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Associations between cognitive frailty and circulating cardiovascular biomarkers in a memory clinic cohort
Xin Tong Tan1,2, Joyce R Chong2,3, Eddie J Y Chong1,2
1Memory, Ageing & Cognition Centre, National University Health System, Singapore, Singapore.
Insights
Cognitive frailty (CF), combining physical frailty and mild cognitive impairment (MCI), is linked to higher cardiac dysfunction biomarkers. This condition accelerates cognitive decline, especially with elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP).
Area of Science:
- Gerontology
- Cardiology
- Neurology
Background:
- Cognitive frailty (CF) is an at-risk state for adverse health outcomes, characterized by the co-occurrence of physical frailty and mild cognitive impairment (MCI).
- Both frailty and MCI are individually associated with cardiovascular dysfunction, but the mechanisms linking them remain unclear.
- Understanding the interplay between cardiovascular health and cognitive decline in CF is crucial for developing targeted interventions.
Purpose of the Study:
- To investigate the association between cognitive frailty (CF) and circulating biomarkers of cardiac dysfunction.
- To examine whether these cardiac biomarkers modify the relationship between CF and future cognitive decline.
- To identify potential cardiovascular pathways involved in the progression of cognitive impairment in frail individuals.
Main Methods:
- A longitudinal study followed 303 Singaporean memory clinic patients for five years.
- Plasma concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP), growth differentiation factor-15 (GDF-15), and high-sensitivity cardiac troponin T (hs-cTnT) were measured.
- Cognitive status (Clinical Dementia Rating; CDR) and physical frailty (Frailty Index; FI) were assessed annually to define CF (CDR 0.5 and FI ≥ 0.18).
Main Results:
- Individuals with CF (11.6%) exhibited significantly higher levels of NT-proBNP, GDF-15, and hs-cTnT compared to non-CF participants (p < 0.001).
- A significant interaction between frailty scores and MCI was observed for NT-proBNP levels (p = 0.006).
- CF predicted greater 5-year cognitive decline (p = 0.013), which was steeper in individuals with higher NT-proBNP levels (p = 0.038).
Conclusions:
- Cognitive frailty (CF) is associated with elevated biomarkers of cardiac dysfunction.
- CF is linked to accelerated cognitive decline over five years.
- Elevated NT-proBNP exacerbates cognitive decline in CF, suggesting cardiovascular pathways as potential therapeutic targets.
Background:
Cognitive frailty (CF), the co-occurrence of physical frailty and mild cognitive impairment (MCI) without dementia, is an at-risk state for adverse health outcomes. While frailty and MCI are individually linked to cardiovascular dysfunction, mechanisms underlying their co-occurrence remain unclear. To investigate whether CF is associated with circulating biomarkers of cardiac dysfunction, and to examine if these biomarkers modify the associations between CF and future cognitive decline. 303 Singaporean memory clinic patients were followed up annually for five years. Plasma concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP), growth differentiation factor-15 (GDF-15), and high-sensitivity cardiac troponin T (hs-cTnT) were quantified using immunoassays. Cognitive status was defined using the Clinical Dementia Rating (CDR; 0 = cognitively unimpaired, 0.5 = MCI). Physical frailty was assessed with the 30-item Frailty Index (FI ≥ 0.18 = frail). CF was defined as the presence of both CDR 0.5 and FI ≥ 0.18. Among 303 participants (mean age = 71.7 ± 7.7 years; 52.2% female), 35 (11.6%) met criteria for CF. CF individuals had higher NT-proBNP, GDF-15, and hs-cTnT levels (all p < 0.001) compared to non-CF counterparts. Frailty scores significantly interacted with CDR 0.5 (MCI) for NT-proBNP levels (β = 0.48; 95%CI = 0.14 to 0.83; p = 0.006). CF predicted for greater 5-year cognitive decline (β = -0.15; 95%CI = -0.27 to -0.03; p = 0.013), with steeper decline evident in those with higher NT-proBNP (β = -0.12; 95%CI = -0.23 to -0.01; p = 0.038). CF is associated with elevated cardiac dysfunction biomarkers and accelerated cognitive decline. High NT-proBNP exacerbates this decline, highlighting cardiovascular pathways as potential intervention targets for CF.
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