Changes in Frailty Predict Changes in Cognition in Older Men: The Honolulu-Asia Aging Study

Abstract

Background: As cognitive decline mostly occurs in late life, where typically it co-exists with many other ailments, it is important to consider frailty in understanding cognitive change.

Objective: Here, we examined the association of change in frailty status with cognitive trajectories in a well-studied cohort of older Japanese-American men.

Methods: Using the prospective Honolulu-Asia Aging Study (HAAS), 2,817 men of Japanese descent were followed (aged 71-93 at baseline). Starting in 1991 with follow-up health assessments every two to three years, cognition was measured using the Cognitive Abilities Screening Instrument (CASI). For this study, health data was used to construct an accumulation of deficits frailty index (FI). Using six waves of data, multilevel growth curve analyses were constructed to examine simultaneous changes in cognition in relation to changes in FI, controlling for baseline frailty, age, education, and APOE-ɛ4 status.

Results: On average, CASI scores declined by 2.0 points per year (95% confidence interval 1.9-2.1). Across six waves, each 10% within-person increase in frailty from baseline was associated with a 5.0 point reduction in CASI scores (95% confidence interval 4.7-5.2). Baseline frailty and age were associated both with lower initial CASI scores and with greater decline across the five follow-up assessments (p < 0.01).

Discussion: Cognition is adversely affected by impaired health status in old age. Using a multidimensional measure of frailty, both baseline status and within-person changes in frailty were predictive of cognitive trajectories.

Keywords: Aging; cognition; cohort studies; frail elderly; risk factors.

Figure 1

Honolulu Heart Project HHP and Honolulu-Asia Aging Study (HAAS) Flowchart.

Figure 2. Growth curves by frailty index levels

Panel A: Predicted cognitive trajectories for hypothetical individuals with average education and age, varied by levels of baseline frailty using results from Model 3 (Time Constant Predictors). Panel B: Predicted trajectories for hypothetical individuals with average education and age, varied by baseline FI and change in FI using results from Model 4 (Full Model).