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Cognitive frailty: A conceptual systematic review and an operational proposal for future research

  • Author Footnotes
    1 These authors have contributed equally to this work.
    David Facal
    Correspondence
    Corresponding author at: Facultade de Psicoloxía - Rúa Xosé María Suárez Núñez, s/n. Campus sur. 15782 Santiago de Compostela, Spain.
    Footnotes
    1 These authors have contributed equally to this work.
    Affiliations
    Department of Developmental Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
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  • Author Footnotes
    1 These authors have contributed equally to this work.
    Ana Maseda
    Footnotes
    1 These authors have contributed equally to this work.
    Affiliations
    Universidade da Coruña, Gerontology Research Group, Instituto de Investigación biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, A Coruña, Spain
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  • Arturo X. Pereiro
    Affiliations
    Department of Developmental Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
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  • Manuel Gandoy-Crego
    Affiliations
    Department of Psychiatry, Radiologist, Public Health, Nursery and Medicine. Faculty of Nursery, University of Santiago de Compostela, Santiago de Compostela, Spain
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  • Laura Lorenzo-López
    Affiliations
    Universidade da Coruña, Gerontology Research Group, Instituto de Investigación biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, A Coruña, Spain
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  • Javier Yanguas
    Affiliations
    Programa de Mayores, Fundación Bancaria La Caixa, Spain

    Socio-Behavioral Section, International Association of Gerontology and Geriatrics for the European Region, Spain
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  • José C. Millán-Calenti
    Affiliations
    Universidade da Coruña, Gerontology Research Group, Instituto de Investigación biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, A Coruña, Spain
    Search for articles by this author
  • Author Footnotes
    1 These authors have contributed equally to this work.

      Highlights

      • There are significant but modest associations between cognitive frailty and physical frailty.
      • Screening instruments have often been used to determine objective cognitive decline.
      • Lifespan trajectories should be taken into account in understanding cognitive frailty.
      • A strong operational definition of cognitive frailty is necessary.
      • Interventional studies are needed to establish the role of preventive strategies.

      Abstract

      Objective

      To analyze the definition of “cognitive frailty” and to study the conceptual and operational definitions used and their implications for empirical research. The relationships between this concept and cognitive reserve, the role of neuropathology and brain reserve, motor signs of aging and the reversibility of cognitive frailty are also discussed.

      Study design

      Systematic review of empirical studies identified from Medline Advanced 1966, CINAHL, Web of Science, PsycINFO, and Scopus until August 2017.

      Main – outcome measures

      Effect sizes. The quality of the articles was assessed by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement. Three independent reviewers participated in the study selection and data extraction.

      Results

      Nineteen studies involving 31,707 participants met the inclusion criteria. Significant associations were reported between cognitive frailty and physical frailty or gait speed. Screening instruments were usually used to determine objective cognitive decline rather than extensive neuropsychological assessments. Educational level was the only indicator of cognitive reserve that was systematically included in the evaluation of cognitive frailty. Motor decline and gait variables were not systematically included in protocols for the assessment of cognitive frailty.

      Conclusions

      A strong operational definition would benefit both the development of treatments to counter cognitive frailty and the assessment of treatment effectiveness. Nevertheless, since there is clear agreement regarding the importance of interventions for and the prevention of cognitive frailty, randomized controlled trials investigating the efficacy of preventive interventions are necessary.

      Keywords

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