In the FREEDOM-LNA cohort of 753 community-dwelling French adults aged ≥75 (or ≥65 with comorbidities), cognitive impairment was strikingly prevalent: 34.4% scored pathologically on the MMSE, 46% failed the clock drawing test, and 68% failed verbal fluency assessments. Frail individuals consistently underperformed pre-frail and robust peers across all cognitive batteries. Multivariate modeling identified both non-modifiable predictors (age, sex, education level) and actionable modifiable ones — low BMI, hypertension, alcohol use, smoking, and polypharmacy — as independent drivers of poor cognitive performance. Functional dependence in ADL/IADL tasks clustered strongly with cognitive impairment.
This cross-sectional study, posted as a preprint and not yet peer-reviewed, adds population-level granularity to a well-established but clinically underutilized triad: frailty, cognition, and functional independence co-deteriorate and share overlapping modifiable risk factors. The polypharmacy finding is particularly notable — it flags an iatrogenic pathway often overlooked in routine geriatric care. However, cross-sectional design precludes causal inference; we cannot determine whether frailty accelerates cognitive decline or vice versa. The cohort's enrichment for multimorbid patients may also overestimate prevalence in healthier older populations. Still, the practical signal is clear: targeting blood pressure control, nutritional status, and substance use in adults over 65 could simultaneously protect both brain function and physical autonomy. For clinicians, this reinforces integrated frailty-cognition screening rather than siloed assessments — a paradigm increasingly supported by longitudinal evidence but still underimplemented.
