Neural embedding of frailty in cognitively unimpaired aging and dementia across Latin America.

INTRODUCTION

Frailty influences dementia risk and severity. However, its role in differentiating dementia subtypes and associations with brain structural and functional alterations remain understudied, especially in Latin America.

METHODS

Multi-Partner Consortium to Expand Dementia Research in Latin America data included 3461 participants (cognitively unimpaired [CU], Alzheimer's disease [AD], and frontotemporal lobar degeneration [FTLD]) from Latin America using a frailty index constructed from 32 health-related variables. XGBoost-logistic regression models tested group discrimination, and voxel-based morphometry plus functional connectivity analyses explored neural correlates.

RESULTS

Frailty distinguished CU from AD (area under the curve [AUC] = 0.85) and CU from FTLD (AUC = 0.88) but not AD from FTLD (AUC = 0.59). Higher frailty was linked to widespread gray matter loss, with temporal involvement in CU and stronger frontotemporal effects in dementia, particularly FTLD. Connectivity analyses showed fronto-temporo-posterior reductions and increased connectivity across the frailty network.

DISCUSSION: Findings position frailty as a promising marker for identifying AD and FTLD relative to CU individuals, linked with brain health alterations in Latin American populations.