Abstract
Background: Frailty is a multidimensional syndrome reflecting reduced physiological reserve, increasingly recognized as a relevant factor in the clinical assessment of older adults with cognitive disorders. Objective: To explore the association between frailty, as measured by the Multidimensional Prognostic Index (MPI), cognitive performance, and plasma biomarkers of Alzheimer's disease (AD), and to examine the correlation between plasma and cerebrospinal fluid (CSF) biomarkers. Methods: This cross-sectional observational study included 40 patients (mean age 68.0 ± 9.0 years; 42.5% female) undergoing a diagnostic workup for cognitive decline. Patients were classified into AD (n = 20) and non-AD (n = 20) groups based on CSF AT[N] profiles. Frailty was assessed using the MPI. Linear and logistic regression models adjusted for age, sex, and education examined associations between MPI, cognitive scores, and plasma biomarkers (Aβ42, Aβ42/40, p-tau181, NfL). Correlations between plasma and CSF biomarkers and ROC analyses were also performed. Results: The AD group showed significantly higher plasma p-tau181 levels and MPI scores. MPI was positively associated with plasma p-tau181 levels (β = 4.26, p = 0.009). Plasma p-tau181 correlated strongly with CSF p-tau181 (R = 0.523, p < 0.001) and with CSF Aβ42/40 ratio (R = -0.541, p < 0.001) and showed high diagnostic accuracy (AUC = 0.910). Combining MPI with plasma biomarkers improved classification between AD and non-AD cases (AUC = 0.941). Conclusions: These findings support the value of incorporating frailty assessment in the diagnostic process of AD. The integration of geriatric tools and blood-based biomarkers may improve early detection and promote a more comprehensive approach in dementia evaluation.