title: Cognitive impairment improves the predictive validity of the phenotype of frailty for adverse health outcomes: the three-city study.
abstract: OBJECTIVE
  To determine whether adding cognitive impairment to frailty improves its predictive validity for adverse health outcomes.
  
  
  METHODS
  Four-year longitudinal study.
  
  
  METHODS
  The French Three-City Study.
  
  
  METHODS
  Six thousand thirty community-dwelling persons aged 65 to 95.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre de Recherche Inserm, U897, Bordeaux, France.
authors.forename: José Alberto
authors.initials: JA
authors.lastname: Avila-Funes
authors.forename: Hélène
authors.initials: H
authors.lastname: Amieva
authors.forename: Pascale
authors.initials: P
authors.lastname: Barberger-Gateau
authors.forename: Mélanie
authors.initials: M
authors.lastname: Le Goff
authors.forename: Nadine
authors.initials: N
authors.lastname: Raoux
authors.forename: Karen
authors.initials: K
authors.lastname: Ritchie
authors.forename: Isabelle
authors.initials: I
authors.lastname: Carrière
authors.forename: Béatrice
authors.initials: B
authors.lastname: Tavernier
authors.forename: Christophe
authors.initials: C
authors.lastname: Tzourio
authors.forename: Luis Miguel
authors.initials: LM
authors.lastname: Gutiérrez-Robledo
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dartigues
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003072:Cognition Disorders / Q000175:diagnosis / Q000401:mortality*; D015897:Comorbidity; D015140:Dementia, Vascular / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D005602:France; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008609:Mental Status Schedule / Q000706:statistics & numerical data; D051346:Mobility Limitation; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D010641:Phenotype; D011594:Psychometrics / Q000706:statistics & numerical data; D012307:Risk Factors; D012959:Socioeconomic Factors; D015431:Weight Loss