Kelaiditi E, Cesari M, Canevelli M, et al.
J Nutr Health Aging 2013;17:726-34
Publication date: November 1, 2013

The frailty syndrome has recently attracted attention of the scientific community and public health organizations as precursor and contributor of age-related conditions (particularly disability) in older persons. In parallel, dementia and cognitive disorders also represent major healthcare and social priorities. Although physical frailty and cognitive impairment have shown to be related in epidemiological studies, their pathophysiological mechanisms have generally been studied separately.

An international consensus conference on cognitive frailty was organized by the International Academy on Nutrition and Aging (IANA) and the International Association of Gerontology and Geriatrics (IAGG) on April 16, 2013 in Toulouse, France. Kelaiditi et al. describe the results of the consensus conference and provide the first definition of a “cognitive frailty” condition in older adults. The main objective of this approach was to facilitate the design of future personalized preventive interventions in older persons. The group discussed the use of multidomain interventions focused on the physical, nutritional, cognitive and psychological domains for improving the well-being and quality of life in the elderly.

The consensus panel proposed the identification of “cognitive frailty” as a heterogeneous clinical manifestation characterized by the simultaneous presence of both physical frailty and cognitive impairment. In particular, the key factors defining such a condition include: 1) presence of physical frailty and cognitive impairment (Clinical Dementia Rating score of 0.5); and 2) exclusion of concurrent Alzheimer disease dementia or other dementias.

Under different circumstances, cognitive frailty may represent a precursor of neurodegenerative processes. A potential for reversibility may also characterize this entity. A psychological component of the condition is evident and concurs at increasing the vulnerability of the individual to stressors.

Cognitive frailty may represent a novel concept to consider in the complex and heterogeneous scenario of frailty in older persons. It is hoped that this initial discussion between experts from clinical, research and industry fields may provide a stimulus for development of new research in the field.

The consensus group proposed the hypothesis of a possible new condition. There was no intention of operationalizing it, because available data are still preliminary and far to be conclusive. The objective of the consensus conference was indeed to stimulate research in the field. A continued dialogue on this topic would benefit investigators with an interest in cognitive frailty to develop new studies with the aim to better understand this condition. It is also important that future research in the field may inform public health policies for the implementation of prevention and treatment programs.

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