Prevalence of Cognitive Frailty and Its Correlation to Self-Perceived Functional Ability Among Older Adults with Mild Cognitive Impairment

Abstract

Introduction Cognitive frailty (CF) refers to the co-occurrence of physical frailty and mild cognitive impairment (MCI), which shares common pathological mechanisms. It is associated with multiple factors, including inflammation, impaired nutrition, vascular integrity, metabolic dysregulation, oxidative stress, cellular senescence, mitochondrial dysfunction, hypothalamic-pituitary axis dysregulation, metabolic imbalance, and neuroendocrine dysfunction. Cognitive frailty complicates health care management and constitutes a risk factor for progression to dementia. Moreover, it is linked to adverse health outcomes among older adults, such as falls, dependency or disability, hospitalization, dementia, reduced quality of life, and increased mortality. Currently, evidence regarding the association between cognitive frailty and functional ability in both basic activities of daily living (ADL) and instrumental activities of daily living (IADL) remains limited, with most studies focusing on community-dwelling older adults. Furthermore, there is a lack of research exploring cognitive frailty among older adults with mild cognitive impairment in hospital settings. As aging may accelerate the progression of both cognitive frailty and chronic diseases, early identification of cognitive frailty during hospital visits and follow-up could provide valuable insights for promoting health and quality of life in this population.

Objectives This study aims to examine the prevalence of cognitive frailty and to investigate the association between cognitive frailty and self-perceived functional ability among older adults with mild cognitive impairment.

Design This cross-sectional study was conducted based on a conceptual framework developed by the researcher through a comprehensive review of the literature.

Methodology The study participants comprised 145 older adults aged 65 years and above who had been diagnosed with mild cognitive impairment and received services at the Outpatient Department of Ramathibodi Hospital during August 2023 to August 2024. Participants were purposively selected based on the following inclusion criteria: 1) diagnosed with mild cognitive impairment by a specialist physician, without clinical manifestations of dementia, and 2) no hearing or visual impairment, with the ability to understand and communicate in Thai. The exclusion criteria were a diagnosis of Alzheimer’s disease, dementia, or current psychiatric treatment. Data were collected through structured interviews using questionnaires consisting of: 1) a personal information interview form, 2) the Thai version of the Reported Edmonton Frail Scale, 3) The Barthel Activity Daily Living Index, assessing basic activities of daily living (ADL), and 4) The Lawton Instrumental Activity of Daily Living Scale, assessing instrumental activities of daily living (IADL). Data were analyzed using descriptive statistics and Spearman’s rank correlation coefficient.

Results The majority of participants were female (70.3%), aged between 65 and 96 years, with a mean age of 76 years (SD = 7.3). Most were married (69.7%). The highest level of education attained was a bachelor’s degree (31.7%), followed by primary education (27.6%). The prevalence of cognitive frailty was 62.1%. Regarding self-perceived functional ability, most participants were able to perform basic activities of daily living (ADLs) independently (97.2%), while 65.5% required assistance with instrumental activities of daily living (IADLs). Spearman’s correlation analysis revealed that cognitive frailty was moderately and negatively correlated with both basic ADL performance (rs = -.418, p < .01) and IADL performance (rs = -.494, p < .01).

Recommendation The findings of this study highlight the importance of screening for cognitive frailty. Health care teams may apply these results to improve the efficiency of public health services in screening, assessment, care, prevention, and health promotion, thereby enhancing the quality of life for older adults.