Frailty Assessment Helps Predict Dementia Risk Long Before Symptoms Emerge, claims research

Frailty is an age-related condition characterized by the decline in the resilience of multiple body systems and therefore contributes to increased vulnerability to adverse health events. This paper, by David Ward, PhD, of the University of Queensland, addressed how frailty levels may be related to dementia risk independently of age. Assessments of frailty, which measure health deficits such as joint pain, vision loss and cardiovascular problems, might help clinicians more clearly identify dementia risk based on their diagnosis of the acceleration of physical health decline occurring before cognitive decline.

This study was done using data obtained from four of the most important longitudinal studies: the English Longitudinal Study of Aging, the Health and Retirement Study, the Rush Memory and Aging Project, and the NIH's National Alzheimer's Coordinating Center. The participants consisted of 29,849 individuals aged 60 and older who were cognitively unimpaired at baseline. Examination of the follow-up periods, with a median range of 5 to 10 years, thereby showing how frailty progresses over time and how it relates to the onset of dementia later on.

The frailty index scores were developed and validated for each cohort, retrospectively calculated to assess frailty, including over 50 health deficits, from vision loss to hearing loss, from osteoarthritis to atrial fibrillation. Every 0.1 increase in frailty index score added 4-5 health deficits. Importantly, cognition-related deficits were excluded from these indices to avoid confounding dementia risk with the presence of existing cognitive impairment.

• This study took place over 257,963 person-years of follow-up, where 3,154 patients developed dementia.

• Adjusted hazard ratios (HRs) for dementia were between 1.18 (95% CI 1.13-1.24) and 1.73 (95% CI 1.57-1.92), with frailty stages drastically increasing from 4 to 9 years before the onset of dementia.

• Women had a higher level of frailty compared to men who eventually developed dementia.

• For each 0.1-point increase in the frailty index, the risk of dementia was increased (HRs between 1.18 and 1.43). Accumulation of health deficits was an independent risk factor underlying many other covariates.

Frailty is a significant risk factor for a quicker onset of dementia risk, and thus its implications hint toward proactive prevention in health management. Routine assessment in health care would also identify more at-risk people and reduce chances of dementia, thus opening earlier opportunities for interventions and targeted preventive dementia strategies.

Reference:

Ward, D. D., Flint, J. P., Littlejohns, T. J., Foote, I. F., Canevelli, M., Wallace, L. M. K., Gordon, E. H., Llewellyn, D. J., Ranson, J. M., Hubbard, R. E., Rockwood, K., & Stolz, E. (2024). Frailty trajectories preceding dementia in the US and UK. JAMA Neurology. https://doi.org/10.1001/jamaneurol.2024.3774