
T1 - Hierarchical Development of Frailty and Cognitive Impairment
T2 - Clues into Etiological Pathways
AU - Chu, Nadia M.
AU - Bandeen-Roche, Karen
AU - Tian, Jing
AU - Kasper, Judith D.
AU - Gross, Alden L.
AU - Carlson, Michelle C.
AU - Xue, Qian Li
N1 - Funding Information:
This work was supported by the National Institute on Aging at the National Institutes of Health (R03AG053743 to Q.X., T32AG000247 to N.M.C., K01AG050699 to A.L.G., P30AG021334 to K.B.R. and J.D.W., and P50AG005146 to K.B.R.).
Publisher Copyright:
© 2019 The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.
PY - 2019/10/4
Y1 - 2019/10/4
N2 - Background: Frailty and cognitive impairment (CI) are associated and often coexist in older adults. Whether temporal patterns of occurrence reflect different etiologies remain unknown. Methods: Participants from the National Health and Aging Trends Study were assessed annually (2011-2016) for frailty (Fried's criteria) and CI (bottom quintile of clock drawing test or immediate and delayed recall; proxy-report of dementia diagnosis or AD8 ≥ 2). We used the Fine & Gray model to identify correlates of frailty onset before CI, CI onset before frailty, and frailty-CI co-occurrence, accounting for death as a competing risk. Results: Of 3,848 free of frailty, CI, and dementia at baseline, 2,183 (61.2%) developed neither frailty nor CI during the 5-year follow-up; 343 (8.3%) developed frailty first; 1,014 (24.4%) developed CI first; and 308 (6.0%) developed frailty-CI co-occurrence. Incident dementia, as a marker of underlying neuropathologies, was associated with greater likelihood of CI onset first (subdistribution hazard ratios [SHR] = 2.60, 95% confidence interval [ci] 2.09 to 3.24), and frailty-CI co-occurrence (SHR = 8.77, 95% ci 5.79 to 13.28), but lower likelihood of frailty onset first (SHR = 0.38, 95% ci 0.21 to 0.68). Number of comorbidities was only associated with frailty occurrence first (1 comorbidity: SHR = 2.51, 95% ci 1.15 to 5.47; 4+ comorbidities: SHR = 6.48, 95% ci 2.78 to 15.48). Conclusions: Different patterns of frailty and CI occurrence exist, and dementia-related pathologies and comorbidities may be important correlates of order of emergence, potentially reflecting different etiologies. Future investigation into relationships between these patterns and dementia subtypes and related pathologies is needed to elucidate etiologic pathways and to provide new targets for prevention, intervention, and risk screening.
AB - Background: Frailty and cognitive impairment (CI) are associated and often coexist in older adults. Whether temporal patterns of occurrence reflect different etiologies remain unknown. Methods: Participants from the National Health and Aging Trends Study were assessed annually (2011-2016) for frailty (Fried's criteria) and CI (bottom quintile of clock drawing test or immediate and delayed recall; proxy-report of dementia diagnosis or AD8 ≥ 2). We used the Fine & Gray model to identify correlates of frailty onset before CI, CI onset before frailty, and frailty-CI co-occurrence, accounting for death as a competing risk. Results: Of 3,848 free of frailty, CI, and dementia at baseline, 2,183 (61.2%) developed neither frailty nor CI during the 5-year follow-up; 343 (8.3%) developed frailty first; 1,014 (24.4%) developed CI first; and 308 (6.0%) developed frailty-CI co-occurrence. Incident dementia, as a marker of underlying neuropathologies, was associated with greater likelihood of CI onset first (subdistribution hazard ratios [SHR] = 2.60, 95% confidence interval [ci] 2.09 to 3.24), and frailty-CI co-occurrence (SHR = 8.77, 95% ci 5.79 to 13.28), but lower likelihood of frailty onset first (SHR = 0.38, 95% ci 0.21 to 0.68). Number of comorbidities was only associated with frailty occurrence first (1 comorbidity: SHR = 2.51, 95% ci 1.15 to 5.47; 4+ comorbidities: SHR = 6.48, 95% ci 2.78 to 15.48). Conclusions: Different patterns of frailty and CI occurrence exist, and dementia-related pathologies and comorbidities may be important correlates of order of emergence, potentially reflecting different etiologies. Future investigation into relationships between these patterns and dementia subtypes and related pathologies is needed to elucidate etiologic pathways and to provide new targets for prevention, intervention, and risk screening.
KW - Cognition
KW - Comorbidities
KW - Dementia
KW - Frailty
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U2 - 10.1093/gerona/glz134
DO - 10.1093/gerona/glz134
M3 - Article
C2 - 31120105
AN - SCOPUS:85072945710
SN - 1079-5006
VL - 74
SP - 1761
EP - 1770
JO - Journals of Gerontology - Series A Biological Sciences and Medical Sciences
JF - Journals of Gerontology - Series A Biological Sciences and Medical Sciences
IS - 11
ER -