title: Disentangling Cognitive-Frailty: Results From the Gait and Brain Study.
abstract: Cognitive-frailty, defined as the presence of both frailty and cognitive impairment, is proposed as a distinctive entity that predicts dementia. However, it remains controversial whether frailty alone, cognitive-frailty, or the combination of cognitive impairment and slow gait pose different risks of incident dementia.
  
  
  
  Two hundred and fifty-two older adults free of dementia at baseline (mean age 76.6±8.6 years) were followed up to 5 years with bi-annual visits including medical, cognitive, and gait assessments. Incident all-cause of dementia and cognitive decline were the main outcomes. Frailty was defined using validated phenotypic criteria. Cognition was assessed using the Montreal Cognitive Assessment while gait was assessed using an electronic walkway. Cox Proportional Hazards models were used to estimate the risk of cognitive decline and dementia for frailty, cognitive-frailty, and gait and cognition models.
  
  
  
  Fifty-three participants experienced cognitive decline and 27 progressed to dementia (incident rate: 73/1,000 person-years). Frailty participants had a higher prevalence of cognitive impairment compared with those without frailty (77% vs. 54%, p = .02) but not significant risk to incident dementia. Cognitive-frailty increased incident rate (80/1,000 person-years) but not risk for progression to dementia. The combination of slow gait and cognitive impairment posed the highest risk for progression to dementia (hazard ratio: 35.9, 95% confidence interval: 4.0-319.2; p = 0.001, incident rate: 130/1,000 person-years). None of the models explored significantly predicted cognitive decline.
  
  
  
  Combining a simple motor test, such as gait velocity, with a reliable cognitive test like the Montreal Cognitive Assessment is superior than the cognitive-frailty construct to detect individuals at risk for dementia. Cognitive-frailty may embody two different manifestations, slow gait and low cognition, of a common underlying mechanism.
authors.affiliation: Gait and Brain Lab, Parkwood Institute and Lawson Health Research Institute, London, Canada. mmontero@uwo.ca.|Department of Medicine and Division of Geriatric Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada.|Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada.
authors.forename: Manuel M
authors.initials: MM
authors.lastname: Montero-Odasso
authors.affiliation: Gait and Brain Lab, Parkwood Institute and Lawson Health Research Institute, London, Canada.
authors.forename: Brittany
authors.initials: B
authors.lastname: Barnes
authors.affiliation: Gait and Brain Lab, Parkwood Institute and Lawson Health Research Institute, London, Canada.|Department of Medicine and Division of Geriatric Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada.|Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Speechley
authors.affiliation: Gait and Brain Lab, Parkwood Institute and Lawson Health Research Institute, London, Canada.|Department of Medicine and Division of Geriatric Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada.
authors.forename: Susan W
authors.initials: SW
authors.lastname: Muir Hunter
authors.affiliation: Department of Physical Medicine and Rehabilitation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Doherty
authors.affiliation: Australian Institute for Musculoskeletal Sciences, University of Melbourne, Melbourne, Australia.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Duque
authors.affiliation: Gait and Brain Lab, Parkwood Institute and Lawson Health Research Institute, London, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Gopaul
authors.affiliation: Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada.
authors.forename: Luciano A
authors.initials: LA
authors.lastname: Sposato
authors.affiliation: Division of Geriatric Medicine, Complejo Hospitalario de Navarra, Pamplona, Spain.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Casas-Herrero
authors.affiliation: Department of Medicine and Division of Geriatric Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Borrie
authors.affiliation: Department of Medicine, Division of Neurology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Camicioli
authors.affiliation: Department of Medicine and Division of Geriatric Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada.
authors.forename: Jennie L
authors.initials: JL
authors.lastname: Wells
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D060825:Cognitive Dysfunction / Q000453:epidemiology*; D003704:Dementia / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006305:Health Status Indicators; D006801:Humans; D015994:Incidence; D008297:Male; D009483:Neuropsychological Tests; D010641:Phenotype; D015995:Prevalence; D012307:Risk Factors; D000072797:Walking Speed
keywords: Cognitive frailty; Dementia.; Frailty; Gait velocity