The summaries are free for public
use. The Chronic Liver Disease
Foundation will continue to add and
archive summaries of articles deemed
relevant to CLDF by the Board of
Trustees and its Advisors.
Abstract Details
Liver fibrosis score, physical frailty, and the risk of dementia in older adults: The Italian Longitudinal Study on Aging
Alzheimers Dement (N Y). 2020 Aug 24;6(1):e12065.doi: 10.1002/trc2.12065. eCollection 2020.
Vincenzo Solfrizzi1, Emanuele Scafato23, Carlo Custodero1, Francesca Loparco1, Alessandro Ciavarella1, Francesco Panza45, Davide Seripa46, Bruno Pietro Imbimbo7, Madia Lozupone8, Nicola Napoli1, Giuseppina Piazzolla1, Lucia Galluzzo3, Claudia Gandin2, Marzia Baldereschi9, Antonio Di Carlo9, Domenico Inzitari910, Alberto Pilotto111, Carlo Sabbà1, Italian Longitudinal Study on Aging Working Group
Author information
1Clinica Medica "Frugoni" and Geriatric Medicine-Memory Unit University of Bari Aldo Moro Bari Italy.
2Population Health and Health Determinants Unit, National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS) Istituto Superiore di Sanità (ISS) Roma Italy.
3Department of Cardiovascular, Dysmetabolic and Ageing-Associated Diseases Istituto Superiore di Sanità (ISS) Roma Italy.
4Geriatric Unit Fondazione IRCCS "Casa Sollievo della Sofferenza" Foggia Italy.
5National Institute of Gastroenterology "Saverio de Bellis" Research Hospital Bari Italy.
6Hematology and Stem Cell Transplant Unit Vito Fazzi Hospital Lecce Italy.
7Research & Development Department Chiesi Farmaceutici Parma Italy.
8Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs University of Bari Aldo Moro Bari Italy.
9Institute of Neuroscience Italian National Research Council (CNR) Firenze Italy.
10Department of NEUROFARBA, Neuroscience Section University of Florence Firenze Italy.
11Geriatrics Unit, Department of Geriatric Care Orthogeriatrics and Rehabilitation Genova Italy.
Abstract
Introduction: Liver fibrosis increases progressively with aging and has been associated with poorer cognitive performance in middle-aged and older adults. We investigated the relationships between a non-invasive score for advanced liver fibrosis (non-alcoholic fatty liver disease [NAFLD] fibrosis score [NFS]) and dementia risk. We also assessed physical frailty, a common geriatric condition which is associated to dementia. We tested the joint effects of physical frailty and fibrosis on dementia incidence.
Methods: A total of 1061 older adults (65 to 84 years), from the Italian Longitudinal Study on Aging, were prospectively evaluated for the risk of dementia in a period between 1992 and 2001. Liver fibrosis was defined according to the NFS. Physical frailty was assessed according to the Fried's criteria. Cox proportional hazards models were used to estimate the short- and long-term risk of overall dementia, associated to the NFS, testing the effect modifier of physical frailty status.
Results: Older adults with only high NFS (F3-F4) did not exhibit a significant increased risk of overall dementia. Over 8 years of follow-up, frail older adults with high NFS had an increased risk of overall dementia (hazard ratio [HR]: 4.23; 95% confidence interval [CI]: 1.22 to 14.70, P = .023). Finally, physically frail older adults with low albumin serum levels (albumin < 4.3 g/dL) and with advanced liver fibrosis (F3-F4 NFS) compared to those with lower liver fibrosis score (F0-F2 NFS) were more likely to have a higher risk of overall dementia in a long term-period (HR: 16.42; 95% CI: 1.44 to 187.67, P = .024).
Discussion: Advanced liver fibrosis (F3-F4 NFS) could be a long-term predictor for overall dementia in people with physical frailty. These findings should encourage a typical geriatric, multidisciplinary assessment which accounts also for the possible co-presence of frail condition in older adults with chronic liver disease and liver fibrosis.