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Physical frailty and decline in general and specific cognitive abilities
  1. Marcus Richards
  1. MRC Unit for Lifelong Health and Ageing, UCL, London, UK
  1. Correspondence to Professor Marcus Richards, MRC Unit for Lifelong Health and Ageing at UCL, UCL, London WC1B 5JU, UK; m.richards{at}

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Frailty has been conceptualised as reduction in the functional capacity of multiple physiological systems, and results in a wide range of outcomes, including physical limitations, impaired activities of daily living, falls and fractures, hospitalisation and mortality.1 These outcomes also include cognitive decline,1 which in combination with psychiatric morbidity is the biggest cause of disability in the UK and other Western countries.

Gale et al report that frailty predicts decline in a range of cognitive functions in the Lothian Birth Cohort 1936. Frailty predicted those of fluid function (memory, processing speed and visuospatial) and crystallised ability, as measured by pronunciation of irregular words.2 Frailty was defined by the Fried phenotype, that is, the presence of at least three of: weakness (measured by grip strength); self-reported exhaustion; slow gait speed; unintentional weight loss (estimated from low body mass index) and low physical activity. In addition to age, sex and education, associations were independent of two important sources of potential confounding: a range of chronic physical conditions, suggesting that frailty is not merely marking general morbidity burden; and depressive symptoms, further suggesting that exhaustion is not a proxy for this well-known dementia risk factor. Finally, results were essentially unchanged when those scoring below the standard Mini-Mental Status Examination clinical threshold were excluded, indicating that associations with frailty operate within the framework of normal cognitive ageing.

So what is it about ‘frailty’ …

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