Supplementary Material for: Risk Factors of Progression to Cognitive Frailty: Singapore Longitudinal Ageing Study 2

Introduction: Cognitive frailty is associated with higher risk of dementia and adverse health outcomes. However, multidimensional factors that influence cognitive frailty transitions are not known. We aim to investigate risk factors of incident cognitive frailty.
Methods: Prospective cohort study participants were community-dwelling adults without dementia and other degenerative disorders and baseline and follow-up, including N=1054 participants aged ≥55 free of cognitive frailty at baseline, with complete baseline (March 6, 2009, to June 11, 2013) and follow-up data at 3–5 years later (January 16, 2013 to August 24, 2018). Incident cognitive frailty, defined by one or more criteria of the physical frailty phenotype and <26 of Mini-Mental State Examination (MMSE) score. Potential risk factors assessed at baseline included demographic, socioeconomic, medical, psychological and social factors, and biochemical markers. Data were analysed using Least Absolute Shrinkage Selection Operator (LASSO) multivariable logistic regression models.
Results: A total of 51(4.8%) participants, including 21(3.5%) of the cognitively normal and physically robust participants, 20(4.7%) of the prefrail/frail only and 10(45.4%) of cognitively impaired only, transited to cognitive frailty at follow-up. Risk factors for transition to cognitive frailty were having eye problem (OR=2.6, 95%CI 1.24–5.43) and low HDL-cholesterol (OR=4.1, 95%CI 2.03–8.40), while protective factors for cognitive frailty transition were higher levels of education (OR=0.3, 95%CI 0.10–0.74) and participation in cognitive stimulating activities (OR=0.4, 95%CI 0.17–0.82).
Discussion/Conclusion: Multi-domain modifiable factors especially related to leisure activities predict cognitive frailty transition and may be targeted for prevention of dementia and associated adverse health outcomes.

引言：认知衰弱（Cognitive frailty）与痴呆及不良健康结局的更高发病风险相关。然而，目前尚不明确影响认知衰弱转归的多维度危险因素。本研究旨在探讨新发认知衰弱的危险因素。
研究方法：本前瞻性队列研究的研究对象为社区居住的成人，均无痴呆及其他退行性疾病，且完成了基线与随访评估。共纳入1054名基线时无认知衰弱、年龄≥55岁的受试者，其基线数据采集时间为2009年3月6日至2013年6月11日，随访数据采集时间为3至5年后（2013年1月16日至2018年8月24日）。新发认知衰弱的判定标准为：符合1项及以上躯体衰弱表型标准，且简易精神状态检查（Mini-Mental State Examination, MMSE）得分＜26分。基线时评估的潜在危险因素包括人口学、社会经济、医学、心理及社会因素，以及生化标志物。数据分析采用最小绝对收缩和选择算子（Least Absolute Shrinkage Selection Operator, LASSO）多变量logistic回归模型。
研究结果：随访期间，共有51名（4.8%）受试者进展为认知衰弱，其中认知正常且躯体健康的受试者中有21名（3.5%）、仅处于衰弱前期/衰弱状态的受试者中有20名（4.7%）、仅存在认知损害的受试者中有10名（45.4%）。认知衰弱进展的危险因素为眼部疾病（优势比OR=2.6，95%置信区间CI：1.24~5.43）与高密度脂蛋白胆固醇（HDL-cholesterol）水平降低（OR=4.1，95%CI：2.03~8.40）；而保护因素为较高的受教育水平（OR=0.3，95%CI：0.10~0.74）与参与认知刺激活动（OR=0.4，95%CI：0.17~0.82）。
讨论与结论：多维度可干预因素（尤其与休闲活动相关）可预测认知衰弱的进展，可作为痴呆及相关不良健康结局的预防靶点。