title: Neuroimaging signatures of frailty: A population-based study in community-dwelling older adults (the Atahualpa Project).
abstract: OBJECTIVE
  Frailty is a geriatric state of physical vulnerability that might be associated with cognitive decline in the absence of a concurrent neurodegenerative disorder. This assumes that neuroimaging studies are normal, but such examinations have rarely been considered for a frailty work-up. The present study identifies neuroimaging signatures in older adults interviewed with the Edmonton Frail Scale (EFS).
  
  
  METHODS
  Community-dwellers aged ≥60 years enrolled in the Atahualpa Project were invited to undergo brain magnetic resonance imaging. Using generalized regression models, we evaluated the association between frailty and diffuse cortical and subcortical brain damage, after adjusting for relevant confounders. Multivariate models estimated the interaction of age in the association between frailty and these neuroimaging signatures.
  
  
  RESULTS
  Out of 298 participants (mean age 70 ± 8 years, 57% women), 151 (51%) had moderate-to-severe cortical atrophy and 74 (25%) had moderate-to-severe white matter hyperintensities of presumed vascular origin. Mean EFS scores were 5 ± 3 points, with 140 (47%) individuals classified as robust, 65 (22%) as pre-frail and 93 (31%) as frail. Multivariate models showed a significant association between cortical atrophy with the continuous (P = 0.002) and the categorized (P = 0.008) EFS score. The relationship between white matter hyperintensities and the EFS was marginal. According to interaction models, prefrail or frail individuals aged ≥67 years presented more prominent neuroimaging signatures of diffuse cortical or subcortical damage than their robust counterparts.
  
  
  CONCLUSIONS
  Neuroimaging signatures of frailty are mainly related to age. This reinforces the importance of early frailty detection to reduce its catastrophic consequences. Geriatr Gerontol Int 2017; 17: 270-276.
authors.affiliation: School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador.
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Del Brutto
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Robertino M
authors.initials: RM
authors.lastname: Mera
authors.affiliation: School of Medicine, Stony Brook University, New York, New York, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Cagino
authors.affiliation: School of Medicine, Stony Brook University, New York, New York, USA.
authors.forename: Kathryn D
authors.initials: KD
authors.lastname: Fanning
authors.affiliation: School of Medicine, Stony Brook University, New York, New York, USA.
authors.forename: Marleni F
authors.initials: MF
authors.lastname: Milla-Martinez
authors.affiliation: School of Medicine, Stony Brook University, New York, New York, USA.
authors.forename: Johnathan L
authors.initials: JL
authors.lastname: Nieves
authors.affiliation: Community Center, Atahualpa, Ecuador.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Zambrano
authors.affiliation: School of Medicine, Stony Brook University, New York, New York, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sedler
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D016330:Frail Elderly; D000073496:Frailty / Q000000981:diagnostic imaging* / Q000473:pathology*; D015577:Geriatric Assessment; D006801:Humans; D057187:Independent Living; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging
keywords: Edmonton Frailty Scale; frailty; global cortical atrophy; magnetic resonance imaging; white matter hyperintensities