Physical Frailty Could Predict Alzheimer's Disease (HealthDay)

WEDNESDAY, Aug. 13 (HealthDay News) -- Physical frailty among theelderly may be linked to early Alzheimer's disease, regardless of whetheror not patients develop dementia, new research reveals.

The finding, based on brain autopsies of deceased elderly patients,raises the notion that motor impairment in the elderly is an early symptomof Alzheimer's -- one that appears before mental decline.

It could also turn out to be that frailty and Alzheimer's are notdirectly linked but stem from a common origin, researchers say.

"What we know is that if you see a very frail person next to somebodynot so frail, the very frail person is more likely to have Alzheimer'spathology in their brain when they die," said study lead author Dr. AronS. Buchman, an associate professor in the department of neurologicalsciences at Rush University Medical Center in Chicago.

"This is important as we try to wrap our heads around the biology ofaging," he added. "Because it turns out that as you get older Alzheimer'spathology, signs of its development are really ubiquitous, even if thatdoesn't mean that you actually have dementia. So, this finding could alterthe way most medical and non-medical people conceptualize Alzheimer's -- as a disease simply of impaired memory and cognition -- while expandingour view of what it actually means to become frail."

Buchman and his colleagues were expected to publish their findings inthe Aug. 12 issue of Neurology.

Prior studies have indicated that about 7 percent of men and women overthe age of 65 are frail, meaning they display a significant loss ofstrength, energy, and agility. That figure rises to 45 percent amongpeople over the age of 85, the researchers said.

In the new study, the Chicago group looked for the presence of themicroscopic protein "plaques and tangles" typically associated withAlzheimer's disease in the autopsied brains of 165 male and female studyparticipants.

The autopsies were conducted on Rush patients who had participated in alarger aging and chronic disease study, launched with support from theU.S. National Institute on Aging in 1997. At the time of their deaths, theparticipants were an average of 88 years old.

While alive, all of the participants had been subject to annualclinical evaluations to assess four markers of frailty: grip strength,time it took to walk eight feet, body mass index (a measure of obesity),and fatigue.

According to the team, patients whose brains showed high levels ofAlzheimer's development had been about twice as physically frail as thosewith low levels of Alzheimer's progression. This was true regardless ofwhether the patient had experienced dementia or not.

A little more than one-third of the patients had displayed signs ofdementia or memory loss prior to their death, the authors noted.

The findings also held up regardless of a patient's physical activitylevel or disease history.

According to Buchman's group, one previous study that focused on thesame group of patients while they were still alive revealed that amongthose with no cognitive impairment, frailer patients had a higher riskfor developing Alzheimer's than those who were less frail.

"So now, we put all this together, and it raises the possibility thatAlzheimer's is much more of a public health issue than previously thought,if it turns out that being weak is a sign of its onset," said Buchman."But, if so, we also now have a clue as to how we can possibly intervene,perhaps by treating motor dysfunction years before people developdementia, so that they won't develop dementia as early."

Dr. Laurel Coleman, an Augusta, Maine-based geriatrician and member ofthe Alzheimer's Association's National Board, described the study as"well-done" and "incredibly provocative."

"This study really ties together two very common syndromes inaging --cognitive processes and motor skills -- in ways I have not seenthem connected before," she noted. "So, I think this is very important andrelevant, because it raises the question of whether frailty could be anearly manifestation of Alzheimer's disease. The study doesn't necessarilyanswer the question, and this is something they now have to go aboutproving. But already, for me, that idea is a whole new thought that willpush me to look at my patients with new eyes."

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