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. 2020 Aug 24;6(1):e12065.
doi: 10.1002/trc2.12065. eCollection 2020.

Liver fibrosis score, physical frailty, and the risk of dementia in older adults: The Italian Longitudinal Study on Aging

Vincenzo Solfrizzi  1 , Emanuele Scafato  2   3 , Carlo Custodero  1 , Francesca Loparco  1 , Alessandro Ciavarella  1 , Francesco Panza  4   5 , Davide Seripa  4   6 , Bruno Pietro Imbimbo  7 , Madia Lozupone  8 , Nicola Napoli  1 , Giuseppina Piazzolla  1 , Lucia Galluzzo  3 , Claudia Gandin  2 , Marzia Baldereschi  9 , Antonio Di Carlo  9 , Domenico Inzitari  9   10 , Alberto Pilotto  1   11 , Carlo Sabbà  1 ; Italian Longitudinal Study on Aging Working Group
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Liver fibrosis score, physical frailty, and the risk of dementia in older adults: The Italian Longitudinal Study on Aging

Vincenzo Solfrizzi et al. Alzheimers Dement (N Y). .

Abstract

Introduction: Liver fibrosis increases progressively with aging and has been associated with poorer cognitive performance in middle-aged and older adults. We investigated the relationships between a non-invasive score for advanced liver fibrosis (non-alcoholic fatty liver disease [NAFLD] fibrosis score [NFS]) and dementia risk. We also assessed physical frailty, a common geriatric condition which is associated to dementia. We tested the joint effects of physical frailty and fibrosis on dementia incidence.

Methods: A total of 1061 older adults (65 to 84 years), from the Italian Longitudinal Study on Aging, were prospectively evaluated for the risk of dementia in a period between 1992 and 2001. Liver fibrosis was defined according to the NFS. Physical frailty was assessed according to the Fried's criteria. Cox proportional hazards models were used to estimate the short- and long-term risk of overall dementia, associated to the NFS, testing the effect modifier of physical frailty status.

Results: Older adults with only high NFS (F3-F4) did not exhibit a significant increased risk of overall dementia. Over 8 years of follow-up, frail older adults with high NFS had an increased risk of overall dementia (hazard ratio [HR]: 4.23; 95% confidence interval [CI]: 1.22 to 14.70, P = .023). Finally, physically frail older adults with low albumin serum levels (albumin < 4.3 g/dL) and with advanced liver fibrosis (F3-F4 NFS) compared to those with lower liver fibrosis score (F0-F2 NFS) were more likely to have a higher risk of overall dementia in a long term-period (HR: 16.42; 95% CI: 1.44 to 187.67, P = .024).

Discussion: Advanced liver fibrosis (F3-F4 NFS) could be a long-term predictor for overall dementia in people with physical frailty. These findings should encourage a typical geriatric, multidisciplinary assessment which accounts also for the possible co-presence of frail condition in older adults with chronic liver disease and liver fibrosis.

Keywords: NAFLD fibrosis score; dementia; frailty; older adults; population‐based study.

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Conflict of interest statement

The authors report no competing interests.

Figures

FIGURE 1
FIGURE 1
Attrition of the study population at the different phases of the survey in assessing the role of non‐alcoholic fatty liver disease fibrosis score on incident dementia. The Italian Longitudinal Study on Aging, first prevalence survey, 1992 to 1993
See this image and copyright information in PMC

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References

    1. Younossi ZM, Stepanova M, Afendy M. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clin Gastroenterol Hepatol. 2011;9:524‐530.e1. quiz e60. - PubMed
    1. Bertolotti M, Lonardo A, Mussi C, et al. Nonalcoholic fatty liver disease and aging: epidemiology to management. World J Gastroenterol. 2014;20:14185‐14204. - PMC - PubMed
    1. Frith J, Day CP, Henderson E, Burt AD, Newton JL. Non‐alcoholic fatty liver disease in older people. Gerontology. 2009;55:607‐613. - PubMed
    1. Angulo P, Kleiner DE, Dam‐Larsen S. Liver fibrosis, but no other histologic features, is associated with long‐term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2015;149:389‐397 e10. - PMC - PubMed
    1. Caballeria L, Pera G, Arteaga I, et al. High prevalence of liver fibrosis among european adults with unknown liver disease: a population‐based study. Clin Gastroenterol Hepatol. 2018;16:1138‐1145.e5. - PubMed

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