CoDAS
https://codas.org.br/article/doi/10.1590/2317-1782/20212020214
CoDAS
Original Article

Factors associated with frailty in patients with neurodegenerative diseases

Fatores associados a fragilidade em pacientes com doenças neurodegenerativas

Rafaela Soares Rech; Marina Martins Pereira Padovani; Nathalia Flores Oliveira; Bruna Graciele Souza Alós; Annelise Ayres; Maira Rozenfeld Olchik

http://dx.doi.org/10.1590/2317-1782/20212020214 CoDAS, vol.34, n5, e20200214, 2022
PDF English
PDF Português
PDF
SciELO
Downloads: 1
Views: 740

Abstract

Purpose

To identify the factors associated with frailty in patients with neurodegenerative diseases.

Methods

Cross-sectional study, whose sample consisted of 150 patients diagnosed with neurodegenerative diseases seen at a speech-language therapy clinic in a reference hospital in southern Brazil. A secondary exploratory analysis of the medical records of patients treated at this clinic between April 2016 and May 2019 was performed. The information collected was sex, age, education, type of neurodegenerative disease, time of disease, frailty (Edmonton Frail Scale-EFS), swallowing (Northwestern Dysphagia Patient CheckSheet-NDPCS, Eating Assessment Tool-EAT 10), and cognition (Mini-Mental State Examination-MMSE and Montreal Cognitive Assessment-MoCA). Continuous quantitative variables were analyzed using mean and standard deviation and categorical quantitative variables from absolute and relative frequency, as well as their association with the outcome using the Chi-square test. Crude and adjusted Prevalence Ratios were assessed using Poisson regression with robust variance. All statistical tests were considered significant at a level of 5%.

Results

The significant factors associated with frailty were the presence of oropharyngeal dysphagia and altered cognitive performance. Individuals with frailty have a higher prevalence of oropharyngeal dysphagia (PR= 1.772(1.094-2.872)), while cognition alteration presented a lower prevalence (PR= 0.335(0.128-0.873).

Conclusion

Oropharyngeal dysphagia can be an important clinical predictive factor for consideration in cases of frailty in patients with neurodegenerative diseases.

Keywords

Frailty; Aging; Swallowing Disorders; Cognition; Speech-Language and Hearing Science

Resumo

Objetivo

Identificar os fatores associados à fragilidade em pacientes com doenças neurodegenerativas.

Método

Estudo transversal, cuja amostra foi composta por 150 pacientes com diagnóstico de doenças neurodegenerativas atendidos em um ambulatório de Fonoaudiologia de um hospital de referência no sul do Brasil. Foi realizada análise secundária exploratória dos prontuários dos pacientes atendidos neste ambulatório entre o período de abril de 2016 e maio de 2019. As informações coletadas foram: sexo, idade, escolaridade, tipo de doença neurodegenerativa, tempo de doença, fragilidade (Edmonton Frail Scale - EFS), deglutição (Northwestern Dysphagia Patient CheckSheet- NDPCS, Eating Assessment Tool-EAT 10) e cognição (Mini-Mental State Examination-MMSE e Montreal Cognitive Assessment-MoCA). As variáveis quantitativas contínuas foram analisadas a partir de média e desvio padrão e as quantitativas categóricas a partir de frequência absoluta e relativa, assim como analisou-se a associação destas com o desfecho pelo teste Qui-Quadrado. As Razões de Prevalência brutas e ajustadas foram avaliadas a partir da Regressão de Poisson com variância robusta. Todos os testes estatísticos foram considerados significativos a um nível de 5%.

Resultados

Os fatores significativos associados à fragilidade foram à presença de disfagia orofaríngea e desempenho cognitivo alterado. Indivíduos com a fragilidade apresentam maior prevalência de disfagia orofaríngea (RP=1,772(1,094-2,872)), enquanto a cognição alterada está associada a menor prevalência de fragilidade (RP=0,335(0,128-0,873).

Conclusão

A disfagia orofaríngea pode ser um importante fator clínico preditivo a ser considerado em casos de fragilidade em pacientes com doenças neurodegenerativas.

