Mental Health: An Important Missing Link to understanding Frailty and Dementia

The following is a guest post by CCNA researcher, Dr. Sarah Pakzad, Ph.D., L.Psych.

Because frailty carries an increased risk for poor health outcomes – including hospitalization, falls, disability, and even mortality – properly measuring and accurately describing frailty remain areas of priority in both research and clinical settings.

Even though the Frailty Index (FI), clinical frailty scale, and the frailty phenotype are useful tools within geriatric settings, less attention has been paid to assessing and improving mental health among the frail (Halil et al., 2015).

To be clear, frailty is already clinically recognizable. Frailty is a state of increased vulnerability that results from age-associated decline in a person’s ability to function. Moreover, given that frailty was recently associated with cognitive impairment and dementia, researchers are beginning to take into account the frail individuals’ cognitive status and psychological well-being to provide a better definition of frailty as a syndrome (Langlois et al., 2012). Not only will this information provide a clearer image of frailty, it will help build resistance to cognitive damage and improve mental health outcomes among the frail (Rolfson et al., 2013).

In other words, including an assessment of cognitive capacities to the Frailty Index will add an important missing piece that will enable better outcomes.

Acting on this, our research team decided to use neuropsychological tests to identify the probability of developing dementia and to help provide appropriate long-term care to the elderly. For this, we designed a novel approach, which resulted in the creation of a new tool called the Neurocognitive Frailty Index (NFI).

Consequently, our first step was to develop the NFI, which includes both physical and neurocognitive dimensions. To do so, the dataset from the Canadian Study of Health and Aging was used to create and to validate the NFI. The results showed that the NFI provides a high accuracy (more than 90%) to predict dementia.

The second step was to develop NFI norms for elderly with hypertension, diabetes, or a history of cardiac problems. This step helped to predict the probability of developing dementia and the probability of a nursing home placement in the elderly who have these chronic conditions. Now, we are working to develop NFI norms with the elderly from the community who do not have any neurocognitive impairments or other major medical conditions.

The benefit of using the NFI is to identify the elderly who are at risk of developing dementia in comparison to normal healthy elderly people.

Through our combined efforts, by using the NFI, we hope to enhance the probability of early diagnosis of dementia in the elderly and facilitate timely and appropriate treatment to improve their quality of life and care throughout Canada.

To learn more about our project, please contact:

The views and opinions expressed in this guest blog are those of the authors (individual CCNA scientists) and do not necessarily reflect the views of the Canadian Consortium on Neurodegeneration in Aging and its partner organizations.