Physical frailty and cognitive function among men with cardiovascular disease

Aims: To assess the relationship between physical frailty and cognitive function among elderly men with a history of cardiovascular disease (CVD). Methods: Three-hundred-twenty-four community-dwelling men with chronic CVD (mean age 77.2 +/- 6.4 years) who previously participated in the Bezafibrate Infarction Prevention (BIP) trial (1990-1998) underwent assessment of frailty and cognitive function between 2011 and 2013. Physical frailty was assessed using the Fried phenotypic model, and cognitive performance overall and in memory, executive function, visuospatial and attention domains was evaluated using a validated set of computerized cognitive tests. Linear regression models were used to assess the cross-sectional relationship of frailty status and its components (gait speed, grip strength, weight loss, exhaustion and activity) with cognitive function overall and in specific domains, adjusting for age, education, smoking status, physical activity, history of myocardial infarction, hypertension, diabetes and dyslipidemia, systolic blood pressure, BMI and depression. Results: Of the 324 men, 91 (28%) were frail and 121 (37%) were pre-frail. After controlling for potential confounders, severity of frailty was strongly associated with global cognitive function (beta = -8.0, 95%CI = -11.9, -4.1 and beta = -3.3, 95%CI = -6.0, -0.5 comparing frail and pre-frail to non-frail, respectively), with the most profound associations observed in executive function and attention. Gait speed was associated with overall cognitive performance and with all cognitive domains assessed in this study, and activity with none. Conclusion: Cognitive function is poor among frail and pre-frail men with CVD, particularly in non-memory domains. Future research is warranted to address mechanisms and to assess the efficacy of interventions to improve physical and cognitive health.