Linking Motor and Cognitive Decline in Aging: Gait Variability and Working Memory as Early Markers of Frailty

Abstract

Highlights: What are the main findings? Shorter stride length during fast walking, mild cognitive impairment, depressive symptoms, and female sex were identified as significant predictors of the transition from non-frail to prefrail status. Additionally, increased stride time variability at fast pace and poorer working memory performance were independently associated with the progression from prefrailty to frailty. What are the implications of the main findings? Spatiotemporal gait variability and executive dysfunction represent sensitive multidomain markers for the early detection of frailty in community-dwelling older adults. Integrating gait and cognitive assessments into routine geriatric evaluations may enhance early identification and prevention efforts, supporting a multidimensional approach to aging care. Background/Objectives: Frailty is an age-related clinical syndrome characterized by diminished physiological reserves and increased vulnerability to adverse outcomes. Growing evidence suggests that frailty involves shared brain networks that regulate both gait and cognitive functions. This study aimed to examine the relationship between frailty status, spatiotemporal gait parameters, and cognitive functions in community-dwelling older adults. Methods: A cross-sectional study was conducted with 99 adults aged ≥70 years, classified as non-frail, prefrail, or frail according to the Fried phenotype. Gait parameters were measured under usual and fast walking conditions using the OptoGait® photoelectric system. Cognitive status was assessed with the Montreal Cognitive Assessment (MoCA) and a comprehensive neuropsychological battery. Multivariate logistic regression analyses were performed to identify factors associated with transitions between frailty stages. Results: The prevalence of frailty was 9.1%, with 51.5% prefrail and 39.4% non-frail. The transition from non-frail to prefrail was associated with shorter stride length at fast pace (OR = 0.92, 95% CI: 0.88–0.96), mild cognitive impairment (OR = 3.71, 95% CI: 1.08–12.69), depressive symptoms (OR = 1.82, 95% CI: 1.26–2.62), and female sex (OR = 4.94, 95% CI: 1.20–16.77). The transition from prefrail to frail was linked to increased stride time variability at fast pace (OR = 2.94, 95% CI: 1.34–6.44) and poorer working memory (OR = 0.40, 95% CI: 0.16–0.97). Conclusions: Shorter stride length, mild cognitive impairment, and depressive symptoms emerged as key markers of the transition from non-frailty to prefrailty, whereas increased stride time variability and poorer working memory distinguished prefrail from frail individuals. These findings highlight gait- and executive-function-related markers as sensitive early indicators of vulnerability. Incorporating quantitative gait assessment and brief cognitive screening into routine geriatric evaluations may substantially enhance early detection and support targeted preventive strategies for healthy aging.