Frailty as a Predictor of Alzheimer Disease, Vascular Dementia, and All Dementia Among Community-Dwelling Older People: A Systematic Review and Meta-Analysis

doi:10.1016/j.jamda.2016.05.013

Journal of the American Medical Directors Association

Volume 17, Issue 10, 1 October 2016, Pages 881-888

https://doi.org/10.1016/j.jamda.2016.05.013 Get rights and content

Abstract

Objective

To perform a systematic search of the literature for currently available evidence on frailty as a predictor of dementia and to conduct a meta-analysis to synthesize the pooled risk estimates among community-dwelling older people.

Design

A systematic review and meta-analysis.

Data Sources

Embase, MEDLINE, CINAHL Plus, PsycINFO, and the Cochrane Library from 2000 to January 2016, and reference lists of relevant articles.

Eligibility Criteria

Any studies that prospectively examined the incident risks of dementia with frailty among community-dwelling older people without language restriction.

Results

Of 2565 studies identified through the systematic review, 7 studies were included in this review. Of these, 4 studies reported hazard ratios (HR) of incident dementia for physical frailty defined by Cardiovascular Health Study criteria and were included in a meta-analysis. Frailty was a significant predictor of incident Alzheimer disease (4 studies: pooled HR = 1.28, 95% confidence interval (95% CI) = 1.00–1.63, P = .05), vascular dementia (2 studies: pooled HR 2.70, 95% CI 1.40–5.23, P = .003), and all dementia (3 studies: pooled HR 1.33, 95% CI 1.07–1.67, P = .01). Heterogeneity across the studies was low to modest (I² = 0%–51%). A random-effects meta-regression analysis showed that the female proportion of the cohort primarily mediated the association of frailty with Alzheimer disease (female proportion coefficient = 0.04, 95%CI = 0.01–0.08, P = .01).

Conclusion

This systematic review and meta-analysis suggests that frailty was a significant predictor of Alzheimer disease, vascular dementia, and all dementia among community-dwelling older people. Frail women may have a higher risk of incident Alzheimer disease than frail men.

Section snippets

Data Sources and Search Strategy

A systematic literature search was conducted in January 2016 based on a protocol developed in accordance with Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA)²⁴ and Meta-analysis of Observational Studies in Epidemiology (MOOSE)²⁵ statements. Five electronic databases (Embase, MEDLINE, CINAHL Plus, PsycINFO, and the Cochrane Library) were searched for studies published in 2000 or later without language restriction and with an explosion function if available. The

Selection Processes

A systematic search of the literature using 5 electronic databases identified 2564 studies, and 1 study²¹ was found via searching bibliographies of the relevant articles. Among the 2565 studies, 832 duplicate studies and 1722 studies that were considered irrelevant to this review during title and abstract screening were excluded, leaving 11 studies for full-text review. Four studies were further excluded because 2 studies did not use dementia as an outcome and another 2 were editorials or

Discussion

This systematic review and meta-analysis demonstrated that baseline physical frailty is a statistically significant predictor of Alzheimer disease, vascular dementia, and all dementia among community-dwelling older people. Among 4 previous studies examining the associations of frailty with incident Alzheimer disease, we confirmed moderate heterogeneity and no evidence of publication bias. A random-effects meta-regression analysis showed that women with frailty had a higher risk of Alzheimer

Conclusion

This systematic review and meta-analysis demonstrated pooled evidence suggesting that frailty was a significant predictor of dementia, including Alzheimer disease, vascular dementia, and all dementia, among community-dwelling older people. As frailty is a dynamic condition and its status can change over time, interventions against frailty may provide the additional benefit of potentially preventing or delaying dementia.

