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From the Rush Alzheimer’s Disease Center (A.S.B., P.A.B., R.S.W., D.A.B.), Rush University Medical Center; Department of Neurological Sciences (A.S.B., R.S.W., D.A.B.), Rush University Medical Center; Department of Behavioral Science (P.A.B., R.S.W.), Rush University Medical Center; Rush Institute for Healthy Aging and Department of Internal Medicine (Y.T.), Rush University Medical Center, Chicago, Illinois.
Address correspondence and reprint requests to Aron S. Buchman, Rush Alzheimer’s Disease Center; Rush University Medical Center; Armour Academic Facility, Suite #1038; 600 South Paulina Street, Chicago, IL 60612. E-mail: Aron_S_Buchman{at}rush.edu
Objective: To assess the association between frailty and incident Alzheimer’s disease (AD) and cognitive decline. Frailty is common in older persons and associated with adverse health outcomes.
Methods: Study subjects included 823 older persons without dementia who participated in the Rush Memory and Aging Project, a longitudinal study of aging, and underwent annual assessments of frailty, cognition, and diagnostic evaluation for AD.
Results: During a 3-year follow-up, 89 of 823 participants developed AD. In a proportional hazards model, both baseline level of frailty and annual rate of change in frailty were associated with an increased risk of incident AD. Each additional one tenth of a unit increase on the frailty scale at baseline was associated with >9% increased risk of AD (hazard ratio: 2.44; 95% confidence interval (CI): 1.49, 3.37); each one tenth of a unit increase in annual rate of change in frailty was associated with a 12% increased risk of AD (hazard ratio: 3.30; 95% CI: 1.52, 7.13). These results were unchanged in analyses controlling for vascular risk factors and vascular diseases. Results were similar with a categorical measure of frailty instead of a continuous measure. Further, linear mixed-effects models showed that the level of and rate of change in frailty were also associated with the rate of cognitive decline.
Conclusion: Increasing frailty is associated with incident AD and the rate of cognitive decline in older persons. These findings suggest that frailty and AD may share similar etiologies.
Key Words: aging • frailty • cognitive decline • Alzheimer's disease • dementia
Abbreviations: AD = Alzheimer’s disease; PD = Parkinson’s disease; CI = confidence interval; BMI = body mass index; SD = standard deviation.
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