Cognitive frailty: an update

This review article provides an update of the empirical research on cognitive fragility conducted in the last four years. The studies retrieved were classified in four different categories. The first category includes articles relating cognitive frailty to cognitive reserve and which continue to highlight the importance of educational level. The second category includes recent research on cognitive fragility biomarkers, involving neuroimaging, metabolism and, in a novel way, microbiota. The third category includes research on how cognitive frailty is related to motor development and physical functioning, exploring e.g. the use of technology to study motor markers of cognitive frailty. Finally, in the fourth category, research clarifying the difference between reversible frailty and potentially reversible cognitive frailty has led to new interventions aimed at reducing cognitive frailty and preventing negative health outcomes. Interventions based on physical activity and multicomponent interventions are particularly emphasized. In addition, recent research explores the long-term effects of dual interventions in older adults living in nursing homes. In summary, research on cognitive frailty has increased in recent years, and applied aspects have gained importanceThis work was financially supported through FEDER founds (A way to make Europe) by the Spanish AEI (doi: 10.13039/501100011033; Refs. PID2020-114521RB-C21 and PSI2017-89389-C2-1-R) and by the Galician Government (Consellería de Cultura, Educación e Ordenación Universitaria; GI-1807-USC: Ref. ED431C 2021/04). CB was supported by a Research Initiation Grant from the University of Santiago de Compostela, co-financed by Banco Santander. The funders were not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publicationS

Dual‑task performance in old adults: cognitive, functional, psychosocial and socio‑demographic variables

Background Dual tasking, or the ability to executing two tasks simultaneously, has been used in recent research to predict cognitive impairments, physical frailty, and has been linked with cognitive frailty in old adults. Aim This study aimed to determine age-related variables can predict dual-task (DT) performance in the older population. Methods A total of 258 healthy community-dwelling participants + 60 years were assessed in relation to their functional capacity, health, well-being, social support and years of education. Performance of a cognitive (Fluency) task and a cognitive– motor (Tracking) task was recorded under single and DT conditions. Multiple linear regression analysis was carried out for each dependent variable, in separate models including cognitive, functional and psychosocial variables. Results Performance in Fluency in DT conditions was predicted by cognitive variables, whereas performance in Tracking DT conditions was predicted by positive interaction, health status, age and motor variables. Discussion The findings suggest that a wide range of cognitive, psychological, social, physical and functional variables influence cognitive and motor performance in aging. Conclusion DT methodology is sensitive to different age-related changes and could be related to frailty conditions in agingOpen Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This research was funded by through FEDER founds by the Spanish Directorate General of Scientific and Technical Research (Project Ref. PSI2014–55316-C3–1-R); and by the Galician Government (Consellería de Cultura, Educación e Ordenación Universitaria; axudas para a consolidación e estruturación de unidades de investigación competitivas do Sistema Universitario de Galicia; GI-1807-USC: Ref. ED431–2017/27)S

Cognitive reserve and mental health in cognitive frailty phenotypes: Insights from a study with a Portuguese sample

Background: Research on prevalence of cognitive frailty phenotypes in community-dwelling older adults in different countries is important to estimate their prevalence and to determine the influence of cognitive reserve and mental health in order to prevent frailty. The aims of this study were to estimate the prevalence of reversible and potentially reversible cognitive frailty (R-CF, PR-CF) in a Portuguese sample of old adults and explore the associations between these phenotypes and demographic, comorbidity, social support, cognitive reserve and mental health factors. Methods: We assessed frailty (Fried criteria) in 250 community-dwelling older adults (179 women) aged 60 years or over (mean 71.04 years) without dementia, neurological or psychiatric disorders. Subjective cognitive decline and Mild cognitive impairment were diagnosed according to standard criteria. The questionnaires Charlson Index, Medical Outcomes Study Social Support, Cognitive Reserve Index and General Health were used for assessing comorbidity, social support, cognitive reserve and mental health, respectively. Results: Prevalence of R-CF was 14%, and that of PR-CF, 15.2%. Cognitive frailty profiles differed significantly in relation to education, comorbidity, mental health, and cognitive reserve, but not in age or sex. Multivariate logistic regression showed that age, sex, comorbidity, social support, mental health, and cognitive reserve together predicted R-CF and PR-CF (90% specificity 75% sensitivity) with significant OR for mental health and cognitive reserve. Discussion: Cognitive reserve and mental health are important factors predicting R-CF and PR-CF. We recommend assessing these factors for early detection of cognitive frailty and promoting psychological well-being and lifestyles that increase cognitive reserve in adultsThis work was financially supported by ERDF funds through the National Research Agency (Spanish Ministry of Science, Innovation and Universities; Projects Ref. PSI2017-89389-C2-1-R and PID2020-114521RB-C21) and the Galician Government [GRC (GI-1807-USC); Ref: ED431-2017/27; ED431C-2021/04]; all with ERDF/FEDER fundsS

