Association between frailty and cognitive impairment in elderly patients with acute cerebral infarction

Post-stroke cognitive impairment is common in older patients, yet the interaction between frailty and cognition remains insufficiently characterized. Evidence using multidimensional frailty tools during hospitalization for acute cerebral infarction is limited, and domain-level cognitive correlates of frailty have not been well described.

In this hospital-based cross-sectional study, consecutive patients aged ≥65 years with acute cerebral infarction were enrolled. Frailty (Edmonton Frail Scale, EFS) and cognition (Montreal Cognitive Assessment, MoCA) were assessed 7-14 days after admission. Cognitive impairment (CI) was defined as MoCA <26, with a 1-point adjustment for ≤12 years of education applied before group assignment. Associations between EFS total score and MoCA domains were evaluated using Spearman correlations. Multivariable logistic regression was used to identify independent predictors of CI, with alcohol intake modeled per 10 g ethanol/day.

Among 179 participants, 117 (65.4%) had CI and 62 (34.6%) were cognitively unimpaired (CU). Patients with CI were older than CU patients (73.0 ± 5.9 vs. 71.3 ± 4.2 years) and had higher admission NIHSS scores (3.85 ± 2.80 vs. 2.77 ± 2.61). The prevalence of pre-frailty/frailty (EFS ≥ 6) was 45.8% overall and was higher in the CI group than in the CU group (59.8% vs. 19.4%). EFS total score was inversely correlated with global cognition and all MoCA domains (total MoCA: ρ = -0.572, p < 0.001). In multivariable analysis (n = 173 complete cases), higher alcohol intake (per 10 g ethanol/day; OR 1.43, 95% CI 1.07-1.90) and higher frailty score (OR 1.34, 95% CI 1.17-1.55) were independently associated with CI, whereas higher education level was protective (OR 0.59, 95% CI 0.37-0.94).

In older patients hospitalized with acute cerebral infarction, cognitive impairment showed an association with higher frailty burden and higher alcohol intake, supporting integrated frailty and alcohol exposure assessment during early in-hospital evaluation.