Frailty and cognitive impairment: a longitudinal analysis of FIBRA study

Author(s)

Beatriz Raz Franco de Santana

• Document type: Doctoral Thesis
• Press: Campinas, SP.
• Institution: Universidade Estadual de Campinas (UNICAMP). Faculdade de Ciências Médicas
• Defense date: 2024-04-16

Examining board members

Mônica Sanches Yassuda; Paula Teixeira Fernandes; Maria Teresa Carthery Goulart; Aline Cristina Martins Gratão; Henrique Salmazo da Silva

• Advisor: Mônica Sanches Yassuda

Abstract

Introduction: Fragility is characterized by a condition of high vulnerability, resulting from reduced functionality in various physiological systems related to aging, which compromises the ability to cope with stressors, whether in acute situations or in daily life. Objectives: Article 1: To characterize a sample of older adults with cognitive impairment, according to frailty status, assessed indirectly by family members, clinical variables, and sociodemographic factors. To assess the overlap of clinical conditions in this sample with cognitive impairment. Article 2: To longitudinally investigate which characteristics of participants in the FIBRA study at baseline would be predictive of cognitive and functional decline (possible dementia) over nine years. Methods: Data from the Brazilian Frailty Study (FIBRA) database were used. In Article 1, data from 130 older adults with cognitive impairment assessed using the Mini-Mental State Examination (MMSE) at the FIBRA follow-up assessment (2016-2017) were used. The Clinical Dementia Rating (CDR) scores, Cornell Scale for Depression in Dementia, and Functional Activities Questionnaire were described. Frailty was indirectly assessed through questions answered by family members according to the five criteria that compose the frailty phenotype. In Article 2, data from baseline and follow-up of 549 participants re-interviewed after nine years were used, with 98 participants who had cognitive impairment at the beginning of the study being excluded. Among the 451 participants included in this analysis, 85 had MMSE scores below the cutoff at follow-up, and 45 were identified with possible dementia. Variables such as sex, age, education, frailty, number of chronic diseases, smoking, and alcohol use were used. Results: Article 1: The majority of the sample consisted of women (n=91), with a mean age of 82.4 years (standard deviation=5.3), averaging 3.3 years of education (standard deviation=3.07), with 47.7% widowed and 68% living with children and/or grandchildren. Additionally, a large portion of the sample had multimorbidity (74.90%), 39.5% exhibited depressive symptoms indicative of major depression, 57% had functional impairment, 49.3% were considered frail, 37.6% pre-frail, and 13.10% robust. Article 2: The follow-up sample was predominantly composed of women (68.1%), aged 65-74 years (71.6%), with low education (75.6%), non-smokers (57.7%), non-alcohol consumers (67.0%), and with two or more chronic diseases (69.1%). Regarding frailty, at baseline, 35.5% were non-frail, 57.0% pre-frail, and 7.5% frail. At follow-up, 29.4% were non-frail, 62.3% pre-frail, and 8.3% were frail. Regarding cognition, 85 elderly individuals showed cognitive deficit on the MMSE, of whom 45 had functional alterations, indicating possible dementia (incidence of 9%). Logistic regression indicated that frailty at baseline was not associated with possible dementia at follow-up, with significant association only for the variable age, with higher risk for older individuals. Higher education showed a tendency for lower risk of possible dementia. Conclusions: Among older adults with cognitive impairments, the co-occurrence of frailty and functional alterations is common. Higher age at baseline was a predictor of possible dementia after nine years, while frailty did not prove to be a significant predictor (AU)

• FAPESP's process: 20/08298-2 - Follow-up study of the Campinas and Ermelino Matarazzo cohorts of the FIBRA study: predictors and outcomes of frailty in the elderly in Brazil
• Grantee: Beatriz Raz Franco de Santana
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)