Abstract
Introduction: Neurodegenerative diseases are a growing concern in an aging global population. Frailty, often conceptualized as a state of diminished physiological reserve and increased susceptibility to stressors, emerges as a pivotal factor in this context. While frailty may be modified, it is essential to recognize its frequently irreversible nature, necessitating a careful approach when considering its role and influence in the progression from mild cognitive impairment (MCI) to dementia and within dementia progression. Methods: A retrospective study including 1,284 participants, attending a Cognitive Disturbances and Dementia unit from January 2021 to May 2023, was conducted. Frailty was assessed using the clinical frailty scale (CFS) score. Multilevel univariate and multivariate logistic regression models were developed to determine the contributions of patient characteristics, including frailty, to disease progression. Results: Frailty significantly increased with higher global clinical dementia rating (CDR) subgroups, suggesting escalating frailty burden with disease progression. Age, CFS, and mini-mental state examination (MMSE) scores were significant predictors of progression from MCI to dementia and to more severe dementia stages, even when considering the independence from variables contributing to frailty. Patients transitioning to a higher CDR group exhibited higher CFS scores. Age, education, anticholinergic burden, cumulative illness rating scale – geriatric, MMSE, and neuropsychiatric inventory scores significantly contributed to frailty. Conclusions: Frailty plays a critical role in the transition from MCI to dementia and within dementia progression. Age, cognitive impairment, and frailty were identified as significant predictors of disease progression. The CFS is a clinically applicable tool for frailty assessment. Regular frailty assessments may be valuable in early detection and management of dementia.
Plain Language Summary
This study focuses on understanding the transition and progression of dementia by investigating the role of frailty, a state of increased vulnerability typically associated with aging. The research involves an analysis of more than 1,200 participants who attended a specialized dementia unit over a span of 2 years. The authors utilized the clinical frailty scale (CFS) to assess the frailty of these individuals, to discern if there is an association between frailty and the progression of dementia, particularly from the initial stage known as mild cognitive impairment (MCI) to more advanced stages of the disease. The results indicate a significant link between the increase in frailty, as quantified by the CFS, and the severity of dementia. The findings also reveal that age, frailty level, and scores from a cognitive assessment test known as the mini-mental state examination (MMSE) were pivotal in predicting the transition from MCI to full-blown dementia and the advancement to more severe dementia stages. In conclusion, the study underscores the critical role of frailty in the progression of dementia. The CFS emerges as a valuable tool for routine frailty assessments, which can aid in the early detection and management of dementia. The research offers vital insights into the progression of dementia and can significantly influence care strategies for affected individuals.
