Frailty Progression Moderates the Association Between Sensory and Cognitive Trajectories Over 6 Years: Evidence From the Canadian Longitudinal Study on Aging.
Fereshteh Mehrabi, Natalie A Phillips, M Kathleen Pichora-Fuller and 3 others
Worsening hearing over 6 years tracked with faster memory decline, and worsening vision with faster executive function decline.
Frailty progression was independently linked to both and made the vision-executive function association stronger.
Key findings
1Worsening hearing was associated with greater memory decline (β = −0.483, 95% CI = −0.731, −0.234) but not with executive function decline.
2Worsening vision was associated with steeper executive function decline (β = −0.119, 95% CI = −0.173, −0.065) but not with memory decline.
3Frailty progression moderated the vision-executive function relationship, with the steepest decline in those with highest frailty progression (β = −0.215, 95% CI = −0.312, −0.118), accounting for 3.1% of variance in the executive function slope.
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What it does not show
28% of participants did not complete follow-up 2, and those lost were older, less healthy, and had lower cognitive performance, which may bias results toward healthier, more cognitively intact individuals. The sample was recruited primarily from urban, higher-educated Canadians and excluded those with baseline dementia, limiting generalizability to rural, less educated, or cognitively impaired populations. CLSA sampling weights were not applied, so results may not represent the broader Canadian population. The interaction effects, while statistically significant, were small in magnitude (3.1% of variance for the vision-frailty interaction; minimal for the hearing-frailty interaction). Sensitivity analyses with alternative measures (better-ear hearing, better-eye vision, reduced 33-item frailty index) rendered several associations nonsignificant, suggesting some findings are sensitive to measurement choices. Physical activity was included as a baseline covariate but may partially mediate the frailty-cognition link, potentially attenuating the observed associations.
Declared interests
Funded by the Canadian Consortium on Neurodegeneration in Aging (CCNA) through Canadian Institutes of Health Research grants. The funding agencies had no role in study design, data collection, analysis, interpretation, or manuscript preparation. The authors declare no conflicts of interest.
The easy way to misread this
Do not read the frailty-sensory interactions as strong clinical effects. The hearing-frailty interaction had a minimal effect size (ΔR² = −0.0048), and the vision-frailty interaction explained 3.1% of variance. Sensitivity analyses with alternative sensory measures and a reduced frailty index rendered several of these associations nonsignificant.
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