December 2024
Frailty trajectories precede dementia by several years
By Dr Emily Lathlean MB BS, FRACGP
Frailty may represent a useful target for dementia-prevention strategies, according to an analysis of four large prospective cohort studies in the USA and UK that found frailty was positively associated with dementia risk.
The study, published in JAMA Neurology, analysed data from nearly 30,000 participants in total, with a mean age of 71.6 years and 62% female. Overall, 257,963 person years of follow up and 3156 cases of incident dementia were assessed. Each participant’s degree of frailty was quantified using retrospectively calculated frailty index scores, combining information from multiple physiological systems and closely reflecting an individual’s risk for adverse health and mortality. A higher score indicated the accumulation of more age-related health deficits and worse health.
Among the groups of patients who developed incident dementia, accelerations in the rates of increase in frailty index scores began four to nine years before the onset of dementia.
‘We found that frailty begins to accelerate approximately nine years before the onset of dementia, exceeding the decline expected for a person’s age, sex and other characteristics,’ said Dr David Ward, lead author of the study. ‘Even when measured prior to this acceleration, frailty was strongly associated with an increased risk of dementia. This indicates that frailty is both a marker of impending dementia and potentially a modifiable risk factor for its development.’
Frailty index scores were, on average, higher in females than in males in three of the four cohort studies. Compared with the censored groups, frailty scores were consistently higher in the incident dementia groups 20, 13, 12 and eight years before dementia onset.
‘Australia’s ageing population faces significant challenges with rising rates of both dementia and frailty. Recognising frailty as a modifiable risk factor under scores the need for comprehensive health assessments in older Australians,’ said Dr Ward, who is a Research Fellow in Ageing and Geriatric Medicine at the Centre for Health Services Research in the Faculty of Medicine at Princess Alexandra Hospital and the University of Queensland, Brisbane.
‘These findings advocate for integrating routine frailty measurements into primary care practices – a standard already implemented in GP settings in the UK.’
Dr Ward emphasised the importance of recognising frailty as a warning sign that should prompt proactive intervention, including optimising chronic disease management, avoiding sedating medications where possible and encouraging patients to prioritise protein rich nutrition, participate in regular strength-based physical activity, and foster social engagement to support their physical and mental health, and to slow frailty progression.