Malmstrom TK, Morley JE
J Nutr Health Aging 2013;17:723-5
Publication date: November 1, 2013
In this editorial, the authors comment on a consensus statement published in the September 2013 of the Journal of Nutrition, Health & Aging.
Physical frailty has now been recognized as an important syndrome in older persons. The concept of “cognitive frailty” appears to be an important one, recognizing the synergistic effect that mild cognitive impairment (MCI) can have in persons with physical frailty.
If cognitive frailty is going to become a widely accepted syndrome, it is essential that a simple screening test is developed for MCI. The Rapid Cognitive Screen (RCS), in concert with the FRAIL test, may be an excellent tool to identify cognitive frailty.
It is important to recognize that a number of treatment strategies exist for MCI. These include identifying treatable causes of cognitive decline (e.g., vitamin B12 deficiency, hypothyroidism, chronic infections, depression, hearing and visual deficits and anticholinergic drugs). In addition, there is now solid data suggesting that physical exercise will delay or reverse early cognitive decline as well as physical frailty. There is some evidence suggesting that hypogonadism in males is associated with rapid transit from MCI to Alzheimer’s disease and that testosterone replacement may improve cognitive function. Nutritional supplements may also slow cognitive decline.
Finally, it needs to be recognized that there is a broader spectrum of psychosocial risk factors for creating frailty. These include social factors such as poverty but also stressful events such as an earthquake or even a pure psychological stress. Dysphoria represents another psychosocial factor that can aggravate frailty. The psychosocial frailty scale “SOCIAL” has undergone preliminary validation.
The international consensus conference has made an important addition to the geriatric armamentarium in recognizing cognitive frailty as an important geriatric syndrome. Further research is needed to demonstrate that the recognition and treatment of cognitive frailty improves outcomes in older persons.