Frailty and Alzheimer’s Disease: Making the Connection for Better Care

November is designated “National Alzheimer’s Disease Awareness Month.” Afflicting more than 5.5 million Americans, most over age 65, it’s essential to understand the connection between frailty and dementia to help victims of this disease and their caregivers. 

First of all, it’s important to realize that frailty increases the risk for further illness including AD pathology, cognitive decline, and dementia (Buchman et al, 2014).  AD causes changes in mobility and function suggesting that older persons with AD may be frail. Several studies suggest that changes in the motor system, reduced strength and slow gait, can predate the onset of AD, suggesting that certain characteristics of frailty may be associated with the development of AD.

Initially, frailty focused primarily on the physical domain (Fried et al., 2001). Then more studies considered the impact of cognition on physical frailty (Rockwood et al., 2005).  Next came the definition of cognitive frailty, defined by the simultaneous presence of both physical frailty and cognitive impairment without the presence of a concomitant neurological disease (Kelaiditi et al., 2013). Cognitive frailty is viewed as a potential precursor of neurodegenerative processes with good potential for reversibility,  and, thus, is the ideal target of early interventions.

More recently still, researchers investigated the relationship between physical activity, cognition, and neuropathology in the same study cohort. This was the first study to identify an association between self-reported physical activity and cognitive status in patients with AD. The authors stressed that the study shows association, not necessarily causation. “Still, this paper favors the idea that physical activity may be considered an important therapeutic tool for patients at risk of cognitive decline.”(Müller S, et al., 2018)

How can we best apply this body of knowledge to our clinical management and what messages are meaningful to those concerned about AD or frailty?

  1. Our starting point is to measure their frailty and cognition.
  2. Next, address any factors contributing to either diagnosis.
  3. Both diagnoses will benefit from movement/mobility — the more the better.
  4. For residents in nursing homes or other settings, activity professionals can build movement programs tailored to both diagnoses. 
  5. For patients living in the community, consider a program to prevent decline, improve deficits, or stabilize. (CFN “AVOID”)

As research continues and clinicians become more proficient at identifying and managing frailty and Alzheimer’s Disease, more therapeutic approaches will be developed to target these conditions earlier and more effectively. In the meantime, Patient Pattern can help you take the next steps to identify, manage, and communicate patient risk in those individuals with Alzheimer’s Disease. This can help improve outcomes, optimize documentation, and maximum reimbursement.

For further reading:

  1. Buchman AS DOI: org/10.1093/gerona/glu117
  2. Kelaiditi E.  DOI:10.1007/s12603-013-0367-2
  3. Müller S.     DOI: 10.1016/j.jalz.2018.06.3059
  4. https://www.cfn-nce.ca/frailty-matters/avoid-frailty/

For more information on frailty and best practices in geriatric medicine contact our team today.