Role of Cognitive Frailty in Older Adults With Cardiovascular Disease

Abstract

As the older adult population expands, an increasing number of patients affected by geriatric syndromes are seen by cardiovascular clinicians. One such syndrome that has been associated with poor outcomes is cognitive frailty: the simultaneous presence of cognitive impairment, without evidence of dementia, and physical frailty, which results in decreased cognitive reserve. Driven by common pathophysiologic underpinnings (eg, inflammation and neurohormonal dysregulation), cardiovascular disease, cognitive impairment, and frailty also share the following risk factors: hypertension, diabetes, obesity, sedentary behavior, and tobacco use. Cardiovascular disease has been associated with the onset and progression of cognitive frailty, which may be reversible in early stages, making it essential for clinicians to diagnose the condition in a timely manner and prescribe appropriate interventions. Additional research is required to elucidate the mechanisms underlying the development of cognitive frailty, establish preventive and therapeutic strategies to address the needs of older patients with cardiovascular disease at risk for cognitive frailty, and ultimately facilitate targeted intervention studies.

Keywords: aging; cardiovascular diseases; cognitive dysfunction; frailty; geriatric assessment; inflammation.

Figure 1. Numerous tools that are used to measure frailty; commonly used in the cardiovascular literature are the Fried Physical Frailty Phenotype, Essential Frailty Toolset, and Frailty Index, which is based on a deficit‐accumulation approach.

Reproduced from Afilalo with permission. Copyright © 2017, Elsevier. BMI indicates body mass index; and MMSE, Mini‐Mental State Examination.

Figure 2. Cellular factors that include inflammation, oxidative stress, neurohormonal dysfunction, and mitochondrial damage manifest in diseases such as hypertension, diabetes, obesity, and depression.

These factors, combined with environmental factors like tobacco use and lack of social supports, serve as risk factors for the development of cardiovascular disease and cognitive frailty. Cognitive frailty is a syndrome defined as the presence of cognitive impairment and physical frailty, which results in an increased vulnerability for the development of dementia, disability, and poor cardiovascular outcomes. CVD indicates cardiovascular disease; MACE, major adverse cardiac events; MMSE, Mini‐Mental State Examination; MoCA, Montreal Cognitive Assessment; and QoL, quality of life.

Figure 3. There is a bidirectional relationship between cognitive impairment, frailty, and cardiovascular disease.

The presence or progression of one may lead to the development of the other. This is in part related to the risk factors shared between the 3. What develops first may allude to the pathophysiological pathway that is causing pathological aging in that individual.