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Psych 403 > W7 > Flashcards

W7 Flashcards

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1
Q

what is frailty?

A

age related condition characterized by decline in physiology and health-related systems
-> leads to reduced physical fxn and increased risk for adverse outcomes

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2
Q

what is at-risk state?

A

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

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3
Q

what happens to independent and dependent people when a minor illness occurs?

A

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

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4
Q

what is debatable about frailty?

A

how to best measure and define frailty in clinical and research settings

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5
Q

what are the two leading and productive approaches to measure and define frailty?

A
  • phenotype
  • index
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6
Q

what do the 2 approach allow?

A
  • to identify frail older adults
  • measuring health-related deficits
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7
Q

with the approaches was is considered to be variable?

A

number
type of frailty-related deficits

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8
Q

what does leading approach(Fried) define frailty as?

A

geriatric syndrome marked by any combo of 3 or more of the 5 deficits

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9
Q

who is considered to be pre-frail?

A

person with 1-2 deficits

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10
Q

what are the 5 deficits?

A

weightloss
fatigue
loss of strength
slow walking speed
low activity level

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11
Q

what were the results from the leading approach study?

A

frail older adults were at an increased for each outcome which supported the validity
- slope is drastically steep

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12
Q

how is phenotype used?

A
  • 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
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13
Q

what did leading approach 2 (Rockwood) define frailty as?

A

age-related condition characterized by accumulation of deficits across multiple and varied aging systems

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14
Q

how is frailty measured in the rockwood study?

A

index
- combo of 30+ deficits
->collectively span range of aging systems
-> increase over time
-> biologically sensible

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15
Q

how is frailty index measured?

A

of deficits present/ # of deficits considered

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16
Q

what did the Rockwood study results conclude?

A
  • 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
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17
Q

what are the pros to frailty index?

A
  • limited stipulations eligible deficits
  • multidimensional
  • continuous or categorical scoring ( > .2 = frail)
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18
Q

what are the cons to frailty index?

A
  • no weighting of deficits
  • no ordering of deficits
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19
Q

what is the most problematic expression of population aging?

A

frailty

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20
Q

what does frailty increase the risk for?

A
  • accelerated cognitive decline
  • SCI/SCD
  • MCI
  • AD
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21
Q

what were the results from study 1 about what is associated with accelerated cognitive decline?

A
  • 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
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22
Q

what were the 3 profiles?

A

mobility > respiratory > not-clinically-frail

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23
Q

is frailty associated with SCD?

A

2+ complaints = SCD
- + association, increased prevalence by 36%
- association detected when frailty was measured using 61-item frailty index

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24
Q

is frailty associated with MCI and dementia?

A
  • 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
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25
Q

what is the analytical approach to study the 3 main research goal?

A
  • RF - random forest analysis
  • analyze large number of individual predictor variables in a competitive computational context
26
Q

what do the results about the 3 main research goals state?

A

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

27
Q

is frailty inevitable?

A

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

28
Q

what is the FINGER study?

A

RCT

29
Q

what does FINGER stand for?

A

Finnish Geriatric Intervention Study

30
Q

what is the purpose of the FINGER study?

A

first intervention trial that takes a multidomain approach to dementia prevention

31
Q

what is the primary aim of the FINGER study?

A

prevent cognitive impairment

32
Q

what is the secondary aim of the FINGER study?

A

decrease disability
cardiovascular RF and related morbidities
depressive symptoms

33
Q

what is the key element to counteract dementia epidemic?

A

prevention

34
Q

how many AD cases are attributed to modifiable factors?

A

1/3

35
Q

what are the modifiable factors for the cases?

A
  • low ed
  • midlife hypertension
  • midlife obesity
  • diabetes
  • physical inactivity
  • smoking
  • depression
36
Q

what doe RCT need to do?

A

confirm associations
investigate strategies to maintain cog fxn and prevent CI

37
Q

what is the proof of concept trial?

A

investigate effects of 2 year multidomain intervention on cognition in at-risk elderly from gen pop

38
Q

what score of CAIDE did participants need to have?

A

6+

39
Q

what was the cognitive screening needed?

A

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

40
Q

what were the 5 interventions for FINGER?

A
  • nutrition
  • physical exercise
  • cognitive training
  • social activities
  • management of metabolic and vascular risk factors
41
Q

what was used to measure cognitive performance?

A

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

42
Q

what were the results from FINGER?

A

dropout rate 14% intervention, 11% control
- dropped out bc health-related, lack of time or motivation, difficulties in arranging participation, 10 died

43
Q

does intervention work?

A

yes
25% higher than control
- risk of cog decline increased in control compared to intervention
- sig intervention effect for BMI, dietary habits, physical activity

44
Q

what was the main hypothesis of FINGER?

A

simultaneous changes in several RF would lead to protective effect on cognition

45
Q

what was the primary outcome?

A

significant intervention effects on overall cog and beneficial effects on risk of cog decline

46
Q

what was the secondary outcome?

A

significant intervention effects for BMI, dietary habits and physical activity

47
Q

what are the limitations of FINGER?

A

novel
hard to apply outside of intervention
cost

48
Q

what are the strengths of FINGER?

A

large scale long term
proof of concept RCT
promising potential direction

49
Q

what was the RCT study conducted in Canada?

A

SYNERGIC

50
Q

what does SYNERGIC stand for?

A

synchronizing exercises, remedies in gait and cognition

51
Q

who created SYNERGIC?

A

ccna
mec

52
Q

what is the overall aim of SYNERGIC?

A

help make lifestyle and behavioral changes to improve cognition in older adults with MCI

53
Q

what are the objectives of SYNERGIC?

A
  • aerobic-resistance exercises would improve cognition relative to an active control
  • multidomain intervention would show greater improvements than exercise alone
54
Q

what did the participants need to fulfill criteria?

A

MCI

55
Q

what are the outcomes of SYNERGIC?

A

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

56
Q

how many withdrew from intervention?

A

18%

57
Q

what were the results from SYNERGIC?

A

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

58
Q

what are the limits to SYNERGIC?

A
  • small sample
  • most vit D deficient at baseline
  • reduced generalizability
  • increased type 1 error rates
59
Q

what are the strengths to SYNERGIC?

A
  • primary outcome sensitive to cog changes in MCI
  • systematic progression of exercise and cog training
  • target population considered to be at ideal intervention stage
60
Q

what is trial 2’s aim?

A

lifestyle interventions
- virtual
- personalized
- improve cog, mobility and falls

Psych 403 (10 decks)

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