Relationship between frailty and white matter hyperintensities: A systematic review and meta-analysis

Frailty, common in aging, contributes to cognitive and motor decline. White matter hyperintensity (WMH), markers of cerebral small vessel disease, show similar effects. Although studies suggest an association between frailty and WMH, the evidence is inconsistent, and their relationship remains uncertain.

This research aimed to examine the relationship between frailty and WMH.

Systematic literature search and meta-analytic methods were employed. Study screening and data extraction were conducted, and quality assessment was performed using the Newcastle-Ottawa Scale and American Agency for Healthcare Research and Quality evaluation tools. StataSE 15.0 software was utilized to carry out statistical analyses.

Nine articles, including 10 studies, were included. The meta-analysis results demonstrated a significant positive relationship between WMH and frailty (odds ratio [OR] = 1.38, 95 % confidence interval [CI]: 1.17-1.64, P < 0.001). Subgroup analysis showed a consistent association between WMH and frailty, which was stronger in hospitalized patients, Asian populations, and studies using the Fried or Fazekas criteria. Sensitivity analyses validated the robustness of the results. After adjustment for publication bias via the trim-and-fill method, the association was still significant (OR = 1.25, 95 % CI: 1.05-1.50, P = 0.012), though limitations of this method and other potential biases should be considered.

WMH is significantly associated with frailty, offering new insights into its potential role in frailty. This meta-analysis suggests that WMH is worth exploring in future longitudinal studies to understand its relevance to frailty mechanisms.