Cognitive performance, frailty and functional dependence in community-dwelling older adults: Results of the FREEDOM cohort.

BACKGROUND: Aging is associated with a progressive decline in cognitive performance and functional autonomy, both closely related to frailty. Understanding the interrelation between these domains is essential to identify modifiable factors influencing cognitive impairment in older adults. OBJECTIVES: To evaluate the relationship between physical frailty, cognitive performance, and functional dependence, and to identify sociodemographic and clinical variables associated with cognitive impairment in community-dwelling older adults. DESIGN: Cross-sectional study. SETTING: FREEDOM-LNA cohort, a population-based study conducted by the University Hospital of Limoges, France. PARTICIPANTS: A total of 753 community-dwelling older adults aged [≥]75 years, or [≥]65 years with at least two comorbidities, were included. MEASUREMENTS: Cognitive function was assessed using the Mini Mental State Examination (MMSE), 5-word test (5WT), clock drawing test (CDT), and verbal fluency tests. Frailty was defined according to Frieds physical criteria, and functional independence was evaluated using ADL and IADL scales. Sociodemographic, clinical, and lifestyle factors were analyzed using multivariate models to identify predictors of cognitive impairment. RESULTS: Of the participants, 34.4% had a pathologic MMSE, 46.0% failed the CDT, 68.0% the verbal fluency test, and 17.0% the 5WT. Cognitive performance was significantly lower among frail compared to prefrail and robust individuals. Older adults with pathologic cognition were more frequently dependent in activities of daily living. Independent predictors of poor cognitive performance included non-modifiable factors (age, sex, education) and modifiable ones (low BMI, hypertension, alcohol consumption, smoking, and polypharmacy). CONCLUSIONS: Cognitive impairment was highly prevalent among frail older adults and was strongly associated with loss of independence. Interventions targeting modifiable risk factors such as low BMI, hypertension, alcohol consumption, and smoking may help preserve cognitive and functional abilities in aging populations. Interventions to improve BMI and reduce alcohol consumption, smoking, and hypertension may preserve cognition in older adults.