Physical Frailty and Cognitive Impairment: Intersection, Measurement & Etiologies

身体虚弱和认知障碍：交叉点、测量

• 批准号: 9336220
• 负责人: Qian-Li Xue
• 金额: $ 8.17万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9336220
• 关键词: Academy; Adult; Age; Aging; Alzheimer' s Disease; Caring; Characteristics; Chronology; Clinical; Cognition; Cognitive; Communities; Comorbidity; Data; Dementia; Development; Disease; Elderly; Epidemiology; Etiology; Event; Future; Geriatrics; Gerontology; Goals; Health; Healthcare; Impaired cognition; International; Intervention; Joints; Literature; Longitudinal Studies; Measurement; Measures; Medical; Medical Economics; Memory; Modeling; Natural History; Nerve Degeneration; Nursing Homes; Outcome; Pathway interactions; Patients; Pattern; Performance; Persons; Phenotype; Physical Function; Physiological Processes; Prevalence; Prevention strategy; Preventive Intervention; Reporting; Risk; Risk Factors; Role; Sampling; Sentinel; Signal Transduction; Symptoms; Syndrome; Testing; Time; Validation; Work; adverse outcome; aged; aging nutrition; care burden; clinical Diagnosis; cognitive function; design; disability; executive function; falls; frailty; improved; instrument; instrumental activity of daily living; mortality; screening; theories; trend

Project Summary One of the biggest challenges of healthcare worldwide is the medical and economic burden of caring for dependent older adults ravaged by physical and cognitive impairments. As two of the most common geriatric conditions, frailty and cognitive impairment are known to be associated with increased risk for poor health outcomes. The fact that physical frailty and cognitive impairments are associated and often coexist in older adults has led to the popular view of expanding the definition of frailty to include cognitive impairment. Meanwhile, there is increasing epidemiological and statistical evidence that cognition is separable from physical functioning, which is reinforced by our personal encounters of older adults who are physically robust but cognitively frail and vice versa. What is unknown is whether there are sentinel patterns in the joint or temporal development of physical frailty and cognitive impairment and whether these patterns reflect different etiologies. We hypothesize that cognitive impairment and physical frailty result in part from distinct physiological processes, hence cannot be considered as a single syndrome, and the varying patterns of symptom emergence may signal different etiologic pathways. Using data collected over 4 years in a nationally representative sample of 7439 adults aged ≥65 from the National Health and Aging Trends Study, the proposal aims to (1) estimate joint prevalence of physical frailty and cognitive impairments, characterize the temporal patterns of incident physical frailty and cognitive impairment, and correlate them with demographic and disease characteristics and health events; (2) develop and validate a new joint phenotype of physical frailty and cognitive impairment independent of neurodegenerative etiologies, and cross-validate it against the construct of “physical frailty” proposed by the International Academy of Nutrition & Aging and the International Association of Gerontology and Geriatrics; and (3) evaluate the predictive accuracy added by the joint phenotype for adverse aging outcomes, above and beyond that achieved by physical frailty alone, chronological age, and comorbidity. In the aggregate, this study may help facilitate a discourse about the precise meaning of “cognitive frailty” and thereby help inform the design, development, and prioritization of preventive and intervention strategies for maximal impact.

项目摘要 全球医疗保健面临的最大挑战之一是医疗和经济负担， 照顾受身体和认知障碍折磨的老年人。其中两 已知大多数常见的老年病、虚弱和认知障碍与 健康状况不佳的风险增加。身体虚弱和认知能力 残疾是相关的，往往在老年人共存，导致了流行的观点， 将脆弱的定义扩大到认知障碍。与此同时， 流行病学和统计学证据表明，认知与身体功能是分开的， 这一点在我们个人遇到的老年人身上得到了加强，他们身体强壮， 认知能力脆弱，反之亦然目前尚不清楚的是， 身体虚弱和认知障碍的联合或暂时发展，以及这些 模式反映了不同的病因。我们假设认知障碍和身体 虚弱部分是由不同的生理过程造成的，因此不能被认为是 单一症状，不同的症状出现模式可能表明不同的病因 途径。使用4年来在全国代表性样本7439中收集的数据 来自国家健康和老龄化趋势研究的65岁以上的成年人，该提案旨在（1） 估计身体虚弱和认知障碍的联合患病率， 偶发性身体虚弱和认知障碍的模式，并将其与 人口统计学和疾病特征以及健康事件;（2）开发并验证新的 独立于神经退行性疾病身体虚弱和认知障碍的联合表型 病因学，并交叉验证它对“身体虚弱”的结构提出的 国际营养与老龄化学会和国际老年学协会， 老年医学;（3）评估关节表型增加的不良反应的预测准确性 衰老的结果，超过了身体虚弱，实足年龄， 和科摩罗。总的来说，这项研究可能有助于促进对精确的话语 “认知缺陷”的含义，从而帮助告知设计，开发和优先级 预防和干预战略，以实现最大的影响。