Physical Frailty and Cognitive Impairment: Intersection, Measurement & Etiologies

项目摘要 全球医疗保健的最大挑战之一是医疗和经济负担 照顾饱受身体和认知障碍蹂躏的依赖的老年人。作为两个 众所周知，最常见的老年病、虚弱和认知障碍是相关的 增加了健康状况不佳的风险。事实上，身体虚弱和认知能力 老年人的障碍是相关的，而且往往是共存的，这导致了一种流行的观点 将脆弱的定义扩大到包括认知障碍。与此同时，有越来越多的 流行病学和统计学证据表明，认知与身体机能是可以分离的， 这一点因我们与老年人的私人接触而得到加强，这些老年人身体健康，但 认知能力弱，反之亦然。目前尚不清楚的是，在 身体虚弱和认知障碍的联合或时间发展以及这些 模式反映了不同的病因。我们假设认知障碍和身体 脆弱部分是由不同的生理过程造成的，因此不能被认为是 单一的症状和不同的症状出现模式可能预示着不同的病因 小路。使用4年来收集的具有全国代表性的7439个样本的数据 ≥65岁的成年人来自国家健康和老龄化趋势研究，该提案旨在(1) 估计身体虚弱和认知障碍的联合患病率，表征时间 偶发的身体虚弱和认知障碍的模式，并将它们与 人口和疾病特征和健康事件；(2)制定和验证新的 独立于神经退行性变的身体虚弱和认知障碍的联合表型 病因学，并对照 国际营养与老龄化学会和国际老年学和老年学协会 老年病学；以及(3)评估联合表型增加的对不良反应的预测准确性 衰老结果，超过了仅由身体虚弱所实现的结果，按年龄段计算， 和合并症。总而言之，这项研究可能有助于促进关于 “认知弱点”的含义，从而有助于指导设计、开发和确定优先顺序 预防和干预战略，以最大限度地发挥影响。

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.