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The aims of this systematic review were to explore the pooled prevalence of multidimensional frailty assessed by the Tilburg Frailty Indicator among community-dwelling older adults.
A systematic review and meta-analysis.
A comprehensive literature search was conducted across multiple databases, including PubMed, Web of Science, Embase, the Cochrane Library, CINAHL and three Chinese databases. Two independent researchers selected the literatures, extracted the data and evaluated the quality. All statistical analyses were performed using STATA version 16.0.
There were 66 studies with a total of 40,597 individuals that were eligible for the meta-analysis. Data from the meta-analysis revealed the pooled prevalence of 42 % for multidimensional frailty (95 % CI: 38 %–45 %, I² = 98.9 %, T² = 0.024, p < 0.001). Among the six studies that provided data for different age groups, the results demonstrated an increasing trend in the prevalence of multidimensional frailty with advancing age. The results of gender-stratified analysis proved that the pooled prevalence of multidimensional frailty in women (45 %, 95 % CI: 39 %–51 %, p < 0.001) was higher than that in men (33 %, 95 % CI: 28 %–39 %, p < 0.001). Based on different education levels, the prevalence of multidimensional frailty is highest in the primary elementary or illiterate group (41 %, 95 % CI: 30 %–52 %, p < 0.001). According to different marital status types, the pooled prevalence of multidimensional frailty in the married group was significantly lower (36 %, 95 % CI: 28 %–43 %) than that in the unmarried, divorced or widowed group (51 %, 95 % CI: 37 %–65 %).
Through a comprehensive review, we identified that 42 % of elderly individuals living in communities exhibit multidimensional frailty, indicating that multidimensional frailty is relatively common in this population. Stratified analysis revealed that advanced age, female gender, lower education level and unmarried status were associated with higher rates of multidimensional frailty.
Protective effects of dog ownership against the onset of disabling dementia in older community-dwelling Japanese: A longitudinal study
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This prospective study examined the associations of dog/cat ownership with incident disabling dementia using propensity score matching based on the physical, social, and psychological characteristics of dog and cat owners. We also examined associations of the interaction between dog/cat ownership and exercise habit and social isolation with dementia. Overall, 11,194 older adults selected using stratified and random sampling strategies in 2016 were analyzed. Dog/cat ownership was defined as “current” or “past and never”. Disabling dementia was defined according to physicians’ rating in the long-term care insurance system in Japan during the approximately 4-year follow-up period. Statistical analysis was weighted by the inverse of the propensity score in the generalized estimating equation after adjusting for follow-up period. Current dog owners (8.6 %) had an odds ratio (OR) of 0.60 (95 %CI: 0.37–0.977) of having disabling dementia compared to past and never owners. For cat ownership, the corresponding OR was 0.98 (95 %CI: 0.62–1.55). Current dog owners with a regular exercise habit had an OR of 0.37 (0.20–0.68) compared to past and never dog owners with no exercise habit. Further, current dog owners with no social isolation had an OR of 0.41 (0.23–0.73) compared to past and never dog owners with social isolation. Dog ownership had a suppressive effect on incident disabling dementia after adjusting for background factors over a 4-year follow-up period. Specifically, dog owners with an exercise habit and no social isolation had a significantly lower risk of disabling dementia.
Hearing Loss and Frailty among Older Adults: The Atherosclerosis Risk in Communities Study
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Hearing loss may contribute to frailty through cognitive and physical decline, but population-based evidence using validated measures remains scarce. We investigated the association of hearing loss with phenotypic frailty and its individual components and explored the potential protective role of hearing aid use.
Cross-sectional study of community-dwelling older adults at visit 6 (2016–2017) of the Atherosclerosis Risk in Communities (ARIC) study, a cohort study of older adults from 4 U.S. communities (Washington County, MD; Forsyth County, NC; Jackson, MS; and Minneapolis, MN).
Population-based study of 3179 participants (mean age = 79.2 years, 58.9% female).
Pure-tone audiometry at 0.5–4 kHz was used to assess unaided hearing, and the better-hearing ear's pure-tone average was categorized as follows: no [≤25 dB hearing level (HL)], mild (26–40 dB HL), and moderate or greater (>40 dB HL) hearing loss. Hearing aid use was self-reported. The Fried/physical frailty phenotype was used to categorize frailty status (robust, pre-frail, or frail). Multivariable multinomial and logistic regression models were used to study the association of hearing loss/hearing aid use with frailty status and individual frailty components, respectively.
In our sample, 40% had mild and 27% had moderate or greater hearing loss (12% and 55% reported hearing aid use, respectively). Moderate or greater hearing loss was associated with greater odds of being pre-frail [odds ratio (OR), 1.25; 95% CI, 1.01–1.57] and frail (OR, 1.62; 95% CI, 1.06–2.47) vs robust, and greater odds of having slow gait, low physical activity, and exhaustion, compared with no hearing loss. Among those with hearing loss (>25 dB HL), compared with hearing aid users, nonusers had greater odds of being frail vs robust, and having unintentional weight loss, slow gait, and low physical activity.
Hearing loss is associated with pre-frailty and frailty. Longitudinal studies are warranted to establish if hearing aid use may prevent or delay frailty onset.
Bidirectional relationship between frailty and cognitive function among Chinese older adults
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Frailty and cognitive function are two common aging-related conditions among older adults. This study examined the bidirectional relationship between frailty and cognitive function according to sex.
All older adults aged ≥65 years who participated in the 2008 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey were included in this study. Binary logistic regression and generalized estimating equation models were used to determine the bidirectional relationship between frailty and cognitive function in cross-sectional and cohort studies, and sex differences were assessed.
We included 12,708 participants who were interviewed in the baseline study. The participants’ mean (standard deviation) age was 85.6 (11.1%) years. In the cross-sectional study, the multivariate-adjusted odds ratio (OR; 95% confidence interval [CI]) for pre-frailty and frailty among participants with cognitive impairment was 3.68 (3.29–4.13). Older adults with pre-frailty and frailty had higher risks of cognitive impairment (OR = 3.79, 95% CI: 3.38–4.25). The GEE models showed that pre-frailty and frailty predicted a higher likelihood of cognitive impairment (OR = 2.02, 95% CI, 1.67–2.46) during follow-up. Moreover, the temporal relationship between these relationships differed slightly by sex. Older women with cognitive impairment at baseline were more likely to develop pre-frailty or frailty than did older men.
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View all citing articles on Scopus

