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Development and validation of a nomogram-assisted tool to predict potentially reversible cognitive frailty in Chinese community-living older adults

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Abstract

Background

Cognitive frailty (CF) is a complex and heterogeneous clinical syndrome that indicates the onset of neurodegenerative processes and poor prognosis. In order to prevent the occurrence and development of CF in real world, we intended to develop and validate a simple and timely diagnostic instrument based on comprehensive geriatric assessment that will identify patients with potentially reversible CF (PRCF).

Methods

750 community-dwelling individuals aged over 60 years were randomly allocated to either a training or validation set at a 4:1 ratio. We used the operator regression model offering the least absolute data dimension shrinkage and feature selection among candidate predictors. PRCF was defined as the presence of physical pre-frailty, frailty, and mild cognitive impairment (MCI) occurring simultaneously. Multivariate logistic regression was conducted to build a diagnostic tool to present data as a nomogram. The performance of the tool was assessed with respect to its calibration, discrimination, and clinical usefulness.

Results

PRCF was observed in 326 patients (43%). Predictors in the tool were educational background, coronary heart disease, handgrip strength, gait speed, instrumental activity of daily living (IADL) disability, subjective cognitive decline (SCD) and five-times-sit-to-stand test. The diagnostic nomogram-assisted tool exhibited good calibration and discrimination with a C-index of 0.805 and a higher C-index of 0.845 in internal validation. The calibration plots demonstrated strong agreement in both the training and validation sets, while decision curve analysis confirmed the nomogram’s efficacy in clinical practice.

Conclusions

This tool can effectively identify older adults at high risk for PRCF, enabling physicians to make informed clinical decisions and implement proper patient-centered individual interventions.

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Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

Not applicable.

Funding

The study was supported by Military Healthcare Fund (20BJZ30) and Opening Foundation of National Clinical Research Center for Geriatric Diseases (NCRCG-PLAGH-2022008).

Author information

Authors and Affiliations

  1. School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Bei**g, China

    Anying Bai

  2. Geriatric Health Care Department 4th of The Second Medical Center & National, Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Bei**g, China

    Anying Bai, Cunmei Yang & Yixin Hu

  3. The outpatient Department of the Fourth Comprehensive Service Guarantee Center of the Veteran Cadre Service Administration of the Bei**g Garrison District, Bei**g, China

    Ming Zhao

  4. Institution of Hospital Management, Department of Medical Innovation and Research, Chinese PLA General Hospital, Bei**g, 100853, China

    Tianyi Zhang

  5. Graduate School of Chinese, PLA General Hospital, Bei**g, 100853, China

    ** Yan

  6. Department of Cardiovascular Medicine, Bei**g University of Chinese Medicine Third Affiliated Hospital, Bei**g, 100029, China

    Guan Wang

  7. Haidian No.51 Outpatient Department, Bei**g, 100142, China

    Peicheng Zhang

  8. Haikou Cadre’s Sanitarium of Hainan Military Region, Haikou, 570203, China

    Weihao Xu

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  1. Anying Bai
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  8. Weihao Xu
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  9. Yixin Hu
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Contributions

AYB and YXH conceived the idea for conducting the study. AYB analyzed the data and wrote the first draft of the manuscript. AYB, YXH, TYZ and GW contributed to statistical analysis and improved the paper. YXH, CMY, JY, PCZ and WHX gave guidance and improved the paper. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Yixin Hu.

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Statement of human and animal rights

The study involved human participants and has been reviewed and approved by the Research Ethics Committee of Chinese PLA General Hospital (Ethic number: S2018-102-02) and registered in Chinese Clinical Trial Register (ChiCTR1900022576, First registration date: 17/04/2019). All regulations and measures of ethics and confidentiality are handled in accordance with the Declaration of Helsinki.

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Bai, A., Zhao, M., Zhang, T. et al. Development and validation of a nomogram-assisted tool to predict potentially reversible cognitive frailty in Chinese community-living older adults. Aging Clin Exp Res 35, 2145–2155 (2023). https://doi.org/10.1007/s40520-023-02494-9

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