Cognitive Impairment Improves the Predictive Validity of the Phenotype of Frailty for Adverse Health Outcomes: The Three-City Study
Cognitive Impairment Improves the Predictive Validity of the Phenotype of Frailty for Adverse Health Outcomes: The Three-City Study
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DOI：
10.1111/j.1532-5415.2008.02136.x
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发表时间：
2009-03-01
影响因子：
6.3
通讯作者：
Dartigues, Jean-Francois
中科院分区：
文献类型：
--
作者：
Avila-Funes, Jose Alberto;Amieva, Helene;Dartigues, Jean-Francois
为了确定在虚弱中加入认知障碍是否能提高其对不良健康结果的预测有效性，一项为期4年的纵向研究，法国三城市研究，6030名65至95岁的社区居民。虚弱被定义为至少有以下三项标准：体重减轻，虚弱，疲惫，缓慢和低体力活动。符合一个或两个标准的受试者为虚弱前期，不符合任何标准的受试者为非虚弱。使用简易精神状态检查（MMSE）和艾萨克斯集合测验（IST）中的最低四分位数来识别认知障碍受试者。首先计算虚弱亚组的虚弱对意外残疾、住院、痴呆和死亡的预测有效性，然后根据存在或不存在认知障碍进行分层，421人（7%）符合虚弱标准。非虚弱、虚弱前期和虚弱受试者中分别有10%、12%和22%存在认知障碍。那些被归类为虚弱的人在MMSE和IST上的得分低于那些被归类为虚弱前和非虚弱的人。调整后，认知障碍的体弱者在接下来的4年中更容易在日常生活活动（ADL）和工具性ADL中发展残疾。意外的行动不便和住院的风险略高。无论其虚弱状态如何，认知障碍组的痴呆发病率更高。相反，虚弱并不是死亡率的显著预测因子，认知障碍提高了虚弱的操作定义的预测有效性，因为它增加了老年人群中这一特定亚组的不良健康结果的风险。
To determine whether adding cognitive impairment to frailty improves its predictive validity for adverse health outcomes.Four-year longitudinal study.The French Three-City Study.Six thousand thirty community-dwelling persons aged 65 to 95.Frailty was defined as having at least three of the following criteria: weight loss, weakness, exhaustion, slowness, and low physical activity. Subjects meeting one or two criteria were prefrail and those meeting none as nonfrail. The lowest quartile in the Mini-Mental State Examination (MMSE) and the Isaacs Set Test (IST) was used to identify subjects with cognitive impairment. The predictive validity of frailty for incident disability, hospitalization, dementia, and death was calculated first for frailty subgroups and then rerun after stratification according to the presence or absence of cognitive impairment.Four hundred twenty-one individuals (7%) met frailty criteria. Cognitive impairment was present in 10%, 12%, and 22% of the nonfrail, prefrail, and frail subjects, respectively. Those classified as frail scored lower on the MMSE and IST than those classified as prefrail and nonfrail. After adjustment, frail persons with cognitive impairment were significantly more likely to develop disability in activities of daily living (ADLs) and instrumental ADLs over the following 4 years. The risk of incident mobility disability and hospitalization was marginally greater. Incident dementia was greater in the groups with cognitive impairment irrespective of their frailty status. Conversely, frailty was not a significant predictor of mortality.Cognitive impairment improves the predictive validity of the operational definition of frailty, because it increases the risk of adverse health outcomes in this particular subgroup of the elderly population.