{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T21:41:45Z","timestamp":1768254105452,"version":"3.49.0"},"reference-count":30,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2024,5,30]],"date-time":"2024-05-30T00:00:00Z","timestamp":1717027200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background\u00a0and Objectives: Dementia is increasing worldwide. This study aimed to examine the impact of comorbidity burden and frailty on dementia prognosis in patients with dementia. Materials and Methods: This retrospective cohort study was conducted with 47 patients with dementia who were followed for up to two years. The Modified Charlson Comorbidity Index (MCCI), Mini-Mental State Examination (MMSE-E), and Edmonton Fragility Scale were used besides laboratory and clinical findings. Results: The mean age of the 47 patients was 78.77 \u00b1 12.44 years. During the follow-up period, MMSE-E scores were observed to improve in 50% of the patients. Initial MMSE-E scores were found to be lowest in men and patients with coronary artery disease or depression, while final MMSE-E scores were observed to be lowest in patients with depression and low vitamin B12 or vitamin D levels. The rates of decrease in MMSE-E scores in non-, moderately and severely frail patients were 21.4%, 55.6%, and 70.6%, respectively. There was a moderate negative correlation between MMSE-E scores and both comorbidity burden and frailty scores. The mediation analysis revealed that frailty was a complete mediator, and that comorbidity burden led to an increase in frailty and a decrease in MMSE-E scores. During the follow-up period, patients with moderate frailty, hypertension, diabetes mellitus, alcohol and tobacco use, low B12 levels, or hypothyroidism showed an increased risk of decrease in cognitive functions. Conclusions: There was a significant association between dementia prognosis and both frailty and biological deficits. We recommend the adoption of a syndemic approach in the follow-up of dementia, as we believe that the prevention of frailty and associated biological deficits will contribute to slowing dementia\u2019s clinical course.<\/jats:p>","DOI":"10.3390\/medicina60060910","type":"journal-article","created":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T12:19:46Z","timestamp":1717417186000},"page":"910","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Mediator Role of Frailty and Biological Deficits in Dementia Prognosis\u2014Retrospective Cohort Study"],"prefix":"10.3390","volume":"60","author":[{"given":"K\u00fcbra","family":"I\u015f\u0131k","sequence":"first","affiliation":[{"name":"Department of Neurology, \u015eanl\u0131urfa Suru\u00e7 State Hospital, \u015eanl\u0131urfa 63800, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0780-6176","authenticated-orcid":false,"given":"Burak","family":"Mete","sequence":"additional","affiliation":[{"name":"Department of Public Health, Faculty of Medicine, Cukurova University, Adana 01330, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatma","family":"Tanr\u0131\u00f6ver","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine, Cukurova University, Adana 01330, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7475-2406","authenticated-orcid":false,"given":"Hakan","family":"Demirhindi","sequence":"additional","affiliation":[{"name":"Department of Public Health, Faculty of Medicine, Cukurova University, Adana 01330, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esra Do\u011fan","family":"Mete","sequence":"additional","affiliation":[{"name":"Child and Adolescent Psychiatry Department, Faculty of Medicine, Cukurova University, Adana 01330, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"993","DOI":"10.3233\/JAD-170963","article-title":"Different Cognitive Frailty Models and Health- and Cognitive-related Outcomes in Older Age: From Epidemiology to Prevention","volume":"62","author":"Panza","year":"2018","journal-title":"JAD"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.1016\/S0140-6736(07)60613-8","article-title":"Frailty in elderly people","volume":"369","author":"Strandberg","year":"2007","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/S1474-4422(18)30446-0","article-title":"Understanding frailty to predict and prevent dementia","volume":"18","author":"Panza","year":"2019","journal-title":"Lancet Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"\u201cMini-mental state\u201d. A practical method for grading the cognitive state of patients for the clinician","volume":"12","author":"Folstein","year":"1975","journal-title":"J. Psychiatr. Res."},{"key":"ref_5","first-page":"41","article-title":"Validity and Reliability Studies of Modified Mini Mental State Examination (MMSE-E) For Turkish Illiterate Patients With Diagnosis of Alzheimer Disease","volume":"27","author":"Kocaman","year":"2016","journal-title":"Turk. J. Psychiatry"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1093\/ageing\/afl041","article-title":"Validity and reliability of the Edmonton Frail Scale","volume":"35","author":"Rolfson","year":"2006","journal-title":"Age Ageing"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.archger.2018.02.003","article-title":"Validation Of Edmonton Frail Scale Into Elderly Turkish Population","volume":"76","author":"Aykar","year":"2018","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/S0002-9343(00)00371-5","article-title":"A simple comorbidity scale predicts clinical outcomes and costs in dialysis patients","volume":"108","author":"Beddhu","year":"2000","journal-title":"Am. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"989","DOI":"10.3233\/JAD-180466","article-title":"Social Dysfunction in Older Age and Relationships with Cognition, Depression, and Apathy: The GreatAGE Study","volume":"65","author":"Lozupone","year":"2018","journal-title":"J. Alzheimer's Dis. JAD"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/S1474-4422(18)30371-5","article-title":"Investigation of frailty as a moderator of the relationship between neuropathology and dementia in Alzheimer\u2019s disease: A cross-sectional analysis of data from the Rush Memory and Aging Project","volume":"18","author":"Theou","year":"2019","journal-title":"Lancet Neurol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/s13195-014-0054-5","article-title":"Age-related deficit accumulation and the risk of late-life dementia","volume":"6","author":"Song","year":"2014","journal-title":"Alzheimer's Res. Ther."