Frailty and dementia: UB geriatrician and colleagues study the link

What is the relationship between frailty and dementia? Many studies acknowledge that frailty and dementia often coexist, but little research has been done on why that is the case.

Bruce R. Troen, MD, professor of medicine and chief of the Division of Geriatrics and Palliative Medicine at the University at Buffalo School of Medicine and Biomedical Sciences, is working with colleagues at the other State University of New York medical schools to change that.

Troen is a co-investigator on the SUNY Network Aging Partnership (SNAP): Investigating Frailty and Enhancing Lifespan Across the Health Spectrum. Sharon A. Brangman, MD, professor of medicine and division chief, Geriatric Medicine, at SUNY Upstate Medical University, is lead investigator.

Part of the SUNY Networks of Excellence program, the goal of the $147,000 grant is to establish a statewide infrastructure for strong interdisciplinary research on aging. SNAP will work to coordinate research across SUNY's four medical universities to facilitate competition for scientific funding, accelerate publication of research and recruit and mentor trainees.

The ultimate goal is to develop the expertise that will attract a national research center designation.

Troen and his colleagues will develop and compare tools to assess frailty risk factors and determine how they correlate with cognitive assessments. The approach will be multidisciplinary, ranging from the identification of biomarkers to assessments that are neurological, psychiatric and behavioral. The grant also will include the training of medical students and fellows.

"Aging is the blockbuster issue of the 21st century," says Troen. Yet in 2008, the Institute of Medicine reported that while the population of older adults in the U.S. will nearly double by 2030, the lack of geriatric health care providers who can care for them will only worsen.

"There aren't enough of us to go around," says Troen. "It's a national crisis in the making."

The gaps in geriatric research are equally huge, Troen says. For example, while there is growing consensus in the field that frailty is at the core of geriatrics, and that frailty is associated with higher rates of cognitive deficit, very little research has explored how the two conditions may be related.

"Even as we see more frailty in our aging patients, the definition of the condition itself has not been well established," says Troen. Some definitions are more biological, others are more physical and some combine physical, biological, psychological and social risk factors.

The goal of SNAP, he says, is to address these and other gaps in understanding the connections between frailty and dementia that will result in maximizing patient outcomes and enhancing patients' quality of life.

A key aim of the project is to develop a unique database on frailty and dementia across the state's diverse populations. That effort, Troen says, will be enhanced by the diverse populations served by the four SUNY medical schools at UB, SUNY Upstate Medical School, SUNY Downstate Medical School and Stony Brook.

"We want to understand what underlies frailty and mild cognitive impairment," says Troen. "The risks overlap."

Troen is especially interested in predicting frailty before it occurs, quantifying it and then intervening with medications where appropriate.

His background as both a molecular biologist who has studied vitamin D and osteoporosis, and a geriatrician who works to help improve his patients' quality of life, has prepared him well for this project.

Some of the work will involve identifying biomarkers found in both and dementia, such as C-reactive protein. Certain vitamin D deficiencies also are found in both conditions, Troen says.

Troen was recruited to the UB School of Medicine and Biomedical Sciences from the University of Miami Miller School of Medicine in 2013. He says he doesn't know of any other state that has developed a statewide infrastructure for research on aging.

"We all want to age successfully," concludes Troen. "This grant is focused on how best to create the circumstances where that can happen."

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