Physical and brain frailty in ischaemic stroke or TIA: shared occurrence and outcomes. A cohort study

Taylor-Rowan, M. , Hafdi, M., Drozdowska, B. , Elliott, E., Warlaw, J. and Quinn, T. J. (2023) Physical and brain frailty in ischaemic stroke or TIA: shared occurrence and outcomes. A cohort study. European Stroke Journal, 8(4), pp. 1011-1020. (doi: 10.1177/23969873231186480) (PMID:37421136)

Abstract

Background: There is increasing interest in the concept of frailty in stroke, including both physical frailty and imaging-evidence of brain frailty. We aimed to establish the prevalence of brain frailty in stroke survivors as well as the concurrent and predictive validity of various frailty measures against long-term cognitive outcomes. Methods: We included consecutively admitted stroke or transient ischaemic attack (TIA) survivors from participating stroke centres. Baseline CT scans were used to generate an overall brain frailty score for each participant. We measured frailty via the Rockwood frailty index, and a Fried frailty screening tool. Presence of major or minor neurocognitive disorder at 18-months following stroke or TIA was established via a multicomponent assessment. Prevalence of brain frailty was established based upon observed percentages within groups defined by frailty status (robust, pre-frail, frail). We assessed the concurrent validity of brain frailty and frailty scales via Spearman’s rank correlation. We conducted multivariable logistic regression analyses, controlling for age, sex, baseline education and stroke severity, to evaluate association between each frailty measure and 18-month cognitive impairment. Results: Three-hundred-forty-one stroke survivors participated. Three-quarters of people who were frail had moderate-severe brain frailty and prevalence increased according to frailty status. Brain frailty was weakly correlated with Rockwood frailty (Rho: 0.336; p < 0.001) and with Fried frailty (Rho: 0.230; p < 0.001). Brain frailty (OR: 1.64, 95% CI = 1.17–2.32), Rockwood frailty (OR: 1.05, 95% CI = 1.02–1.08) and Fried frailty (OR: 1.93, 95% CI = 1.39–2.67) were each independently associated with cognitive impairment at 18 months following stroke. Conclusions: There appears to be value in the assessment of both physical and brain frailty in patients with ischaemic stroke and TIA. Both are associated with adverse cognitive outcomes and physical frailty remains important when assessing cognitive outcomes.

• Item Type: Articles
• Additional Information: This work was funded by the Scottish Neurological Research Fund, Stroke Association, and Chief Scientist Office of Scotland.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Quinn, Professor Terry and Drozdowska, Bogna and Hafdi, Melanie and Taylor-Rowan, Dr Martin and Elliott, Emma

Creator Roles

Taylor-Rowan, M.: Conceptualization, Formal analysis, Writing – original draft
Quinn, T.: Conceptualization
Elliott, E.: Data curation
Drozdowska, B.: Data curation

• Authors: Taylor-Rowan, M., Hafdi, M., Drozdowska, B., Elliott, E., Warlaw, J., and Quinn, T. J.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
• Journal Name: European Stroke Journal
• Publisher: SAGE Publications
• ISSN: 2396-9873
• ISSN (Online): 2396-9881
• Published Online: 07 July 2023
• Copyright Holders: Copyright © 2023 European Stroke Organisation
• First Published: First published in European Stroke Journal 8(4):1011-1020
• Publisher Policy: Reproduced under a Creative Commons License