[Frailty in dementia with Lewy bodies: relationship with clinical features, intrinsic capacity and cognitive and functional decline]

Abstract

Frailty and intrinsic capacity (IC) decline are associated with worse clinical trajectories and poorer outcomes in Alzheimer's disease. However, few studies focused on dementia with Lewy bodies (DLB). The aim of this study is to analyze the factors associated with frailty in DLB by investigating the association between frailty phenotype and clinical features of DLB, IC, and their associations with cognitive and functional decline. A monocentric longitudinal retrospective study was carried out between 2014 and 2023, including patients with probable DLB who underwent a comprehensive geriatric assessment. Frailty was assessed according to the Fried phenotype criteria. The IC were evaluated using the ICOPE tools proposed by the WHO: the Short Physical Performance Battery (SPPB) for locomotion, the Mini Nutritional Assessment (MNA) for nutrition, the 4-items Geriatric Depression Scale (GDS) for psychology, and the Hearing Vision Equilibrium and Cognitive (HVEC) questionnaire for hearing. Multivariate linear and logistic regression models were performed, adjusted for age and gender. Fifty-five patients were included, with a mean age of 80.2 years. Twenty-nine patients were frail (52.7%) and only 6 were robust (10.9%). Frailty was associated with a decrease in nutritional IC (mean MNA score 20.8 versus 24.2, p-value = 0.004) and locomotor IC (mean SPPB score 4.28 versus 8.96, p-value = 0.001). Among the disease characteristics, only parkinsonism was associated with the risk of frailty (OR 5, 95% CI [1.09-29.27]) and a decrease in nutritional and locomotor IC. The exploratory longitudinal analysis did not show a significant association between frailty or IC decrease at baseline and cognitive or functional decline. This study shows that patients with DLB are at high risk of frailty and decreased IC, particularly among those with parkinsonism, requiring early identification and care of frailty and loss of IC in this population.

Keywords: dementia with Lewy bodies; frailty; intrinsic capacity.