Observational studies (cross-sectional or longitudinal cohort studies) were included if they reported on community-dwelling older adults aged 60 years and above. This age cutoff point was selected because studies on frailty typically included participants aged 60 years and above (27 (link)). Cross-sectional, prospective cohort studies were included due to the small number of longitudinal studies that reported on the association between cognitive frailty and disability. Cognitive frailty was defined by the presence of frailty or prefrailty, and concurrent cognitive impairment was identified using validated physical frailty and cognitive assessments. A preliminary literature search has identified that most studies on cognitive frailty have slightly modified the definition of cognitive frailty by the consensus group, defining this condition with the presence of mild cognitive impairment instead of a CDR of 0.5 with the exclusion of concurrent Alzheimer’s disease or other dementias, and physical frailty using the modified Fried frailty phenotype (28 (link)). Thus, the utilization of CDR was not compulsory for study inclusion in this review if a validated cognitive assessment tool was reported. Studies must report the association between cognitive frailty and functional disability (ADL or IADL, mobility, physical function).
Studies were excluded if they included hospitalized or institutionalized older adults or those with neurological disorders or dementia. Conference abstracts, reviews, randomized controlled trials, protocols, and studies published in other languages besides English were excluded. Study titles and abstracts were screened based on the inclusion/exclusion criteria, and full texts of relevant studies were screened for eligibility. Data were extracted using a piloted data extraction form, including study and participant characteristics, frailty assessment and classification, and corresponding disability outcomes and measurement. Data extraction was conducted by 1 reviewer (K.F.T.) and checked by the second reviewer (S.W.H.L.), with discrepancies resolved by consensus.
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