| BACKGROUNDThe aging degree of our country is further deepened,and the social pension burden is becoming more and more serious.Cognitive frailty is a nonspecific syndrome that occurs with population aging and is an important risk factor for adverse health outcomes and disease burden in the elderly.As a secondary intervention target for the prevention of self-care disorders in the elderly,many studies have explored its correlation with the risk of disability,but there are large differences among studies,and the conclusions have not been unified.Cognitive frailty is potentially reversible,early detection and timely intervention can reverse the course of the disease to a certain extent.Although there are many epidemiological investigations on cognitive frailty,there is a large heterogeneity of research on the elderly in different regions and places.The risk factors for early identification are still unclear,and it is urgent to develop convenient and quick early warning tools based on the perspective of tertiary prevention.OBJECTIVES1.Through meta-analysis,clarify the relationship between cognitive frailty and the risk of disability in the elderly.2.Investigate the status of cognitive frailty among the elderly in community,analyze the influencing factors and establish risk prediction model,draw a nomogram and develop a web calculator based on the model.3.Conduct internal and external validation and clinical validity evaluation of the constructed model.METHODS1.Systematic review:Comprehensively searched PubMed,The Cochrane Library,Web of Science,ScienceDirect,ClinicalTrials.gov,CBM,CNKI,Wanfang,VIP and other databases.To search for prospective studies on the correlation between cognitive frailty and disability in the elderly at home and abroad,the retrieval period was from database construction to 2020.8.15.Two researchers independently screened literatures according to inclusion and exclusion criteria,evaluated literature quality and extracted data.Meta-analysis was performed using RevMan 5.3 and Stata 12.0 software.2.Cross-sectional survey:From August 2020 to March 2021,368 elderly people who underwent physical examination in a community health service center in Guangzhou were conveniently recruited as the research objects.As the modeling group,the general information questionnaire and cognitive frailty assessment tools were used to collect data,based on Logistic regression analysis to establish a risk prediction model for cognitive frailty in community elderly.The strengthen Bootstrap method for internal validation,and 158 elderly people collected in the same community from April to July 2021 were used as validation group for external validation,C statistics,Brier score and calibration curve were used to evaluate the discrimination and calibration of the model.The clinical decision curve(DCA plot)was drawn to evaluate the clinical validity of the model.RESULTS1.Seven studies were included,all of which took the elderly in the community(n=20578)as the research objects.Different types of cognitive frailty predict disability risk in elderly differently.Among them,the elderly with frailty and cognitive impairment had a higher risk of disability than those without cognitive frailty[RR=4.82,95%CI(2.09,11.14),P<0.0005],while pre-frailty combined with cognitive impairment did not increase disability occurrence risk[RR=1.67,95%CI(0.95,2.96),P=0.08].2.The detection rate of cognitive frailty was 36.3%in 526 community elderly.Impaired instrumental activities of daily living(IADL),poor self-rating of health,poor self-rating of daytime mental state,multiple chronic diseases and aging were risk factors for cognitive frailty,while physical exercise and good nutrition were the protective factors.In the risk prediction model constructed based on these seven factors,the area under the ROC curve was 0.920(95%CI:0.892-0.947),and the HosmerLemeshow test value was 3.878(P=0.794).The yuden index of the model was 0.688,the best cutoff value was 0.401,the sensitivity was 79.7%,the specificity was 89.1%,and the accuracy was 85.6%.3.The corrected C statistic of internal validation was 0.910(95%CI:0.863-0.936),and Brier score was 0.117;The external validation C statistic was 0.850(95%CI:0.7850.915),the Brier score was 0.145.The calibration graph showed that the risk of cognitive frailty predicted by the model was in good agreement with the actual situation,with a sensitivity was 60.4%,specificity was 87.6%,and accuracy was 78.5%.The DCA plot showed that the curve representing the model was far away from the two extreme invalid lines,indicating that the model had good clinical validity.CONCLUSIONS1.The coexistence of frailty and cognitive impairment will significantly increase the risk of disability in the elderly.2.The detection rate of cognitive frailty among the elderly in the community is relatively high,the risk prediction model is:logit P=-4.580+2.360×IADL+0.867(general self-rating of health)/1.822(poor self-rating of health)+1.292×self-rating of daytime mental state+0.720×chronic disease quantity+0.620×age-1.015×nutritional status-1.372×physical exercise.The model has a good degree of discrimination and calibration by internal and external validation,which can intuitively and easily screen the elderly at high risk of cognitive frailty in the community. |
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