Frailty represents a critical geriatric syndrome characterized by decreased physiologic reserve and increased vulnerability to adverse health outcomes. In the context of acute ischemic stroke, a predominantly age-related condition, frailty emerges as a pivotal prognostic factor that significantly influences both short-term and long-term patient outcomes. This narrative review synthesizes current evidence on the bidirectional relationship between frailty and stroke, examining its prevalence, assessment methodologies, pathophysiological mechanisms, and clinical implications. Contemporary meta-analytic evidence demonstrates that at least one in five stroke patients exhibits frailty, with prevalence rates varying considerably based on assessment tools, study populations, and clinical settings. Prestroke frailty independently predicts increased mortality, poor functional outcomes, and reduced quality of life following acute stroke. The complex pathophysiological interplay between frailty and cerebrovascular disease involves shared mechanisms, including chronic inflammation, endothelial dysfunction, sarcopenia, and accelerated brain aging processes. Assessment tools such as the Fried Frailty Phenotype, Clinical Frailty Scale, and deficit-accumulation frailty indices demonstrate varying degrees of predictive accuracy, with emerging evidence promoting their integration into routine stroke care protocols. The frailty trajectory following stroke appears bidirectional, with acute cerebrovascular events potentially accelerating frailty progression, while preexisting frailty compromises recovery potential. Treatment considerations for frail stroke patients necessitate individualized approaches, with multicomponent exercise interventions showing significant efficacy in randomized controlled trials. This review emphasizes the imperative for standardized frailty assessment in stroke care, the development of frailty-specific treatment protocols, and the implementation of targeted interventions to optimize outcomes in this vulnerable population.
Kyrili et al. (Wed,) studied this question.