: The authors declare no conflicts of interest.

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Review ArticleFrailty as a Predictor of Alzheimer Disease, Vascular Dementia, and All Dementia Among Community-Dwelling Older People: A Systematic Review and Meta-Analysis

Abstract

Objective

Design

Data Sources

Eligibility Criteria

Results

Conclusion

Section snippets

Data Sources and Search Strategy

Selection Processes

Discussion

Conclusion

Lancet

Lancet Neurol

Lancet

J Am Med Dir Assoc

Bone

J Am Med Dir Assoc

Alzheimers Dement

J Nutr Health Aging

Lancet Neurol

Am J Cardiol

J Nutr Health Aging

Arch Gerontol Geriatr

Exp Gerontol

Ageing Res Rev

J Nutr Health Aging

Front Neuroendocrinol

Ageing Res Rev

J Am Med Dir Assoc

J Nutr Health Aging

2015 Alzheimer's disease facts and figures

Alzheimers Dement

The global prevalence of dementia: A systematic review and metaanalysis

Alzheimers Dement

Dementia: A public health priority

Dementia before death in ageing societies—the promise of prevention and the reality

PLoS Med

Frailty in older adults: Evidence for a phenotype

J Gerontol A Biol Sci Med Sci

Frailty as a predictor of hospitalisation among community-dwelling older people: A systematic review and meta-analysis

J Epidemiol Community Health

Association between frailty and quality of life among community-dwelling older people: A systematic review and meta-analysis

J Epidemiol Community Health

Frailty as a Predictor of Nursing Home Placement among Community-Dwelling Older Adults: A Systematic Review and Meta-analysis

J Geriatr Phys Ther

Review Article
Frailty as a Predictor of Alzheimer Disease, Vascular Dementia, and All Dementia Among Community-Dwelling Older People: A Systematic Review and Meta-Analysis