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Title:	Identification of cognitive frailty, the mediator and its predictive value on adverse health outcomes among Malaysian older adults
Authors:	Nurul Fatin Malek Rivan (P97327)
Supervisor:	Suzana Shahar, Prof. Dr.
Keywords:	Cognition Disorders Dementia Universiti Kebangsaan Malaysia -- Dissertations Dissertations, Academic -- Malaysia
Issue Date:	26-Feb-2022
Description:	Cognitive frailty (CF) is known as the co-existence of physical frailty and cognitive impairment in the absence of dementia. However, its relevance, validity, and utilisation among Malaysian older adults at present are unclear. Therefore, this study aimed to determine the prevalence, incidence, predictors, biomarkers, and impact of CF and develop a simple screening tool for its categorisation. In Phase 1, an analysis of secondary data generated from LRGS-Towards Useful Ageing study (LRGS TUA) study wave III involving 1318 older respondents was performed to determine the prevalence and risk factors of CF. Meanwhile, Phase 2 comprised four sections, wherein Section 1 denoted a longitudinal study involving 425 respondents without CF at baseline and served to determine its incidence and predictors after two years of followup. Section 2 involved a follow-up of a sub-sample made up of 120 respondents for an evaluation of potential biomarkers associated with CF. Alternatively, the development of a simple screening tool (i.e. Cognitive Frailty Screening Tool, CFST) for the syndrome occurred in Section 3, comprising its risk factors and predictors, while its impact on adverse health outcomes was determined in Section 4. Findings from Phase 1 indicated the prevalence of cognitive pre-frailty and cognitive frailty was 32.7% and 4.1%, respectively. After combining these two groups, the prevalence of CF was 36.8%. Factors associated with CF while associated factors were as follows: being male (OR:1.592; 95%CI:1.230-2.06), having depressive symptoms (OR:2.993; 95%CI:2.252-3.978), showing low functional status as indicated by minimal instrumental activities of daily living (IADL) score (OR:0.830; 95%CI:0.784-0.878), and the lack of participation in gardening (OR:1.466; 95%CI:1.106-1.944), exercise (OR:1.395; 95% CI:1.066-1.824), and reading (OR:1.694; 95%CI:1.163-2.466) activities. In Phase 2, Section 1 first revealed the CF incidence of 10.1 per 100 peryears, whereas the predictors included lesser education years (OR:3.061; 95%CI:1.822- 5.142), having diabetes (OR:2.007; 95%CI:1.163-3.465), lower physical function as measured by using the timed-up-and-go (TUG) test (OR:1.099; 95%CI:1.015-1.189), having depressive symptoms (OR:1.798; 95%CI:1.007-3.211), irregular use of modern gadgets (OR:2.921; 95%CI:1.219-7.001), and low vitamin C intake (OR:0.994; 95% CI:0.989-0.998). Section 2, meanwhile, showed that osteoprotegerin (OPG) partially mediated the relationship between the TUG test and vitamin C intake with CF incidence. In contrast, malonaldehyde (MDA) and vitamin D appeared to be the full mediators linking depressive symptoms with said incidence. Similarly, the brainderived neurotrophic factor (BDNF) fully mediated the relationship between irregular use of modern gadgets and CF while appearing as a partial mediator linking vitamin C and CF incidence. Here, the CFST had an area under the curve of 0.817 (95%CI:0.774􀀓􀀑􀀛􀀙􀀔􀀌􀀃􀁚􀁌􀁗􀁋􀀃􀀼􀁒􀁘􀁇􀁈􀁑􀂶􀁖􀀃􀀬􀁑􀁇􀁈􀁛􀀃􀁒􀁉􀀃􀀘􀀜􀀑􀀛􀀏􀀃􀁊􀁒􀁒􀁇􀀃􀁖􀁈􀁑􀁖􀁌􀁗􀁌􀁙􀁌􀁗􀁜􀀃􀀋􀀛􀀓􀀑􀀛􀀈􀀌􀀃􀁄􀁑􀁇􀀃􀁖􀁓􀁈􀁆􀁌􀁉􀁌􀁆􀁌􀁗􀁜􀀃􀀋􀀚􀀜􀀑􀀓􀀈􀀌􀀏􀀃 a positive predictive value (PPV) of 73.3%, and a negative predictive value (NPV) of 85.2%. An adjustment for the covariates was done in Section 4 and revealed that CF significantly predicted the incidence of falls (OR:1.367; 95%CI:0.934-1.999), disability (OR:1.871; 95%CI:1.210-2.895), and dementia (OR:2.348; 95%CI:1.247-4.420). In conclusion, more than one-third and one out of ten of the older adults in this study had CF and were associated with sociodemographic, physical, psychosocial, and nutrition through the mediation of specific biomarkers. These findings of the predictors of CF could be used to formulate multi-domain intervention to prevent adverse health outcomes among older adults with CF.,Ijazah Doktor Falsafah
Notes:	e-thesis
Pages:	340
Publisher:	UKM, Kuala Lumpur
Appears in Collections:	Faculty of Health Sciences / Fakulti Sains Kesihatan

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