Integrating frailty into decision-making for disease-modifying therapies in Alzheimer’s disease: a proposed expert-opinion based approach
Year: 2026
Type: article
Abstract: The introduction of disease-modifying therapies for Alzheimer's disease (AD-DMTs) is reshaping clinical practice, raising critical questions about patient selection, diagnostic pathways, treatment appropriateness, and equity of access. Frailty, a multidimensional condition of reduced physiological reserve and increased vulnerability to stressors, is common in older adults with AD, yet has not been systematically assessed in AD-DMTs trials, limiting the generalizability of trial findings to real-world populations. In this review, we examine the role of frailty in the emerging era of AD-DMTs, summarizing evidence on its prevalence and prognostic relevance, approaches to its assessment, and its potential impact on treatment safety and effectiveness. We propose that regular frailty assessment should inform decision-making in both clinical trials and clinical practice, while frailty-informed management-including medication review and multidomain interventions-may support more appropriate, individualized care.
Authors: Giuseppe Bellelli, Ovidio Brignoli, Marco Canevelli, Antonio Cherubini, Andrew Clegg, Bruno Dubois, Maria Cristina Ferrara, Laura Fratiglioni, Giovanni B. Frisoni, Giulia Grande, Frank Jessen, Sean P Kennelly, Alberto Magni, Martina Marelli, Alessandra Marengoni, Nicolás Martínez Velilla, Susan D. Shenkin, Marc Suárez-Calvet, Suzanne Timmons, Alessandro Padovani
Institutions: University of Milano-Bicocca, Stockholm University, Karolinska Institutet, Sapienza University of Rome, Marche Polytechnic University, Istituto Nazionale di Riposo e Cura per Anziani, Bradford Institute for Health Research, Inserm, Sorbonne Université, Pitié-Salpêtrière Hospital, Institut du Cerveau, University Hospital of Geneva, University Hospital Cologne, Trinity College Dublin, University of Brescia, Universidad Pública de Navarra (UPNA), Instituto de Salud Carlos III, Navarre Institute of Health Research, Navarrabiomed, Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, University of Edinburgh, Pasqual Maragall Foundation, Barcelonaβeta Brain Research Center, Hospital Del Mar, University College Cork, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia
Language: English
Topic: Frailty in Older Adults
Subfield: Geriatrics and Gerontology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,060
OpenAlex ID: W7204884403
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