Abellan van Kan Cognitive Frailty

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

Need to be differentiated from prodromal dementia

Conclusion

Thank you for your attention

“ Old age isn't so bad

when you consider the alternative “

Maurice Chevalier