title: The Case for Stage-Specific Frailty Interventions Spanning Community Aging to Cognitive Impairment.
abstract: OBJECTIVE
  To explore factors associated with frailty across the continuum of healthy aging to cognitive impairment (mild cognitive impairment [MCI], mild and moderate Alzheimer disease [AD]).
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Senior activity centers and the outpatient memory clinic of a tertiary hospital.
  
  
  METHODS
  Community-dwelling and functionally independent adults aged 50 years and older and older adults attending the memory clinic with MCI, and mild and moderate AD diagnoses.
  
  
  METHODS
  We recruited 299 participants comprising 200 cognitively healthy individuals, 16 with MCI, 68 with mild AD, and 15 with moderate AD. We collected measures of comorbidities, cognitive and functional performance, physical activity level, and anthropometric and nutritional status. Frailty was defined using Buchmann criteria, and sarcopenic obesity (SO) was defined using the Asian Working Group for Sarcopenia criteria and the revised National Cholesterol and Education Panel-obesity definition of waist circumference. Multiple logistic regression was performed to identify factors associated with frailty as a whole group and separately based on cognitive subgroups.
  
  
  RESULTS
  There were 16.7% of patients who met frailty criteria. Frailty prevalence was lowest in the well elderly (3.5%) and subsequently followed a U-shaped prevalence from MCI to mild and moderate AD, respectively. Specific univariate differences were noted in age, hypertension, ischemic heart disease, depressive symptoms, social differences, and functional scores. Multivariable logistic regression showed age, cognitive status, and SO to be significantly associated with frailty status. Subgroup analysis showed only SO to be significant (odds ratio [OR] 15.55, 95% confidence interval [CI] 1.63-148.42) in well elderly and only cognition to be associated with frailty (OR 0.89, 95% CI 0.80-0.99) among the cognitively impaired.
  
  
  CONCLUSIONS
  Our findings lend initial support to the case for stage-specific interventions for physical frailty with the focus on SO in healthy community-dwelling older persons and cognitive-based measures in older adults with cognitive impairment. The accurate clinical phenotyping would then set the stage for future potential investigative therapies along these specific lines, rather than an undifferentiated approach.
authors.affiliation: Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore; Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore. Electronic address: Mei_Sian_Chong@ttsh.com.sg.
authors.forename: Mei Sian
authors.initials: MS
authors.lastname: Chong
authors.affiliation: Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore; Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore. Electronic address: Laura_tay@ttsh.com.sg.
authors.forename: Laura
authors.initials: L
authors.lastname: Tay
authors.affiliation: Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore; Department of Community and Continuing Care, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Noor Hafizah
authors.initials: NH
authors.lastname: Ismail
authors.affiliation: Department of Pharmacology, National University of Singapore, Singapore, Singapore.
authors.forename: Chay Hoon
authors.initials: CH
authors.lastname: Tan
authors.affiliation: Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Yew
authors.affiliation: Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Audrey
authors.initials: A
authors.lastname: Yeo
authors.affiliation: Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Ruijing
authors.initials: R
authors.lastname: Ye
authors.affiliation: Department of Rheumatology, Allergy, and Immunology, Tan Tock Seng Hospital, Singapore, Singapore; Department of Physiology, National University of Singapore, Singapore, Singapore.
authors.forename: Bernard
authors.initials: B
authors.lastname: Leung
authors.affiliation: Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore; Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Yew Yoong
authors.initials: YY
authors.lastname: Ding
mesh_terms: D000368:Aged; D000375:Aging / Q000523:psychology*; D000544:Alzheimer Disease; D003072:Cognition Disorders; D060825:Cognitive Dysfunction; D003430:Cross-Sectional Studies; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D057187:Independent Living; D008875:Middle Aged; D009765:Obesity; D055948:Sarcopenia
keywords: Frailty; cognitive impairment; obesity; sarcopenia