Frailty in Parkinson's disease: time to integrate it into treatment decision-making?
Frailty in Parkinson's disease: time to integrate it into treatment decision-making?
Where did the research take place?
The study site has not been established. Author addresses may differ from where the research occurred.
FR · Author affiliation · country only
France Développement Electronique (FDE), CIC 1414, Monswiller, France.Location evidence
Rennes, FR · Author affiliation
CHU de Rennes, Université de Rennes, Rennes, France.Location evidence
Pavia, IT · Author affiliation
Department of Brain and Behavioral Sciences , University of Pavia , Pavia, Italy.Location evidence
Stockholm, SE · Author affiliation
Department of Clinical Neuroscience, Karolinska Institutet Karolinska University Hospital, NKS A8 :06, 17176, Stockholm, Sweden.Location evidence
Lund, SE · Author affiliation
Division of Neurology, Department of Clinical Sciences Lund, Department of Neurology, Rehabilitation Medicine, Memory and Geriatrics , Lund University , Lund, Sweden.Location evidence
BE · Author affiliation · country only
Department of Neurology , Ghent University Hospital , Ghent, Belgium.Location evidence
Salzburg, AT · Author affiliation
Institute of Palliative Care Department of Neurology and Palliative Care , Paracelsus Medical University , Streubergasse 16, 5020, Salzburg, Austria. stefan.lorenzl@pmu.ac.at.Location evidence
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Original abstract
Frailty is increasingly defined as a multidimensional clinical condition whose prevalence rises with advancing age, extending across multiple medical specialties and exhibiting significant sex- and gender-related differences. Chronic diseases, including neurological conditions such as Parkinson's disease (PD), are key contributors to frailty, possibly through shared mechanisms. Conversely, frailty adversely influences clinical outcomes and disease trajectories, increases mortality risk and alters the risk-benefit profile of therapeutic interventions. This review summarizes current evidence on the aetiologies, clinical and instrumental assessment, emerging fluid biomarkers, and therapeutic implications of frailty in PD. Conventional frailty tools, including the Frailty Index and Fried phenotype, are useful but lack specificity in this specific population, notably because PD-related symptoms overlap with frailty criteria. A multimodal approach integrating gait and balance analysis, cognitive testing, dysautonomia assessment, sarcopenia screening, dysphagia evaluation, and nutritional markers may improve risk stratification. Emerging biomarkers, including inflammatory cytokines, albumin, C-reactive protein/albumin ratio, vitamin D, sarcopenia-related markers, neurofilament light chain, and glial fibrillary acidic protein (GFAP), may further capture biological vulnerability, although validation remains limited. Frailty substantially modulates PD treatment decisions by increasing susceptibility to adverse effects, polypharmacy, falls, cognitive complications, and procedural risk. Frailty should therefore be systematically integrated into pharmacological prescribing, deprescribing, rehabilitation, neuropalliative approaches, and selection (as well as timing) of device-aided therapies. Routine frailty assessment, independent of chronological age, may support more individualized, patient-centred PD care, prioritizing functional independence, safety, quality of life, and minimisation of treatment burden alongside conventional motor management.