Frailty Trajectories Preceding Dementia in the US and UK.

Autor:	Ward DD; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.; Australian Frailty Network, The University of Queensland, Woolloongabba, Queensland, Australia., Flint JP; Advanced Care Research Centre School of Engineering, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom.; Alzheimer Scotland Dementia Research Centre, The University of Edinburgh, Edinburgh, United Kingdom.; Genetic Epidemiology, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia., Littlejohns TJ; Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom., Foote IF; Institute for Behavioral Genetics, University of Colorado Boulder, Boulder., Canevelli M; Department of Human Neuroscience, Sapienza University, Rome, Italy.; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.; National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy., Wallace LMK; Cambridge Public Health, University of Cambridge, Cambridge, United Kingdom., Gordon EH; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.; Australian Frailty Network, The University of Queensland, Woolloongabba, Queensland, Australia., Llewellyn DJ; University of Exeter Medical School, Exeter, United Kingdom.; Alan Turing Institute, London, United Kingdom., Ranson JM; University of Exeter Medical School, Exeter, United Kingdom., Hubbard RE; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.; Australian Frailty Network, The University of Queensland, Woolloongabba, Queensland, Australia., Rockwood K; Geriatric Medicine & Neurology, Nova Scotia Health, Halifax, Nova Scotia, Canada.; Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada., Stolz E; Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria.
Jazyk:	angličtina
Zdroj:	JAMA neurology [JAMA Neurol] 2024 Nov 11. Date of Electronic Publication: 2024 Nov 11.
DOI:	10.1001/jamaneurol.2024.3774
Abstrakt:	Importance: An accessible marker of both biological age and dementia risk is crucial to advancing dementia prevention and treatment strategies. Although frailty is a candidate for that role, the nature of the relationship between frailty and dementia is not well understood. Objective: To clarify the temporal relationship between frailty and incident dementia by investigating frailty trajectories in the years preceding dementia onset. Design, Setting, and Participants: Participant data came from 4 prospective cohort studies: the English Longitudinal Study of Ageing, the Health and Retirement Study, the Rush Memory and Aging Project, and the National Alzheimer Coordinating Center. Data were collected between 1997 and 2024 and were analyzed from July 2023 to August 2024. The settings were retirement communities, national-level surveys, and a multiclinic-based cohort. Included individuals were 60 years or older and without cognitive impairment at baseline. Included individuals also had data on age, sex, education level, and ethnicity and a frailty index score calculated at baseline. Exposure: Frailty was the main exposure, with participants' degrees of frailty quantified using retrospectively calculated frailty index scores. Main Outcomes and Measures: Incident all-cause dementia ascertained through physician-derived diagnoses, self- and informant-report, and estimated classifications based on combinations of cognitive tests. Results: The participant number before exclusions was 87 737. After exclusions, data from 29 849 participants (mean [SD] age, 71.6 [7.7] years; 18 369 female [62%]; 257 963 person-years of follow-up; 3154 cases of incident dementia) were analyzed. Bayesian generalized linear mixed regression models revealed accelerations in frailty trajectories 4 to 9 years before incident dementia. Overall, frailty was positively associated with dementia risk (adjusted hazard ratios [aHRs] ranged from 1.18; 95% CI, 1.13-1.24 to 1.73; 95% CI, 1.57-1.92). This association held among participants whose time between frailty measurement and incident dementia exceeded the identified acceleration period (aHRs ranged from 1.18; 95% CI, 1.12-1.23 to 1.43; 95% CI, 1.14-1.80). Conclusions and Relevance: These findings suggest that frailty measurements may be used to identify high-risk population groups for preferential enrolment into clinical trials for dementia prevention and treatment. Frailty itself may represent a useful upstream target for behavioral and societal approaches to dementia prevention.
Databáze:	MEDLINE
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