Defining the Role of Frailty in the Transition from Mild Cognitive Impairment to Dementia and in Dementia Progression.

INTRODUCTION: Neurodegenerative diseases are a growing concern in an aging global population. Frailty, often conceptualized as a state of diminished physiological reserve and increased susceptibility to stressors, emerges as a pivotal factor in this context. While frailty may be modified, it is essential to recognize its frequently irreversible nature, necessitating a careful approach when considering its role and influence in the progression from mild cognitive impairment (MCI) to dementia and within dementia progression. METHODS: A retrospective study including 1,284 participants, attending a Cognitive Disturbances and Dementia unit from January 2021 to May 2023, was conducted. Frailty was assessed using the clinical frailty scale (CFS) score. Multilevel univariate and multivariate logistic regression models were developed to determine the contributions of patient characteristics, including frailty, to disease progression. RESULTS: Frailty significantly increased with higher global clinical dementia rating (CDR) subgroups, suggesting escalating frailty burden with disease progression. Age, CFS, and mini-mental state examination (MMSE) scores were significant predictors of progression from MCI to dementia and to more severe dementia stages, even when considering the independence from variables contributing to frailty. Patients transitioning to a higher CDR group exhibited higher CFS scores. Age, education, anticholinergic burden, cumulative illness rating scale - geriatric, MMSE, and neuropsychiatric inventory scores significantly contributed to frailty. CONCLUSIONS: Frailty plays a critical role in the transition from MCI to dementia and within dementia progression. Age, cognitive impairment, and frailty were identified as significant predictors of disease progression. The CFS is a clinically applicable tool for frailty assessment. Regular frailty assessments may be valuable in early detection and management of dementia.

Validation and convergent validity of the Boston cognitive assessment (BOCA) in an Italian population: a comparative study with the Montreal cognitive assessment (MoCA) in Alzheimer's disease spectrum.

BACKGROUND: The Boston Cognitive Assessment (BOCA) is a self-administered online test developed for cognitive screening and longitudinal monitoring of brain health in an aging population. The study aimed to validate BOCA in an Italian population and to investigate the convergent validity with the Montreal Cognitive Assessment (MOCA) in healthy ageing population and patients within the Alzheimer Disease spectrum. METHODS: BOCA was administered to 150 participants, including cognitively healthy controls (HC, n = 50), patients with mild cognitive impairment (MCI, n = 50), and dementia (DEM, n = 50). The BOCA reliability was assessed using (i) Spearman's correlation analysis between subscales; (ii) Cronbach's alpha calculation, and (iii) Principal Component Analysis. Repeated-measures ANOVA was employed to assess the impact of the sequence of test administrations between the groups. BOCA performance between HS, MCI and DEM and within different severity subgroups were compared using Kruskall Wallis test. Furthermore, a comparison was conducted between MCI patients who tested positive for amyloid and those who tested negative, utilizing Mann Whitney's U-test. RESULTS: Test scores were significantly different between patients and controls (p < 0.001) suggesting good discriminative ability. The Cronbach's alpha was 0.82 indicating a good internal consistency of the BOCA subscales and strong-to-moderate Spearman's correlation coefficients between them. BOCA total and subscores differ across different MoCA severity subgroups and demonstrated strong correlation with MoCA scores (rho = 0.790, p < 0.001). CONCLUSIONS: The Italian version of the BOCA test exhibited validity, feasibility, and accurate discrimination closely performing as MoCA.