Just like a fragile vase that is more likely to break, being physically, cognitively, socially, or biopsychosocially frail makes older adults more vulnerable to developing cognitive disorders such as dementia. In this updated systematic review and meta-analysis, the researchers gathered evidence from 30 longitudinal studies that examined the association between multi-concept frailty and cognitive decline or dementia. The findings revealed that physical frailty was linked to a higher risk of developing cognitive disorders, while cognitive frailty and pre-frailty were associated with an increased risk of all-cause dementia. Importantly, biopsychosocial frailty was found to predict an elevated risk of cognitive decline or dementia, Alzheimer’s disease, and AD. The review also demonstrated that preventing frailty could potentially avoid up to 9.9% of cognitive disorders globally. However, the overall strength of the evidence was rated as low-to-moderate due to inconsistency and imprecision in the studies. These results highlight the importance of monitoring cognitive dynamics in frail elderly individuals and implementing early prevention measures for dementia. For more details on this comprehensive review, check out the original research article.

BackgroundFrailty is a multidimensional syndrome that increases an individual’s vulnerability for developing adverse health outcomes, which include dementia. It might serve as a promising target for dementia prevention. However, there are currently no studies summarizing the association between multi-concept frailty and the risk of cognitive disorders. This study aims to summarize the evidence of associations between multi-concept frailty and cognitive disorders based on longitudinal studies.MethodsScopus, The Cochrane Library, PsycINFO, CINAHL, PubMed, and EMBASE databases were searched from inception to January 2, 2022. Longitudinal studies, which explored the association of frailty with incident risk of cognitive decline or dementia, were included. The multivariable-adjusted effect estimates were pooled by random-effects models. The evidence credibility was depicted according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method.ResultsA total of 30 longitudinal studies were included. Four types of frailty concepts were involved, including physical, cognitive, social, and biopsychosocial frailty. The meta-analysis comprised 20 studies of 252,571 older adults (mean age: 64.1–80.4 years), among whom 7,388 participants developed cognitive decline or dementia. Physical frailty was associated with higher risk of developing cognitive disorders [pooled relative risk (pRR) = 1.52, 95% confidence interval (CI): 1.28–1.80, I2 = 21.2%, pRR = 1.62 for cognitive decline, 95% CI: 1.07–2.45, I2 = 40.2%, pRR = 1.37 for all-cause dementia (ACD), 95% CI: 1.13–1.66, I2 = 0.0%]. Cognitive frailty (pRR = 2.90, 95% CI: 1.28–6.55, I2 = 78.1%) and pre-frailty (pRR = 4.24, 95% CI: 2.74–6.56, I2 = 30.2%) were linked to higher risk of ACD. Biopsychosocial frailty could predict a 41% (pRR = 1.41, 95% CI: 1.17–1.71) elevated risk of cognitive decline or dementia [pRR = 1.53 (95% CI: 1.19–1.96) for ACD and 1.11 (95% CI: 1.05–1.17) for Alzheimer’s disease (AD)]. In the systematic review, social frailty was associated with a 53% higher risk of AD. Preventing frailty could avoid a maximum of 9.9% cognitive disorders globally. The overall evidence strength is rated as low-to-moderate. Inconsistency and imprecision are major sources of bias.ConclusionFrailty in late life is a promising risk factor for cognitive disorders. Frail elderly should be monitored for their cognitive dynamics and initiate early prevention of dementia.Systematic Review Registrationwww.ClinicalTrials.gov, identifier CRD4202127 3434.

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