Unravelling cognitive frailty: perceptions, misconceptions, and the path to prevention

As populations age, extending healthy life expectancy and reducing morbidity are priorities. Cognitive frailty, the co-occurrence of cognitive impairment and physical frailty without dementia, may offer a window for prevention. However, there is limited evidence on how cognitive frailty is understood, which may undermine recognition and risk reduction. This study provides new insights into how cognitive frailty is conceptualized across public and professional contexts by exploring perceptions, causes, and risk factors of cognitive frailty to inform public health and clinical practice.

We conducted 22 semi-structured interviews with members of the public and healthcare professionals. Interviews examined perceived definitions, symptoms, and risk factors. Data were analyzed using reflexive thematic analysis.

Three analytic domains were identified: conceptualizations, manifestations, and risk factors. Participants often conflated cognitive frailty with cognitive impairment or described it as an early stage of dementia. The physical frailty aspect was under-recognized, particularly among public participants. When presented with the international definition, many reframed cognitive frailty as a transitional and potentially preventable state. Healthcare professionals articulated broader symptom profiles and more integrated risk frameworks, whereas the public emphasized observable physical change. Across both groups, mood changes, social withdrawal, and unhealthy lifestyle were viewed as central risks, though their interplay was described with varying detail.

Inconsistent understanding of cognitive frailty may hinder early recognition and prevention. Clearer operational definitions, supportive policy, and targeted education are needed to strengthen detection, risk reduction, and intervention strategies that protect independence in later life.