ICFSR 2014: International Conference on Frailty & Sarcopenia Research Does Cognitive Frailty Exist? Gabor Abellan van Kan, Mathieu Lillamand, Matteo Cesari, Eirini Keilaiditi, Sophie Guyonnet, Bruno Vellas Toulouse Gerontopole Wednesday 12th, 2014 Barcelona
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ICFSR 2014: International Conference on
Frailty & Sarcopenia Research
Does Cognitive Frailty Exist?
Gabor Abellan van Kan, Mathieu Lillamand, Matteo Cesari, Eirini
Keilaiditi, Sophie Guyonnet, Bruno Vellas
Toulouse Gerontopole
Wednesday 12th, 2014
Barcelona
Introduction
Common characteristics between frailty and
cognitive dysfunction
Results from Literature
Results of MAPT study
Results of the Frailty Day Hospital
Conclusions
Introduction
Common characteristics between frailty and
cognitive dysfunction
Results from Literature
Results of MAPT study
Results of the Frailty Day Hospital
Conclusions
Common characteristics
Physical phenotype
Weight loss
Gait speed
Hand grip
fatique
Physical activity
Robust = 0
Pre-frail = 1-2
Frail = 3-5
Fried 1998, Fried 2001
Common characteristics between
frailty and cognitive dysfunction
Frailty Cognitive Dysfunction
Weight loss
Low gait speed
Low hand grip strength
Sedentary
Body composition (obesity, sarcopenia)
Biomarkers (inflammation…)
Fried 2001, Cronin-Stubbs 1997, Soto 2011, Wang 2006, Buchman 2007, Yassuda 2012, Raji 2012 , Abellan van Kan
2011,
frailty and cognitive
dysfunction share outcomes
Frailty cognitive dysfunction
Mortality
Disability
Institutionalization
Hospitalization
falls
Fried 2001, Abellan van Kan 2008, Abellan van Kan 2008, Abellan van Kan 2010, Nguyen 2003, Johnson 2007, Chen
2011,
Frailty and cognitionShared biological mechanisms
Inflammation:
IL-1, IL-6, TNF α
Adipokines:
Leptine
Vitamin D ↓ Obesity
White matter
hyperintensitiesPhysical activity
CVDRFInsulin Resistance
Glycemia ↑
Buchman et al., Neurology 2008 Houles et al., J Frailty Aging 2012
AD pathology Other mechanisms
Introduction
Common characteristics between frailty and
cognitive dysfunction
Results from Literature
Results of MAPT study
Results of the Frailty Day Hospital
Conclusions
Frailty and risk of cognitive decline
Frailty and cognitionCross-sectional studies
French Three City Study cohortN=6030; community-dwelling older adults
Avila-Funes et al., J Am Geriatr Soc 2009
Frailty and cognitionLongitudinal studies
N=1370; older adults with MMSE ≥21; follow-up=10 years
Samper-Ternent et al., J Am Geriatr Soc 2008
p<0.001
Expanded models of Frailty
(5+ models)
Abellan van Kan 2010, Masel 2009, Szanton 2010, Avila-Funes 2009, Buchman 2007
Frieds’ criteria + …
Functional decline
Cognitive decline
Quality of life
Socio-cultural determinants
Expanded models of frailty
(5+ modelos)
Introduction
Common characteristics between frailty and
cognitive dysfunction
Results from Literature
Results of MAPT study
Results of the Frailty Day Hospital
Conclusions
MAPT Results (1586)
Frailty and cognitive dysfunction
Abellan van Kan 2012, unpublished
Introduction
Common characteristics between frailty and
cognitive dysfunction
Results from Literature
Results of MAPT study
Results of the Frailty Day Hospital
Conclusions
Frailty day Hospital
Frailty and cognitive impairment
Abellan van Kan 2013, unpublished
Cognitive Frailty
i. Robust older individuals(i.e. no evidence of physicalfrailty) without cognitive problems
ii. Physically frail older adults withnormal cognitive functioning(CDR = 0), including individualswith subjective memory complaints
iii. Older adults with no physicalfrailty but already exhibiting a cognitive impairment (CDR = 0.5)
iv. Physically frail older adults withcognitive impairment (CDR = 0.5)
Cognitive FrailtyOperational categories of
older non-demented persons
• Physical frailty
• Cognitive impairment
(CDR=0.5)
• No concurrent AD
dementia or other
dementias
Cognitive Frailty
Proposed definition
IANA/IAGG International Consensus Group, 2013
IANA/IAGG International Consensus Group, 2013
Kelaiditi E et al. J Nutr Health Aging 2013
Cesari M et al. J Nutr Health Aging 2013
Frailty
Frail older adults suffer from cognitive dysfunction
Frailty shares common characteristics
Expanded models show that including a cognitive parameter enhances frailty outcomes
Cognitive frailty
Distinct entity, not yet correctly defined
Physically frail older adults with cognitive complaints
Improvement is possible when intervention on frailty