Phonological fluency norms for Spanish middle-aged and older adults provided by the SCAND initiative (P, M, & R)

Objective: Verbal fluency tests are quick and easy to administer neuropsychological measures and are regularly used in neuropsychological assessment. Additionally, phonological fluency is a widely used paradigm that is sensitive to cognitive impairment. This paper offers normative data of phonological verbal fluency (letters P, M, R) for Spanish middle- and older-aged adults, considering sociodemographic factors, and different measures such as the total number of words, errors (perseveration and intrusions), and 15 sec-segmented scores. Method: A total of 1165 cognitively unimpaired participants aged between 50 and 89 years old, participated in the study. Data for P were obtained for all participants. Letters M and R were also administered to a subsample of participants (852) aged 60 to 89 years. In addition, errors and words produced every 15 seconds were collected in the subsample. To verify the effect of sociodemographic variables, linear regression was used. Adjustments were calculated for variables that explained at least 5% of the variance (R2 ≥ .05). Results: Means and standard deviations by age, scaled scores, and percentiles for all tests across different measures are shown. No determination coefficients equal to or greater than .05 were found for sex or age. The need to establish adjustments for the educational level was only found in some of the measures. Conclusions: The current norms provide clinically useful data to evaluate Spanish-speaking natives from Spain aged from 50 to 89 years. Specific patterns of cognitive impairment can be analyzed using these normative data and may be important in neuropsychological assessmentObjective: Verbal fluency tests are quick and easy to administer neuropsychological measures and are regularly used in neuropsychological assessment. Additionally, phonological fluency is a widely used paradigm that is sensitive to cognitive impairment. This paper offers normative data of phonological verbal fluency (letters P, M, R) for Spanish middle- and older-aged adults, considering sociodemographic factors, and different measures such as the total number of words, errors (perseveration and intrusions), and 15 sec-segmented scores. Method: A total of 1165 cognitively unimpaired participants aged between 50 and 89 years old, participated in the study. Data for P were obtained for all participants. Letters M and R were also administered to a subsample of participants (852) aged 60 to 89 years. In addition, errors and words produced every 15 seconds were collected in the subsample. To verify the effect of sociodemographic variables, linear regression was used. Adjustments were calculated for variables that explained at least 5% of the variance (R2 ≥ .05). Results: Means and standard deviations by age, scaled scores, and percentiles for all tests across different measures are shown. No determination coefficients equal to or greater than .05 were found for sex or age. The need to establish adjustments for the educational level was only found in some of the measures. Conclusions: The current norms provide clinically useful data to evaluate Spanish-speaking natives from Spain aged from 50 to 89 years. Specific patterns of cognitive impairment can be analyzed using these normative data and may be important in neuropsychological assessmentS

Puntuaciones normativas para el test Timed Up & Go en una muestra comunitaria española de adultos con funcionalidad preservada

