Measuring the Frailty Phenotype and its Association with Cognition in Mid-Life and Older Age

Article type: Research Article

Authors: Goodman, Zachary T.^{a; b; 1} | Banerjee, Nikhil^{a; c; 1} | Rooks, Joshua^a | McInerney, Katalina^{a; c} | Sun, Xiaoyan^{a; c} | Getz, Sarah^{a; c} | Kaur, Sonya^{a; c} | Sun-Suslow, Ni^d | Junco, Barbara^a | Levin, Bonnie E.^{a; c; *}

Affiliations: [a] Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA | [b] Department of Psychology, University of Miami, Miami, FL, USA | [c] Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA | [d] Department of Psychiatry, UCSD School of Medicine, San Diego, CA, USA

Correspondence: [*] Correspondence to: Bonnie E. Levin, PhD, Bernard and Alexandria Schoninger Professor of Neurology, Director, Division of Neuropsychology, University of Miami, Miller School of Medicine, 1120 NW 14th Street, Suite 1336, Miami, FL 33136, USA. Tel.: +1 305 243 7529; E-mail: blevin@med.miami.edu.

Note: [1] These authors contributed equally to this work.

Abstract: Background:Frailty is directly linked to physical robustness and cognitive decline in older age. The Fried Frailty phenotype (FP) is a construct composed of five core symptoms that has been studied predominately in older age. There is little research contrasting the psychometric properties of the FP in mid-life versus older age. Objective:We compared the psychometric properties of the FP in mid-life and older age and investigated relationships between the FP and cognition. Methods:Frailty and neuropsychological assessments were completed on 361 adults, between 45 and 92 years of age, without primary neurological disorders. Confirmatory factor analysis was used to examine FP, indicated by Grip Strength, Gait Speed, Physical Activity, Fatigue, and Weight Loss. Measurement invariance was tested in mid-life (45–64 years) versus older age (≥65 years). Associations were examined between FP and language, executive functions, memory, processing speed, and visuospatial domains as well as a Generalized Cognition factor. Age was tested as a moderator of these associations. Results:Weight Loss was a poor indicator of FP. Factor loadings were comparable across age groups; however, Fatigue was disproportionately higher among those in mid-life. FP was negatively associated with all cognitive domains and remained invariant across age groups. Conclusion:Results support the construct validity of the FP and document its stable associations with poorer cognition in middle and older life. Future research investigating central features of frailty earlier in life may offer avenues for developing targeted prevention measures and better characterization of individuals with elevated dementia risk.

Keywords: Aging, cognition, confirmatory factor analysis, frailty, measurement invariance, neuropsychology, quantitative methods

DOI: 10.3233/JAD-215475

Journal: Journal of Alzheimer's Disease, vol. 89, no. 2, pp. 415-426, 2022