Frailty, Disability, and Comorbidity in Multiple Sclerosis: Overlap and Distinct Associations with Quality of Life and Falls

IF 3 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders Pub Date : 2026-04-01 Epub Date: 2026-02-02 DOI:10.1016/j.msard.2026.107043

Tobia Zanotto , Nida’ Al Worikat , Anna Zanotto , Sharon G Lynch , Jacob J Sosnoff

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引用次数: 0

Abstract

Background

Owing to the global aging of people with multiple sclerosis (pwMS), there is an emerging need to distinguish neurological disability from age-related conditions in this population.

Objective

To examine the overlap between frailty, disability, and comorbidity in pwMS, and their associations with quality of life (QoL) and falls.

Methods

Two hundred and three pwMS (mean age=51.8 ± 12.6 years; median Patient Determined Disease Steps (PDDS) score=1.0 [IQR=2.0]; 73.9% women) underwent established assessments of frailty (FRAIL scale, Tilburg frailty indicator, and frailty index), disability (PDDS), comorbidity (Charlson comorbidity index), QoL (MSQoL-54), and falls (12-month fall-history survey).

Results

Frailty, disability, and comorbidity were distinct but overlapping: 1.5–10.3% of participants had frailty alone, 4.4–14.3% had disability alone, and 11.8–14.3% had comorbidity alone; between 9.4% and 19.7% had all three. Multivariable quantile and logistic regression analyses revealed that all frailty measures were more strongly associated with lower QoL (median regression coefficients ≤-4.76, p-values˂0.001) and greater odds of falling (OR_s ≥1.47, p-values≤0.001) than disability or comorbidity. Participants with all three conditions had significantly worse physical QoL and a higher median number of falls than those with any one condition alone.

Conclusions

Frailty, disability, and comorbidity represent separate conditions in pwMS, as they can present in isolation, and each has distinct associations with QoL and falls. Comprehensive assessment of all three conditions may enhance risk stratification and inform individualized rehabilitation and aging support strategies.

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多发性硬化症的虚弱、残疾和合并症：与生活质量和跌倒的重叠和明显关联

背景：随着多发性硬化症（pwMS）患者的全球老龄化，越来越需要将这一人群的神经功能障碍与年龄相关疾病区分开来。目的探讨虚弱、残疾和合并症在pwMS中的重叠性及其与生活质量（QoL）和跌倒的关系。方法203例pwMS患者（平均年龄51.8±12.6岁），PDDS评分中位数=1.0 [IQR=2.0]；73.9%女性)接受了既定的虚弱评估（虚弱量表、Tilburg虚弱指标和虚弱指数）、残疾（PDDS）、合并症（Charlson合并症指数）、生活质量（MSQoL-54）和跌倒（12个月跌倒史调查）。结果虚弱、残疾和合并症不同但又重叠：1.5 ~ 10.3%的参与者仅虚弱，4.4 ~ 14.3%的参与者仅残疾，11.8 ~ 14.3%的参与者仅合并症；9.4%到19.7%的人三者都有。多变量分位数和逻辑回归分析显示，与残疾或共病相比，所有虚弱指标与较低的生活质量（回归系数中位数≤-4.76，p值小于0.001）和较高的跌倒几率（or≥1.47，p值≤0.001）的相关性更强。所有三种情况下的参与者的身体生活质量明显差于任何一种情况下的参与者，跌倒的中位数也高于任何一种情况下的参与者。虚弱、残疾和合并症是pwMS的独立症状，因为它们可以单独出现，并且每一种都与生活质量和跌倒有明显的关联。综合评估这三种情况可以加强风险分层，为个性化康复和老年支持策略提供信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Multiple sclerosis and related disorders CLINICAL NEUROLOGY-

CiteScore

5.80

自引率

20.00%

发文量

814

审稿时长

66 days

期刊介绍： Multiple Sclerosis is an area of ever expanding research and escalating publications. Multiple Sclerosis and Related Disorders is a wide ranging international journal supported by key researchers from all neuroscience domains that focus on MS and associated disease of the central nervous system. The primary aim of this new journal is the rapid publication of high quality original research in the field. Important secondary aims will be timely updates and editorials on important scientific and clinical care advances, controversies in the field, and invited opinion articles from current thought leaders on topical issues. One section of the journal will focus on teaching, written to enhance the practice of community and academic neurologists involved in the care of MS patients. Summaries of key articles written for a lay audience will be provided as an on-line resource. A team of four chief editors is supported by leading section editors who will commission and appraise original and review articles concerning: clinical neurology, neuroimaging, neuropathology, neuroepidemiology, therapeutics, genetics / transcriptomics, experimental models, neuroimmunology, biomarkers, neuropsychology, neurorehabilitation, measurement scales, teaching, neuroethics and lay communication.