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1159\/000353859","article-title":"Association between frailty and dementia: A population-based study","volume":"60","author":"Kulmala","year":"2014","journal-title":"Gerontology"},{"key":"ref_14","first-page":"206","article-title":"Frailty Is Associated with Disability and Recent Hospitalization in Community-Dwelling Elderly: The Coyoacan Cohort","volume":"3","author":"Amieva","year":"2014","journal-title":"J. Frailty Aging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1111\/ggi.12114","article-title":"Frailty among community-dwelling elderly Mexican people: Prevalence and association with sociodemographic characteristics, health state and the use of health services","volume":"14","year":"2014","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"979","DOI":"10.6061\/clinics\/2013(07)15","article-title":"Prevalence and factors associated with frailty in an older population from the city of Rio de Janeiro, Brazil: The FIBRA-RJ Study","volume":"68","author":"Moreira","year":"2013","journal-title":"Clinics"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1590\/S0102-311X2013000800015","article-title":"Metodologia e perfil sociodemogr\u00e1fico, cognitivo e de fragilidade de idosos comunit\u00e1rios de sete cidades brasileiras: Estudo FIBRA [Methodology and social, demographic, cognitive, and frailty profiles of community-dwelling elderly from seven Brazilian cities: The FIBRA Study]","volume":"29","author":"Neri","year":"2013","journal-title":"Cad. Saude Publica"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1590\/S0034-71672013000300008","article-title":"Sono, fragilidade e cogni\u00e7\u00e3o: Estudo multic\u00eantrico com idosos brasileiros [Sleep, fragility and cognition: A multicenter study with Brazilian elderly]","volume":"66","author":"Ceolim","year":"2013","journal-title":"Rev. Bras. Enferm."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1017\/S1041610213001841","article-title":"Association of cognitive impairment with frailty in community-dwelling older adults","volume":"26","author":"Han","year":"2014","journal-title":"Int. Psychogeriatr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1093\/ageing\/afs185","article-title":"An assessment of neurocognitive speed in relation to frailty","volume":"42","author":"Rolfson","year":"2013","journal-title":"Age Ageing"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1007\/s12603-011-0110-9","article-title":"Physical frailty predicts future cognitive decline\u2014A four-year prospective study in 2737 cognitively normal older adults","volume":"15","author":"Auyeung","year":"2011","journal-title":"J. Nutr. Health Aging"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1590\/0004-282X20130039","article-title":"Frailty and cognitive impairment among community-dwelling elderly","volume":"71","author":"Alencar","year":"2013","journal-title":"Arq. Neuro-Psiquiatr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1111\/j.1532-5415.2009.02671.x","article-title":"Physical frailty is associated with incident mild cognitive impairment in community-based older persons","volume":"58","author":"Boyle","year":"2010","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1093\/gerona\/glt013","article-title":"Frailty and incident dementia","volume":"68","author":"Gray","year":"2013","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1007\/s12603-011-0096-3","article-title":"Frailty, cognitive impairment and mortality among the oldest old","volume":"15","author":"Jacobs","year":"2011","journal-title":"J. Nutr. Health Aging"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1093\/eurjpc\/zwad173","article-title":"Insulin resistance drives cognitive impairment in hypertensive pre-diabetic frail elders: The CENTENNIAL study","volume":"30","author":"Mone","year":"2023","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1111\/jch.14439","article-title":"Global cognitive function correlates with P-wave dispersion in frail hypertensive older adults","volume":"24","author":"Mone","year":"2022","journal-title":"J. Clin. Hypertens."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.amjms.2020.03.021","article-title":"Gait Speed Test and Cognitive Decline in Frail Women With Acute Myocardial Infarction","volume":"360","author":"Mone","year":"2020","journal-title":"Am. J. Med. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Kim, D.Y., Park, S.W., Han, H.W., Kim, M.K., and Kim, H.J. (2023). Extremely Low Activity of Serum Alanine Aminotransferase Is Associated with Long-Term Overall-Cause Mortality in the Elderly Patients Undergoing Percutaneous Coronary Intervention after Acute Coronary Syndrome. Medicina, 59.","DOI":"10.3390\/medicina59020415"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Cohen, C.I., Hashem, S., Kyaw, K.T., Brangman, S.A., Fields, S., Troen, B.R., and Reinhardt, M. (2024). The Relationships between Caregiver Burden, Physical Frailty, Race, Behavioral and Psychological Symptoms (BPSD), and Other Associated Variables: An Exploratory Study. Medicina, 60.","DOI":"10.3390\/medicina60030426"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/6\/910\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:51:04Z","timestamp":1760107864000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/6\/910"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,30]]},"references-count":30,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["medicina60060910"],"URL":"https:\/\/doi.org\/10.3390\/medicina60060910","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,30]]}}}