Frailty Plus Depression Equals Greater Dementia Risk

 How is your competent? doctor ensuring frailty and depression don't occur? Oh, NO PLAN AT ALL?

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Frailty Plus Depression Equals Greater Dementia Risk

A combination of physical frailty and depression is associated with a substantially increased risk for subsequent dementia, exceeding the risk linked to either condition alone.

In a cohort study of nearly 221,000 participants, frailty was associated with roughly a 2.5-fold higher risk for dementia compared with healthy individuals, while depression alone was linked to a 60% increased risk.

Those with both frailty and depression faced the highest risk, with a more than threefold increased risk for dementia.

Overall, 17% of dementia risk was attributable to the combined effects of frailty and depression.

“These results underscore the complex relationship between frailty, depression, and cognitive function,” Yihong Ding, Zhejiang University School of Medicine, Hangzhou, China, and colleagues wrote.“Given that physical frailty and depression are modifiable, concurrent interventions targeting these conditions could significantly reduce dementia risk,” they added.

The findings were published online on December 16 in General Psychiatry.

Novel Research

Previous research has focused primarily on associations between dementia risk and either frailty or depression. The investigators noted that this study is the first to investigate the combined effect of both conditions on dementia risk, the investigators noted.

The investigators assessed data for 220,947 participants aged 60 years or older (mean age, 64.5 years; 53% women) from the English Longitudinal Study of Ageing, the UK Biobank, and the Health and Retirement Study.

Measures included modified versions of the Fried frailty phenotype, mental health questionnaires, and hospital admission records. The primary outcome was incident all-cause dementia, which occurred in 9088 participants over 2,832,696 person-years of follow-up.

Results showed that frailty and depression did not multiply each other’s effects on dementia risk, but together they increased risk more than would be expected from either condition alone.

However, individuals with physical frailty alone had a 155% higher risk for dementia compared with healthy individuals (pooled hazard ratio [HR], 2.55; 95% CI, 2.36-2.76), while depression alone was associated with a 59% increased risk (pooled HR, 1.59; 95% CI, 1.50-1.69).Those with both frailty and depression had an even higher pooled HR of 3.23 for risk for dementia (95% CI, 2.86-3.65).

The interaction between frailty and depression accounted for 17.1% of dementia risk (95% CI, 6.0%-28.3%).

“These two factors interact in an additive manner, further amplifying dementia risk,” the researchers wrote.

When both factors were added to traditional dementia risk models across all three cohorts, prediction accuracy improved significantly (all area under the curve P values < .05).

The investigators noted the findings underscore the need to integrate assessments of frailty and depression into clinical practice, potentially enabling earlier identification of high-risk individuals and the implementation of targeted interventions.

This study was funded by the National Key Research and Development Program of China. The investigators reported no relevant financial relationships.