Frailty in multiple sclerosis: A scoping review

Abstract

This scoping review aims to provide a comprehensive overview of frailty in multiple sclerosis (MS), building upon the increasing number of studies that have recently begun to explore the potential impact of this age-related condition on the lives of people with MS (pwMS). A systematic search was conducted on PubMed, Scopus, Embase, Ovid MEDLINE, CINAHL, CENTRAL, Web of Science, PEDRO, and clinicaltrials.gov. The search results were limited to studies published between 2000 and 2024 without language restrictions. After the screening process, 11 studies (10 original articles and one conference paper) met the inclusion criteria and were included. The scope of the included studies was mainly aimed at quantifying frailty levels and prevalence in pwMS, investigating the association between MS clinical characteristics and frailty, and exploring the relationship between frailty and adverse clinical outcomes in pwMS. All studies concluded that frailty is highly prevalent in MS, with prevalences ranging from 17 % to 66 % (ambulatory patients only) and that pwMS have an early onset of frailty compared to the general non-MS population, as the mean age of the included participants ranged from 41.2 ± 9.0 to 58.6 ± 6.0 years. Higher disability levels, disease duration, and progressive MS subtypes were commonly associated with frailty. In addition, several studies showed that frailty was strongly associated with reduced walking performance, lower sleep quality, fatigue, lower quality of life, falls, primary care visits, and mortality. In conclusion, frailty represents a common yet underinvestigated clinical concern for the MS community.