Association of Cognitive Frailty With Subsequent All-Cause Mortality Among Middle-Aged and Older Adults in 17 Countries.

Objectives: Cognitive frailty refers to the co-occurrence of cognitive impairment and frailty without concurrent Alzheimer's disease or dementia. Studies of cognitive frailty and mortality have been limited to single country or older people. However, frailty and cognitive decline may occur much earlier. We aimed to examine the association between different cognitive frailty status and subsequent all-cause mortality among middle-aged and older people in 17 countries.
Methods: Participants aged 50 and over were drawn from six prospective cohorts of aging. We classified participants according to their cognitive impairment and frailty status into the following groups: none, only cognitive impairment, only frailty and cognitive frailty. Competing-risks regression models were used to evaluate the association of different cognitive frailty status at baseline with subsequent all-cause mortality.
Results: The cognitive frailty group had a higher mortality risk compared to those without cognitive impairment and frailty groups. Meta-analysis results showed participants with cognitive frailty (pooled subhazard ratio [SHR] = 2.34, 95% confidence interval [CI]: 2.01-2.72, I ² = 68.0%) had a higher mortality risk compared with those with only cognitive impairment status (pooled SHR = 1.36, 95% CI: 1.25-1.48, I ² = 3.0%) or only frailty status (pooled SHR = 1.83, 95% CI: 1.72-1.95, I ² = 31.0%). The association between cognitive frailty and mortality were stronger among those who were aged 70 years and older, males, single and nonconsumers of alcohol.
Conclusions: Cognitive frailty, frailty or cognitive impairment alone, is associated with an increased risk of all-cause mortality in Asian, European and American countries. Physical and cognitive function screening should be conducted as early as possible in middle-aged and older people, and targeted intervention approaches should be developed to reduce the incidence of adverse health outcomes.
Competing Interests: DISCLOSURES The authors report no conflicts with any product mentioned or concept discussed in this article. This research was supported by a grant from the Postdoctoral Fellowship Program of CPSF (grant number: GZB20230037, GZC20230131), and The Major Project of National Social Science Fund of China (grant number: 21&ZD187). The funders had no role in the study design; data collection, analysis, or interpretation; in the writing of the report; or in the decision to submit the article for publication.
(Copyright © 2024 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)