Motoric cognitive risk syndrome, physio-cognitive decline syndrome, cognitive frailty and reversibility with dual-task exercise.

INTRODUCTION: Cognitive frailty (CF) is associated with dementia and disability. It was initially proposed in 2013 by the International Institute of Nutrition and Aging and the International Geriatrics Association. Over the years, there have been many emerging definitions e.g., Motoric Cognitive Risk Syndrome (MCR), Physio-cognitive Decline Syndrome (PCDS), reversible CF and potentially reversible CF. OBJECTIVE: Our objective was to determine the demographics including physical, functional, and psychosocial factors for the four CF definitions amongst community-dwelling older adults. In addition, the effect of dual-task exercise on the reversibility of different definitions of CF was also studied. METHODS: Participants were community-dwelling older adults aged ≥60 years recruited between August 2017 and December 2019. Older adults screened to be frail, prefrail or have cognitive impairment were invited to participate in dual-task exercise program called HAPPY (Healthy Ageing Promotion Program for You). Improvement in cognition, frailty, and physical performance after a 3-month dual-task exercise intervention program was compared with controls. RESULTS: The prevalence of CF depending on definition ranged from 8.8% to 28.7% with minimal overlap. The cognitive scores were significantly lower in all the groups predominantly affecting non-memory domains except for reversible CF. Frailty was three to seven times more prevalent in CF. MCR group had higher prevalence of functional limitation, pain and depression. All four groups had significant increase in global cognition scores especially in the attention domain where the control group declined, and reduction in the prevalence of frailty post intervention. MCR and reversible CF were significantly associated with increased odds of cognitive improvement after 3 months of intervention compared with control. CONCLUSION: CF is a novel concept and regardless of the definitions, is a target for reversing frailty, functional limitation and cognitive impairment through dual-task exercise. Long-term prospective studies are needed to evaluate the effectiveness of dual-task interventions in delaying the conversion to dementia and reduction of disability.

Relationship Between Fear of Falling, Fear-Related Activity Restriction, Frailty, and Sarcopenia.

OBJECTIVES: To determine the prevalence of fear of falling (FOF) and fear-related activity restriction (FAR) and their association with frailty, sarcopenia, gait speed and grip strength, cognitive impairment, depression, social isolation, self-perceived health, and vision. DESIGN: Observational cross-sectional study. SETTING: Community. PARTICIPANTS: A total of 493 community-dwelling older adults, 60 years and older. MEASURES: FOF and FAR were assessed using validated single closed-ended questions. Questionnaire was administered to evaluate frailty (FRAIL scale - Fatigue, Resistance, Aerobic, Illness, and Loss of Weight), sarcopenia (SARC-F - lifting and carrying 10 pounds, walking across a room, transferring from bed/chair, climbing a flight of 10 stairs, and frequency of falls in the past 1 year), social isolation (six-item Lubben Social Network Scale), depression (Even Briefer Assessment Scale), cognition (Chinese Mini-Mental State Examination), and perceived general health and pain (The EuroQol-5 Dimension (EQ-5D)and EQ visual analogue scale (EQ VAS)) . Binary logistic regression was performed to determine the influence of sociodemographic, medical, functional, and cognitive variables on FOF with/without FAR. RESULTS: Prevalence of FOF was 69.2%, and among them, 38.4% had FAR. Prevalence of FOF with or without FAR in those with sarcopenia was 93.3% and in prefrail/frail was 76.6%. FOF was significantly associated with prefrail/frail (odds ratio (OR) = 2.17; 95% confidence interval (CI) = 1.26-3.73), depression (OR = 4.90; 95% CI = 1.06-22.67), number of medications (OR = 1.28; 95% CI = 1.03-1.59), and female sex (OR = 3.54; 95% CI = 1.82-6.90). FOF + FAR was associated with depression (OR = 5.17; 95% CI = 1.84-14.54) and sarcopenia (OR = 8.13; 95% CI = 1.52-43.41). CONCLUSION: FOF with/without FAR is highly prevalent among community-dwelling older adults, especially in those with sarcopenia, prefrailty, and frailty, with significant negative impact on function, quality of life, social network, and mental health. Further research is needed to investigate the value of population-level screening, causal relationship, and efficacy of comprehensive intervention strategies.