Association between frailty status and cognitive performance of elderly patients attending the Family Medicine Outpatient Clinic in Ismailia, Egypt

Introduction
Frailty and cognitive impairment are serious problems affecting older adults. Screening for frailty in primary health care decreases unplanned secondary care use. There is still controversy about the association of frailty with cognitive impairment. This study aimed to assess the prevalence of frailty among aging patients, to evaluate the association between physical frailty and cognitive function among elderly patients who presented to the Family Medicine Outpatient Clinic and to determine the most impaired cognitive domains among frail patients.

Material and methods
This is a descriptive-analytical cross-sectional study. It included 404 elderly patients attending the Family Medicine Outpatient Clinic in Ismailia, Egypt. Study participants were classified into three frailty groups according to Fried criteria. The Montreal cognitive function (MoCA) and Mini-Mental State Examination (MMSE) tools were used to assess cognitive function. A multinomial logistic regression analysis was performed to investigate the association between performance in the cognitive (MoCA) domains and frailty.

Results
19.3% of the study participants were frail. Frailty was associated with cognitive impairment by both MMSE and MoCA tests. About 85.69% of frail elderly patients had cognitive impairment. Frailty showed a significant association with lower global MoCA scores (OR = 0.54, p < 0.05). A specific MoCA cognitive domain: poor attention (OR = 0.47, p < 0.05), was a positive predictor of frailty.

Conclusions
Frailty has been associated with lower total scores of both MMSE and MoCA. Specific impaired MoCA cognitive domains [fluency, orientation, calculation, abstraction, delayed recall, visuo-perception, naming and attention] were significantly associated with frailty status.