W7 Flashcards
what is frailty?
age related condition characterized by decline in physiology and health-related systems
-> leads to reduced physical fxn and increased risk for adverse outcomes
what is at-risk state?
minor health event or stressor can trigger dramatic and disproportionate changes in health and functional abilities
- independent to dependent
- mobile to immobile
- postural stability to falls
what happens to independent and dependent people when a minor illness occurs?
independent people bounce back to baseline after recovery
dependent people take longer to recover and do not return to baseline, there is a new baseline and it is just above functional
what is debatable about frailty?
how to best measure and define frailty in clinical and research settings
what are the two leading and productive approaches to measure and define frailty?
- phenotype
- index
what do the 2 approach allow?
- to identify frail older adults
- measuring health-related deficits
with the approaches was is considered to be variable?
number
type of frailty-related deficits
what does leading approach(Fried) define frailty as?
geriatric syndrome marked by any combo of 3 or more of the 5 deficits
who is considered to be pre-frail?
person with 1-2 deficits
what are the 5 deficits?
weightloss
fatigue
loss of strength
slow walking speed
low activity level
what were the results from the leading approach study?
frail older adults were at an increased for each outcome which supported the validity
- slope is drastically steep
how is phenotype used?
- based on a small number of physical deficits (unidimensional, ceiling effects)
- no weighting of deficits or consideration of whether the order in which deficits are accumulated affects risk for adverse outcome
what did leading approach 2 (Rockwood) define frailty as?
age-related condition characterized by accumulation of deficits across multiple and varied aging systems
how is frailty measured in the rockwood study?
index
- combo of 30+ deficits
->collectively span range of aging systems
-> increase over time
-> biologically sensible
how is frailty index measured?
of deficits present/ # of deficits considered
what did the Rockwood study results conclude?
- supported the validity
- advancing age associated with higher frailty index values
- higher values predicted increased mortality risk
- sex differences
F more frail than M but M die more than F when frail
what are the pros to frailty index?
- limited stipulations eligible deficits
- multidimensional
- continuous or categorical scoring ( > .2 = frail)
what are the cons to frailty index?
- no weighting of deficits
- no ordering of deficits
what is the most problematic expression of population aging?
frailty
what does frailty increase the risk for?
- accelerated cognitive decline
- SCI/SCD
- MCI
- AD
what were the results from study 1 about what is associated with accelerated cognitive decline?
- initial frailty lvls vary and the manner in which it changes over time
- higher frailty associated with accelerated memory decline relative to lower frailty
- higher frailty predicted accelerated memory decline for F (more cognitive cost of frailty)
- M resilient to frailty effect on memory decline
what were the 3 profiles?
mobility > respiratory > not-clinically-frail
is frailty associated with SCD?
2+ complaints = SCD
- + association, increased prevalence by 36%
- association detected when frailty was measured using 61-item frailty index
is frailty associated with MCI and dementia?
- each 0.1 increment increased risk of conversion from NCI to MCI 66%
- increased risk of dementia conversion by 37%
- reduced likelihood of reversion to NCI by 28%
- frailty is a key contributor by increasing likelihood of progressive CI and reducing likelihood of reversion
what is the analytical approach to study the 3 main research goal?
- RF - random forest analysis
- analyze large number of individual predictor variables in a competitive computational context
what do the results about the 3 main research goals state?
patterns of deficit accumulation and impact across AD spectrum and aspects of frailty could be targeted in early intervention protocols for prevention or delay of CI and D
is frailty inevitable?
common condition but not an inevitable part of aging
- CFN: Canadian Frailty Network promotes healthy aging and prevent or reduce risk of frailty
- AVOID program for healthy aging
what is the FINGER study?
RCT
what does FINGER stand for?
Finnish Geriatric Intervention Study
what is the purpose of the FINGER study?
first intervention trial that takes a multidomain approach to dementia prevention
what is the primary aim of the FINGER study?
prevent cognitive impairment
what is the secondary aim of the FINGER study?
decrease disability
cardiovascular RF and related morbidities
depressive symptoms
what is the key element to counteract dementia epidemic?
prevention
how many AD cases are attributed to modifiable factors?
1/3
what are the modifiable factors for the cases?
- low ed
- midlife hypertension
- midlife obesity
- diabetes
- physical inactivity
- smoking
- depression
what doe RCT need to do?
confirm associations
investigate strategies to maintain cog fxn and prevent CI
what is the proof of concept trial?
investigate effects of 2 year multidomain intervention on cognition in at-risk elderly from gen pop
what score of CAIDE did participants need to have?
6+
what was the cognitive screening needed?
CERAD
- consortium to establish a registry for AD
- word list memory task (10x3) - 19 or less
- word list recall - 75% or less
- MMSE - 26 pts or less
- mean level or slightly lower than expected according to age
what were the 5 interventions for FINGER?
- nutrition
- physical exercise
- cognitive training
- social activities
- management of metabolic and vascular risk factors
what was used to measure cognitive performance?
neuropsychological test battery
- 14 tests measuring exec fxn, processing speed, memory
domain scores in exec function, processing speed and memory
- vascular and lifestyle factors
- depressive symptoms
- diasability
what were the results from FINGER?
dropout rate 14% intervention, 11% control
- dropped out bc health-related, lack of time or motivation, difficulties in arranging participation, 10 died
does intervention work?
yes
25% higher than control
- risk of cog decline increased in control compared to intervention
- sig intervention effect for BMI, dietary habits, physical activity
what was the main hypothesis of FINGER?
simultaneous changes in several RF would lead to protective effect on cognition
what was the primary outcome?
significant intervention effects on overall cog and beneficial effects on risk of cog decline
what was the secondary outcome?
significant intervention effects for BMI, dietary habits and physical activity
what are the limitations of FINGER?
novel
hard to apply outside of intervention
cost
what are the strengths of FINGER?
large scale long term
proof of concept RCT
promising potential direction
what was the RCT study conducted in Canada?
SYNERGIC
what does SYNERGIC stand for?
synchronizing exercises, remedies in gait and cognition
who created SYNERGIC?
ccna
mec
what is the overall aim of SYNERGIC?
help make lifestyle and behavioral changes to improve cognition in older adults with MCI
what are the objectives of SYNERGIC?
- aerobic-resistance exercises would improve cognition relative to an active control
- multidomain intervention would show greater improvements than exercise alone
what did the participants need to fulfill criteria?
MCI
what are the outcomes of SYNERGIC?
change in cog function as assessed by ADAS-Cog-13 and plus
-> 13 tests assessing various cog domains
- sensitive to exec fxn
- individual ADAS-Cog-13 and ADAS-Cog-Plus items
how many withdrew from intervention?
18%
what were the results from SYNERGIC?
at 6M - all active arms with aerobic-resistance exercises improved ADAS-COG-13
- no sig changes in ADAS-Cog-Plus
compared with exercise alone, exercise and cog training improved ADAS-COG-13, no improv in vit D
what are the limits to SYNERGIC?
- small sample
- most vit D deficient at baseline
- reduced generalizability
- increased type 1 error rates
what are the strengths to SYNERGIC?
- primary outcome sensitive to cog changes in MCI
- systematic progression of exercise and cog training
- target population considered to be at ideal intervention stage
what is trial 2’s aim?
lifestyle interventions
- virtual
- personalized
- improve cog, mobility and falls
