Prevalence and influencing factors of cognitive frailty in elderly with diabetes mellitus in China:A meta-analysis

Objective:To systematically review the epidemiological characteristics and influencing factors of cognitive frailty in Chinese elderly with diabetes mellitus.Methods:PubMed,Embase,Web of Science,CINAHL,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang and Chinese biomedical literature database(CBM)were electronically searched to collect cross-sectional studies on the prevalence and influencing factors of cognitive frailty in Chinese elderly with diabetes mellitus from inception to November 1st,2022.After quality evaluation and data extraction of included studies,R4.2.2 software was used to perform metaanalysis.Results:A total of 7 Chinese and one English literatures involving 2208 participants were included.The results of meta-analysis showed that the prevalence rate of cognitive frailty in elderly diabetic patients was 17.1%(95%CI 8.7%to 30.9%).Subgroup analysis showed that the prevalence rate of cognitive frailty was 10.2%(95%CI 5.0%to 19.7%)in old diabetic adults in community,35.7%(95%CI 20.8%to 53.9%)in hospital,and the difference was statistically significant(P=0.01).The prevalence rate of cognitive frailty was 21.7%(95%CI 10.3%to 40.2%)in male diabetic old adults,24.2%(95%CI 13.3%to 40.1%)in female diabetic old adults,and the difference was not statistically significant(P=0.81).The rate was 12.6%(95%CI 6.6%to 22.5%)in 60~69 years old group,25.8%(95%CI 12.6%to 45.5%)in 70~79 years old group,53.0%(95%CI 23.9%to 80.2%)in diabetic old adults aged 80 years and above,and the difference was statistically significant(P=0.02).The influencing factors for cognitive frailty in diabetic old adults included educational level[OR=0.230,95%CI(0.117~0.454),P<0.0001],regular exercise[OR=0.357,95%CI(0.217~0.588),P<0.01],malnutrition[OR=2.372,95%CI(1.472~3.822),P=0.0004],depression[OR=3.207,95%CI(2.156~4.768),P<0.0001],and HbA1c≥7.0%[OR=3.112,95%CI(1.880~5.152),P<0.0001].Conclusion:The prevalence of cognitive frailty in Chinese elderly patients with diabetes is high,and there are differences in cognitive frailty prevalence among different sources and different ages.Educational level,exercise habits,nutritional status,depression and HbA1c are the factors affecting cognitive frailty in elderly patients with diabetes.Depression,malnutrition,HbA1c≥7.0%were risk factors,and high educational level,regular exercise were protective factors.Attention should be paid to early and accurate identification of cognitive frailty and intervention targeting influencing factors to delay or reverse its progression to adverse health outcomes.

Oral frailty and neurodegeneration in Alzheimer’s disease

Frailty is a critical intermediate status of the aging process with a multidimensional and multisystem nature and at higher risk for adverse health-related outcomes,including falls,disability,hospitalizations,institutionalization,mortality,dementia,and Alzheimer’s disease.Among different frailty phenotypes,oral frailty has been recently suggested as a novel construct defined as a decrease in oral function with a coexisting decline in cognitive and physical functions.We briefly reviewed existing evidence on operational definitions of oral frailty,assessment and screening tools,and possible relationships among oral frailty,oral microbiota,and Alzheimer’s disease neurodegeneration.Several underlying mechanism may explain the oral health-frailty links including undernutrition,sarcopenia linked to both poor nutrition and frailty,psychosocial factors,and the chronic inflammation typical of oral disease.Oral microbiota may influence Alzheimer’s disease risk through circulatory or neural access to the brain and the interplay with periodontal disease,often causing tooth loss also linked to an increased Alzheimer’s disease risk.On this bases,COR388,a bacterial protease inhibitor targeting Porphyromonas gingivalis implicated in periodontal disease,is now being tested in a double-blind,placebocontrolled Phase II/III study in mild-to-moderate Alzheimer’s disease.Therefore,oral status may be an important contributor to general health,including Alzheimer’s disease and latelife cognitive disorders,suggesting the central role of preventive strategies targeting the novel oral frailty phenotype and including maintenance and improvement of oral function and nutritional status to reduce the burden of both oral dysfunction and frailty.