Our aim was to calculate the ‘Timed Up & Go’ (TUG) normative scores in a Spanish sample composed of functional older adults. The TUG test provides a measure of global ambulation skills and its total score has been successfully related with functionality and other important health variables in older adults. Reliable norms are needed for adults 50 years and older that allow the early identification and intervention in motor disturbances. The study was carried out with adults from Galicia and Valencia living in the community. A total of 314 Spanish community-living participants, aged from 50 to 90 years and functionality preserved were assessed through the implementation of a cross-sectional design. Health, comorbidity, physical activity, cognitive status, functionality measures and TUG test scores were obtained. TUG scores were successfully predicted by age and gender, and significantly correlated with cognitive status and comorbidity. TUG norms were calculated by age-group for women and men. TUG normative scores were below 13 s and slightly lower in men. Normative scores for women and men were lower than those proposed in studies carried-out in our context. Our norms showed risk reference scores close to those obtained by meta-analytical proceduresConocer las puntuaciones normativas del test Timed Up & Go (TUG) sobre una muestra de adultos mayores con funcionalidad preservada. El test TUG proporciona una medida global de deambulación, y su puntuación total se ha relaciona con medidas de funcionalidad y otras relacionadas con la salud en las personas mayores. Conviene disponer de valores normativos para adultos a partir de los 50 años que permitan realizar una identificación e intervención tempranas en las dificultades motrices. El estudio se llevó a cabo con personas adultas de Galicia y Valencia que viven en la comunidad. Un total de 314 participantes mayores, de entre 50 y 90 años, que vivían en la comunidad fueron evaluadas implementando un diseño transversal. Se obtuvieron medidas de salud, comorbilidad, actividad física, cognición, funcionalidad, además de las puntuaciones en el test TUG. Edad y género predijeron de modo significativo la puntuación total en el TUG que, además, estableció correlaciones significativas con estatus cognitivo y comorbilidad. Se calcularon los valores normativos para el TUG por grupo de edad para varones y mujeres. Las puntuaciones normativas estuvieron por debajo de los 13 s, y fueron ligeramente inferiores en los varones. Las puntuaciones normativas estuvieron, en ambos géneros ,por debajo de los valores propuestos en estudios previos realizados con población española. Nuestros valores normativos ofrecen puntuaciones de referencia para la detección de riesgo semejantes a las obtenidas por procedimientos meta-analíticosThis work was financially supported through FEDER founds by the National Research Agency (Spanish’ Ministry of Science, Innovation and Universities) (Project Ref. PSI2017-89389-C2-1-R), the Galician Government (Consellería de Cultura, Educación e Ordenación Universitaria; axudas para a consolidación e estruturación de unidades de investigación competitivas do Sistema Universitario de Galicia; GI-1807-USC: Ref. ED431-2017/27), and by the Frailty Network IN607C 2016/08. The funders played no role in the designing,conducting, or reporting of this studyS

Características psicológicas de mães de pacientes com anorexia nervosa: implicações para o tratamento e prognóstico

INTRODUCTION: The complexity of factors involved in anorexia nervosa (AN) and the recommendations of prominent health organizations underscore the importance of reflecting on therapeutic interventions aimed at patients' family members. OBJECTIVE: To expand knowledge about the mother-daughter relationship in AN, with a focus on developing a conceptual framework that is able to improve the treatment of the disorder, reduce factors that perpetuate it and improve prognosis. METHOD: A clinical method, anchored by psychodynamic references, was employed in a group of family members of patients with eating disorders. The group met weekly, and sessions were led by psychologists from the eating disorder outpatient clinic of a university hospital. RESULTS AND DISCUSSION: Common characteristics in the mother-daughter relationship in cases of AN were identified. The issue of mutual control, the dialectic between omnipotence and impotence, and the relationship of devotion, passion and annihilation between mothers and daughters are phenomena that form the basis of AN, with a direct influence on the severity of each case and on treatment success. CONCLUSION: Our findings allowed us to identify important aspects in the mother-daughter relationship in AN, which may improve the clinical interventions aimed at treating the disorder.INTRODUÇÃO: A complexidade de fatores que compõem a anorexia nervosa (AN) e as recomendações de importantes organizações ligadas à saúde torna fundamental uma reflexão acerca de propostas de intervenções psicoterapêuticas direcionadas aos familiares desses pacientes. OBJETIVO: Expandir o conhecimento acerca da relação mãe-filha na AN, visando desenvolver uma estrutura conceitual que aperfeiçoe o tratamento do transtorno, reduza os fatores que o mantêm e melhore o prognóstico. MÉTODO: Utilizou-se um método clínico de observação fundamentado em referenciais psicodinâmicos de um grupo de familiares de pacientes com transtornos alimentares. O grupo aberto, semanal, era coordenado por psicólogas do ambulatório de transtornos alimentares de um hospital universitário. RESULTADOS E DISCUSSÃO: Foram identificadas características comuns da relação mãe-filha nos casos de AN. A questão do controle mútuo, a dialética entre onipotência e impotência e a relação de devoção, paixão e aniquilamento entre mães e filhas são fenômenos que estão na base da estrutura da AN, com influência direta sobre a gravidade de cada caso e sobre o sucesso das possibilidades terapêuticas. CONCLUSÃO: Os achados possibilitaram identificar importantes aspectos da relação mãe-filha na AN, que podem aprimorar as intervenções clínicas para seu tratamento.131