Palavras-chave

Fragilidade; Envelhecimento; Transtornos da Deglutição; Cognição; Fonoaudiologia

References

  1. Luchesi KF, Campos BM, Mituuti CT. Identificação das alterações de deglutição: percepção de pacientes com doenças neurodegenerativas. CoDAS. 2018;30(6):e20180027. http://dx.doi.org/10.1590/2317-1782/20182018027 PMid:30517269.
  2. Baxter AJ, Charlson FJ, Cheng HG, Shidhaye R, Ferrari AJ, Whiteford HA. Prevalence of mental, neurological, and substance use disorders in China and India: a systematic analysis. Lancet Psychiatry. 2016;3(9):832-41. http://dx.doi.org/10.1016/S2215-0366(16)30139-0 PMid:27528097.
  3. Suresh SN, Verma V, Sateesh S, Clement JP, Manjithaya R. Neurodegenerative diseases: model organisms, pathology and autophagy. J Genet. 2018;97(3):679-701. http://dx.doi.org/10.1007/s12041-018-0955-3 PMid:30027903.
  4. Santos JAFG. Exercício físico, radicais livres, espécies reativas de oxigênio, envelhecimento e doenças neurodegenerativas [especialização]. Curitiba: Universidade Federal do Paraná; 2013.
  5. Payne M, Morley JE. Dysphagia, dementia and frailty. J Nutr Health Aging. 2018;22(5):562-5. http://dx.doi.org/10.1007/s12603-018-1033-5 PMid:29717753.
  6. Charlson FJ, Baxter AJ, Cheng HG, Shidhaye R, Whiteford HA. The burden of mental, neurological, and substance use disorders in China and India: a systematic analysis of community representative epidemiological studies. Lancet. 2016;388(10042):376-89. http://dx.doi.org/10.1016/S0140-6736(16)30590-6 PMid:27209143.
  7. Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet. 2019;394(10206):1365-75. http://dx.doi.org/10.1016/S0140-6736(19)31786-6 PMid:31609228.
  8. Tanaka T, Takahashi K, Hirano H, Kikutani T, Watanabe Y, Ohara Y, et al. Oral frailty as a risk factor for physical frailty and mortality in community-dwelling elderly. J Gerontol A Biol Sci Med Sci. 2018;73(12):1661-7. http://dx.doi.org/10.1093/gerona/glx225 PMid:29161342.
  9. Setiati S, Laksmi PW, Suka Aryana IGP, Sunarti S, Widajanti N, Dwipa L, et al. Frailty state among Indonesian elderly: prevalence, associated factors, and frailty state transition. BMC Geriatr. 2019;19(1):182. http://dx.doi.org/10.1186/s12877-019-1198-8 PMid:31269921.
  10. Lorenzo-López L, Maseda A, de Labra C, Regueiro-Folgueira L, Rodríguez-Villamil JL, Millán-Calenti JC. Nutritional determinants of frailty in older adults: a systematic review. BMC Geriatr. 2017;17:108. http://dx.doi.org/10.1186/s12877-017-0496-2
  11. Ticinesi A, Tana C, Nouvenne A, Prati B, Lauretani F, Meschi T. Gut microbiota, cognitive frailty and dementia in older individuals: a systematic review. Clin Interv Aging. 2018;13:1497-511. http://dx.doi.org/10.2147/CIA.S139163 PMid:30214170.
  12. Ahmed NN, Sherman SJ, Vanwyck D. Frailty in Parkinson’s disease and its clinical implications. Parkinsonism Relat Disord. 2008;14(4):334-7. http://dx.doi.org/10.1016/j.parkreldis.2007.10.004 PMid:17988926.
  13. Feigin VL, Nichols E, Alam T, Bannick MS, Beghi E, Blake N, et al. Global, regional, and national burden of neurological disorders, 1990-2016: a systematic analysis for the global burden of disease study 2016. Lancet. 2019;5:459-80. http://dx.doi.org/10.1016/S1474-4422(18)30499-X
  14. Pegorani MS, Tavares DMS. Fatores associados à síndrome de fragilidade em idosos residentes em área urbana. Rev Lat Am Enfermagem. 2014;22(5):874-82. http://dx.doi.org/10.1590/0104-1169.0213.2493
  15. Bock JO, König HH, Brenner H, Haefeli WE, Quinzler R, Matschinger H, et al. Associations of frailty with health care costs--results of the ESTHER cohort study. BMC Health Serv Res. 2016;16:128. http://dx.doi.org/10.1186/s12913-016-1360-3 PMid:27074800.
  16. Grden CRB, Barreto MFC, Sousa JAV, Chuertniek JA, Reche PM, Borges PKO. Association between physical frailty and cognitive scores in older adults. Rev Rene. 2015;16(3):391-7. http://dx.doi.org/10.15253/2175-6783.2015000300012
  17. Fabrício-Wehbe SCC, Schiaveto FV, Vendrusculo TRP, Haas VJ, Dantas RAS, Rodrigues RAP. Adaptação cultural e validade da Edmonton Frail Scale - EFS em uma amostra de idosos brasileiros. Rev Lat Am Enfermagem. 2009;17(6):1043-9. http://dx.doi.org/10.1590/S0104-11692009000600018 PMid:20126949.
  18. Monteiro DR, Kruse MHL, Almeida MA. Avaliação do instrumento Edmonton Symptom Assessment System em cuidados paliativos: revisão integrativa. Rev Gaúcha Enferm. 2010;31(4):785-93. http://dx.doi.org/10.1590/S1983-14472010000400024 PMid:21805891.
