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Navigating and diagnosing cognitive frailty in research and clinical domains

Nature Aging volume 3, pages 1325–1333 (2023)Cite this article

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Abstract

While physical frailty has been recognized as a clinical entity for some time, the concept of cognitive frailty (CF) is now gaining increasing attention in the geriatrics research community. CF refers to the co-occurrence of physical frailty and cognitive impairment in older adults, which has been suggested as a potential precursor to both dementia and adverse physical outcomes. However, this condition represents a challenge for researchers and clinicians, as there remains a lack of consensus regarding the definition and diagnostic criteria for CF, which has limited its utility. Here, using insights from both the physical frailty literature and cognitive science research, we describe emerging research on CF. We highlight areas of agreement as well as areas of confusion and remaining knowledge gaps, and provide our perspective on fine-tuning the current construct, aiming to stimulate further discussion in this developing field.

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Fig. 1: Schematic of the interplay of biological mechanisms, biomarkers and risk factors in CF.
Fig. 2: Integrating CF concepts for clarity as a complex, multidimensional geriatric syndrome resulting from the complex interplay of biological, environmental, and psychosocial factors.
Fig. 3: Schematic of CF categories.

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Acknowledgements

This work was supported by the Bright Focus Foundation Research Award (to P.M.A.); and the Johns Hopkins University Claude D. Pepper Older Americans Independence Center, which is funded by the National Institute on Aging of the National Institutes of Health under award number P30AG021334. The funding source had no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. We gratefully acknowledge J. E. Fairman from The Johns Hopkins Department of Arts as Applied to Medicine for contributing to the creation of figures.

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  1. These authors contributed equally: Monica M. Nader, Caglar Cosarderelioglu.

Authors and Affiliations

  1. Johns Hopkins University School of Medicine, Division of Geriatric Medicine and Gerontology, Baltimore, MD, USA

    Monica M. Nader, Caglar Cosarderelioglu, Qian-Li Xue, Esther Oh, Jeremy D. Walston & Peter M. Abadir

  2. Ankara University School of Medicine, Department of Internal Medicine, Division of Geriatrics, Ankara, Turkey

    Caglar Cosarderelioglu

  3. Albert Einstein College of Medicine/Montefiore Medical Center, Department of Medicine, Division of Geriatrics, New York, NY, USA

    Emily Miao & Claudene George

  4. Duke University School of Medicine, Center for the Study of Aging, Durham, NC, USA

    Heather Whitson

  5. Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA

    Qian-Li Xue

  6. Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA

    Francine Grodstein & David A. Bennett

  7. National Institute on Aging, Baltimore, MD, USA

    Luigi Ferrucci

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Contributions

M.M.N. and C.C. led the initial drafting of the manuscript. All authors, including E.M., H.W., Q.-L.X., F.G., E.O., L.F., D.A.B., J.D.W., C.G. and P.M.A. contributed to manuscript writing and the development of the suggested model based on their respective areas of expertise. All authors reviewed and approved the final manuscript. M.M.N. and C.C. contributed equally.

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Nader, M.M., Cosarderelioglu, C., Miao, E. et al. Navigating and diagnosing cognitive frailty in research and clinical domains. Nat Aging 3, 1325–1333 (2023). https://doi.org/10.1038/s43587-023-00504-z

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