Vascular Cerebral Damage in Frail Older Adults: The AMImage Study

Abstract

Background: Frailty has been associated with increased risk of adverse-health related outcomes including cognitive impairment. However, little is know about the pathogenesis relating frailty to cognitive decline. Therefore, the main objective of this study was to investigate the association between vascular cerebral damage and frailty.

Methods: Cross-sectional study involving 176 community-dwelling participants aged 67-86 years, participating in the AMImage Study, an ancillary neuro-imaging project of the AMI cohort, a French prospective cohort including older farmers living in rural areas. Frailty was defined as proposed by Fried. 3T magnetic resonance imaging (MRI) examination was performed with anatomical, diffusion, and fluid-attenuated inversion recovery sequences. The evaluation included the assessment of white matter hyperintensities (WMH) volumes and of microstructural white matter integrity through exploration of diffusion tensor imaging (DTI) parameters.

Results: The analyses showed that WMH volumes were higher in frail persons compared with nonfrail subgroup. Frail participants presented DTI modifications in extensive areas of white matter. In comparison with nonfrail subgroup, frail participants showed a strong association between WMH volumes and DTI changes.

Conclusion: These results show that subclinical cerebrovascular damage is present in the frail older person, which could support the hypothesis that frailty is a prodromal state of central nervous system vascular injury.

Keywords: Diffusion tensor imaging; Frailty; Magnetic resonance imaging; Microstructural white matter integrity; White matter hyperintensities.