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M.S. Chong, L. Tay, M. Chan, W.S. Lim, R. Ye, W.C. Wong, J.P. Lim, E.K. Tan, Y.Y. Ding

J Frailty Aging 2014;3(2):113-119

Background: It is unclear if the complex relationship between physical frailty and cognition varies across the severity of cognitive impairment. Objectives: We therefore aimed to explore if there are stage-specific differences in the relationship between frailty and cognitive impairment. Design: Cross-sectional study. Setting: A specialist Memory Clinic setting. Participants: Mild cognitive impairment (MCI) and mild-moderate Alzheimer’s disease (AD) community-dwelling subjects. Measurements: We obtained data on demographics, multimorbidity, cognition-related measures, nutrition, neuroimaging measures, muscle mass, Vitamin D level, apolipoprotein – e (APOE) status and physical performance measures. Frailty measures of gait speed, hand grip strength, question on exhausation and weight loss, classified subjects according to the Buchmann criteria into non-frail and frail categories. Results: Forty-five MCI, 64 mild AD and 13 moderate AD subjects (total n=122) were studied. The prevalence of frailty for MCI, mild AD and moderate AD was 35.6%, 21.9% and 46.2% respectively, indicating a u-shaped trend. Significant differences were noted in fatigue, grip strength and gait speed frailty sub-items. Significant correlation of frailty with cognition were noted in mild-moderate AD (Spearman’s coefficient 0.26, p<0.05) but not in MCI (0.01, p=0.6). No other differences in multimorbidity, Vitamin D, APOE, nutritional measures, white matter lesions were observed. Sarcopenia interestingly had an inverse stage-specific relationship unlike frailty. Conclusions: Our results suggest a U-shaped relationship between frailty and cognition, characterized by initial dissociation with cognitive impairment and subsequent convergence at later stages. Future studies incorporating immune markers and endocrine pathways with longitudinal follow-up could potentially elucidate intermediary mechanisms in the frailty cascade.

CITATION: M.S. Chong ; L. Tay ; M. Chan, ; W.S. Lim ; R. Ye, ; W.C. Wong ; J.P. Lim ; E.K. Tan ; Y.Y. Ding (2014): STAGE-SPECIFIC RELATIONSHIP BETWEEN FRAILTY AND COGNITIVE IMPAIRMENT IN A SPECIALIST MEMORY CLINIC SETTING. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2014.11

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