Cognitive Frailty and Its Association with Nutrition and Depression in Community-Dwelling Older People
Cognitive frailty is a condition where physical frailty and mild cognitive impairment (MCI) co-exist. It is associated with increased risk of dementia and dependency. Previous studies reported that malnutrition and depression are associated with physical frailty and MCI; however, their relationships with cognitive frailty remained to be explored. The aims of this study were to examine the association of nutrition and depression with cognitive frailty, in comparison to having physical frailty or MCI alone.
This study employed a cross-sectional design. Data collection was conducted in the community settings on the older people without dementia. Dependent variables were cognitive frailty, physical frailty, and MCI. The independent variables were depression and nutrition. Multi-nominal regression was employed to examine the relationships between the dependent and independent variables. The associations were adjusted by four known co-variates, including age, gender, education and APOE ε4 carrier status.
A total of 185 participants were recruited from four community centres and one elderly hostel and completed the data collection. Approximately 44.9% of the older people with physical frailty and 82.5% of elderly with MCI belonged to cognitive frailty. Multi-nominal regression models showed that depression is positively associated with cognitive frailty and with physical frailty, but not associated with solely MCI. Nutrition is negatively associated with cognitive frailty, but not associated with physical frailty or MCI alone.
Cognitive frailty is associated with malnutrition and depression. Therapeutic interventions managing depression and malnutrition may focus the older people with cognitive frailty to improve efficacy and cost-effectiveness.
Key wordsCognitive frailty nutrition depression APOE gene
Conflict of interest: Moonchu Foundation funded the project; none of the authors have any conflict of interest to declare
Ethical standards: This article complies with the law. The study received an ethical approval from the institutional review board at The Hong Kong Polytechnic University with the reference number of HSEARS20161101002.
- 7.Solfrizzi V, Scafato E, Lozupone M, et al. Additive Role of a Potentially Reversible Cognitive Frailty Model and Inflammatory State on the Risk of Disability: The Italian Longitudinal Study on Aging. The American Journal of Geriatric Psychiatry. 2017;25(11):1236–1248.PubMedCrossRefPubMedCentralGoogle Scholar
- 9.Panza F, Lozupone M, Solfrizzi V, et al. Cognitive frailty: a potential target for secondary prevention of dementia. In: Taylor & Francis; 2017.Google Scholar
- 14.Kwan RY, Cheung DS, Lo SK, et al. Frailty and its association with the Mediterranean diet, life-space, and social participation in community-dwelling older people. Geriatric Nursing. 2019.Google Scholar
- 18.Ma L, Zhang L, Zhang Y, Li Y, Tang Z, Chan P. Cognitive frailty in China: Results from China comprehensive geriatric asessment study. Frontiers in Medicine. 2017;4(174).Google Scholar
- 36.Manal B, Suzana S, Singh D. Nutrition and frailty: a review of clinical intervention studies. ON FRAILTY. 2015:25.Google Scholar
- 39.Aprahamian I, Suemoto CK, Lin SM, et al. Depression is associated with self-rated frailty in older adults from an outpatient clinic: a prospective study. International psychogeriatrics. 2018:1–10.Google Scholar
- 42.Mourao RJ, Mansur G, Malloy-Diniz LF, Castro Costa E, Diniz BS. Depressive symptoms increase the risk of progression to dementia in subjects with mild cognitive impairment: systematic review and meta-analysis. International journal of geriatric psychiatry. 2016;31(8):905–911.PubMedCrossRefPubMedCentralGoogle Scholar
- 44.Bartels C, Wagner M, Wolfsgruber S, Ehrenreich H, Schneider A, Initiative AsDN. Impact of SSRI therapy on risk of conversion from mild cognitive impairment to Alzheimer’s dementia in individuals with previous depression. American Journal of Psychiatry. 2017;175(3):232–241.PubMedCrossRefPubMedCentralGoogle Scholar