Frailty increases with cognitive decline severity in older adults: a cross-sectional study

Abstract

Background: Frailty is a geriatric syndrome characterized by reduced physiological reserve and increased vulnerability to adverse health outcomes, including disability, hospitalization and mortality. Emerging evidence suggests that frailty is also associated with cognitive decline and may contribute to dementia progression. However, few studies have evaluated frailty using simple screening tools across different stages of cognitive impairment. Objective: To evaluate the association between frailty and different stages of cognitive impairment in older adults. Methods: Cross-sectional study including individuals aged ≥55 years undergoing comprehensive clinical and cognitive evaluation in a tertiary geriatric outpatient setting. Exclusion criteria included stroke, active psychiatric disorders, neuroinfections, other neurodegenerative diseases, and advanced dementia. Frailty was assessed using the FRAIL scale (0–5 points). Participants were classified into four groups: cognitively normal controls, mild cognitive impairment (MCI), mild dementia and moderate dementia. Frailty was categorized as robust (0), pre-frail (1–2) and frail (≥3), and compared between groups using the chi-square test. Mean FRAIL scores were also compared using Welch ANOVA followed by Games-Howell post-hoc tests. Analyses were performed using RStudio. Results: A total of 154 older adults were included (mean age 74.2 ± 7.6 years). The proportion of frail individuals increased progressively with worsening cognitive status. In the control group, 65.5% were robust, 23.6% pre-frail and 10.9% frail. In MCI, 53.0% were robust, 30.3% pre-frail and 16.7% frail. In mild dementia, 44.0% were robust, 40.0% pre-frail and 16.0% frail. In moderate dementia, 19.2% were robust, 42.3% pre-frail and 38.5% frail. The categorical distribution differed significantly across groups (χ² = 18.99; p = 0.004). Mean FRAIL scores were 0.77 in controls, 1.08 in MCI, 0.92 in mild dementia and 2.05 in moderate dementia, with a significant global difference (FWelch = 5.00; p = 0.003). In post-hoc comparisons, individuals with moderate dementia had significantly higher frailty scores compared with controls (p = 0.02) and those with mild dementia (p = 0.04). After adjustment for age, the global effect remained significant (FWelch = 3.08; p = 0.03; ω² = 0.08). Conclusion: Frailty increases with the severity of cognitive impairment and is particularly pronounced in individuals with moderate dementia. Frailty assessment may represent a useful tool for risk stratification and early intervention planning in older adults with cognitive decline.