It is important to establish whether frailty among older individuals is reversible with nutritional, physical, or cognitive interventions, singly or in combination. We compared the effects of 6-month-duration interventions with nutritional supplementation, physical training, cognitive training, and combination treatment vs control in reducing frailty among community-dwelling prefrail and frail older persons. We conducted a parallel group, randomized controlled trial in community-living prefrail and frail old adults in Singapore. The participants' mean age was 70.0 years, and 61.4% (n = 151) were female. Five different 6-month interventions included nutritional supplementation (n = 49), cognitive training (n = 50), physical training (n = 48), combination treatment (n = 49), and usual care control (n = 50). Frailty score, body mass index, knee extension strength, gait speed, energy/vitality, and physical activity levels and secondary outcomes (activities of daily living dependency, hospitalization, and falls) were assessed at 0 months, 3 months, 6 months, and 12 months. Frailty score and status over 12 months were reduced in all groups, including control (15%), but were significantly higher (35.6% to 47.8%) in the nutritional (odds ratio [OR] 2.98), cognition (OR 2.89), and physical (OR 4.05) and combination (OR 5.00) intervention groups. Beneficial effects were observed at 3 months and 6 months, and persisted at 12 months. Improvements in physical frailty domains (associated with interventions) were most evident for knee strength (physical, cognitive, and combination treatment), physical activity (nutritional intervention), gait speed (physical intervention), and energy (combination intervention). There were no major differences with respect to the small numbers of secondary outcomes. Physical, nutritional, and cognitive interventional approaches were effective in reversing frailty among community-living older persons.

There is a recent consensus proposal of "cognitive frailty" defined by the presence of both physical frailty and cognitive impairment in the absence of dementia. The relevance, validity, and utilization of cognitive frailty, however, is presently unclear. We determine whether concurrent physical frailty and cognitive impairment, compared with physical frailty alone substantially increased adverse health outcomes (functional disability, hospitalization, poor quality of life [QOL], and mortality). Longitudinal study. Population-based cohort (Singapore Longitudinal Ageing Study, SLAS). Two thousand three hundred seventy-five Chinese Singaporeans aged 55 and above without dementia and degenerative disorders. The associations of physical frailty (Cardiovascular Health Study criteria: 0 = robust, 1-2 = pre-frail, 3-5 = frail) with and without cognitive impairment (mini-mental state examination <26) and adverse outcomes were estimated, controlling for age, gender, education, comorbidity, smoking, alcohol consumption, depressive symptoms, baseline activities of daily living-instrumental and basic activities of daily living disability or QOL score. Compared to robust noncognitively impaired individuals, physical pre-frailty with cognitive impairment was associated with a twofold increased prevalence and incidence of functional disability, a twofold increased incidence of poor QOL, and 1.8-fold increased mortality risks. Cognitively impaired frail individuals stood out with 12- to 13-fold increased prevalence and incidence of functional disability, a five- and 27-fold increased prevalence and incidence of low QOL, and a fivefold increased mortality risk. The estimated prevalence of physical frailty with cognitive impairment was 1.8%, and physical pre-frailty with cognitive impairment was 8.9%. Pre-frailty and frailty with impaired cognitive function, found in 10.7% of this dementia-free population, was associated with an evidently high risk of adverse health outcomes.

The metabolic syndrome (MetS) is a clustering of cardiovascular risk factors (CVRFs) (namely, obesity, diabetes mellitus, hypertension, and dyslipidemia) that is known to predict increased risks of cardiovascular disease and stroke.¹ Among them, diabetes mellitus in midlife and late life is consistently and strongly associated with subsequent dementia (particularly vascular dementia), as well as with mild cognitive impairment (MCI), a predementia syndrome known to confer an increased risk of progressing to dementia.² Studies show that hypertension in midlife is strongly associated with incident dementia in later life, particularly vascular dementia,² but late-life hypertension is not associated with dementia.^3,4 There are contradictory reports of associations of body and fat mass and total cholesterol level with incident dementia or vascular dementia in the elderly.^5-7

Background: Laboratory research suggests that tea has potential neurocognitive protective effects, but this is not established in humans. Objective: We aimed to examine the relation between tea intake and cognitive impairment and decline. Design: Among community-living Chinese adults aged ≥55 y in the Singapore Longitudinal Ageing Studies cohort, we measured tea consumption at baseline and administered the Mini-Mental State Examination (MMSE) at baseline and 1–2 y later. Cognitive impairment was defined as an MMSE score ≤ 23 and cognitive decline as a drop in MMSE score of ≥1 point. We performed cross-sectional analysis of baseline data from 2501 participants and longitudinal analysis of data from 1438 cognitively intact participants. Odds ratios (ORs) of association were calculated in logistic regression models that adjusted for potential confounders. Results: Total tea intake was significantly associated with a lower prevalence of cognitive impairment, independent of other risk factors. Compared with the ORs for rare or no tea intake, the ORs for low, medium, and high levels of tea intake were 0.56 (95% CI: 0.40, 0.78), 0.45 (95% CI: 0.27, 0.72), and 0.37 (95% CI: 0.14, 0.98), respectively (P for trend < 0.001). For cognitive decline, the corresponding ORs were 0.74 (95% CI: 0.54, 1.00), 0.78 (95% CI: 0.55, 1.11), and 0.57 (95% CI: 0.32, 1.03), respectively (P for trend = 0.042). These effects were most evident for black (fermented) and oolong (semi-fermented) teas, the predominant types consumed by this population. In contrast, no association between coffee intake and cognitive status was found. Conclusion: Regular tea consumption was associated with lower risks of cognitive impairment and decline.

Background Information from well-established dementia risk models can guide targeted intervention to prevent dementia, in addition to the main purpose of quantifying the probability of developing dementia in the future. Methods We conducted a systematic review of published studies on existing dementia risk models. The models were assessed by sensitivity, specificity and area under the curve (AUC) from receiver operating characteristic analysis. Results Of 8462 studies reviewed, 61 articles describing dementia risk models were identified, with the majority of the articles modelling late life risk (n=39), followed by those modelling prediction of mild cognitive impairment to Alzheimer’s disease (n=15), mid-life risk (n=4) and patients with diabetes (n=3). Age, sex, education, Mini Mental State Examination, the Consortium to Establish a Registry for Alzheimer’s Disease neuropsychological assessment battery, Alzheimer’s Disease Assessment Scale-cognitive subscale, body mass index, alcohol intake and genetic variables are the most common predictors included in the models. Most risk models had moderate-to-high predictive ability (AUC>0.70). The highest AUC value (0.932) was produced from a risk model developed for patients with mild cognitive impairment. Conclusion The predictive ability of existing dementia risk models is acceptable. Population-specific dementia risk models are necessary for populations and subpopulations with different characteristics.