Cognitive Frailty: A Review of the Mechanisms and Challenges Grace Shu Hui Chiang MPH Introduction Population aging is a transforming demographic force. The proportion of older adults and life expectancy is expected to increase with global population expansion and aging. This demographic shift is accompanied by various challenges such as ensuring successful aging and preventing illness, disability and dependency; and has implications for health care and social costs. The process of aging is a deterioration and decline of functional properties at the cellular, tissue and organ level, this results in homeostatic dysregulation and increased vulnerability to stressors(Holliday, 1995). The global failure in hemodynamics resultant from aging contributes to frailty which has been postulated to be induced by reaching a threshold resultant from multisystem dysregulation(Gruenewald, Seeman, Karlamangla, & Sarkisian, 2009; Walston et al., 2006). Frail elderly experience decline in reserve and function in one or more domains (physical, cognitive and psychosocial)(R. Gobbens, Luijkx, Wijnen-Sponselee, & Schols, 2010; T. Malmstrom & J. E. Morley, 2013). While physical frailty has been acknowledged to be an important geriatric syndrome(Abate et al., 2007; R. J. Gobbens, van Assen, Luijkx, Wijnen-Sponselee, & Schols, 2010; Sourdet, Rougé-Bugat, Vellas, & Forette, 2012), cognitive frailty is still a novel concept. An international consensus group recently proposed the concept of cognitive frailty as “an heterogenous clinical manifestation characterized by the simultaneous presence of both physical frailty and cognitive impairment”, excluding concurrent dementia or 1 Cognitive Frailty: A Review of the Mechanisms and Challenges
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Cognitive Frailty: A Review of the Mechanisms and Challenges
Grace Shu Hui Chiang MPH
Introduction
Population aging is a transforming demographic force. The proportion of older adults and life
expectancy is expected to increase with global population expansion and aging. This
demographic shift is accompanied by various challenges such as ensuring successful aging and
preventing illness, disability and dependency; and has implications for health care and social
costs.
The process of aging is a deterioration and decline of functional properties at the cellular,
tissue and organ level, this results in homeostatic dysregulation and increased vulnerability to
stressors(Holliday, 1995). The global failure in hemodynamics resultant from aging contributes
to frailty which has been postulated to be induced by reaching a threshold resultant from
multisystem dysregulation(Gruenewald, Seeman, Karlamangla, & Sarkisian, 2009; Walston et
al., 2006).
Frail elderly experience decline in reserve and function in one or more domains (physical,
cognitive and psychosocial)(R. Gobbens, Luijkx, Wijnen-Sponselee, & Schols, 2010; T.
Malmstrom & J. E. Morley, 2013). While physical frailty has been acknowledged to be an
important geriatric syndrome(Abate et al., 2007; R. J. Gobbens, van Assen, Luijkx,
Secondary prevention measures are instituted in older adults with potential cognitive
frailty. Multidomain interventions which include targeting the physical, cognitive, psychological
and nutrition aspects of frailty have been found to be potentially effective in delaying the
progression of cognitive frailty(Ngandu et al., 2015; D. A. Robertson et al., 2013). Physical
activity in particular has been found to be protective against sarcopenia and cognitive
impairment(F. Landi et al., 2010; Langlois et al., 2013).
Summary
The global aging population heralds an increase in age-related illnesses such as frailty
and cognitive decline which pose a serious challenge to the healthcare, economic and social
systems. As such, a better understanding of the relationship between frailty and cognitive
impairment will be needed to move forward if we are to effectively manage and prevent these
conditions. Further research will need to be done before cognitive frailty can be definitively
operationalized and be considered a geriatric syndrome.
13 Cognitive Frailty: A Review of the Mechanisms and Challenges
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