Global Prevalence of Cognitive Frailty in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

Cognitive frailty, defined as the co-occurrence of physical frailty/prefrailty and cognitive impairment in the absence of dementia, is a potentially reversible condition that may signal high risk for disability and dementia. This systematic review and meta-analysis estimated the global prevalence of cognitive frailty among community-dwelling older adults and examined methodological and contextual moderators of prevalence differences.

We searched for relevant studies published up to October 22, 2025 in international (PubMed, Web of Science, Embase, PsycINFO) and Chinese (CNKI, Wanfang) databases. Pooled prevalence rates and 95% confidence intervals (CIs) were calculated with random-effects models. Subgroup and meta-regression analyses examined possible sociodemographic, methodological, and clinical moderators. Study quality was assessed with the Joanna Briggs Institute checklist.

Sixty-six studies of 127 556 participants were included. The pooled prevalence of cognitive frailty was 12.2% (95% CI: 9.4%-15.7%). Prevalence was higher in studies using the "Fatigue, Resistance, Ambulation, Illness, and Loss of weight" (FRAIL) scale or Fried phenotype and those using the Montreal Cognitive Assessment (MoCA) or composite cognitive criteria, in upper-middle-income countries, and in studies published after 2021. In meta-regression analyses, alcohol use status was significantly associated with cognitive frailty prevalence but most sociodemographic factors were not related to rates of cognitive frailty. Trim-and-fill analysis suggested that potential publication bias may have led to underestimation of prevalence.

Cognitive frailty is common among community-dwelling older adults worldwide. Given its potential reversibility and strong links to adverse outcomes, systematic identification and targeted multi-domain interventions should be prioritized in aging societies.