  19. Logemann JA, Veis S, Colangelo L. A screening procedure for oropharyngeal dysphagia. Dysphagia. 1999;14(1):44-51. http://dx.doi.org/10.1007/PL00009583 PMid:9828274.
  20. Gonçalves MIR, Remaili CB, Behlau M. Equivalência cultural da versão brasileira do Eating Assessment Tool - EAT–10. CoDAS. 2013;25(6):601-4. http://dx.doi.org/10.1590/S2317-17822013.05000012 PMid:24626972.
  21. Folstein MF, Folstein SE, Mchugh PR. Mini Mental State. A practical method for rading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-98. http://dx.doi.org/10.1016/0022-3956(75)90026-6 PMid:1202204.
  22. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment (MoCA): a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695-9. http://dx.doi.org/10.1111/j.1532-5415.2005.53221.x PMid:15817019.
  23. Gómez-Gómez ME, Zapico SC. Frailty, cognitive decline, neurodegenerative diseases and nutrition interventions. Int J Mol Sci. 2019;20(11):2842. http://dx.doi.org/10.3390/ijms20112842 PMid:31212645.
  24. Bahat G, Yilmaz O, Durmazoglu S, Kilic C, Tascioglu C, Karan MA. Association between Dysphagia and Frailty in Community Dwelling Older Adults. J Nutr Health Aging. 2019;23(6):571-7. http://dx.doi.org/10.1007/s12603-019-1191-0 PMid:31233080.
  25. Hathaway B, Vaezi A, Egloff AM, Smith L, Wasserman-Wincko T, Johnson JT. Frailty measurements and dysphagia in the outpatient setting. Ann Otol Rhinol Laryngol. 2014;123(9):629-35. http://dx.doi.org/10.1177/0003489414528669 PMid:24707011.
  26. Butler SG, Stuart A, Leng X, Wilhelm E, Rees C, Williamson J, et al. The relationship of aspiration status with tongue and handgrip strength in healthy older adults. J Gerontol A Biol Sci Med Sci. 2011;66(4):452-8. http://dx.doi.org/10.1093/gerona/glq234 PMid:21300744.
  27. Utanohara Y, Hayashi R, Yoshikawa M, Yoshida M, Tsuga K, Akagawa Y. Standard values of maximum tongue pressure taken using newly developed disposable tongue pressure measurement device. Dysphagia. 2008;23(3):286-90. http://dx.doi.org/10.1007/s00455-007-9142-z PMid:18574632.
  28. Nagayoshi M, Higashi M, Takamura N, Tamai M, Koyamatsu J, Yamanashi H, et al. Social networks, leisure activities and maximum tongue pressure: cross-sectional associations in the Nagasaki Islands Study. BMJ Open. 2017;7(12):e014878. http://dx.doi.org/10.1136/bmjopen-2016-014878 PMid:29217718.
  29. Liguori I, Russo G, Aran L, Bulli G, Curcio F, Della-Morte D, et al. Sarcopenia: assessment of disease burden and strategies to improve outcomes. Clin Interv Aging. 2018;13:913-27. http://dx.doi.org/10.2147/CIA.S149232 PMid:29785098.
  30. Wu MC, Chang YC, Wnag TG, Lin LC. Evaluating swallowing dysfunction using a 100-ml water swallowing test. Dysphagia. 2004;19(1):43-7. http://dx.doi.org/10.1007/s00455-003-0030-x PMid:14745645.
  31. Ge ML, Simonsick EM, Dong BR, Kasper JD, Xue QL. Frailty, with or without cognitive impairment, is a strong predictor of recurrent falls in a us population-representative sample of older adults. J Gerontol: Series A. 2021;76(11):e354-e360. http://dx.doi.org/10.1093/gerona/glab083
  32. Hao Q, Dong B, Yang M, Dong B, Wei Y. Frailty and cognitive impairment in predicting mortality among oldest-old people. Front Aging Neurosci. 2018;10:295. http://dx.doi.org/10.3389/fnagi.2018.00295 PMid:30405390.
  33. Yoon SJ, Kim JO, Choi SH, Park K-W, Jeong J-H, Yoon B. Frailty and cognitive impairment. Parkinsonism Relat Disord. 2018;46:E47. http://dx.doi.org/10.1016/j.parkreldis.2017.11.161
  34. Cigolle C, Blaum C, Ha J, Gure T, Lee P, Min L, et al. Disentangling frailty and cognitive impairment? J Am Geriatr Soc. 2012;60(4):S99-100.
  35. Paraizo MA, Almeida AL, Pires LA, Abrita RS, Crivellari MH, Pereira BS, et al. Montreal Cognitive Assessment (MoCA) no rastreio de comprometimento cognitivo leve (CCL) em pacientes com doença renal crônica (DRC) pré-dialítica. Braz J Nephrol. 2016;38(1):31-41. http://dx.doi.org/10.5935/0101-2800.20160006 PMid:27049362.
  36. Alagiakrishnan K, Zhao N, Mereu L, Senior P, Senthilselvan A. Montreal Cognitive Assessment is superior to Standardized Mini-Mental Status Exam in detecting mild cognitive impairment in the middle-aged and elderly patients with type 2 diabetes mellitus. Biomed Res Int. 2013;2013:186106. http://dx.doi.org/10.1155/2013/186106 PMid:23936778.
62d62a49a953950b9e4ad273 codas Articles
2317-1782 (Electronic)
CoDAS ©2024 All rights reserved.

CoDAS

Share this page
Page Sections